Virtual diagnostics and guided tooth preparation for the minimally invasive rehabilitation of a patient with extensive tooth wear: A validation of a digital workflow

Digital guided veneer preparation: A dental technique

This article describes a digital workflow for ceramic veneer preparation using computer-aided design and computer-aided manufacturing technology. A digital waxing was planned on the exocad software program to reestablish esthetic and functional parameters. Then, the digital guides for veneer preparation were designed by using the Meshmixer design software program to control the tooth structure removed during preparation to the minimal thickness necessary for the definitive restorations. The digital guides were printed in an additively manufactured clear resin and used in the preparation appointment, allowing a more conservative and controlled preparation.

The impact of passive alveolar molding vs. nasoalveolar molding on cleft width and other parameters of maxillary growth in unilateral cleft lip palate

OBJECTIVE

Passive alveolar molding (PAM) and nasoalveolar molding (NAM) are established presurgical infant orthodontic (PSIO) therapies for cleft lip palate (CLP) patients. PAM guides maxillary growth with a modified Hotz appliance, while NAM also uses extraoral taping and includes nasal stents. The effects of these techniques on alveolar arch growth have rarely been compared.

MATERIAL AND METHODS

We retrospectively compared 3D-scanned maxillary models obtained before and after PSIO from infants with unilateral, non-syndromic CLP treated with PAM (n = 16) versus NAM (n = 13). Nine anatomical points were set digitally by four raters and transversal/sagittal distances and rotations of the maxilla were measured.

RESULTS

Both appliances reduced the anterior cleft, but NAM percentage wise more. NAM decreased the anterior and medial transversal width compared to PAM, which led to no change. With both appliances, the posterior width increased. The alveolar arch length of the great and small segments and the sagittal length of the maxilla increased with PAM but only partially with NAM. However, NAM induced a significant greater medial rotation of the larger and smaller segment compared to PAM with respect to the lateral angle.

CONCLUSIONS

NAM and PAM presented some significant differences regarding maxillary growth. While NAM reduced the anterior cleft and effectively rotated the segments medially, PAM allowed more transversal and sagittal growth.

CLINICAL RELEVANCE

The results of this study should be taken into consideration when to decide whether to use PAM or NAM, since they show a different outcome within the first few months. Further studies are necessary regarding long-term differences.

Perceptual difference of smile aesthetics between 2-dimensional photographs and 3-dimensional dentofacial images: a cross-sectional study

BACKGROUND

The aim of this study was to compare the perceptual difference of smile aesthetics between 2D photographs and 3D dentofacial images as perceived by orthodontists and graduate students.

METHODS

Forty-eight subjects finished orthodontic treatment were recruited with 2D photographs of frontal, oblique and lateral views as well as 3D dentofacial images. Twelve senior orthodontists and 13 postgraduate students were asked to rate the 2D and 3D smile simulations based on visual analog scale (VAS) and to vote for smile features that affect the attractiveness of smile. At the end, they completed a questionnaire about their views on different smile simulations. Wilcoxon signed-rank, Bland-Altman analysis, and multiple linear regression were used to compare the ratings and votes of smile perception between raters and between records.

RESULTS

Orthodontists and postgraduate students rated smile consistently with 2D photographs, while orthodontists tended to give a higher rate for unattractive smiles and a lower rate for attractive smiles with 3D dentofacial images. The 3D dentofacial images were rated significantly lower than 2D photographs and the voting of most of the smile features showed significant negative main effect on VAS scores, while the effect of demographic characteristics of raters, voting on visible width of upper dentition and buccal corridor was not significant. In addition, a significant negative main effect of commissure and facial profile was found on the rating discrepancy between 2D and 3D images.

CONCLUSIONS

Senior orthodontists tend to perceived 3D images more conservatively in smile evaluation. 3D dentofacial images were rated lower than 2D photographs and most of the smile features affect the aesthetic perception of smile. The perceptual difference of commissure and facial profile contributed to the lower ratings in 3D dentofacial images.

A diagnostically and digitally driven tooth preparation protocol by using a patient monitoring tool with an intraoral scanner

Finding the right balance between the preservation of tooth structure and providing adequate space for the restorative material is a major challenge in prosthetic dentistry. A technique is presented using the patient monitoring tool available in standard software programs of an intraoral scanner to constantly monitor preparation dimensions in relation to the optimal definitive restoration.

Rehabilitation of Worn Dentition with Direct Resin Composite Restorations: A Case Report

The incidence of tooth wear has steadily increased in all Western populations during the past decades. A through-care strategy, extendable for a lifetime, has become crucial to prevent the extensive loss of sound dental structure and to make an eventual retreatment affordable in the long term. An interceptive treatment using resin composite materials and no-preparation approaches meets these requirements. Moreover, continual developments in digital dentistry makes possible to predict the treatment plan for the restorative rehabilitation of the mouth. The availability of digital resources allows clinicians to increase predictability for excellent esthetics and good functional results. This article provides a step-by-step description of a full-mouth additive rehabilitation achieved by employing digital workflows and direct resin composite restorations. A comprehensive functional and esthetic evaluation of the treatment is proposed and discussed.

Shear bond strength of ceramic laminate veneers to finishing surfaces with different percentages of preserved enamel under a digital guided method

Background

The purpose of this in vitro study was to evaluate the effect of the percentages of preserved enamel on ceramic laminate veneers’ (CLVs) shear bond strength (SBS).

Methods

Seventy extracted human maxillary central incisors were scanned and reconstructed into three-dimensional models. The extracted teeth were then embedded and randomly divided into seven groups (n = 10 per group). Based on digital analyses of the three-dimensional models, guided tooth preparation and bonding procedures were performed individually to form seven different percentages (100%, 80%, 60% 50%, 40%, 20% and 0%) of remaining enamel thickness on the bonding surface. Finally, the SBS test was performed, and the data were statistically analysed by one-way ANOVA with LSD post hoc test (α = 0.05).

Results

The complete enamel surface exhibited the highest SBS (19.93 ± 4.55 MPa), followed by 80% enamel (19.03 ± 3.66 MPa), 60% enamel (18.44 ± 3.65 MPa), 50% enamel (18.18 ± 3.41 MPa), 40% enamel (17.83 ± 3.01 MPa) and 20% enamel (11.32 ± 3.42 MPa) group. The lowest SBS (9.63 ± 3.46 MPa) was detected in 0% enamel group. No significant difference was observed among the 40–100% enamel groups, while the 20% or 0% enamel group demonstrated a significantly lower mean SBS than the 40% enamel group (p < 0.05).

Conclusion

The SBS value of CLVs bonded to 100% enamel on the finishing surfaces (nearly 20 MPa) was twice that which bonded to 0% enamel (nearly 10 MPa). Bonding to 100% enamel is the most reliable treatment. When dentin exposure is inevitable, enamel should be preserved as much as possible to maintain good bonding. In addition, 40% of preserved enamel on the bonding surface was the minimal acceptable value to fulfil the requirements of good bonding strength.

Preliminary application and evaluation of digital step-by-step tooth-preparation templates

STATEMENT OF PROBLEM

Tooth preparation is a fundamental technique, and inaccurate preparation may lead to excessive irreversible tooth removal or insufficient restorative space. The conventional process depends mostly on operator experience, and variable quality is inevitable. Whether a tooth preparation template would be beneficial, especially for inexperienced dentists, is unclear.

PURPOSE

The purpose of this preliminary study was to evaluate the application of new digitally designed step-by-step templates to guide tooth preparation.

MATERIAL AND METHODS

A laboratory scanner was used to obtain digital scans of dental casts. A 3-dimensional reverse engineering software program was used for the step-by-step digital design. The data for a series of guide templates were imported into a computer-aided manufacturing (CAM) machine for milling. Ten experts and 10 inexperienced dentists prepared teeth on a dentoform in a mannequin head. They were instructed to complete the preparation within 20 minutes both with and without the step-by-step template. The prepared crowns were subsequently scanned with an intraoral scanner, the scans were imported into a preparation evaluation software program, and various indexes were scored. The t test was used to analyze the differences between the 2 methods of tooth preparation in each group (α=.05).

RESULTS

No significant differences were found in total scores with and without the guide templates in the expert group (P=.256), but the scores in the inexperienced group differed significantly between the 2 preparation methods (P<.001). In undercut comparisons, the 2 methods of preparation did not differ significantly in the expert (P=.912) or inexperienced groups (P=.601). However, the scores for taper and occlusal reduction were significantly higher in the inexperienced group when using the guide template (P<.001).

CONCLUSIONS

The new digitally designed step-by-step tooth preparation guide template significantly improved the efficiency and quality of tooth preparation for inexperienced dentists when preparing multiple teeth.

A stereolithographic template for computer-assisted teeth preparation in dental esthetic ceramic veneer treatment

OBJECTIVE

This article describes a digital dental esthetic ceramic veneer treatment workflow using a stereolithographic template for teeth preparation.

CLINICAL CONSIDERATIONS

We have presented the case of a 33-year-old woman with dental fluorosis who wanted an esthetic ceramic veneer treatment. A digital smile design was created on a virtual patient, and a virtual diagnostic wax-up was made. Based on the suggested ceramic material thickness, virtual teeth preparation was performed on the diagnostic wax-up. A special-teeth preparation template was then created digitally and fabricated using a stereolithographic technique. This template guided the teeth preparation using a special bur with a stopper. The veneers were fabricated by CAD/CAM and delivered good esthetics and function.

CONCLUSIONS

The stereolithographic tooth reduction template helps realize digital restorative planning. It provides better control of the reduction depth of the labial and incisal preparation, making the operation simpler.

CLINICAL SIGNIFICANCE

The digital dental esthetic ceramic veneer treatment workflow described here using a stereolithographic template for teeth preparation helped with the accurate control of reduction depth for minimally invasive teeth preparation, making the operation simpler, which is a significant improvement over the previous methods.

Investigations on the Processing of Ceramic Filled Inks for 3D InkJet Printing

3D inkjet printing is moving from a technology of rapid prototyping to rapid manufacturing. The introduction of ultraviolet curable composites filled with functional ceramics could expand the possibilities of this technology. In this work, a simple and scalable process was investigated as a template for the production of inkjet printable functional ceramics. Pyrogenic alumina particles with an average size of 13 nm, 35 nm and 100 nm were used as fillers in an acrylate mixture. The physical coating of the ceramics with 2-[2-(2-methoxyethoxy)ethoxy] acetic acid results in a low-viscosity dispersion with a ceramic content of up to 2 vol%, Newtonian behavior and surface tension within the limits allowed for inkjet printing. The material has sufficient stability for printing tensile specimens. Tensile tests have shown that modulus of elasticity, tensile strength and toughness can be kept constant despite the light scatter caused by the particles. The final production steps could be reduced to grinding and drying of the powders, their resuspension in the organic matrix and inkjet printing. The process can be used in an industrial-scale production of materials for abrasion-resistant components with adapted tribology.