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Taha D, Allam S, Morsi T. Accuracy of computer-aided design trial restorations fabricated with different digital workflows. J Prosthet Dent 2024; 132:578-585. [PMID: 37925250 DOI: 10.1016/j.prosdent.2023.09.034] [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: 07/10/2023] [Revised: 09/27/2023] [Accepted: 09/27/2023] [Indexed: 11/06/2023]
Abstract
STATEMENT OF PROBLEM Trial restorations are a versatile tool for visualizing the esthetic treatment plan and should be an accurate replica of the planned smile design. The accuracy of conventionally fabricated trial restorations has been investigated; however, studies on the accuracy of different digital workflows for trial restoration fabrication are lacking. PURPOSE The purpose of this in vitro study was to evaluate the accuracy of computer-aided design (CAD) trial restorations fabricated with different digital workflows. MATERIAL AND METHODS A patient in need of additive esthetic treatment was examined, and intraoral and extraoral photographs and intraoral digital scans were made, followed by 3D digital smile design using the exocad software program. The reference virtual design was converted into trial restorations (N=40) by using different digital workflows: subtractive manufacturing, additive manufacturing, additive manufacturing of 3D designed index, and silicone index on an additively manufactured cast. Fabricated trial restorations of all groups were scanned with a desktop scanner, providing a standard tessellation language (STL) file serving as the test data for each trial restoration. All the STL files of the test and reference data were imported into a reverse engineering software program to evaluate the 3D trueness of each workflow. Also, analog and digital 2D linear measurements (maxillary left central incisor height, maxillary left central incisor width, and intercanine width) were made to assess any dimensional alterations between the fabricated trial restorations and the reference digital smile design. A 1-way analysis of variance (ANOVA) was used to analyze the data followed by the Tukey post hoc test (α=.05). RESULTS For 3D trueness measurements, root mean square (RMS) values representing the deviations between the fabricated trial restorations and the reference digital smile design varied significantly among the different groups (P<.001), with the highest mean deviation found in the group of additive manufacturing of 3D designed index (0.21 ±0.01 mm), while the lowest mean value of deviation was found in the group of subtractive manufacturing (0.11 ±0.02 mm). For both the digital and analog 2D linear measurements, post hoc pairwise comparisons showed the group of additive manufacturing of 3D designed index to have significantly higher values of deviation than the other groups in all assigned measurements (P<.001). CONCLUSIONS The accuracy of CAD trial restorations was affected by the fabrication technique, and implementing conventional steps in the digital workflows of trial restoration fabrication may result in discrepancies that affect accuracy when compared with the reference design.
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Affiliation(s)
- Doaa Taha
- Associate Professor, Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; Associate Professor, Department of Fixed Prosthodontics, School of Dentistry, Newgiza University, Giza, Egypt; and Visiting Researcher, Section Medical Materials Science & Technology, University Hospital Tübingen, Tübingen, Germany.
| | - Sara Allam
- Postgraduate student, Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt
| | - Tarek Morsi
- Professor, Department of Fixed Prosthodontics, Faculty of Dentistry, Ain Shams University, Cairo, Egypt; and Vice Dean of Postgraduate Affairs, Faculty of Oral and Dental Medicine, Misr International University, Cairo, Egypt
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Bessadet M, Auduc C, Drancourt N, Nicolas E, El Osta N. Comparative analyses of time efficiency and cost in fabricating fixed implant-supported prostheses in digital, hybrid, and conventional workflows: A systematic review and meta-analysis. J Prosthet Dent 2024:S0022-3913(24)00456-6. [PMID: 39069390 DOI: 10.1016/j.prosdent.2024.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/27/2024] [Accepted: 06/28/2024] [Indexed: 07/30/2024]
Abstract
STATEMENT OF PROBLEM Economic considerations affect whether new technologies are adopted in dental practice. Limited evidence exists regarding the time and cost efficiency of different workflows for fabricating implant-supported restorations. PURPOSE The purpose of this systematic review and meta-analysis was to compare the time and cost involved in fabricating fixed implant-supported prostheses using digital, hybrid, and conventional methods throughout the entire prosthetic treatment by analyzing both clinical and laboratory steps. MATERIAL AND METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-P 2015 guidelines. The methods and inclusion criteria were specified in a protocol registered with the International Prospective Register of Systematic Reviews (PROSPERO) (registration number CRD42023458734). The databases PubMed, Cochrane, and PROSPERO were searched using keywords: (Prosthodontic OR restorative dentistry OR denture) AND (CAD CAM OR Digital workflow OR Computer Dentistry OR Digital Design) AND (Economic OR cost OR Financial OR time efficiency). Two investigators selected articles independently. RESULTS A qualitative synthesis of 12 articles published from 2010 to 2023 showed that digital scans took less time than conventional impressions (P<.05) in 7 out of 9 articles. Additionally, 8 articles revealed significant reductions in laboratory working time with digital workflows, intermediate times with hybrid workflows, and longer times with conventional workflows (P<.001). Meta-analysis confirmed the time efficiency of digital scanning over conventional impressions (Hedges g=1.65, 95% CI [0.33, 2.98]) and a substantial reduction in laboratory time with digital workflows compared with other workflows (Hedges g=6.55, 95% CI [2.69; 10.42]). However, no significant difference was found in adjustment time between digital and other workflows (Hedges g=0.91, 95% CI [-0.72; 2.55]). Direct laboratory costs were observed to be higher in conventional workflows compared with hybrid or digital workflows, with hybrid workflows also showing elevated costs compared with digital workflows (P<.05). CONCLUSIONS The digital workflow demonstrates potential benefits in reducing scan time, laboratory processing time, and direct laboratory costs for implant-supported restorations in partial edentulism. Further research is needed to validate these findings, particularly for long-span implant-supported fixed partial prostheses.
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Affiliation(s)
- Marion Bessadet
- Vice Dean and Senior Lecturer, Department of Prosthodontics, UFR d'Odontologie, Clinical Odontology Research Center (CROC), University of Clermont Auvergne, Clermont-Ferrand, France; and Hospital Practitioner, CHU Clermont-Ferrand, Odontology Department, Clermont-Ferrand, France
| | - Chantal Auduc
- Hospital Practitioner, CHU Clermont-Ferrand, Odontology Department, Clermont-Ferrand, France
| | - Noémie Drancourt
- Lecturer, Department of Prosthodontics, UFR d'Odontologie, Clinical Odontology Research Center (CROC), University of Clermont Auvergne, Clermont-Ferrand, France; and Hospital Practitioner, CHU Clermont-Ferrand, Odontology Department, Clermont-Ferrand, France
| | - Emmanuel Nicolas
- Dean and Professor, Department of Prosthodontics, UFR d'Odontologie, Clinical Odontology Research Center, University of Clermont Auvergne, Clermont-Ferrand, France; and Hospital Practitioner, CHU Clermont-Ferrand, Odontology Department, Clermont-Ferrand, France
| | - Nada El Osta
- Professor, Department of Prosthodontics, UFR d'Odontologie, Clinical Odontology Research Center (CROC), University of Clermont Auvergne, Clermont-Ferrand, France.
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A completely digital workflow aided by cone beam computed tomography scanning to maintain jaw relationships for implant-supported fixed complete dentures: A clinical study. J Prosthet Dent 2023; 129:116-124. [PMID: 36549956 DOI: 10.1016/j.prosdent.2022.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/15/2022] [Accepted: 08/16/2022] [Indexed: 12/24/2022]
Abstract
STATEMENT OF PROBLEM The conventional workflow for the fabrication of implant-supported fixed complete dentures (IFCDs) is complex and makes it impossible to maintain jaw relationships. A fully digital workflow might solve this problem. PURPOSE The purpose of this clinical study was to develop a completely digital workflow aided by a cone beam computed tomography (CBCT) scan for the fabrication of IFCDs and to evaluate the accuracy of this workflow with regard to the maintenance of jaw relationships. MATERIAL AND METHODS All participants received a preoperative CBCT scan while wearing radiographic diagnosis dentures and occluding in the maximum intercuspal position. After the implant surgery, CBCT scanning, intraoral scanning, and stereophotogrammetry were performed to identify jaw anatomy, soft tissue, and the 3-dimensional (3D) locations of the implants, respectively. Then, all data were merged to transfer jaw relationships and generate digital casts to fabricate interim prostheses. A posttreatment CBCT scan was performed while the participants were wearing the interim prostheses and occluding in the maximum intercuspal position. The preoperative and postoperative jaw relationships were compared by CBCT cephalometric analysis. A meaningful and unacceptable difference was defined as 0.8 degrees and 2.4 degrees, respectively. RESULTS Six participants (6 jaw relationships, 9 arches, and 58 implants) were included. All interim prostheses were stable and achieved symmetric occlusion after only minimal adjustment. A total of 18 angles were measured. Three angles revealed a meaningful minimal difference, and 1 angle revealed an unacceptable minimal difference. No prosthodontic complications were reported during the study. CONCLUSIONS A completely digital workflow for fabricating IFCDs achieved sufficient accuracy for the maintenance of jaw relationships throughout the treatment.
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Caponi LQ, de Lima Flor E, Vidal-Ponsoda C, Figueras-Alvarez O, Roig M. Fabrication of a CAD-CAM combination matrix for trial restorations: A dental technique. J Prosthet Dent 2022:S0022-3913(22)00701-6. [PMID: 36543701 DOI: 10.1016/j.prosdent.2022.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 10/10/2022] [Accepted: 10/11/2022] [Indexed: 12/23/2022]
Abstract
The trial restoration increases outcome predictability in restorative treatments, enhances communication among specialists and patients, and guides tooth preparations. It should reproduce the planned design precisely because many decisions will be made based on the transferred design. Traditionally, a diagnostic waxing design is transferred to the mouth with a flexible silicone matrix. However, a rigid matrix would ensure an accurate transfer of the planned design by avoiding the deformation of the silicone index. A step-by-step technique for fabricating a computer-aided design and computer-aided manufactured (CAD-CAM) rigid matrix relined with polyvinyl siloxane material to fabricate a trial restoration is presented. The technique ensures accurate detail reproduction and dimensional stability, avoiding deformation and ensuring a predictable transfer of the planned design.
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Affiliation(s)
- Lucas Queiroz Caponi
- Associate Professor, Department of Restorative Dentistry, School of Dentistry, International University of Catalunya, Barcelona, Spain; Private practice, San Benedetto del Tronto, Italy
| | - Eduardo de Lima Flor
- Assistant Professor, Department of Restorative Dentistry, School of Dentistry, International University of Catalunya, Barcelona, Spain; Private practice, Guarda, Portugal
| | - Carla Vidal-Ponsoda
- Associate Professor, Department of Restorative Dentistry, School of Dentistry, International University of Catalunya, Barcelona, Spain
| | - Oscar Figueras-Alvarez
- Contracted Doctor Professor, Department of Restorative Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Miguel Roig
- Chairman and Professor, Department of Restorative Dentistry, School of Dentistry, International University of Catalunya, Barcelona, Spain
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Clinical Evaluation of Resin Composite CAD/CAM Restorations Placed by Undergraduate Students. J Clin Med 2021; 10:jcm10153269. [PMID: 34362055 PMCID: PMC8348683 DOI: 10.3390/jcm10153269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/17/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
To evaluate the clinical outcomes of resin composite CAD/CAM restorations in a prospective cohort study, and to assess patient and operator satisfaction after restoration placement, 59 indirect resin composite were placed by supervised undergraduate students, of which 43 restorations were followed over a mean period of 28 months (14–44 months) and evaluated using USPHS criteria. Patient and operator satisfaction levels were assessed using a visual analogue scale (VAS) after restoration placement. A total of 37 patients and 47 restorations were included for further study. Four teeth were extracted—three due to extensive drug-induced secondary caries in the same patient, and one tooth due to large periapical periodontitis after 44 months of service. The overall survival rate was 91.4%, and success rate was 87.2%. Differences between baseline and endpoint scores were significant for marginal discoloration (p < 0.05) and adaptation (p < 0.001). Color match (p < 0.05) and surface texture (p < 0.001) differed significantly, affecting all restoration types. VAS scores for patient and operator satisfaction showed a significant rank correlation (p < 0.01), and pairwise comparison showed significant differences for mean overall patient and operator VAS scores (p < 0.001). Lava Ultimate CAD/CAM may be considered a suitable material for overlays and endocrown restorations when combined with IDS, air abrasion, and MDP-containing adhesive systems. Marginal disintegration may present in inlays and onlays over time.
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Cattoni F, Teté G, Calloni AM, Manazza F, Gastaldi G, Capparè P. Milled versus moulded mock-ups based on the superimposition of 3D meshes from digital oral impressions: a comparative in vitro study in the aesthetic area. BMC Oral Health 2019; 19:230. [PMID: 31664999 PMCID: PMC6819647 DOI: 10.1186/s12903-019-0922-2] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 09/27/2019] [Indexed: 01/18/2023] Open
Abstract
Background Aesthetic porcelain veneers proved to be a long-term reliable prosthetic solution, ensuring minimal invasiveness. The use of veneers requires an adhesive cementation technique, so maintaining as much enamel as possible is to ensure lasting success. A diagnostic mock-up is a key tool that allows a preview of the outcome of the aesthetic restoration: it is obtainable both in an analog and digital way. With the recent developments in impression technology and the ever so fast growing use of CAD-CAM technologies it is useful to understand the pros and cons of either one of these techniques (analog and digital) in order to identify the easier and more convenient workflow in aesthetic dentistry. Methods After taking pictures and impressions of the dental arcs of a patient in need of aesthetic rehabilitation, 52 resin models were produced and a digital drawing of the smile was outlined. Both an analog and a digital wax-up were obtained from two of the 52 models: the latter was obtained using digital impressions and a dedicated software. The analog wax-up was then used to produce 25 matrices that have later been used to mould 25 resin mock-ups using a traditional moulding protocol (Control Group - CG). The digital wax-up was used to mill 25 PMMA mock-ups. Each mock-up, both milled and moulded (total 50), was then laid on the other 50 resin models as a digital impression of it was taken. The STL. files of the milled mock-ups were compared with the 3D CAD wax-up made using a specific software. The STL. files of the analog printed mock-ups were compared with the traditional wax-up design. A statistical analysis was carried out to evaluate the difference between the groups. Results The statistical analysis showed a significant difference (P > 0.01) between the mean value of the distance between the points of the overlapping STL. meshes in GC (0.0468 mm) and in TG (Test Group - TG) (0,0109 mm). Conclusions The study showed a difference in accuracy between traditional moulded and milled mock-ups compared to their original wax-up. The data analysis reports that the digital method allows for greater accuracy. Within the limitations of this study, a fully digital workflow is to considered more reliable when it come to creating an esthetic mockup: the digital procedure has been shown to be more accurate than the one made manually which is much more operator dependent and it brings an increase to the chance of error, and that could ultimately affect the final result.
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Affiliation(s)
- Francesca Cattoni
- Dental School, Vita-Salute San Raffaele University, Milan, Italy.,Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giulia Teté
- Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy.,Specialisation School in Oral Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Alessandro Mauro Calloni
- Dental School, Vita-Salute San Raffaele University, Milan, Italy.,Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy
| | - Fabio Manazza
- Dental School, Vita-Salute San Raffaele University, Milan, Italy.,Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giorgio Gastaldi
- Dental School, Vita-Salute San Raffaele University, Milan, Italy.,Unit of Oral Maxillofacial Surgery, San Rocco Clinical Institute, Ome, Brescia, Italy
| | - Paolo Capparè
- Dental School, Vita-Salute San Raffaele University, Milan, Italy. .,Department of Dentistry, IRCCS San Raffaele Hospital, Milan, Italy.
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López Gualdrón CI, Bravo Ibarra ER, Murillo Bohórquez AP, Garnica Bohórquez I. Present and future for technologies to develop patient-specific medical devices: a systematic review approach. MEDICAL DEVICES-EVIDENCE AND RESEARCH 2019; 12:253-273. [PMID: 31496840 PMCID: PMC6689557 DOI: 10.2147/mder.s215947] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 07/08/2019] [Indexed: 01/25/2023] Open
Abstract
The main purpose of this investigation was to systematically review the literature regarding case studies on patient-specific implants and devices, with the goal of analyzing the process of developing custom-made medical devices. A content analysis was performed to identify design processes and methodologies implemented to develop devices such as implants adapted to bone geometries. Reverse engineering, computer-aided design, simulation of assets, and rapid prototyping technologies were selected according to their interoperability in a process framework for developing new products. Finally, results from the case studies and process stages identified in the consulted research were analyzed. These results showed a relationship between the scope and complexity of the process and the stage of technology integration of the patient-specific device development. The analyzed case studies were characterized by technical, scientific, and multidisciplinary components to achieve research goals. Likewise, integration of technologies using patient-specific technologies is needed for product development that converges into designing devices, such as implants, biomodels, and cutting drilling guides.
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Affiliation(s)
| | - Edna-Rocío Bravo Ibarra
- Industrial and Business Studies School, Universidad Industrial de Santander, Bucaramanga, Colombia
| | | | - Israel Garnica Bohórquez
- Industrial and Business Studies School, Universidad Industrial de Santander, Bucaramanga, Colombia
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Joda T, Ferrari M, Gallucci GO, Wittneben JG, Brägger U. Digital technology in fixed implant prosthodontics. Periodontol 2000 2018; 73:178-192. [PMID: 28000274 DOI: 10.1111/prd.12164] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Digital protocols are increasingly influencing prosthodontic treatment concepts. Implant-supported single-unit and short-span reconstructions will benefit mostly from the present digital trends. In these protocols, monolithic implant crowns connected to prefabricated titanium abutments, which are created based on data obtained from an intraoral scan followed by virtual design and production, without the need of a physical master cast, have to be considered in lieu of conventional manufacturing techniques for posterior implant restorations. No space for storage is needed in the complete digital workflow, and if a remake is required a replica of the original reconstruction can be produced quickly and inexpensively using rapid prototyping. The technological process is split into subtractive methods, such as milling or laser ablation, and additive processing, such as three-dimensional printing and selective laser melting. The dimensions of the supra-implant soft-tissue architecture can be calculated in advance of implant placement, according to the morphologic copy, and consequently are individualized for each patient. All these technologies have to be considered before implementing new digital dental workflows in daily routine. The correct indication and application are prerequisite and crucial for the success of the overall therapy, and, finally, for a satisfied patient. This includes a teamwork approach and equally affects the clinician, the dental assistant and the technician as well. The digitization process has the potential to change the entire dental profession. The major benefits will be reduced production costs, improvement in time efficiency and fulfilment of patients' perceptions of a modernized treatment concept.
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Joda T, Zarone F, Ferrari M. The complete digital workflow in fixed prosthodontics: a systematic review. BMC Oral Health 2017; 17:124. [PMID: 28927393 PMCID: PMC5606018 DOI: 10.1186/s12903-017-0415-0] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 09/13/2017] [Indexed: 11/22/2022] Open
Abstract
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.
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Affiliation(s)
- Tim Joda
- Section for Digital Reconstructive Technology + Implant Dentistry [DiRecT + ID], Department of Reconstructive Dentistry, School of Dental Medicine, University of Bern, Freiburgstr. 7, 3010 Bern, Switzerland
- Department of Reconstructive Dentistry, University Center for Dental Medicine, Basel, Switzerland
| | - Fernando Zarone
- Department of Prosthodontics, School of Dental Medicine, University of Napoli, Naples, Italy
| | - Marco Ferrari
- Department of Prosthodontics & Dental Materials, School of Dental Medicine, University of Siena, Siena, Italy
- Department of Restorative Dentistry, School of Dental Medicine, University of Leeds, Leeds, UK
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Joda T, Ferrari M, Brägger U. Monolithic implant-supported lithium disilicate (LS2) crowns in a complete digital workflow: A prospective clinical trial with a 2-year follow-up. Clin Implant Dent Relat Res 2017; 19:505-511. [PMID: 28093860 DOI: 10.1111/cid.12472] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Revised: 11/13/2016] [Accepted: 12/19/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND The technical development of digital processing allows the production of anatomically full-contoured implant-supported restorations. PURPOSE The aim of this prospective clinical trial was to analyze the treatment concept of monolithic lithium disilicate (LS2) single-unit restorations in a complete digital workflow. MATERIAL AND METHODS Forty-four patients were restored with 50 screw-retained monolithic implant LS2 crowns bonded to pre-fabricated titanium abutments on soft tissue level implants (Institut Straumann AG, Basel, Switzerland) in premolar and molar sites. All implant restorations were digitally designed after intraoral optical scanning (IOS) and CAD/CAM-processing without physical model situations. Study participants were clinically and radiographically examined based on an annually performed follow-up. The "Functional Implant Prosthodontic Score" (FIPS) was applied for objective outcome assessment after 2 years of loading. Five variables were defined for FIPS evaluation, resulting in a maximum score of 10 per implant restoration. Descriptive statistics were calculated for mean scores standard deviations, medians, and Q25 -Q75 . RESULTS All patients could be successfully treated within two clinical appointments. No clinical modifications were necessary for the seating of the monolithic crowns, neither for interproximal nor occlusal sites. The implant LS2 restorations demonstrated survival rates of 100% without any technical or biological complications after 2 years. The mean total FIPS score was 7.7 ± 1.0, ranging from 6 to 10. CONCLUSIONS CAD/CAM-produced monolithic implant crowns out of LS2 in a complete digital workflow seem to be a feasible treatment concept for the rehabilitation of single-tooth gaps in posterior sites under mid-term observation.
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Affiliation(s)
- Tim Joda
- Section for Digital Reconstructive Technology + Implant Dentistry [DiRecT+ID], University of Bern
| | - Marco Ferrari
- Department of Fixed Prosthodontics and Dental Materials, University of Siena
| | - Urs Brägger
- School of Dental Medicine, University of Bern
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Sailer I, Benic GI, Fehmer V, Hämmerle CHF, Mühlemann S. Randomized controlled within-subject evaluation of digital and conventional workflows for the fabrication of lithium disilicate single crowns. Part II: CAD-CAM versus conventional laboratory procedures. J Prosthet Dent 2016; 118:43-48. [PMID: 28024819 DOI: 10.1016/j.prosdent.2016.09.031] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 09/20/2016] [Accepted: 09/20/2016] [Indexed: 11/29/2022]
Abstract
STATEMENT OF PROBLEM Clinical studies are needed to evaluate the entire digital and conventional workflows in prosthetic dentistry. PURPOSE The purpose of the second part of this clinical study was to compare the laboratory production time for tooth-supported single crowns made with 4 different digital workflows and 1 conventional workflow and to compare these crowns clinically. MATERIAL AND METHODS For each of 10 participants, a monolithic crown was fabricated in lithium disilicate-reinforced glass ceramic (IPS e.max CAD). The computer-aided design and computer-aided manufacturing (CAD-CAM) systems were Lava C.O.S. CAD software and centralized CAM (group L), Cares CAD software and centralized CAM (group iT), Cerec Connect CAD software and lab side CAM (group CiL), and Cerec Connect CAD software with centralized CAM (group CiD). The conventional fabrication (group K) included a wax pattern of the crown and heat pressing according to the lost-wax technique (IPS e.max Press). The time for the fabrication of the casts and the crowns was recorded. Subsequently, the crowns were clinically evaluated and the corresponding treatment times were recorded. The Paired Wilcoxon test with the Bonferroni correction was applied to detect differences among treatment groups (α=.05). RESULTS The total mean (±standard deviation) active working time for the dental technician was 88 ±6 minutes in group L, 74 ±12 minutes in group iT, 74 ±5 minutes in group CiL, 92 ±8 minutes in group CiD, and 148 ±11 minutes in group K. The dental technician spent significantly more working time for the conventional workflow than for the digital workflows (P<.001). No statistically significant differences were found between group L and group CiD or between group iT and group CiL. No statistical differences in time for the clinical evaluation were found among groups, indicating similar outcomes (P>.05). CONCLUSIONS Irrespective of the CAD-CAM system, the overall laboratory working time for a digital workflow was significantly shorter than for the conventional workflow, since the dental technician needed less active working time.
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Affiliation(s)
- Irena Sailer
- Professor, Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.
| | - Goran I Benic
- Senior Teaching and Research Assistant, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Vincent Fehmer
- Master Dental Technician, Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Christoph H F Hämmerle
- Professor, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Sven Mühlemann
- Senior Teaching and Research Assistant, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Joda T, Katsoulis J, Brägger U. Clinical Fitting and Adjustment Time for Implant-Supported Crowns Comparing Digital and Conventional Workflows. Clin Implant Dent Relat Res 2015; 18:946-954. [PMID: 26395013 DOI: 10.1111/cid.12377] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE The aim of this prospective cohort study was to investigate clinical and laboratory performance of implant-supported reconstructions comparing the digital to the conventional workflow. MATERIALS AND METHODS Twenty study participants were treated in a cross-over design for single-tooth replacement in posterior sites, each with a customized titanium abutment plus computer-assisted design and computer-assisted manufacturing (CAD/CAM)-zirconia-suprastructure (test: digital workflow; n = 20) and a standardized titanium abutment plus PFM-crown (control: conventional pathway; n = 20). Evaluation of the 40 reconstructions included: 1) feasibility of laboratory cross-mounting of each abutment-crown-connection, and 2) assessment of adaptation time for clinical adjustments of interproximal and occlusal surfaces. Statistical analyses were performed using the exact Wilcoxon rank sum tests. RESULTS Laboratory cross-mounting was feasible for three reconstruction pairings revealing a 15% vice versa transfer success rate. All implant crowns could be provided successfully within two clinical appointments, independently of the workflow used. The mean clinical adjustment time was significantly lower (p < .001) for test reconstructions from the digital workflow with 2.2 min (standard deviation [SD] ± 2.1) compared with the ones from the conventional pathway with 6.0 min (SD ± 3.9). CONCLUSIONS The digital workflow was almost threefold more efficient than the established conventional pathway for fixed implant-supported crowns. Clinical fitting could be predictably achieved with no or minor adjustments within the digital process of intraoral scanning plus CAD/CAM technology.
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Affiliation(s)
- Tim Joda
- Department of Reconstructive Dentistry, University of Bern, Bern, Switzerland.
| | - Joannis Katsoulis
- Department of Reconstructive Dentistry, University of Bern, Bern, Switzerland
| | - Urs Brägger
- Department of Reconstructive Dentistry, University of Bern, Bern, Switzerland
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Krishnan SP, Dawood A, Richards R, Henckel J, Hart AJ. A review of rapid prototyped surgical guides for patient-specific total knee replacement. ACTA ACUST UNITED AC 2013; 94:1457-61. [PMID: 23109622 DOI: 10.1302/0301-620x.94b11.29350] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Improvements in the surgical technique of total knee replacement (TKR) are continually being sought. There has recently been interest in three-dimensional (3D) pre-operative planning using magnetic resonance imaging (MRI) and CT. The 3D images are increasingly used for the production of patient-specific models, surgical guides and custom-made implants for TKR. The users of patient-specific instrumentation (PSI) claim that they allow the optimum balance of technology and conventional surgery by reducing the complexity of conventional alignment and sizing tools. In this way the advantages of accuracy and precision claimed by computer navigation techniques are achieved without the disadvantages of additional intra-operative inventory, new skills or surgical time. This review describes the terminology used in this area and debates the advantages and disadvantages of PSI.
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Affiliation(s)
- S P Krishnan
- Royal National Orthopaedic Hospital, Stanmore, UK.
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Dawood A, Brown J, Sauret-Jackson V, Purkayastha S. Optimization of cone beam CT exposure for pre-surgical evaluation of the implant site. Dentomaxillofac Radiol 2011; 41:70-4. [PMID: 22184628 DOI: 10.1259/dmfr/16421849] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aim of this study was to investigate the possibility of reducing patient X-ray dose in the course of implant site evaluation. METHODS Retrospective practice-based study using a Morita F170 Accuitomo cone beam CT (CBCT) scanner with variable exposure parameters and operating a small cylindrical field of view of 4 cm diameter and 4 cm height. 6 experienced dental surgeons scored the image quality of dental scans on a 5-point scale for adequacy in providing the required information in 2 categories: bone height from alveolar crest to the relevant anatomical structure and bone width. RESULTS Lower-dose protocols only marginally affected the preference of the reviewers of the resulting images. CONCLUSIONS There is potential to reduce patient dose very significantly in CBCT examinations for implant site evaluation.
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