Combined Tooth-Implant–Supported Telescopic Prostheses in a Midterm Follow-up of > 2 Years

Purpose: The aim of this trial was to evaluate telescopic-retained prostheses on teeth and implants. Materials and Methods: Ten patients with a mean of 2.8 teeth received strategic implants to achieve triangular/quadrangular support. Survival and complication rates were estimated for telescopic abutments and prostheses. Results: After a mean observation period of > 2 years, no abutment was lost and all prostheses were in function. Complication rates were low, and maintenance services were limited to minor interventions. Conclusions: Combined tooth-implant-retained telescopic prostheses improve prosthetic support and offer successful function over a midterm period in patients with a severely reduced dentition

Die Fernröntgenfrontalaufnahme:Analyse von Indikation, Häufigkeit und Relation in der kieferorthopädischen Röntgendiagnostik für den Zeitraum von 1993 bis 2001

Die Studie setzt sich aus einer Literaturübersicht zur Fernröntgenfrontalaufnahme und einer statistischen Auswertung zur kieferorthopädischen Röntgendiagnostik zusammen. Orthopantomogramme und Fernröntgenseitenaufnahmen sind die häufigsten Aufnahmen in der Kieferorthopädie und werden in der Literatur als "Gold-Standard" bezeichnet. Mit spezieller Indikation werden Fernröntgenfrontalaufnahmen entsprechend weniger häufig angefertigt. Cranio-faciale und transversale Asymmetrien sind die Hauptindikationen zur Fernröntgenfrontalanalyse. Patienten mit einer Asymmetrie ohne Grundlage einer syndromalen Manifestation stellen mit über 50% an der Indikation die grösste Anzahl dar. Zusätzliche Indikationen sind die unilaterale mandibuläre Hyper- bzw. Hypoplasie sowie Störungen der Maxilla-Breiten-Entwicklung, gefolgt vom Komplex der cranio-facialen Syndrome. Insgesamt konnten 20715 Röntgenaufnahmen von 9283 Patienten in dem ausgewiesenen Zeitraum erfasst und statistisch analysiert werden

Conventional, Speed Sintering and High-Speed Sintering of Zirconia: A Systematic Review of the Current Status of Applications in Dentistry with a Focus on Precision, Mechanical and Optical Parameters.

The aim of this systematic review was to provide an overview of the technical and clinical outcomes of conventional, speed sintering and high-speed sintering protocols of zirconia in the dental field. Data on precision, mechanical and optical parameters were evaluated and related to the clinical performance of zirconia ceramic. The PICOS search strategy was applied using MEDLINE to search for in vitro and in vivo studies using MeSH Terms by two reviewers. Of 66 potentially relevant studies, 5 full text articles were selected and 10 were further retrieved through a manual search. All 15 studies included in the systematic review were in vitro studies. Mechanical, precision and optical properties (marginal and internal fit, fracture strength and modulus, wear, translucency and opalescence, aging resistance/hydrothermal aging) were evaluated regarding 3-, 4- and 5-YTZP zirconia material and conventional, high- and high-speed sintering protocols. Mechanical and precision results were similar or better when speed or high-speed sintering methods were used for 3-, 4- and 5-YTZP zirconia. Translucency is usually reduced when 3 Y-TZP is used with speed sintering methods. All types of zirconia using the sintering procedures performed mechanically better compared to lithium disilicate glass ceramics but glass ceramics showed better results regarding translucency

Comparison of functional and esthetic outcomes in digital versus analog rehabilitation of one-piece screw-retained implant crowns placed at second stage surgery

PURPOSE Analog and digital impressions are established procedures for restoration of single-tooth implants. In this study, single-tooth implants were restored with definitive restorations during second-stage surgery. Analog and digital workflows were compared. MATERIAL AND METHODS Eighty single-tooth implants were examined in total. In 40 implants, an index was taken immediately after implant placement using composite resin to fabricate the final crowns (analog workflow). For the other 40 single-tooth implants, intraoral intraoperative scans were performed (digital workflow) during primary surgery. The custom-fabricated screw-retained crowns were placed during second-stage surgery. Photographs and examinations for the scores were taken at the time of the follow-up visit, 1-4 years after placement of the crowns. The number of treatment appointments required was recorded and the modified pink esthetic score (PES) was determined. Additionally, the functional implant prosthetic score (FIPS) was measured. RESULTS The mean PES was 12.15/14 for the digital workflow and 11.95/14 for the analog workflow. The most common deficit was incomplete papillae for both workflows. Three treatment appointments were required for both workflows: (1) Scan and/or impressions making and patient consent, (2) implant placement, and (3) second-stage surgery with crown insertion. The FIPS was 9.1/10 for the digital workflow group and 9.2/10 for the analog workflow group. Common deficits presented as missing papillae as well as open approximal contacts. The FIPS was not significantly different between workflows (p = 0.679). The PES also did not show a statistically significant difference for both workflows (p = 0.654), however, the analog workflow showed better values for the papillae (p < 0.05). A significant difference was also found in the other PES values, with the digital workflow showing better results here (p < 0.05). A chronological analysis of the results of the digital technique showed that the cases treated last had significantly better values than the cases treated first. CONCLUSIONS According to the results of this study, both workflows allowed placement of the definitive crowns on single-tooth implants during second-stage surgery. Both workflows were found to be equivalent in terms of esthetic results in this study, although the digital workflow demonstrated a learning curve

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

A digital approach for one-step formation of the supra-implant emergence profile with an individualized CAD/CAM healing abutment.

PURPOSE This Technical Procedure describes a novel workflow for a one-step formation of the supra-implant emergence profile in the esthetic zone - the 'Digitally Flip Technique' (DFT). METHODS After implant placement, a post-operative intra-oral optical scan (IOS) was performed to capture the final three-dimensional implant position. Based on the superimposition of the digitally slice-wise DICOM-segmentation of the digitally flipped (mirrored) contra-lateral tooth and the STL-file of the IOS, an individualized healing abutment was CAD/CAM-fabricated out of PMMA-based restoration material in a fully digital workflow and seated at the stage of reopening surgery. One single treatment step was necessary for final modulation of the supra-implant mucosa architecture in order to mimic the morphological emergence profile of the contra-lateral tooth within a short-span time frame of four days after insertion of the individualized healing abutment. CONCLUSIONS The implant crown emergence profile could be shaped immediately after reopening according to the three-dimensional radiographic contour of the digitally flipped contra-lateral tooth. Estimating the emergence profile or time-consuming step-by-step conditioning of the mucosa through an additionally produced implant provisional was therefore avoided

Registering Maxillomandibular Relation to Create a Virtual Patient Integrated with a Virtual Articulator for Complex Implant Rehabilitation: A Clinical Report

The virtual patient, a unique computer simulation of the patient’s face, teeth, oral mucosa, and bone, provides an extraordinary mechanism for digital dental implant surgery planning and prosthetic design. However, the seamless registration of digital scans with functional information in the context of a virtual articulator remains a challenge. This report describes the treatment of a 47- year- old male with full- mouth guided immediate implant placement and immediate loading of CAD/CAM interim prostheses. Utilizing a novel digital workflow, a multifactorial registration of the vertical dimension of occlusion, centric occlusion, and facebow record were completed digitally and paired within a digital articulator. Utilizing this innovative approach, a complex treatment plan and procedure was executed smoothly with a successful prosthetic outcome demonstrating good fit, occlusion, esthetics, and patient reported satisfaction.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/156492/2/jopr13204.pdfhttp://deepblue.lib.umich.edu/bitstream/2027.42/156492/1/jopr13204_am.pd

Prosthetic articulator-based implant rehabilitation virtual patient: A technique bridging implant surgery and reconstructive dentistry

This technique report describes a fully digital workflow to create a prosthetic articulator-based implant rehabilitation (PAIR) virtual patient for complete-arch or complete-mouth implant rehabilitation. This workflow uses a custom gothic arch tracer during the cone beam computed tomography (CBCT) scan and a 3-dimensional virtual facebow when superimposing data. The PAIR virtual patient possesses reliable centric relation and vertical dimension of occlusion and is compatible with virtual articulators. Computer-aided implant planning and a digital prosthetic design can be seamlessly integrated by using this virtual patient

The complete digital workflow in fixed prosthodontics: a systematic review

Background The continuous development in dental processing ensures new opportunities in the field of fixed prosthodontics in a complete virtual environment without any physical model situations. The aim was to compare fully digitalized workflows to conventional and/or mixed analog-digital workflows for the treatment with tooth-borne or implant-supported fixed reconstructions. Methods A PICO strategy was executed using an electronic (MEDLINE, EMBASE, Google Scholar) plus manual search up to 2016–09-16 focusing on RCTs investigating complete digital workflows in fixed prosthodontics with regard to economics or esthetics or patient-centered outcomes with or without follow-up or survival/success rate analysis as well as complication assessment of at least 1 year under function. The search strategy was assembled from MeSH-Terms and unspecific free-text words: {((“Dental Prosthesis” [MeSH]) OR (“Crowns” [MeSH]) OR (“Dental Prosthesis, Implant-Supported” [MeSH])) OR ((crown) OR (fixed dental prosthesis) OR (fixed reconstruction) OR (dental bridge) OR (implant crown) OR (implant prosthesis) OR (implant restoration) OR (implant reconstruction))} AND {(“Computer-Aided Design” [MeSH]) OR ((digital workflow) OR (digital technology) OR (computerized dentistry) OR (intraoral scan) OR (digital impression) OR (scanbody) OR (virtual design) OR (digital design) OR (cad/cam) OR (rapid prototyping) OR (monolithic) OR (full-contour))} AND {(“Dental Technology” [MeSH) OR ((conventional workflow) OR (lost-wax-technique) OR (porcelain-fused-to-metal) OR (PFM) OR (implant impression) OR (hand-layering) OR (veneering) OR (framework))} AND {((“Study, Feasibility” [MeSH]) OR (“Survival” [MeSH]) OR (“Success” [MeSH]) OR (“Economics” [MeSH]) OR (“Costs, Cost Analysis” [MeSH]) OR (“Esthetics, Dental” [MeSH]) OR (“Patient Satisfaction” [MeSH])) OR ((feasibility) OR (efficiency) OR (patient-centered outcome))}. Assessment of risk of bias in selected studies was done at a ‘trial level’ including random sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting, and other bias using the Cochrane Collaboration tool. A judgment of risk of bias was assigned if one or more key domains had a high or unclear risk of bias. An official registration of the systematic review was not performed. Results The systematic search identified 67 titles, 32 abstracts thereof were screened, and subsequently, three full-texts included for data extraction. Analysed RCTs were heterogeneous without follow-up. One study demonstrated that fully digitally produced dental crowns revealed the feasibility of the process itself; however, the marginal precision was lower for lithium disilicate (LS2) restorations (113.8 μm) compared to conventional metal-ceramic (92.4 μm) and zirconium dioxide (ZrO2) crowns (68.5 μm) (p < 0.05). Another study showed that leucite-reinforced glass ceramic crowns were esthetically favoured by the patients (8/2 crowns) and clinicians (7/3 crowns) (p < 0.05). The third study investigated implant crowns. The complete digital workflow was more than twofold faster (75.3 min) in comparison to the mixed analog-digital workflow (156.6 min) (p < 0.05). No RCTs could be found investigating multi-unit fixed dental prostheses (FDP). Conclusions The number of RCTs testing complete digital workflows in fixed prosthodontics is low. Scientifically proven recommendations for clinical routine cannot be given at this time. Research with high-quality trials seems to be slower than the industrial progress of available digital applications. Future research with well-designed RCTs including follow-up observation is compellingly necessary in the field of complete digital processing

Recommendations for successful virtual patient-assisted esthetic implant rehabilitation: A guide for optimal function and clinical efficiency

OBJECTIVE Complete arch implant rehabilitation necessitates meticulous treatment planning and high-level collaboration between surgical and prosthetic dental teams. Emerging virtual technologies hold considerable promise in streamlining this process. The aim of this article is to extend recommendations to clinicians venturing into the virtual patient-assisted esthetic implant rehabilitation workflow. OVERVIEW This article summarizes recommendations for virtual patient-assisted esthetic implant rehabilitation in the following five aspects: three-dimensional data handling and superimposition, occlusion and virtual articulator integration in creating virtual patients, streamlined face- and prosthetic-driven surgical planning, reuse of presurgical data ("Copy & Paste"), and final impression for passive fitting of final restoration. To illustrate these principles, a case with complete-mouth implant rehabilitation completed within six visits using this virtual patient workflow is presented. CONCLUSION The virtual patient workflow serves as an invaluable tool to perform treatment planning, enhance efficiency, and ensure predictable outcomes in esthetic complete arch implant rehabilitation. CLINICAL SIGNIFICANCE Virtual workflows are increasingly prevalent in esthetic implant rehabilitation. Nevertheless, these workflows necessitate a distinct set of knowledge and tools divergent from conventional dentistry practices. This article offers guidelines and recommendations for dental clinicians who are new to this field