A new mathematical process for the calculation of average forms of teeth

Generative deep learning approaches for the design of dental restorations: A narrative review

OBJECTIVES

This study aims to explore and discuss recent advancements in tooth reconstruction utilizing deep learning (DL) techniques. A review on new DL methodologies in partial and full tooth reconstruction is conducted.

DATA/SOURCES

PubMed, Google Scholar, and IEEE Xplore databases were searched for articles from 2003 to 2023.

STUDY SELECTION

The review includes 9 articles published from 2018 to 2023. The selected articles showcase novel DL approaches for tooth reconstruction, while those concentrating solely on the application or review of DL methods are excluded. The review shows that data is acquired via intraoral scans or laboratory scans of dental plaster models. Common data representations are depth maps, point clouds, and voxelized point clouds. Reconstructions focus on single teeth, using data from adjacent teeth or the entire jaw. Some articles include antagonist teeth data and features like occlusal grooves and gap distance. Primary network architectures include Generative Adversarial Networks (GANs) and Transformers. Compared to conventional digital methods, DL-based tooth reconstruction reports error rates approximately two times lower.

CONCLUSIONS

Generative DL models analyze dental datasets to reconstruct missing teeth by extracting insights into patterns and structures. Through specialized application, these models reconstruct morphologically and functionally sound dental structures, leveraging information from the existing teeth. The reported advancements facilitate the feasibility of DL-based dental crown reconstruction. Beyond GANs and Transformers with point clouds or voxels, recent studies indicate promising outcomes with diffusion-based architectures and innovative data representations like wavelets for 3D shape completion and inference problems.

CLINICAL SIGNIFICANCE

Generative network architectures employed in the analysis and reconstruction of dental structures demonstrate notable proficiency. The enhanced accuracy and efficiency of DL-based frameworks hold the potential to enhance clinical outcomes and increase patient satisfaction. The reduced reconstruction times and diminished requirement for manual intervention may lead to cost savings and improved accessibility of dental services.

Notch Signaling Pathway in Tooth Shape Variations throughout Evolution

Evolutionary changes in vertebrates are linked to genetic alterations that often affect tooth crown shape, which is a criterion of speciation events. The Notch pathway is highly conserved between species and controls morphogenetic processes in most developing organs, including teeth. Epithelial loss of the Notch-ligand Jagged1 in developing mouse molars affects the location, size and interconnections of their cusps that lead to minor tooth crown shape modifications convergent to those observed along Muridae evolution. RNA sequencing analysis revealed that these alterations are due to the modulation of more than 2000 genes and that Notch signaling is a hub for significant morphogenetic networks, such as Wnts and Fibroblast Growth Factors. The modeling of these tooth crown changes in mutant mice, via a three-dimensional metamorphosis approach, allowed prediction of how Jagged1-associated mutations in humans could affect the morphology of their teeth. These results shed new light on Notch/Jagged1-mediated signaling as one of the crucial components for dental variations in evolution.

Comparison of the morphological accuracy of automatic crowns designed by multiple computer-aided design software programs with different levels of dentition information acquisition

STATEMENT OF PROBLEM

Information on the morphological accuracy of crowns automatically produced by different computer-aided design (CAD) software programs for multilevel dentition defects is limited.

PURPOSE

The purpose of this in vitro study was to compare the morphological accuracy of crowns fabricated using different CAD software programs with different design theories for multilevel dentition defects.

MATERIAL AND METHODS

Four dentition defect types (the standard group, the abrasion group, the adjacent-teeth-missing group, and the antagonist-tooth-missing group, n=10) were fabricated to represent different levels of missing dentition information. Two design modes (the library mode and correlation mode) of 3 common CAD software programs (3Shape [3Shape Dental system], CEREC [Dentsply Sirona], and exocad DentalCAD [exocad GmbH]) were used to design crowns automatically, and the morphologies of the generated crowns and original teeth were recorded. The root mean square (RMS) value was calculated to evaluate the morphological deviations between the autogenerated crowns and original teeth using the 3D matching system (Geomagic GmbH). As each group in this study represented 3 factors, the mean differences between the treatment combinations and the interaction effects were analyzed by performing factorial analysis of variance (α=.05).

RESULTS

The RMS values of autogenerated crowns designed using the correlation method were significantly lower than those designed using the library method of each software program in the 4 groups (P<.05). The RMS values of crowns designed by the 3Shape and CEREC software programs in library mode under conditions with dentition information loss were lower than those of crowns designed by the exocad software program (P<.05). Changes in the acquisition of dental information did not decrease the CEREC design accuracy (P>.05), while they did decrease the 3Shape and exocad design accuracy (P<.05).

CONCLUSIONS

The correlation method showed higher accuracy in rebuilding the original morphology of the teeth than the library method. Both the 3Shape and CEREC software programs showed higher accuracy than the exocad software program in library mode under conditions with dentition information loss, while CEREC showed higher stability than the 3Shape and exocad software programs.

Design of wear facets of mandibular first molar crowns by using patient-specific motion with an intraoral scanner: A clinical study

STATEMENT OF PROBLEM

Although computer-aided design has become popular, restorations are typically designed from static occlusion and dynamically by using an average-value virtual articulator. Patient-specific motion recorded by using an intraoral scanner has rarely been used to design restorations, and its design ability has not been analyzed.

PURPOSE

The purpose of this clinical study was to record patient-specific motion by using an intraoral scanner and to analyze its ability to design the morphology of the wear facets on mandibular first molar crowns.

MATERIAL AND METHODS

An intraoral scanner was used to scan complete arch digital casts and to record patient-specific motion of 11 participants. Right and left mandibular first molars were selected as the target teeth. The complete crown preparations of the target teeth were virtually prepared on the digital mandibular casts by using the Geomagic Studio 2013 software program. High points were created by elevating the wear facets of the target teeth by 0.3 mm in the occlusal direction to generate digital wax patterns. The Dental System software program was used to design crowns with the anatomic coping design method. Occlusal adjustment with static occlusion (STA crown), with the average-value virtual articulator (DYN crown), and with patient-specific motion (FUN crown) was carried out. The crowns adjusted with these 3 methods were compared with the original wear facets. The mean value and root mean square (RMS) of 3D deviation were measured. One-way ANOVA was used to analyze the influence of the occlusal surface design methods on the morphology of the wear facets (α=.05).

RESULTS

The STA crowns had the poorest results with the mean ±standard deviation 3D deviation value of 0.15 ±0.05 mm and RMS value of 0.19 ±0.04 mm. The best results occurred in the FUN group, with the mean ±standard deviation 3D deviation value of 0.05 ±0.06 mm and RMS value of 0.13 ±0.03 mm. Significant differences were found among the 3 groups (P<.01). Except for the RMS value between the STA and DYN groups, significant differences were found between groups from the pairwise comparisons.

CONCLUSIONS

The occlusal surface of the crowns designed by using the patient-specific motion recorded with the intraoral scanner had the best coincidence with the morphology of the wear facets on the original teeth.

Comparison and evaluation of the morphology of crowns generated by biogeneric design technique with CEREC chairside system

Objectives

To better guide clinicians to choose the appropriate chairside system, we compared and evaluated the morphology of crowns generated by three different biogeneric design modes (biogeneric copy (BC), biogeneric individual (BI), and biogeneric reference (BR)) of the CEREC software.

Methods

Maxillary and mandibular casts were obtained from twelve volunteers and digital impressions were acquired. All ceramic crown preparations of all right maxillary central incisors were prepared and digital impressions were taken. Then, crowns were automatically designed under BC, BI and BR modes separately and their morphologies were evaluated by six doctors. The “optimal fitting alignment” and “3D analysis” functions of the Geomagic Qualify software were carried out between original teeth and auto-generated full crowns. The auto-generated crowns were modified by a technician according to clinical criteria and the adjustment time was recorded. The discrepancies between technician modified crowns and the auto-generated full crowns were evaluated with the same functions in the Geomagic Qualify software.

Results

The subjective evaluation results of BC group were significantly better than those of BI and BR group (p < 0.05). Compared with the original teeth and modified crowns, auto-generated crowns in BC group all had the smallest differences, followed by BR and BI group (p < 0.05). BC group needed the shortest adjustment time than BI and BR group (p < 0.05).

Conclusions

Using crowns generated by BC mode is more aesthetic and suitable in clinics use than those generated by BI and BR modes and can reduce clinic adjustment time.

Comparison of chairside and laboratory CAD/CAM to conventional produced all-ceramic crowns regarding morphology, occlusion, and aesthetics

OBJECTIVES

There are many ways to produce all-ceramic crowns. Computer-aided design and computer-aided manufacturing (CAD/CAM) procedures compete against conventional fabricated restorations. As different methods of production may produce variable results, this study aims to compare chairside and laboratory-based CAD/CAM systems to conventional crowns regarding their similarity to original tooth morphology, number of occlusal contacts, occlusal adjustment time, and subjective aesthetic perception.

MATERIAL AND METHODS

Impressions of caries-free jaws were taken, and the resulting gypsum casts were scanned with a laboratory scanner. Preparations for all-ceramic full crowns were performed on first molars, and three different restorations were made: CEREC restorations (CER), laboratory-produced CAD/CAM crowns (LABCAD), and conventional waxed-up/pressed ceramic crowns (CONV). Time for occlusal adaptation and the number of occlusal contacts were noted. Two dentists performed aesthetic gradings of restorations. Statistical analysis included one-way ANOVA with least significant difference (LSD) post hoc test, t test, and Kruskal-Wallis test.

RESULTS

Metrical deviations of the re-scanned crowns to the original, unprepared tooth surface were 220.55 ± 54.31 μm for CER, 265.94 ± 61.39 for LABCAD, and 252.44 ± 68.77 μm for CONV group. One-way ANOVA showed significant lower deviations for the CER group. LABCAD crowns showed significantly more occlusal contacts, whereas CONV crowns required the least time for occlusal adaptation and showed excellent aesthetic gradings.

CONCLUSION

All three methods had pros and cons regarding different parameters. Further improvements of CAD/CAM software shall lead to restorations comparable to conventional restorations in all aspects, especially in aesthetics.

CLINICAL RELEVANCE

All tested methods of production for all-ceramic crowns produced clinically acceptable results. Thus, in an individual case, the method chosen can be determined by the dentist's preference.

Effect of prosthodontic planning on lateral occlusion scheme: a comparison between conventional and digital planning

Recently, digital wax-up is proposed as a tool to aid prosthodontic planning. However, there are no data about the effect of prosthodontic planning on lateral occlusion scheme.

OBJECTIVE

This study aims to evaluate the impact of conventional and digital prosthodontic planning on lateral occlusion scheme.

MATERIAL AND METHODS

Dental models of 10 patients were collected. All models had Angle Class I occlusion and were undergoing prosthodontic treatment that would influence the lateral occlusion scheme. Each set of models had received both conventional wax-up and digital wax-up. In relation to the lateral occlusion scheme, the following variables were evaluated: the prevalence of the different lateral occlusion scheme, number of contacting teeth and percentage of each contacting tooth. Four excursive positions on the working side were included: 0.5, 1.0, 2.0 and 3.0 mm from the maximal intercuspation position.

RESULTS

The lateral occlusion scheme of the two wax-up models was subjected to alterations following excursion. There was a tendency for the prevalence of canine-guided occlusion to increase and for the prevalence of group function occlusion to decrease with increasing excursion. The number of contacting teeth was decreasing with the increasing magnitude of excursion. For the 0.5 mm and 1.0 mm positions, the two wax-ups had significantly greater contacts than the pre-treatment models, while at the 2.0 mm and 3.0 mm positions, all the models were similar. For all models, canines were the most commonly contacting teeth, followed by the teeth adjacent to them. No difference was observed between the two wax-ups in relation to the number of contacting teeth.

CONCLUSION

Although the prosthodontic planning had influenced the pattern of the lateral occlusion scheme and contacts, there was no difference between the conventional and digital prosthodontic planning.

Effect of prosthodontic planning on intercuspal occlusal contacts: comparison of digital and conventional planning

BACKGROUND

Adequate occlusal contacts are critical for masticatory function. The aim of this study is to evaluate the intercuspal occlusal contacts following conventional and digital wax-ups.

METHODS

Stone casts of 15 patients undergoing prosthodontic treatment were gathered. Each cast was duplicated twice, so that conventional and digital wax-ups could be performed. To assess the occlusion, the following variables were evaluated: contact number per tooth (CNT), contact area per tooth (CAT) and contact accuracy. Further, the impact of tooth location in the arch was assessed.

RESULTS

The CNT and CAT after the wax-ups increased significantly following each wax-up, and this increase was more prominent for the posterior teeth than the anterior teeth. The conventional wax-up was associated with lower CNT than the digital wax-up, especially for the posterior teeth. On the other hand, the CAT was greater for the conventional wax-up than the digital wax-up for the anterior and posterior teeth. In terms of accuracy, the two wax-ups showed greater discrepancies than the pre-treatment casts, however, the magnitude of discrepancy was greater for the digital wax-up.

CONCLUSIONS

The two wax-ups improved the contact number and area. Despite the statistical variation between the wax-ups, the actual difference was minimal. Therefore, it could be speculated that the two wax-ups produced a similar outcome.