Patient-reported outcome measures compared to professional dental assessments of monolithic ZrO(2) implant fixed dental prostheses in complete digital workflows: A double-blind crossover randomized controlled trial

PURPOSE This double-blind randomized controlled trial analyzed patient-reported outcome measures in terms of subjective patient satisfaction compared to objective dental evaluation of prosthetic treatment with 3-unit monolithic zirconium dioxide implant fixed dental prostheses (iFDPs) in 3 digital workflows. MATERIAL AND METHODS Twenty patients were restored with 3 iFDPs each on Straumann TL-implants with 2 completely digital workflows using different intraoral optical scanning systems with model-free fabrication of the restoration (Trios 3/3Shape [Test-1]; Virtuo Vivo/Straumann [Test-2]), and mixed analog-digital workflow with conventional impressions and digitized gypsum casts (Impregum/3M Espe [Control]). The order of impression-taking and the prosthetic try-in were randomly allocated. Sixty iFDPs were compared for patient satisfaction and dental evaluation using ANOVA. RESULTS For iFDP evaluation, patients generally provided more favorable ratings than dental experts, regardless of the workflow. ANOVA revealed no significant difference for overall satisfaction when comparing Test-1, Test-2, or Control, either for patients (f-ratio: 0.13; p = 0.876) or dentist (f-ratio: 1.55: p = 0.221). Secondary, patients clearly favored the digital impression workflows over the conventional approach (f-ratio: 14.57; p < 0.001). Overall, the 3Shape workflow (Test-1) received the highest scores for all analyses. CONCLUSIONS The different digital workflows demonstrated minor influence on the subjective and objective evaluation of the monolithic zirconium dioxide iFDPs in nonesthetic regions; however, the dentist may significantly increase patient satisfaction by choosing intraoral scanning instead of conventional impressions. The dentist has to consider individual patients' needs to fulfill their expectations for a personalized solution

Monolithic implant‐supported lithium disilicate (LS2) crowns in a complete digital workflow: A prospective clinical trial with a 2‐year follow‐up

Background: The technical development of digital processing allows the production of anatomically full‐contoured implant‐supported restorations. Purpose: The aim of this prospective clinical trial was to analyze the treatment concept of monolithic lithium disilicate (LS2) single‐unit restorations in a complete digital workflow. Material and Methods: Forty‐four patients were restored with 50 screw‐retained monolithic implant LS2 crowns bonded to pre‐fabricated titanium abutments on soft tissue level implants (Institut Straumann AG, Basel, Switzerland) in premolar and molar sites. All implant restorations were digitally designed after intraoral optical scanning (IOS) and CAD/CAM‐processing without physical model situations. Study participants were clinically and radiographically examined based on an annually performed follow‐up. The “Functional Implant Prosthodontic Score” (FIPS) was applied for objective outcome assessment after 2 years of loading. Five variables were defined for FIPS evaluation, resulting in a maximum score of 10 per implant restoration. Descriptive statistics were calculated for mean scores standard deviations, medians, and Q₂₅–Q₇₅. Results: All patients could be successfully treated within two clinical appointments. No clinical modifications were necessary for the seating of the monolithic crowns, neither for interproximal nor occlusal sites. The implant LS2 restorations demonstrated survival rates of 100% without any technical or biological complications after 2 years. The mean total FIPS score was 7.7 ± 1.0, ranging from 6 to 10. Conclusions: CAD/CAM‐produced monolithic implant crowns out of LS2 in a complete digital workflow seem to be a feasible treatment concept for the rehabilitation of single‐tooth gaps in posterior sites under mid‐term observation

Digital technology in fixed implant prosthodontics

Digital protocols are increasingly influencing prosthodontic treatment concepts. Implant-supported single-unit and short-span reconstructions will benefit mostly from the present digital trends. In these protocols, monolithic implant crowns connected to prefabricated titanium abutments, which are created based on data obtained from an intraoral scan followed by virtual design and production, without the need of a physical master cast, have to be considered in lieu of conventional manufacturing techniques for posterior implant restorations. No space for storage is needed in the complete digital workflow, and if a remake is required a replica of the original reconstruction can be produced quickly and inexpensively using rapid prototyping. The technological process is split into subtractive methods, such as milling or laser ablation, and additive processing, such as three-dimensional printing and selective laser melting. The dimensions of the supra-implant soft-tissue architecture can be calculated in advance of implant placement, according to the morphologic copy, and consequently are individualized for each patient. All these technologies have to be considered before implementing new digital dental workflows in daily routine. The correct indication and application are prerequisite and crucial for the success of the overall therapy, and, finally, for a satisfied patient. This includes a teamwork approach and equally affects the clinician, the dental assistant and the technician as well. The digitization process has the potential to change the entire dental profession. The major benefits will be reduced production costs, improvement in time efficiency and fulfilment of patients’ perceptions of a modernized treatment concept

Digital subtraction radiographic analysis of the combination of bioabsorbable membrane and bovine morphogenetic protein pool in human periodontal infrabony defects

Objectives: This study assessed the bone density gain and its relationship with the periodontal clinical parameters in a case series of a regenerative therapy procedure. Material and Methods: Using a split-mouth study design, 10 pairs of infrabony defects from 15 patients were treated with a pool of bovine bone morphogenetic proteins associated with collagen membrane (test sites) or collagen membrane only (control sites). The periodontal healing was clinically and radiographically monitored for six months. Standardized presurgical and 6-month postoperative radiographs were digitized for digital subtraction analysis, which showed relative bone density gain in both groups of 0.034 ± 0.423 and 0.105 ± 0.423 in the test and control group, respectively (p>0.05). Results: As regards the area size of bone density change, the influence of the therapy was detected in 2.5 mm2 in the test group and 2 mm2 in the control group (p>0.05). Additionally, no correlation was observed between the favorable clinical results and the bone density gain measured by digital subtraction radiography (p>0.05). Conclusions: The findings of this study suggest that the clinical benefit of the regenerative therapy observed did not come with significant bone density gains. Long-term evaluation may lead to a different conclusions

Surgical extension of the clinical crown | Chirurgische Verlängerung der klinischen Krone.

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Periodontal diagnosis in the 1990s.

Clinicians are usually inclined to reduce data obtained from diagnosis to a simpler form such as "yes or no" answers in order to obtain useful parameters for daily practice. It should be realized, however, that the diagnostic process very rarely exhibits "black and white" situations. Rather the evaluation of numerous "grey levels" is imperative. The diagnostic process, therefore, remains always incomplete and inaccurate, and it represents an evaluation of probabilities rather than certainties. For this reason, the diagnostician should realize and understand the mathematical relations between the information provided by diagnostic tests and the clinical situation actually present at the time of the test. This will allow one to convert diagnostic results into therapeutic procedures with a high degree of confidence. Since results from diagnostic tests are quite often used to decide on treatment, complex data are reduced to simple dichotomy, such as presence or absence of disease, normal or abnormal conditions, etc. In order to react to diagnostic tests in an ordinal, dichotomous manner, the clinician has to choose a particular level of a test at which he initiates treatment without having the assurance that this level represents the one and only standard at which treatment has to be initiated.link_to_subscribed_fulltex

Effect of chlorhexidine (0.12%) rinses on periodontal tissue healing after tooth extraction. (I). Clinical parameters.

The aim of the present study was to evaluate the effects of a 1-month period of chlorhexidine (CHX) rinses on the periodontal conditions of teeth adjacent to extraction sockets. 40 patients signed consent forms for this double blind trial and were randomly assigned to either the test group rinsing 2 x daily with 15 ml of a 0.12% CHX solution (Peridex) starting 2 days after tooth extraction or the control group rinsing with a placebo solution for 30 days. Clinical periodontal parameters were obtained from test sites located adjacent to as well as matched controls distant to the extraction sites. The measurements were performed at baseline before the extraction and 1, 2, 3 and 6 months thereafter. During the observation period, the patients were exposed to initial periodontal therapy. The test sites of the group rinsing with CHX demonstrated significantly reduced (p < 0.05) plaque indices, gingival indices and lower %s of sites bleeding on probing one month following the extraction. The test sites of the control group rinsing with the placebo demonstrated a tendency for loss of clinical attachment between 1 and 2 months after the tooth extraction. The mean pocket probing depth (PPD) at test sites of the CHX rinsing group was smaller than in the placebo rinsing group at the one month examination. Also, the mean PPD of the test sites in the CHX group was significantly smaller than at the control sites at 1 month. This difference was not observed in the control group rinsing with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)link_to_subscribed_fulltex