The development of quantitative methods using virtual models for the measurement of tooth wear

3D Surface Deviation Wear Analysis of Veneered PEEK Crowns and Its Correlation with Optical Digital Profilometry

PURPOSE

To verify whether 3D surface deviation analysis software can detect the surface changes of composite veneered polyetheretherketone posterior crowns following wear simulation compared to optical digital profilometry.

MATERIALS AND METHODS

Twenty dental crowns, fabricated from CAD-CAM polyetheretherketone (PEEK) and veneered with high impact polymer composite (HIPC), were subjected to wear test (50N, 5/55°C; 120,000 chewing cycles). Optical digital profilometry and 3D surface deviation using Geomagic design X software was used before and after the wear test to measure volumetric wear loss (mm³ ). The data were statistically analyzed with Wilcoxon signed-rank test to compare the two methodologies. The significance level was set at p ≤ 0.05.

RESULTS

There was no statistically significant difference between the two assessment methods (p-value = 0.075, Effect size = 0.854). Regarding the optical digital profilometry analysis, HIPC veneered PEEK crowns showed 0.01686 (0.018-0.02155) mm³ as a median volumetric wear loss value. While the crowns analyzed by 3D surface deviation showed -0.0398 (-0.0913 to -0.0042) mm³ as a median volumetric loss value (p-value = 0.075, Effect size = 0.854). In addition, there was no statistically significant correlation between wear measurements by optical digital profilometry and 3D surface deviation analyses (ρ = -0.177, p-value = 0.685).

CONCLUSIONS

There was no significant difference or correlation between optical digital profilometry and 3D surface deviation analyses for volumetric wear loss of veneered PEEK crowns.

3D Occlusal Tooth Wear Assessment in Presence of Limited Changes in Non-Occlusal Surfaces

The study aimed to develop an accurate and convenient 3D occlusal tooth wear assessment technique, applicable when surfaces other than the occlusal undergo changes during the observation period. Various degrees of occlusal tooth wear were simulated in vitro on 18 molar and 18 premolar plaster teeth. Additionally, their buccal and lingual surfaces were gently grinded to induce superficial changes and digital dental models were generated. The grinded and the original tooth crowns were superimposed using six different 3D techniques (two reference areas with varying settings; gold standard: GS). Superimposition on intact structures provided the GS measurements. Tooth wear volume comprised the primary outcome measure. All techniques differed significantly to each other in their accuracy (p < 0.001). The technique of choice (CCD: complete crown with 30% estimated overlap of meshes) showed excellent agreement with the GS technique (median difference: 0.045, max: 0.219 mm³), no systematic error and sufficient reproducibility (max difference < 0.040 mm³). Tooth type, tooth alignment in the dental arches, and amount of tooth wear did not significantly affect the results of the CCD technique (p > 0.01). The suggested occlusal tooth wear assessment technique is straightforward and offers accurate outcomes when limited morphological changes occur on surfaces other than the occlusal.

An accurate and efficient method for occlusal tooth wear assessment using 3D digital dental models

Tooth or material wear in a dentition is a common finding that requires timely diagnosis for management and prevention of further loss or associated esthetic or functional impairment. Various qualitative and quantitative methods have been suggested to measure tooth or material wear, but they present with limitations, such as imprecision, subjectivity, or high complexity. Here we developed and assessed an efficient 3D superimposition method to accurately measure occlusal tooth wear on 3D digital dental models. For this purpose, teeth on plaster casts were manually grinded on their occlusal surfaces to simulate various degrees of tooth wear. The casts were scanned using a surface scanner. Grinded tooth crowns (T1) were segmented and compared to the original crowns (T0) using five 3D surface superimposition techniques and a gold standard technique (GS). GS measurements were obtained by using intact adjacent structures as superimposition references. The technique of choice (complete crown with 30% estimated overlap of meshes) showed the best reproducibility (maximum difference < 0.050 mm³) and excellent agreement with the GS technique (median difference: 0.032 mm³). The suggested 3D superimposition method offers a highly efficient and accurate tool for tooth wear assessment, which could be applicable to clinical conditions.

Effect of occlusal slope related to uneven attrition on root stress distribution and potential fracture

Background/purpose

Severely uneven occlusal attrition is thought to play an important role in the occurrence of spontaneous vertical root fracture (VRF), a frequent problem among Chinese people. This study evaluated the influence of occlusal slope related to uneven attrition on the root stress condition.

Materials and methods

A finite element model of the mandibular first molar was established. Two different occlusal slope patterns were simulated in 5 models: (A) sound tooth, (B) 0.5–1.5 mm and (C) 2–3 mm attrition increased buccally, and (D) 0.5–1.5 mm and (E) 2–3 mm attrition increased distally. A static load of 200 N was applied vertically or angled at 45° to the longitudinal axis. The von Mises stress was evaluated.

Results

Under vertical loading, more stress was transferred from the cervical to the middle root with attrition, especially the mesial root, while stress declined with attrition under oblique loading. Stress was mainly distributed in the buccal surface and mesial root with vertical loading, or in the lingual surface and distal root with oblique loading. The maximum von Mises with oblique loading was significantly higher than with vertical loading.

Conclusion

Uneven occlusal attrition made the middle of the mesial root bear more stress, increasing fracture risk under vertical load. This finding suggests that timely restoration of the sloped occlusal morphology in teeth with severe attrition should be recommended to prevent VRFs. Lateral loading was not a risk factor of typical vertical root fractures, but the high stress could cause distal root cervical fracture.

Maxillary first molar wear: a longitudinal study of children

The aim of this study is to examine the correlation between tooth wear and age by quantitatively measuring maxillary first molar wear in children. A total of 150 maxillary dental models were analyzed in 30 subjects (male, 11; female, 19) with an age range of 6-14 years. Maxillary first molar wear were assessed based on area, volume and the shortest distance from the buccal occlusal plane to the central pit point (BCPH). The area and volume of the tooth cusps were measured at four different offset-plane heights (0.2, 0.4, 0.6, and 0.8 mm). Relationship between age and the amount of wear or BCPH were statistically analyzed. Correlation and regression analyses were also performed, and age estimation was obtained with linear regression analysis. Repeated measures analysis of variance (ANOVA) revealed significant differences between age and the amount of wear based on area, volume, and offset-plane height. Except age of 8 and 10, 12 and 14's 0.2-mm offset-plane-measured volume, all area and volume measurement of all ages and offset-plane height showed a significant amount of increase. Wear speeds were calculated using the BCPH. Among age and measurement variables, the correlation coefficient was strongest when the volume was measured from the 0.4-mm offset-plane. As age increases, the amount of wear, as quantified by area and volume measurements, also increases. According to this study, a regression equation that can be used for age estimation is follows: Age (y)=0.16×0.4V+0.85 (R ²=0.490) using volume.

Methods for quantitative measurement of tooth wear using the area and volume of virtual model cusps

Purpose

Clinicians must examine tooth wear to make a proper diagnosis. However, qualitative methods of measuring tooth wear have many disadvantages. Therefore, this study aimed to develop and evaluate quantitative parameters using the cusp area and volume of virtual dental models.

Methods

The subjects of this study were the same virtual models that were used in our former study. The same age group classification and new tooth wear index (NTWI) scoring system were also reused. A virtual occlusal plane was generated with the highest cusp points and lowered vertically from 0.2 to 0.8 mm to create offset planes. The area and volume of each cusp was then measured and added together. In addition to the former analysis, the differential features of each cusp were analyzed.

Results

The scores of the new parameters differentiated the age and NTWI groups better than those analyzed in the former study. The Spearman ρ coefficients between the total area and the area of each cusp also showed higher scores at the levels of 0.6 mm (0.6A) and 0.8A. The mesiolingual cusp (MLC) showed a statistically significant difference (P<0.01) from the other cusps in the paired t-test. Additionally, the MLC exhibited the highest percentage of change at 0.6A in some age and NTWI groups. Regarding the age groups, the MLC showed the highest score in groups 1 and 2. For the NTWI groups, the MLC was not significantly different in groups 3 and 4. These results support the proposal that the lingual cusp exhibits rapid wear because it serves as a functional cusp.

Conclusions

Although this study has limitations due to its cross-sectional nature, it suggests better quantitative parameters and analytical tools for the characteristics of cusp wear.

Evaluation of the effectiveness of the new tooth wear measurement parameters

Nowadays, there has been an increasing interest in the preservation of natural dentition and the proper occlusion related to tooth wear for quality of life. To overcome the problems of the existing qualitative tooth wear analysis method, virtual three-dimensional models have been used. This study was designed to develop and validate a new quantitative method using tooth wear measurement parameters with angles obtained from virtual vectors and planes of the three-dimensional models. Sixteen parameters were evaluated in the virtual models of 20 students (7.57±1.55 years old) and 20 adults (56.85±6.34 years old). There were 12 angle and 4 height parameters, and the number of parameters measured from the virtual planes and vectors were 10 and 6, respectively. For each parameter, means and standard deviations were calculated, and an unpaired sample t test was performed to compare the young and the adult groups. Also, differences between the means were determined and expressed as percentages. The results were statistically significant between the two groups (P<0.001). In general, parameters using virtual vectors showed greater change than virtual plane. Although there were statistically significant differences among all parameters using virtual planes (P<0.001), the changes of the three angles were similar, except distolingual cusp angle. It was found that the parameters using virtual vectors were effective and tooth wear took place in both buccal and lingual cusps. Likewise, the validation of the new measurement parameters suggests that they can also be applied in the assessment of tooth wear related to dental biomaterials.

Quantification of incisal tooth wear in upper anterior teeth: conventional vs new method using toolmakers microscope and a three-dimensional measuring technique

OBJECTIVES

This study aimed to quantify tooth wear in upper anterior teeth using a new CAD-CAM Laser scanning machine, tool maker microscope and conventional tooth wear index.

METHODS

Fifty participants (25 males and 25 females, mean age = 25 ± 4 years) were assessed for incisal tooth wear of upper anterior teeth using Smith and Knight clinical tooth wear index (TWI) on two occasions, the study baseline and 1 year later. Stone dies for each tooth were prepared and scanned using the CAD-CAM Laser Cercon System. Scanned images were printed and examined under a toolmaker microscope to quantify tooth wear and then the dies were directly assessed under the microscope to measure tooth wear. The Wilcoxon Signed Ranks Test was used to analyze the data.

RESULTS

TWI scores for incisal edges were 0-3 and were similar at both occasions. Score 4 was not detected. Wear values measured by directly assessing the dies under the toolmaker microscope (range = 113 - 150 μm, mean = 130 ± 20 μm) were significantly more than those measured from Cercon Digital Machine images (range=52-80 μm, mean = 68 ± 23 μm) and both showed significant differences between the two occasions.

CONCLUSIONS

Wear progression in upper anterior teeth was effectively detected by directly measuring the dies or the images of dies under toolmaker microscope. Measuring the dies of worn dentition directly under tool maker microscope enabled detection of wear progression more accurately than measuring die images obtained with Cercon Digital Machine. Conventional method was the least sensitive for tooth wear quantification and was unable to identify wear progression in most cases.

Making three-dimensional Monson's sphere using virtual dental models

OBJECTIVES

The Monson's sphere and curve of Wilson can be used as reference for prosthetic reconstructions or orthodontic treatments. This study aimed to generate and measure the three-dimensional (3-D) Monson's sphere and curve of Wilson using virtual dental models and custom software.

METHODS

Mandibular dental casts from 79 young adults of Korean descent were scanned and rendered as virtual dental models using a 3-D digitizing scanner. 26 landmarks were digitized on the virtual dental models using a custom made software program. The Monson's sphere was estimated by fitting a sphere to the cusp tips using a least-squares method. Two curves of Wilson were generated by finding the intersecting circle between the Monson's sphere and two vertical planes orthogonal to a virtual occlusal plane. Non-parametric Mann-Whitney and Kruskal-Wallis tests were performed to test for difference between sex and in cusp number within tooth position.

RESULTS

The mean radius of Monson's sphere was 110.89 ± 25.75 mm. There were significant differences between males and females in all measurements taken (p<0.01), within 16.87-17.27 mm. Furthermore, morphological variation derived from variability in cusp number in the second premolar and second molar were not found to influence occlusal curvature (p>0.05).

CONCLUSIONS

This study describes a best-fit algorithm for generating 3-D Monson's sphere using occlusal curves quantified from virtual dental models. The radius of Monson's sphere in Korean subjects was greater than the original four-inch value suggested by Monson.

CLINICAL SIGNIFICANCE

The Monson's sphere and curve of Wilson can be used as a reference for prosthetic reconstruction and orthodontic treatment. The data found in this study may be applied to improve dental treatment results.