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

A Double-Blind Crossover RCT Analyzing Technical and Clinical Performance of Monolithic ZrO2 Implant Fixed Dental Prostheses (iFDP) in Three Different Digital Workflows

This double-blind randomized controlled trial with a crossover design analyzed the technical and clinical performance of three-unit monolithic ZrO2 implant-fixed dental prostheses (iFDPs), prepared using two complete digital workflows (Test-1, Test-2) and one mixed analog–digital workflow (Control). Each of the 20 study patients received three iFDPs, resulting in 60 restorations for analysis. The quality of the restorations was assessed by analyzing laboratory cross-mounting and calculating the chairside adjustment time required during fitting. All iFDPs could be produced successfully with all three workflows. The highest cross-mounting success rate was observed for the original pairing iFDP/model of the Control group. Overall, 60% of iFDPs prepared with Test-1 workflow did not require chairside adjustment compared with 50% for Test-2 and 30% for Controls. The mean total chairside adjustment time, as the sum of interproximal, pontic, and occlusal corrections was 2.59 ± 2.51 min (Control), 2.88 ± 2.86 min (Test-1), and 3.87 ± 3.02 min (Test-2). All tested workflows were feasible for treatment with iFDPs in posterior sites on a soft tissue level type implant system. For clinical routine, it has to be considered that chairside adjustments may be necessary, at least in every second patient, independent on the workflow used

Die Modellgussprothese 2.0: Digital von A bis Z?

Der Fallbericht dokumentiert die Therapie eines teilbezahnten Patienten mittels Modellgussprothese im digitalen und konventionellen Workflow. Die entscheidenden Unterschiede liegen in der Abformung, Bissregistrierung, Modellherstellung, Zahnaufstellung, Konstruktionsplanung und Gerüstherstellung. Ausarbeitung und Finalisierender Teilprothese sind identische Schritte und (momentan) nur manuell möglich. Das 3-D-gedruckte Gerüst wurde aufgrund der sehr präzisen Passung von Patient und Behandler bevorzugt. Mit zunehmender Digitalisierung können die manuellen Arbeitsschritte stetig reduziert werden, sodass die Präzision zu erhöhen und die Behandlungsdauer zu verkürzen ist. Dabei zeigt sich der Einsatz von Intraoralscannern als patientenfreundlicher im Vergleich zur konventionellen Abformung mit Elastomeren. Technologische Weiterentwicklungen sind erforderlich, um einen komplett digitalen Workflow zu ermöglichen. Modellgussprothese 2.0: Ja – aber (noch) nicht ganz von A bis Z.This case report presents the treatment of a partially edentulous patient with a clasp-retained removable dental prosthesis (RDP) using both, digital and conventional workflows. Differences were demonstrated in impression taking, bite registration, manufacturing of models, prosthetic set-up, framework design and production; the technical steps for the finish of the RDPs were identical and (currently) still dependent on manual skills. The digitally 3D-printed framework were favored by the patient and the dentist due to the precise fit. The number of manual steps will be continuously reduced applying digital technologies for the treatment with RDPs, resulting in shortened clinical and technical work time and higher precision of the final prosthetic restoration. In addition, the use of intraoral scanners is more patient-friendly than classic impressions with elastomers. Technological advancements are required to eliminate today’s limitations and enable a complete digital workflow, even without any physical models. Removable Dental Prosthesis 2.0: yes – but not yet completely from A to Z

Patient-reported outcome measures compared to professional dental assessments of monolithic ZrO2 implant fixed dental prostheses in complete digital workflows: A double-blind crossover randomized controlled trial.

PURPOSE This double-blinded 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-value: 0.876) or dentist (f-ratio: 1.55: p-value: 0.221). Secondary, patients clearly favored the digital impression workflows over the conventional approach (f-ratio: 14.57; p-value: <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 non-esthetic 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. This article is protected by copyright. All rights reserved

Time-efficiency and cost-analysis comparing three digital workflows for treatment with monolithic zirconia implant fixed dental prostheses: A double-blinded RCT.

OBJECTIVES This double-blinded randomized controlled trial investigated economic performance indicators (EPI) in terms of time-efficiency and production costs of 3-unit monolithic zirconium-dioxide (ZrO2) implant fixed dental prostheses (iFDP) in three different workflows. METHODS Twenty patients with two Straumann Tissue-Level-Implants received three iFDPs; two were fabricated in proprietary complete digital workflows with intraoral optical scanning and model-free fabrication with company-related CAD/CAM lab-software while one iFDP was manufactured on digitized casts from conventional impressions. The sequence of impression-taking for the three workflows (TRIOS 3/3Shape [Test-1]; Virtuo Vivo/Dental Wings [Test-2]; Impregum/3M Espe [Control]) was randomly allocated. Sixty iFDPs bonded to ti-base abutments were analyzed. Clinical and technical worksteps for Test-1/Test-2/Control were recorded and evaluated for time-efficiency including cost-analysis (CHF=Swiss Francs) using ANOVA-Tests (significance level α=0.05). RESULTS Mean total work time, as the sum of clinical plus technical steps, was 97.5 min (SD±23.6) for Test-1, 193.1 min (SD±25.2) for Test-2, and 172.6 min (SD±27.4) for Control. Times were significantly different between Test-1/Test-2 (p<0.00001), Test-1/Control (p<0.00001), and Test-2/Control (p<0.03610). Technical costs were 566 CHF (SD±49.3) for Test-1, 711 CHF (SD±78.8) for Test-2, 812 CHF (SD±89.6) for Control, and were also significantly different for all comparisons (p<0.00001). CONCLUSIONS Test-1 demonstrated the best performance for time-efficiency, Test-2 revealed the worst result. This indicates that digital workflows are not the same and not necessarily superior to analog workflows of monolithic ZrO2 iFDPs. Complexity decreases by reducing the number of steps following complete digital workflows, resulting in lower production costs compared to the mixed analog-digital workflow with conventional impressions. CLINICAL SIGNIFICANCE Complete digital workflows comprising intraoral optical scanning without physical models for treatment with monolithic ZrO2 iFDPs is an efficient alternative to mixed analog-digital workflows with conventional impressions and labside digitization of dental casts

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

Abstract 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