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

Efficacy of tooth splinting and occlusal adjustment in patients with periodontitis exhibiting masticatory dysfunction: A systematic review

Objective: To evaluate the efficacy of tooth splinting (TS) and occlusal adjustment (OA) compared to no TS or OA in patients with periodontitis exhibiting masticatory dysfunction. Material: The primary outcome criterion was tooth loss (TL), and the secondary outcome parameters were change in probing pocket depth (PPD), change in clinical attachment level (CAL), tooth mobility (TM), and patient-reported outcome measures (PROMs). Literature search was performed on three electronic databases (from 01/1965 to 04/2021) and focused on clinical studies with at least 12 months follow-up. Results: From a total of 1515 publications, 51 articles were identified for full-text reading, of which 2 retrospective case series on TS with low risk of bias and 1 randomized and 2 prospective studies on OA with unclear risk of bias were included. For TS, synthesis of data showed that in 72 patients, 26 out of 311 teeth (weighted mean incidence of TL 8.4%) and 156 out of 1541 teeth with no TS (weighted mean incidence of TL 10.1%) were lost over 2 years following non-surgical periodontal therapy. The randomized controlled clinical trial (RCT) indicated CAL gain for teeth with OA compared to no OA. For the effect of OA on TL, PPD, and TM, heterogeneous data were retrieved from the included studies. Conclusions: Within the limitations of this review and based on a low level of evidence, it is concluded that TS does not improve survival of mobile teeth in patients with advanced periodontitis. OA on teeth with mobility and/or premature contacts may lead to improved CAL, while the effect of OA on the remaining periodontal parameters remains unclear

Health Data in Dentistry: An Attempt to Master the Digital Challenge

Biomedical research has recently moved through three stages in digital healthcare: (1) data collection; (2) data sharing; and (3) data analytics. With the explosion of stored health data (HD), dental medicine is edging into its fourth stage of digitization using artificial intelligence (AI). This narrative literature review outlines the challenge of managing HD and anticipating the potential of AI in oral healthcare and dental research by summarizing the current literature.; The basis of successful management of HD is the establishment of a generally accepted data standard that will guide its implementation within electronic health records (EHR) and health information technology ecosystems (HIT Eco). Thereby continuously adapted (self-) learning health systems (LHS) can be created. The HIT Eco of the future will combine (i) the front-end utilization of HD in clinical decision-making by providers using supportive diagnostic tools for patient-centered treatment planning, and (ii) back-end algorithms analyzing the standardized collected data to inform population-based policy decisions about resource allocations and research directions. Cryptographic methods in blockchain enable a safe, more efficient, and effective dental care within a global perspective. Key Message: The interoperability of HD with accessible digital health technologies is the key to deliver value-based dental care and exploit the tremendous potential of AI

The Complete Digital Workflow in Fixed Prosthodontics Updated: A Systematic Review

Digital applications have changed therapy in prosthodontics. In 2017, a systematic review reported on complete digital workflows for treatment with tooth-borne or implant-supported fixed dental prostheses (FDPs). Here, we aim to update this work and summarize the recent scientific literature reporting complete digital workflows and to deduce clinical recommendations. A systematic search of PubMed/Embase using PICO criteria was performed. English-language literature consistent with the original review published between 16 September 2016 and 31 October 2022 was considered. Of the 394 titles retrieved by the search, 42 abstracts were identified, and subsequently, 16 studies were included for data extraction. A total of 440 patients with 658 restorations were analyzed. Almost two-thirds of the studies focused on implant therapy. Time efficiency was the most often defined outcome (n = 12/75%), followed by precision (n = 11/69%) and patient satisfaction (n = 5/31%). Though the amount of clinical research on digital workflows has increased within recent years, the absolute number of published trials remains low, particularly for multi-unit restorations. Current clinical evidence supports the use of complete digital workflows in implant therapy with monolithic crowns in posterior sites. Digitally fabricated implant-supported crowns can be considered at least comparable to conventional and hybrid workflows in terms of time efficiency, production costs, precision, and patient satisfaction

The effects of anti-infective preventive measures on the occurrence of biologic implant complications and implant loss: a systematic review.

PURPOSE To systematically appraise whether anti-infective protocols are effective in preventing biologic implant complications and implant loss after a mean observation period ≥ 10 years after loading. MATERIALS AND METHODS An electronic search of Medline via PubMed and Embase via Ovid databases complemented by manual search was conducted up to October 31, 2012. Studies were included provided that they were published in English, German, French, or Italian, and conducted on ≥ 20 partially and fully edentulous patients with dental implants and regular (≥ 1×/year) supportive periodontal therapy (SPT) over a mean observation period ≥ 10 years. Assessment of the identified studies and data extraction were performed independently by two reviewers. Authors were contacted if required. Collected data were reported by descriptive methods. RESULTS The initial electronic search resulted in the identification of 994 titles from Medline via PubMed and 531 titles from Embase via Ovid databases, respectively. After elimination of duplicate titles and exclusion of 60 full-text articles, 143 articles were analyzed, resulting in 15 studies eligible for qualitative analysis. The implant survival rate ranged from 85.7% to 99.2% after a mean observation period ≥ 10 years. One comparative study assessed the effects of regular SPT on the occurrence of biologic complications and implant loss. Overall, regular diagnosis and implementation of anti-infective therapeutic protocols were effective in the management of biological complications and prevention of implant loss. Residual probing depths at the end of active periodontal therapy and development of reinfection during supportive periodontal therapy (SPT) represented a significant risk for the onset of peri-implantitis and implant loss. Comparative studies indicated that implant survival and success rates were lower in periodontally compromised vs noncompromised patients. CONCLUSIONS In order to achieve high long-term survival and success rates of dental implants and their restorations, enrollment in regular SPT including anti-infective preventive measures should be implemented. Therapy of peri-implant mucositis should be considered as a preventive measure for the onset of peri-implantitis. Completion of active periodontal therapy should precede implant placement in periodontally compromised patients

Narrative : case history 2

The selected case history describes a 76-year-old retired housewife who requires dental treatment

Dental care behaviour in Switzerland

Improvements in oral health are changing the requirements for oral health care provision. This study assessed the frequency and major reason of dental visits and personal oral hygiene measures in Switzerland, and temporal trends in visit frequency. The number of dental visits in the previous twelve months, the reason for these visits, and the prevalence of oral hygiene measures were quantified from weighted data from the 2012 Swiss Health Survey. The frequency of dental visits in 2012 was compared with previous surveys (1992-2007). Almost two thirds of subjects reported visiting a dentist and almost half had visited a dental hygienist in the previous twelve months. Voluntary (33%) or recall check-ups (25%) were the most common reasons for the last dental visit across age groups. Treatment needs including caries/filling/endodontic treatment (10%), crowns/FDP/RDP/implants (8%), toothache (5%), extraction (5%), periodontal complaints (2%), or orthodontic appliances (2%) were more heterogeneously distributed across age groups. One in ten subjects had dental implants; prevalence increased with increasing age as did the number of missing teeth. Use of interdental cleaning devices and frequent tooth brushing were more common among subjects with few or no missing teeth and among subjects with higher versus lower income or education. Oral health awareness varied with a higher awareness in women than in men and in subjects with higher versus lower income or education. The prevalence of dental implants and dental hygienist's visits has increased in Switzerland since 2002, but oral hygiene measures remained stable

Oral health improvements in Switzerland over 20 years

While the time trends in oral health are favourable, differences still persist in dental status and in prosthetic dental restorations (PDR) between population subgroups. This study aimed to identify changes in oral health in Switzerland over two decades and to describe their relationship to sociodemographic factors in 2012. Swiss Health Surveys were conducted in 1992, 2002, and 2012. The mean number of missing teeth and the prevalence of PDR were calculated at each time point. Logistic regression analysis was performed to assess associations between the prevalence of PDR and sociodemographic factors. The mean number of missing teeth decreased from five in 1992 to three in 2012. Dental status - as indicated by the number of teeth present - improved across all sociodemographic groups, with the greatest improvements being found in obese participants and in participants with the lowest incomes and educational levels. The prevalence of implant-based restorations increased from 3.2% in 2002 to 9.8% in 2012, and the shift from fixed to removable restorations occurred in the age group being 10 years older. The overall prevalence of PDR decreased in middle-aged people. In conclusion, over the two decades of the study, the oral health of the Swiss population substantially improved. Although sociodemographic differences persisted, they decreased considerably in terms of the number of missing teeth and percentage of the population with a functional dentition

Impact of Aging on the Accuracy of 3D-Printed Dental Models: An In Vitro Investigation

The aim of this in vitro study was to analyze the impact of model aging on the accuracy of 3D-printed dental models. A maxillary full-arch reference model with prepared teeth for a three-unit fixed dental prosthesis was scanned ten times with an intraoral scanner (3Shape TRIOS Pod) and ten models were 3D printed (Straumann P-Series). All models were stored under constant conditions and digitized with a desktop scanner after 1 day; 1 week; and 2, 3, and 4 weeks. For accuracy, a best-fit algorithm was used to analyze the deviations of the abutment teeth (GFaI e.V Final Surface&reg;). Wilcoxon Rank Sum Tests were used for comparisons with the level of significance set at &alpha; = 0.05. Deviation analysis of the tested models showed homogenous intragroup distance calculations at each timepoint. The most accurate result was for 1 day of aging (3.3 &plusmn; 1.3 &micro;m). A continuous decrease in accuracy was observed with each aging stage from day 1 to week 4. A time-dependent difference was statistically significant after 3 weeks (p = 0.0008) and 4 weeks (p &lt; 0.0001). Based on these findings, dental models should not be used longer than 3 to 4 weeks after 3D printing for the fabrication of definitive prosthetic reconstructions