Versorgungsforschung in der Zahnmedizin in Deutschland

Over the past eight years, the continuous call for 'more oral health services research' in Germany has been (at least partially) answered. Today, relevant oral and dental health services research activities can be found at 12 medical faculties in Germany and nine large-scale projects are funded by the German Ministry for Education and Research (BMBF) or the Innovation Fund of the Federal Joint Committee (G-BA). However, the demand for high-level research in this field exceeds the current capacities of university and non-university dentistry; structured and methodically competent research networks that are cross-linked within the dental and public health services are required. These would allow research to assure sustainable and demand-oriented dental services, scientifically supporting the demographically, economically, and socially driven major changes to be expected in the coming years.The article describes the current status of dental and oral health services research in Germany and addresses major challenges: methodological competence, data accessibility and usage, and the prospects for this field of research. Therefore, it takes stock of existing research activities and infrastructure (including educational and funding opportunities).Knowledge obtained from dental and oral health services research in Germany can be pioneering for other countries, while researchers in Germany may be able to adopt and adapt servicing strategies from other countries and health systems for Germany. To achieve these aims, dental and oral health services researchers should professionalize and network. Sustainable structures (professorships, staff) and frameworks (data availability, funding) should be established and findings promptly translated into use

Implementation of Patient-Individualized 3D-Printed Models in Undergraduate Students’ Education for Various Prosthetic Treatments: A Cross-Sectional Survey Study

Background: Due to rapid changes in dental practice, digital technologies have become prominent in undergraduate dental education at German universities in recent years. This shift has prompted a re-evaluation of content as well as teaching methods, particularly in courses where students are prepared for patient treatment. Traditional training on standardized models with resin teeth cannot cover the complexity of individual dental arch configuration encountered in patient situations. This study explores the use of 3D printing technology to create individualized models for prosthetic treatment simulations, aiming to evaluate students’ feedback towards their experience with this training setting. Methods: First, the study describes the design and fabrication of individualized models with exchangeable teeth based on intraoral scans, mounted on connected plates with distance holders that can be fixed to standard phantom heads. Second, students provided feedback through a questionnaire, assessing various aspects such as the effectiveness of the 3D-printed models compared to traditional frasaco models for preparation exercises. Results: The results indicated that the design of the realized models was feasible for preparation training (question no. 4: 93% positive rating) and showed positive perceptions of the 3D-printed models, with students finding them effective for preparation exercises and beneficial in bridging the gap between simulation and real patient situations (question no. 6: 69% positive rating). Conclusions: The study suggests that 3D printing technology offers a valuable tool in dental education, providing realistic and patient-specific scenarios for students to enhance their skills and readiness for clinical practice. Further improvements in material properties in hand with cost-effective approaches are essential for widespread implementation

Multi-Material 3D Printing of a Customized Sports Mouth Guard: Proof-of-Concept Clinical Case

A multilayer mouth guard is known to have the best protective performance. However, its manufacturing in a digital workflow may be challenging with regards to virtual design and materialization. The present case demonstrates a pathway to fabricate a multilayer individualized mouth guard in a fully digital workflow, which starts with intraoral scanning. A free-form CAD software was used for the virtual design. Two various CAM techniques were used, including Polyjet 3D printing of rubber-like soft material and silicone printing using Drop-on-Demand technique. For both methods the outer layer was manufactured from more rigid materials to facilitate its protective function; the inner layer was printed from a softer material to aid a better adaptation to mucosa and teeth. Both 3D printed multilayer mouth guards showed a clinically acceptable fit and were met with patient appraisal. Their protective capacities must be evaluated in further clinical studies

All-ceramic prosthetic rehabilitation of a worn dentition: Use of a distal cantilever. Two-year follow-up

The rehabilitation of heavily abraded occlusion in patients with parafunctional habits is a restorative challenge to the dentist. Use of all-ceramic systems in such cases is widely considered, but uncertainty over their resistance hinders their broad use. The authors would like to illustrate a possible approach by mixing two all-ceramic systems based on zirconium dioxide and lithium disilicate. A 48-year-old female patient attended with reduced vertical dimension in a full dentition. She suffered from craniomandibular (CMD) pain and desired an esthetic rehabilitation. Prosthodontic treatment was started in a pain-free condition, after correction of the vertical dimension with an occlusal splint, over four months. Determination of the treatment was based on the clinical findings: IPS e.max® ZirCAD frameworks veneered with IPS e.max® Ceram were used for discolored retainers or subgingival finishing lines. All the rest received IPS e.max® Press crowns. A zirconia-based, single-tooth-retained distal cantilever reconstruction was used to replace a missing second molar. No technical or biological complication was observed 24 months after treatment. The patient was highly satisfied and pain-free

Retention Forces of Prosthetic Clasps over a Simulated Wearing Period of Six Years In-Vitro: Direct Metal Laser Melting Versus Dental Casting

This study determinates the persistence of retention force in Akers-clasps for removable partial dentures made from Co-Cr alloy. Therefore, standardized computer-aided designed (CAD) clasp #1 specimens were made by direct metal laser melting (DMLM, n = 10) and by lost-wax dental casting (DC) of computer-aided manufactured (CAM) replicas (n = 10, DC) from two comparable Co-Cr alloys. The retention force was tested after manufacturing for 9000 cycles of setting and removal from a molar tooth crown analog made from zirconia; simulating in-vitro a duration of six years in service. The first and last 360 cycles (T0 and T1, 3 months each) of all specimens were selected for comparison of retention forces between the materials. A constant decrease of 6% from the initial retention force (T0 = 4.86 N, SD = 0.077; T1 = 4.57 N, SD = 0.037) was detected at the DC specimens, and an increase of 4% in DMLM specimens (T0 = 5.69 N, SD = 0.078; T1 = 5.92 N, SD = 0.077); all differences were statistically significant (p < 0.0001). Even if these deviations are not of clinical relevance, further studies and applications should investigate the fatigue behavior of laser melted Co-Cr-alloys for dental application

Intraoral scanning to fabricate complete dentures with functional borders: a proof-of-concept case report

Abstract Background The utilization of intraoral scanning for manufacturing of complete dentures (CD) has been reported recently. However, functional border molding still cannot be supported digitally. A proof-of-concept trial shows two possible pathways to overcome this limitation by integrating a relining procedure into the digital workflow for CD manufacturing. Case presentation Intraoral scans and additional facial scans were performed with two various scanning systems for the rehabilitation of an edentulous male patient. The obtained raw data was aligned and used for the computer aided design (CAD) of the CD. The virtually constructed dentures were materialized in two various ways, considering rapid manufacturing and digital relining approaches in order to apply functionally molded borders. Conclusion The use of intraoral edentulous jaws scans in combination with the digital relining procedure may allow for fabrication of CD with functional borders within a fully digital workflow

Implementation of a Full Digital Workflow by 3D Printing Intraoral Splints Used in Dental Education: An Exploratory Observational Study with Respect to Students’ Experiences

Fully digital workflows gained acceptance in dental practice and thereby are of interest for undergraduate education. An exploratory clinical observation was designed to track the implementation of such a workflow with novice digital users in order to describe its feasibility, time investment, and pitfalls. Methods: Students were invited to provide feedback for their experiences with a training module that consisted of the following: intraoral scanning, computer-aided design (CAD), manual finishing, and insertion of a 3D-printed bite splint for the lower jaw. Results: A total of 82 fourth-year students participated in the module. The average time required to perform an intraoral scan was 17 m 5 s, and all students were able to design a splint with an average time of 2 h 38 m. Students who indicated prior experience with CAD seem to outperform inexperienced students in both CAD task completion and intraoral scanning. The initial fit was reported as clinically acceptable by 68.5% of the participants, while 79% rated the workflow as very good to satisfactory and indicated that the training was helpful for dental practice. Conclusions: The implementation of a digital workflow in undergraduate dental education is feasible and has acceptable clinical results. However, CAD is time-intensive, and the experience can be challenging

3D Printing of Polyamide to Fabricate a Non-Metal Clasp Removable Partial Denture via Fused Filament Fabrication: A Case Report

The fabrication of a non-metal clasp removable partial denture (RPD) using polymethylmethacrylate in a fully digital workflow has been reported. According to some studies, the polyamide material may be alternatively used for this purpose. The authors are unaware of any reports concerning the additive manufacturing of polyamide. The current proof-of-concept dental technique describes the pathway to construct the non-metal clasp RPD using intraoral scanning and fused filament fabrication (FFF) printing of gingiva-colored polyamide. The present RPD showed acceptable fit and sufficient retention and was considered a valid temporary treatment option

Bonding Interface and Repairability of 3D-Printed Intraoral Splints: Shear Bond Strength to Current Polymers, with and without Ageing

This in-vitro study investigates the bonding interfaces reached by the conditioning of a splint material additively manufactured by digital light processing (AM base) as well as the shear bond strength (SBS) of resins bonded to these surfaces (repair material). Therefore, the AM base was either stored in dry for 12 h or wet environment for 14 days to simulate ageing by intraoral wear. The dry and wet group was bonded after physical and/or chemical conditioning to cylinders made from polymethylmethacrylate or four novel polymers allowing splint modifications. Blasted and methylmethacrylate (MMA)-conditioned Polymethylmethacrylate (PMMA) bonded to PMMA acted as the gold standard. The surface profiles revealed highest differences of Ra towards the gold standard in AM base conditioned with other than MMA after sandblasting. The adhesively bonded repair materials of the wet AM base were further aged in wet environment for 14 days. The SBS of the gold standard (25.2 MPa and 25.6 MPa) was only reached by PMMA bonded to blasted and MMA-conditioned AM base after dry (22.7 MPa) and non-conditioned after wet storage (23 MPa). Four repair materials failed to reach the threshold of 5 MPa after dry storage and three after wet storage, respectively. Non-conditioned AM base revealed the highest risk for adhesive fractures when using other resins than PMMA

Bonding Behavior of Conventional PMMA towards Industrial CAD/CAM PMMA and Artificial Resin Teeth for Complete Denture Manufacturing in a Digital Workflow

When applying a digital workflow, custom artificial resin teeth have to be integrated into a milled complete denture base, using polymethylmethacrylate (PMMA) applied with a powder–liquid technique. Debonding of denture teeth from dentures is reported to be a frequent complication. No evidence is provided as to which method of surface treatment may enhance the bonding strength. The bonding strength between artificial teeth and PMMA (Group A, n = 60), as well as between the PMMA and industrial PMMA (Group B, n = 60), was investigated following no treatment, monomer application, sandblasting, oxygen plasma, and nitrogen plasma treatment. Surface-roughness values and SEM images were obtained for each group. Shear bond strength (SBS) and fracture mode were analyzed after thermocycling. Within Group A, statistically significant higher SBS was found for all surface treatments, except for nitrogen plasma. In Group B, only nitrogen plasma showed a statistically lower SBS compared to the reference group which was equivalent to all surface treatments. Conclusions: Within the limitations of the present study, the monomer application can be proposed as the most effective surface-treatment method to bond custom artificial teeth into a milled PMMA denture base, whereas nitrogen plasma impairs the bonding strength