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Zhang T, Zheng Y, Zhong S, Bai S. Fully integrated additive manufacturing of an obturator prosthesis for an edentulous patient with a maxillectomy defect. J Prosthet Dent 2024:S0022-3913(24)00375-5. [PMID: 38942715 DOI: 10.1016/j.prosdent.2024.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 06/30/2024]
Abstract
Maxillary defects pose challenges for prosthodontists, especially when patients have no remaining teeth. This clinical report describes rehabilitation with a complete denture obturator fabricated in 2 visits for an edentulous patient after a maxillectomy. The obturator base and artificial teeth were digitally designed and merged into a 1-piece prosthesis. Following a virtual reduction, the integrated prosthesis and a gingival veneer were calculated and then printed and bonded together to complete the fabrication. Balanced occlusion was achieved with the assistance of a digital occlusion analyzer at the insertion visit. This approach avoided base-tooth assembly deviations and provided a prosthesis with good patient-reported outcomes at the 6-month follow-up.
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Affiliation(s)
- Tingmin Zhang
- Graduate student, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Yuying Zheng
- Graduate student, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Sheng Zhong
- Dental Technologist, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Shizhu Bai
- Associate Professor, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China.
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2
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Srivastava G, Padhiary SK, Mohanty N, Patil PG, Panda S, Cobo-Vazquez C, Çakmak G, Molinero-Mourelle P. Digital workflow feasibility for the fabrication of intraoral maxillofacial prosthetics after surgical resection: a systematic literature review. Acta Odontol Scand 2024; 83:392-403. [PMID: 38895776 DOI: 10.2340/aos.v83.40870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVES To evaluate the current evidence of digital workflow feasibility based on the data acquisition methods and the software tools used to fabricate intraoral prostheses for patients with partial or total maxillary and mandibular defects. MATERIALS AND METHODS An electronic search was performed in PubMed, SCOPUS, and Web of Science using a combination of relevant keywords: digital workflow, digital designing, computer-assisted design-computer aided manufacturing, 3D printing, maxillectomy, and mandibulectomy. The Joanna Briggs Institute Critical Appraisal Tool was used to assess the quality of evidence in the studies reviewed. RESULTS From a total of 542 references, 33 articles were selected, including 25 on maxillary prostheses and 8 on mandibular prostheses. The use of digital workflows was limited to one or two steps of the fabrication of the prostheses, and only four studies described a complete digital workflow. The most preferred method for data acquisition was intraoral scanning with or without a cone beam computed tomography combination. CONCLUSION Currently, the fabrication process of maxillofacial prostheses requires combining digital and conventional methods. Simplifying the data acquisition methods and providing user-friendly and affordable software may encourage clinicians to use the digital workflow more frequently for patients requiring maxillofacial prostheses.
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Affiliation(s)
- Gunjan Srivastava
- Department of Prosthodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India.
| | - Subrat Kumar Padhiary
- Department of Oral and Maxillofacial Surgery, Institute of Dental Sciences, Siksha 'O' Anusandhan Deemed to be Univesity, Bhubaneswar, India
| | - Neeta Mohanty
- Department of Oral and Maxillofacial Pathology, Institute of Dental Sciences, Siksha 'O' Anusandhan Deemed to be University, Bhubaneswar, India
| | - Pravinkumar G Patil
- Department of Prosthodontics, Division of Restorative Dentistry, School of Dentistry, International Medical University, Kuala Lumpur, Malaysia
| | - Saurav Panda
- Department of Periodontics, Institute of Dental Sciences, Siksha 'O' Anusandhan, University, Bhubaneswar, India
| | - Carlos Cobo-Vazquez
- Department of Dental Clinical Specialties, Faculty of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Gülce Çakmak
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Pedro Molinero-Mourelle
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Kakinuma H, Koyama S, Kondo T, Harata T, Furukawa H, Egusa H. In vitro evaluation of shape-memory hydrogels for removable dental prostheses and optimization of phase-transition temperature for intraoral use. J Prosthet Dent 2024; 131:708.e1-708.e8. [PMID: 38383280 DOI: 10.1016/j.prosdent.2024.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/13/2024] [Accepted: 01/16/2024] [Indexed: 02/23/2024]
Abstract
STATEMENT OF PROBLEM Removable dental prostheses require periodic relining with the loss of intaglio surface fit because of mucosal shape changes over time. Therefore, a new material with high adaptability to tissue changes over time would be beneficial. PURPOSE This study focused on a shape-memory gel (SMG) that softens when heated, retains its shape when cooled, and returns to its original shape when reheated. The purpose was to optimize SMG for intraoral use by controlling the ratio of 2 acrylate monomers and to evaluate the changes in the shape memory and physical properties of SMG with temperature and to evaluate biocompatibility. MATERIAL AND METHODS SMG specimens were synthesized using the following mixing ratios of 2 monomers, docosyl acrylate (DA) and stearyl acrylate (SA): 0:100, 25:75, 50:50, 75:25, and 100:0. SMG specimens were photopolymerized using a fluorescent light-polymerizing unit. To evaluate shape memory as a function of temperature, permanent deformation was measured based on the standardized compression set test for thermoplastic rubber. For evaluation of the physical properties and cytotoxicity, a 3-dimensionally printed denture base material was used as the control material. All assessments were compared between the groups by using 1-way analysis of variance followed by the Tukey-Kramer multiple comparison test (α=.05). RESULTS SMGs with a higher amount of DA maintained their compressed shape at room and intraoral temperatures. However, the SMG matrices softened and recovered their original shapes above 60 °C. SMGs showed Shore A hardness equivalent to that of the denture-base polymer material at intraoral temperatures because of the high phase-transition temperature. The low water solubility of SMGs supported the biocompatibility test results. CONCLUSIONS SMG, in which the phase-transition temperature was controlled by mixing acrylate monomers with different melting points, exhibited shape memory in the intraoral environment. The results indicate the feasibility of applying SMG for the fabrication of removable dental prostheses because of its high adaptability to tissue changes over time and biocompatibility.
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Affiliation(s)
- Hiroaki Kakinuma
- Graduate student, Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Shigeto Koyama
- Associate Professor, Maxillofacial Prosthetics Clinic, Tohoku University Hospital, Miyagi, Japan.
| | - Takeru Kondo
- Assistant Professor, Division of Molecular and Regenerative Prosthodontics, Tohoku University Graduate School of Dentistry, Miyagi, Japan
| | - Takayuki Harata
- Dental Technician, Dental Laboratory, Tohoku University Hospital, Miyagi, Japan
| | - Hidemitsu Furukawa
- Professor, Department of Mechanical Systems Engineering, Graduate School of Science and Engineering, Yamagata University, Yamagata, Japan
| | - Hiroshi Egusa
- Professor, Division of Advanced Prosthetic Dentistry, Tohoku University Graduate School of Dentistry, Miyagi, Japan
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Tasopoulos T, Naka O, Tampakos I, Kouveliotis G, Zoidis P. A fully digital approach to replacing an obturator prosthesis using a 3D printed closed hollow bulb: Α dental technique. J Prosthet Dent 2024:S0022-3913(24)00195-1. [PMID: 38556405 DOI: 10.1016/j.prosdent.2024.02.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 02/14/2024] [Accepted: 02/15/2024] [Indexed: 04/02/2024]
Abstract
The replacement of an obturator prosthesis using conventional methods has multiple issues. Standard tessellation language files generated from the superimposition of an accurate intraoral scanning of the maxillary defect and direct data acquisition of the existing hollow bulb obturator can facilitate the precise design of the prosthesis, requiring only minor adjustments. Rapid prototyping manufacturing techniques seem to ensure precise control of the integrity of the prosthetic component completion. The success of the technique is the simplicity and repeatability of designing and fabricating a retrievable and easily repairable obturator.
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Affiliation(s)
| | - Olga Naka
- Assistant Professor, Department of Prosthodontics, School of Dentistry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - George Kouveliotis
- Assistant Professor, Division of Prosthodontics, Department of Restorative Dental Sciences, University of Florida College of Dentistry, Gainesville, Fla
| | - Panagiotis Zoidis
- Professor, Division of Prosthodontics, Department of Restorative Dental Sciences, University of Florida College of Dentistry, Gainesville, Fla; Associate Dean, Clinical Affairs and Quality, University of Florida College of Dentistry, Gainesville, Fla.
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Liu N, Wang X, Bai S, Ren N. An integrated hollow bulb obturator prosthesis with a metal framework for a soft palate defect fabricated by multiple digital techniques. J Prosthet Dent 2023:S0022-3913(23)00700-X. [PMID: 37993320 DOI: 10.1016/j.prosdent.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 11/24/2023]
Abstract
The digital workflow to fabricate an integrated hollow bulb obturator prosthesis with a metal framework for a patient with soft palate defect is described. The framework was digitally designed with an open lattice denture base connector to facilitate the assembly of the hollow bulb obturator and printed with titanium. A functional impression of the palatopharyngeal area was made, and an integrated 3-dimensional (3D) cast was obtained by aligning the data of the functional impression to the preliminary intraoral scan data. The hollow bulb obturator and a palatal cover were designed based on the integrated 3D cast and the framework design data and printed with light-polymerizing denture base resin. The printed framework, obturator, and palatal cover were assembled and bonded without a physical cast, and the definitive prosthesis exhibited good fit, retention, and stability.
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Affiliation(s)
- Ningning Liu
- Researcher, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Xin Wang
- Graduate student, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Shizhu Bai
- Associate Professor, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China
| | - Nan Ren
- Researcher, State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, National Clinical Research Center for Oral Diseases, Shaanxi Key Laboratory of Stomatology, Digital Dentistry Center, School of Stomatology, The Fourth Military Medical University, Xi'an, Shaanxi, PR China.
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Spatz HI, Schmitz JT, Singh A, Golden M, Riedel E, Randazzo JD, Huryn JM. Comparison of the weight of conventionally heat-processed hollow and solid obturators and 3D printed hollow obturators. J Prosthet Dent 2023:S0022-3913(23)00645-5. [PMID: 37914607 DOI: 10.1016/j.prosdent.2023.09.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 11/03/2023]
Abstract
STATEMENT OF PROBLEM The weight of larger obturators places increased stress on the supportive teeth and bearing tissue and allows gravity to act as a dislodging factor affecting the stability and retention of the prosthesis. However, whether conventionally processed and 3-dimensionally (3D) printed hollow obturators have similar reduced weights compared with solid obturators is unclear. PURPOSE The purpose of this in vitro study was to evaluate the weight difference between conventionally heat-processed complete denture obturators with and without hollowing and 3D printed obturators with a hollow bulb. MATERIAL AND METHODS Obturators were fabricated as conventionally heat-processed solid obturators, conventionally heat-processed with a hollow obturator bulb, and 3D printed with a hollow obturator bulb. Nine obturator prostheses were fabricated for each type of Aramany Class I, Class II, and Class III defect. The weights of each of the 27 obturator prostheses were measured, and a statistical analysis was performed with exact versions of the Kruskal-Wallis test or Wilcoxon Rank Sum test (α=.05). RESULTS Conventionally heat-processed solid obturators were significantly heavier than the conventionally heat-processed hollow (P<.001) or the 3D printed hollow obturators (P<.001). No significant difference (P=.222) was found between the conventionally heat-processed hollow and 3D printed hollow obturators. The decrease in weight was proportional to the size of the defect with the Aramany Class I defect having the largest differences in weight between the different fabrication methods, followed by Class II, and then Class III with a much smaller defect. CONCLUSIONS Additive manufacturing could be a suitable alternative to conventional techniques for the fabrication of a closed hollow obturator because of the comparable weights.
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Affiliation(s)
- Harrison I Spatz
- Maxillofacial Prosthetics Fellow, Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Jaclyn T Schmitz
- Biomedical Engineer, Biomedical Systems, Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Annu Singh
- Research Fellow, Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Marjorie Golden
- Senior Dental Technician, Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Elyn Riedel
- Senior Biostatistician, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph D Randazzo
- Attending, Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Joseph M Huryn
- Chief, Dental Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY..
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Alfaraj A, Su FY, Lin WS. CAD-CAM Hollow Obturator Prosthesis: A Technical Report. J Prosthodont 2022; 31:635-638. [PMID: 35343606 PMCID: PMC9544696 DOI: 10.1111/jopr.13513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/23/2022] [Indexed: 11/29/2022] Open
Abstract
An obturator with a hollow bulb can decrease the overall weight of the prosthesis, stress on the underlying tissues, and patient discomfort. Although many techniques and materials have been proposed in the literature for hollowing the obturator prosthesis, they are often time consuming and technique sensitive. This proposed technique used an open‐source software program to hollow a digital design of a solid obturator base from a commercially available software in one single convenient step. The hollowing process allowed precise control of prosthesis thickness at the hollow space area for desirable hermetic seal and prosthesis strength.
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Affiliation(s)
- Amal Alfaraj
- Implant Fellow, Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, IN, USA
| | - Fang-Yu Su
- Clinical Assistant Professor, Department of Restorative Dentistry, Temple University Kornberg School of Dentistry, Philadelphia, PA, USA
| | - Wei-Shao Lin
- Associate Professor, Program Director, and Interim Chair, Advanced Education Program in Prosthodontics, Department of Prosthodontics, Indiana University School of Dentistry, Indianapolis, IN, USA
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Krämer Fernandez P, Kuscu E, Weise H, Engel EM, Spintzyk S. Rapid additive manufacturing of an obturator prosthesis with the use of an intraoral scanner: A dental technique. J Prosthet Dent 2020; 127:189-193. [PMID: 33276962 DOI: 10.1016/j.prosdent.2020.07.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 12/27/2022]
Abstract
A protocol for a completely digital manufacturing process for an obturator prosthesis is described. An intraoral scanner was used to capture the mandible and maxilla together with the sinus defect. The obturator base and the artificial teeth were created with a computer-aided design software program and manufactured by 3-dimensional printing. Stainless steel clasps provided the retention for the prosthesis.
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Affiliation(s)
- Pablo Krämer Fernandez
- Graduate student, Department of Prosthodontics at the Centre of Dentistry, Oral Medicine, and Maxillofacial Surgery with Dental School, Tuebingen University Hospital, Tuebingen, Germany.
| | - Ebru Kuscu
- Graduate student, Department of Prosthodontics at the Centre of Dentistry, Oral Medicine and Maxillofacial Surgery with Dental School, Tuebingen University Hospital, Tuebingen, Germany
| | - Hannes Weise
- Research Associate, Department of Oral and Maxillofacial Surgery, Oral Medicine and Maxillofacial Surgery with Dental School, Tuebingen University Hospital, Tübingen, Germany
| | - Eva M Engel
- Head of the Department, Department of Prosthodontics at the Centre of Dentistry, Oral Medicine and Maxillofacial Surgery with Dental School, Tuebingen University Hospital, Tuebingen, Germany
| | - Sebastian Spintzyk
- Material Science Engineer, Section, Medical Materials Science and Technology, Tuebingen University Hospital, Tuebingen, Germany
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