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Zumstein K, Waller T, Hämmerle CHF, Jung RE, Benic G, Mühlemann S. Clinical performance of monolithic zirconia crowns on titanium-zirconium reduced-diameter implants in the molar area: Interim data at three years of a randomized controlled trial. Clin Oral Implants Res 2023; 34:1354-1362. [PMID: 37668109 DOI: 10.1111/clr.14179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 08/10/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
AIM The aim of the present study was (i) to evaluate the clinical performance of reduced-diameter implants placed in the molar area and (ii) to test whether monolithic zirconia implant-supported crowns lead to similar clinical outcomes compared to porcelain-fused-to-metal crowns. MATERIALS AND METHODS A total of 76 patients needing a single implant crown in the posterior region were recruited. All patients received a titanium-zirconium reduced-diameter implant (Straumann Roxolid, Tissue Level, Standard Plus, diameter 3.3 mm, regular neck) randomly allocated to receive either a (1) monolithic zirconia crown (test) or (2) porcelain-fused-to-metal crown (control). Implant survival, prosthetic outcomes, and patient-reported outcomes were assessed at crown delivery and after 3 years of follow-up. Marginal bone levels (MBL) as well as clinical parameters including probing depth (PD), bleeding on probing (BOP), and plaque levels (PCR) were also recorded. RESULTS A total of 59 patients were available at the 3-year follow-up; 32 patients with a monolithic zirconia crown (TEST) and 27 patients with a porcelain-fused-to-metal crown (CONTROL). 14 implants (11 implant fractures/3 aseptic losses) were lost leading to an estimated implant survival rate of 80% ± 5.1% (95% CI 70.8%-90.8%). Prosthetic complications were limited to the control group and involved minor chippings. CONCLUSIONS This type of reduced-diameter implant to support single implant molar crowns in the molar area cannot be recommended. Monolithic zirconia crowns appear to be a viable option in the posterior region showing similar prosthetic outcomes to porcelain-fused-to-metal crowns.
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Affiliation(s)
- K Zumstein
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - T Waller
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - C H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - R E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - G Benic
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - S Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Guo D, Mühlemann S, Pan S, Zhou Y, Jung RE. A double-blind randomized within-subject study to evaluate clinical applicability of four digital workflows for the fabrication of posterior single implant crown. Clin Oral Implants Res 2023; 34:1319-1329. [PMID: 37638493 DOI: 10.1111/clr.14171] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 08/03/2023] [Accepted: 08/13/2023] [Indexed: 08/29/2023]
Abstract
OBJECTIVE To compare efficiency and clinical efficacy of posterior single implant crowns (PSIC) fabricated using four digital workflows. MATERIALS AND METHODS Twenty-two patients with one missing first molar were included. Each patient received four screw-retained implant crowns fabricated through four different workflows including a fully digital workflow with immediate digital impression (Group i-IOS), a fully digital workflow with digital impression after implant osseointegration (Group d-IOS), a model-based hybrid workflow using immediate analogue impression (Group i-AI), and a model-based hybrid workflow with conventional analogue impression after implant osseointegration (Group d-AI). The crown delivery sequence was randomized and blinded. The efficiency for each workflow and clinical outcome of each crown were recorded. RESULTS The average clinical working time in fully digital workflows (i-IOS 46.90 min, d-IOS 45.66 min) was significantly lower than that in the hybrid workflows (i-AI 54.59 min, d-AI 55.96 min; p < .001). Significantly more laboratory time was spent in hybrid workflows (i-AI 839.60 min, d-AI 811.73 min) as compared to fully digital workflows (i-IOS 606.25 min, d-IOS 607.83 min, p < .01). No significant differences in the chairside time at delivery were found. More crowns in Group i-AI (15%) needed additional laboratory interventions than in the other groups (p = .029). CONCLUSION Digital impression and model-free fully digital workflow improved prosthetic efficiency in the fabrication of PSIC. With the limitation that the results were only applicable to the implant system used and the digital technologies applied, findings suggested that workflows integrating immediate impression with implant surgery procedure was clinically applicable for restoration of PSIC.
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Affiliation(s)
- Danni Guo
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Shaoxia Pan
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Yongsheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, China
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Wang J, Ge Y, Mühlemann S, Pan S, Jung RE. The accuracy of dynamic computer assisted implant surgery in fully edentulous jaws: A retrospective case series. Clin Oral Implants Res 2023; 34:1278-1288. [PMID: 37642206 DOI: 10.1111/clr.14168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 07/28/2023] [Accepted: 08/13/2023] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To evaluate the accuracy of implant placement using a dynamic navigation system in fully edentulous jaws and to analyze the influence of implant distribution on implant position accuracy. MATERIALS AND METHODS Edentulous patients who received implant placement using a dynamic navigation system were included. Four to six mini screws were placed in the edentulous jaw under local anesthesia as fiducial markers. Then patients received CBCT scans. Virtual implant positions were designed in the planning software based on CBCT data. Under local anesthesia, implants were inserted under the guidance of the dynamic navigation system. CBCTs were taken following implant placement. The deviation between the actual and planned implant positions was measured by comparing the pre- and postsurgery CBCT. RESULTS A total of 13 edentulous patients with 13 edentulous maxillae and 7 edentulous mandibles were included, and 108 implants were placed. The average linear deviations at the implant entry point and apex were 1.08 ± 0.52 mm and 1.15 ± 0.60 mm, respectively. The average angular deviation was 2.85 ± 1.20°. No significant difference was detected in linear and angular deviations between the maxillary and mandibular implants, neither between the anterior and posterior implants. CONCLUSIONS The dynamic navigation system provides high accuracy for implant placement in fully edentulous jaws, while the distribution of the implants showed little impact on implant position accuracy.
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Affiliation(s)
- Jiayi Wang
- Department of Orthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Yanjun Ge
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Shaoxia Pan
- Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology & Research Center of Engineering and Technology for Computerized Dentistry Ministry of Health & NMPA Key Laboratory for Dental Materials, Beijing, People's Republic of China
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Kheur M, Lakha T, Mühlemann S, Hämmerle CHF, Haider A, Qamri B, Kheur S. Evaluation of Oral Health-Related Quality of Life and Patient Satisfaction in Three-Implant-Retained Mandibular Overdentures: A Randomized Crossover Clinical Trial. INT J PROSTHODONT 2023; 36:554-562. [PMID: 36484663 DOI: 10.11607/ijp.7909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
PURPOSE To assess oral health-related quality of life (OHRQoL) and patient satisfaction with a three-implant-retained mandibular overdenture. MATERIALS AND METHODS In this randomized crossover clinical trial, 20 edentulous patients received a new set of conventional complete dentures (CDs; baseline). Subsequently, three implants were placed in the anterior mandible: two were placed in the canine regions bilaterally and one in the midline. After successful osseointegration, CDs were attached to the implants using resilient attachments. The overdenture was retained either by three implants (test group) or two implants (control group). The sequence of treatment was randomized such that each patient experienced both treatment options for 6 months each. OHRQoL was assessed at baseline and after 6 months of function for each treatment option using the Oral Health Impact Profile (OHIP-14) and visual analog scale (VAS) scores. Statistical analyses were performed using Friedman and Wilcoxon signed rank tests. RESULTS CD resulted in significantly higher OHIP-14 and VAS scores (25.25 + 6.42, 8.55 + 1.73) compared to both the control group (11.15 + 5.39, 4 + 2; P < .001) and the test group (6.25 + 4.02, 2.06 + 1.48; P < .001). Similarly, significantly higher mean OHIP-14 and VAS scores were noted for the control group compared to the test group (P < .001). CONCLUSIONS Overdentures retained by three implants resulted in better OHRQoL scores and higher patient satisfaction compared to overdentures retained by two implants and CDs. Int J Prosthodont 2023;36:554-56.
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Pala K, Bindl A, Mühlemann S, Özcan M, Hüsler J, Ioannidis A. The Capacity to Change the Lightness of Discolored Tooth Substrates by Means of Minimally Invasive Restorations: Perception by Dentists, Dental Technicians, and Laypersons. INT J PROSTHODONT 2023; 36:7–12. [PMID: 33751004 DOI: 10.11607/ijp.7287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To evaluate the minimal ceramic thickness needed to increase the lightness by one value by means of glass-ceramic restorations perceived by dental technicians, dentists, and laypersons. MATERIAL AND METHODS A total of 15 assessment pairs (reference and test samples) were formed using glass-ceramic blocks in four different colors. Each assessment pair was comprised of two underground blocks differing in one value of lightness. On top of the underground blocks, glass-ceramic platelets were cemented in five different thicknesses (0.1 to 0.5 mm) and in the same color as the reference. Dental technicians, dentists, and laypersons (n = 41/group) were asked to determine the presence of a color difference between the two samples under standardized lighting conditions. The threshold ceramic thickness was defined as the thickness at which ≥ 50% of the evaluators were not able to perceive a difference within an assessment pair. The thresholds were analyzed, and groups were compared by applying chi-square test (P < .05). RESULTS The majority of dentists and dental technicians (> 50%) detected a lightness difference between the test and reference samples up to a ceramic thickness of 0.5 mm. The majority of laypersons (≥ 50%) did not perceive a lightness difference with ceramic thickness of 0.5 mm. If separated by the different color changes, the threshold ceramic thickness started at 0.4 mm and varied within the groups of evaluators and by the lightness of the assessed color. CONCLUSION A considerable number of evaluators perceived a lightness difference when minimally invasive ceramic restorations of 0.5-mm thickness were applied. The threshold ceramic thickness, however, was reduced when the lightness of the substrate was lower.
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Hjerppe J, Jung RE, Hämmerle CH, Özcan M, Mühlemann S. Mechanical stability of fully personalized, abutment-free zirconia implant crowns on a novel implant-crown interface. J Dent 2022; 121:104121. [PMID: 35395344 DOI: 10.1016/j.jdent.2022.104121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/24/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To test the failure load and failure mode of a novel implant-crown interface specifically designed for the fabrication of fully personalized, abutment-free monolithic zirconia CAD-CAM crowns compared to conventional implant-abutment interfaces involving prefabricated or centrally manufactured abutments for zirconia CAD-CAM crowns. METHODS Implants (N=48) were divided into groups (n=12) according to different implant-abutment interface designs: (1) internal implant connection with personalized, abutment-free CAD-CAM crowns (Abut-Free-Zr), (2) internal conical connection with customized, centrally manufactured zirconia CAD-CAM abutments (Cen-Abut-Zr), (3) prefabricated titanium base abutments from manufacturer 1 (Ti-Base-1), (4) additional prefabricated titanium base abutments from manufacturer 2 (Ti-Base-2). All specimens were restored with a screw-retained monolithic zirconia CAD-CAM molar crown and subjected to thermomechanical aging (1.200.000 cycles, 49 N, 1.67 Hz, 30° angulation, thermocycling 5-50°C). Static load until failure was applied in a universal testing machine. Failure modes were analyzed descriptively under digital microscope. Mean failure load values were statistically analyzed at a significance level of p<0.05. RESULTS All specimens survived thermomechanical aging. The mean failure loads varied between 1332 N (Abut-Free-Zr) and 1601 N (Ti-Base-2), difference being significant between these groups (p<0.05). No differences between the other groups were seen. The predominant failure mode per group was crown fracture above implant connection (Abut-Free-Zr, 75%), abutment fracture below implant neck (Cen-Abut-Zr, 83%), crown fracture leaving an intact abutment (Ti-Base-1/Ti-Base-2 100%). CONCLUSIONS Implant-crown interface with fully personalized, abutment-free monolithic CAD-CAM zirconia crowns exhibited similar failure loads as conventional implant-abutment interfaces (except group Ti-Base-2) involving CAD-CAM crowns with prefabricated or centrally manufactured abutment. CLINICAL SIGNIFICANCE The new implant connection simplifies the digital workflow for all-ceramic implant reconstructions. The specific design of the implant-crown interface allows the fabrication of fully personalized, abutment-free zirconia implant crowns both in-house and in-laboratory without the need of a prefabricated abutment or central manufacturing.
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Affiliation(s)
- Jenni Hjerppe
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland.
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Christoph Hf Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Mutlu Özcan
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
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Mühlemann S, Hjerppe J, Hämmerle CHF, Thoma DS. Production time, effectiveness and costs of additive and subtractive computer-aided manufacturing (CAM) of implant prostheses: A systematic review. Clin Oral Implants Res 2021; 32 Suppl 21:289-302. [PMID: 34642980 PMCID: PMC9293467 DOI: 10.1111/clr.13801] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/16/2021] [Accepted: 06/10/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To systematically review the dental literature for clinical studies reporting on production time, effectiveness and/or costs of additive and subtractive computer-aided manufacturing (CAM) of implant prostheses. MATERIALS AND METHODS A systematic electronic search for clinical studies from 1990 until June 2020 was performed using the online databases Medline, Embase and Cochrane. Time required for the computer-aided design (CAD) process, the CAM process, and the delivery of the CAD-CAM prostheses were extracted. In addition, articles reporting on the effectiveness and the costs of both manufacturing technologies were included. RESULTS Nine clinical studies were included reporting on subtractive CAM (s-CAM; 8 studies) and additive CAM (a-CAM; 1 study). Eight studies reported on the s-CAM of prosthetic and auxiliary components for single implant crowns. One study applied a-CAM for the fabrication of an implant bar prototype. Time was provided for the CAD process of implant models (range 4.9-11.8 min), abutments (range 19.7-32.7 min) and crowns (range 11.1-37.6 min). The time for s-CAM of single implant crown components (abutment/crown) ranged between 8.2 and 25 min. Post-processing (e.g. sintering) was a time-consuming process (up to 530 min). At delivery, monolithic/veneered CAD-CAM implant crowns resulted in additional adjustments chairside (51%/93%) or labside (11%/19%). CONCLUSIONS No scientific evidence exists on production time, effectiveness and costs of digital workflows comparing s-CAM and a-CAM. For both technologies, post-processing may substantially contribute to the production time. Considering effectiveness, monolithic CAD-CAM implant crowns may be preferred compared to veneered CAD-CAM crowns.
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Affiliation(s)
- Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Jenni Hjerppe
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Sehovic E, Ioannidis A, Hämmerle CH, Özcan M, Mühlemann S. Effect of tooth brush abrasion on the color, gloss and surface roughness of internally and externally stained monolithic ceramic materials. J Prosthodont Res 2021; 66:303-311. [PMID: 34193746 DOI: 10.2186/jpr.jpr_d_20_00276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To measure the durability of the color, change in surface roughness and gloss of stained monolithic ceramic materials subjected to artificial tooth brush abrasion. MATERIALS AND METHODS Standardized specimens were manufactured from pressable lithium-disilicate glass ceramic (PC; IPS e.max Press), machinable lithium-disilicate glass ceramic (MC; IPS e.max CAD), and zirconia (ZR; Zenostar). Ceramic staining was applied before (internal; in) and after crystallization/sintering (external; ex). Of each ceramic material, specimens without staining were prepared (no staining; no). Porcelain-fused-to-metal specimens served as control (PFM). Each group consisted of 15 specimens. Tooth brushing was simulated with tooth brushing strokes of 21.6 k, 43.2 k, and 64.8 k. Color, gloss and roughness were measured at baseline and after cycle intervals. Kruskal-Wallis and paired Post-hoc Conover tests were applied to detect statistical differences between treatment groups. Differences before and after aging were calculated by Wilcoxon signed rank test (α=0.05). RESULTS In all groups, color difference (∆E) was statistically significant after aging: no-PC (P<.001, 95% CI[0.14,0.84]), no-MC (P=.003, 95% CI[0.23,1.12]), no-ZR (P=.003, 95% CI [0.33,0.62]), in-MC (P=.003, 95% CI[0.35,0.73]), in-ZR (P=.003, 95% CI[0.09,0.32]), ex-PC (P=.003, 95% CI[0.54,0.98]), ex-MC (P<.001, 95% CI[0.23,1.26]), ex-ZR (P=.003, 95% CI[0.27,0.55]), and PFM (P=.002, 95% CI[0.22,0.34]). Aging increased surface roughness and decreased the gloss within all subgroups showing statistical significance. CONCLUSIONS Color, gloss and roughness of stained monolithic ceramic materials changed significantly by means of tooth brush abrasion in vitro. Color changes were below the threshold value for the detection by the human eye (∆E 1.8).
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Affiliation(s)
- Edis Sehovic
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich
| | - Alexis Ioannidis
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich
| | | | - Mutlu Özcan
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich
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Jokstad A, Pjetursson BE, Mühlemann S, Wismeijer D, Wolfart S, Fehmer V, Frederik Güth J, Paterno Holtzman L, Hämmerle CHF, Makarov N, Meijer HJA, Milinkovic I, Sailer I, Spitznagel FA, Vandeweghe S, Van de Velde T, Zwahlen M, Giertmuehlen PC. Fabrication, workflow and delivery of reconstruction: Summary and consensus statements of group 4. The 6th EAO Consensus Conference 2021. Clin Oral Implants Res 2021; 32 Suppl 21:336-341. [PMID: 34145922 DOI: 10.1111/clr.13797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To report assessments of four systematic reviews (SRs) on (i) clinical outcomes of all-ceramic implant-supported crowns (iSCs), (ii) production time, effectiveness, and costs of computer-assisted manufacturing (CAM), (iii) computer-assisted implant planning and surgery (CAIPS) time and costs, and (iv) patient-reported outcome measures (PROMS). MATERIAL AND METHODS An author group consisting of experienced clinicians and content experts discussed and evaluated the SRs and formulated consensus on the main findings, statements, clinical recommendations, and need for future research. RESULTS All four SRs were conducted and reported according to PRISMA and detailed comprehensive search strategies in at least three bibliometric databases and hand searching. The search strategies were deemed reproducible. Variation was noted regarding language restrictions and inclusion of grey literature, but the search comprehensiveness appeared persuasive. The SRs included bias risk assessments of the primary studies, and their study methodology impacted the interpretations of the extracted data. CONCLUSIONS (i) There is limited evidence (49 NRCT) showing that veneered and monolithic all-ceramic iSCs have excellent outcomes observed up to 3 years. (ii) There is no evidence evaluating production time and effectiveness comparing subtractive and additive CAM of implant models, abutments and crowns. (iii) There is limited evidence (4 RCT) that CAIPS involves more time and costs when considering the entire workflow and for diagnostics, manufacturing, and insertion of the restoration. Time seems to be the decisive factor for higher costs. (iv) Patients´ comfort increase when optical compared to conventional impressions is used for fabricating iSCs and short-span FPDs (2 RCT, 5 NRCT).
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Affiliation(s)
- Asbjorn Jokstad
- Department of Clinical Dentistry, UiT, The Arctic University of Norway, Tromsø, Norway
| | - Bjarni E Pjetursson
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel Wismeijer
- Academic Center for Dentistry Amsterdam (ACTA), Amsterdam, the Netherlands
| | - Stefan Wolfart
- Department of Prosthodontics and Biomaterials, University Hospital RWTH Aachen, Aachen, Germany
| | - Vincent Fehmer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Jan Frederik Güth
- Department of Prosthodontics, Center for Dentistry and Oral Medicine, Goethe-University Frankfurt am Main, Frankfurt, Germany
| | | | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Nikolay Makarov
- Oral Surgery and Implant Prosthetic Unit, "Sapienza" University of Rome, Rome, Italy
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, Groningen, the Netherlands
| | - Iva Milinkovic
- Department of Periodontology and Oral Medicine, University of Belgrade, Belgrade, Serbia
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Frank A Spitznagel
- Department of Prosthodontics, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
| | | | | | - Marcel Zwahlen
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Petra C Giertmuehlen
- Department of Prosthodontics, Medical Faculty, University Hospital Düsseldorf, Düsseldorf, Germany
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Ioannidis A, Park JM, Hüsler J, Bomze D, Mühlemann S, Özcan M. An in vitro comparison of the marginal and internal adaptation of ultrathin occlusal veneers made of 3D-printed zirconia, milled zirconia, and heat-pressed lithium disilicate. J Prosthet Dent 2021; 128:709-715. [PMID: 33741143 DOI: 10.1016/j.prosdent.2020.09.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 09/11/2020] [Accepted: 09/11/2020] [Indexed: 10/21/2022]
Abstract
STATEMENT OF PROBLEM Whether additively produced zirconia could overcome problems with conventional computer-aided design and computer-aided manufacture (CAD-CAM) such as milling inaccuracies and provide accurate occlusal veneers is unclear. PURPOSE The purpose of this in vitro study was to compare the marginal and internal fit of 3D-printed zirconia occlusal veneers with CAD-CAM-fabricated zirconia or heat-pressed lithium disilicate ceramic (LS2) restorations on molars. MATERIAL AND METHODS The occlusal enamel in 60 extracted human molars was removed, with the preparation extending into dentin. Occlusal veneers at a thickness of 0.5 mm were designed and manufactured according to their group allocation: 3DP, 3D-printed zirconia; CAM, milled zirconia; and HPR, heat-pressed LS2. The prepared teeth and restorations were scanned and superimposed, and the marginal and internal adaptation were measured 2- and 3-dimensionally; the production accuracy (trueness) was also measured. The comparisons of the group medians were performed with nonparametric methods and a pairwise group comparison (α=.05). RESULTS Three-dimensionally printed zirconia revealed median outcomes of 95 μm (margin), 252 μm (cusp), 305 μm (fossa), and 184 μm (3D internal adaptation). CAM showed median values of 65 μm (margin), 128 μm (cusp), 203 μm (fossa), and 120 μm (3D internal adaptation). The respective values for the group HPR were 118 μm (margin), 251 μm (cusp), 409 μm (fossa), and 180 μm (3D internal adaptation). Significant differences (P<.001) between CAM and 3DP (cusp, fossa, 3D internal adaptation) and between CAM and HPR (all regions) were found, with the former group showing higher accuracies. The trueness showed median discrepancies of 26 μm (3DP), 13 μm (CAM), and 29 μm (HPR) with significant differences (P<.001) for the comparisons 3DP-CAM and CAM-HPR. CONCLUSIONS Three-dimensionally printed zirconia occlusal veneers produced by means of lithography-based ceramic manufacturing exhibit a marginal adaptation (95 μm) and a production accuracy (26 μm) similar to those of conventional methods.
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Affiliation(s)
- Alexis Ioannidis
- Senior Teaching and Research Assistant, Clinic of Reconstructive Dentistry, Center of Dental, University of Zurich, Zurich, Switzerland.
| | - Ji-Man Park
- Associate Professor, Department of Prosthodontics, Yonsei University, Seoul, Republic of Korea
| | - Jürg Hüsler
- Professor, Institute of Mathematical Statistics and Actuarial Science (IMSV), University of Bern, Bern, Switzerland
| | - Daniel Bomze
- Head of Business Unit Medical, Lithoz GmbH, Vienna, Austria
| | - Sven Mühlemann
- Senior Teaching and Research Assistant, Clinic of Reconstructive Dentistry, Center of Dental, University of Zurich, Zurich, Switzerland
| | - Mutlu Özcan
- Head, Division of Dental Biomaterials, Clinic of Reconstructive Dentistry, Center of Dental, University of Zurich, Zurich, Switzerland
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Mühlemann S, Stromeyer S, Ioannidis A, Attin T, Hämmerle CH, Özcan M. Change in Color and Gloss Parameters of Stained Monolithic Resin-Ceramic CAD/CAM Materials After Simulated Aging: An In Vitro Study. INT J PROSTHODONT 2021; 34:79-87. [PMID: 33570523 DOI: 10.11607/ijp.7019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To measure the effect of simulated aging on stained resin-ceramic CAD/CAM materials regarding the durability of color and gloss. MATERIALS AND METHODS Test specimens (n = 15 per material) were prepared out of CAD/CAM ingots from two resin nanoceramics (Lava Ultimate [LVU], Cerasmart [CER]) and a polymer-infiltrated ceramic (ENA, VITA Enamic) stained with the manufacturer's recommended staining kit using photopolymerization. Control specimens were made of feldspathic ceramic (VITA Mark II [VM2]) and stained by means of ceramic firing. Negative control specimens (n = 15) (no staining) were prepared for each group. Color and gloss measurements were performed before and after each aging cycle by means of mechanical abrasion with a toothbrush. Groups were compared using Kruskal-Wallis test and paired post hoc Conover test. Changes within a group were calculated using Wilcoxon signed-rank test (α = .05). RESULTS The color difference (ΔE) was statistically significant for all stained CAD/CAM materials after simulated aging: CER (P < .001, 95% CI: 2.96 to 3.69), LVU (P = .004, 95% CI: 1.09 to 1.46), ENA (P = .004, 95% CI: 0.20 to 0.42), and VM2 (P < .001, 95% CI: 0.29 to 1.08). Aging resulted in a statistically significant increase in gloss in the LVU group (P < 0.001, 95% CI: 13.78 to 17.29), whereas in the ENA (P < .001, 95% CI: 7.83 to 12.72), CER (P < .001, 95% CI: 2.69 to 8.44), and VM2 (P = .014, 95% CI: 0.22 to 1.87) groups, a significant decrease in gloss was noted. CONCLUSION Color and gloss of stained resin-ceramic CAD/CAM materials changed significantly after aging by means of toothbrush abrasion in vitro.
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12
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Guo D, Pan S, Mühlemann S, Zhou Y, E Jung R. The migration of neighboring and antagonist teeth three months after implant placement in healed single tooth-missing sites. Clin Oral Implants Res 2020; 32:233-241. [PMID: 33258186 DOI: 10.1111/clr.13694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/19/2020] [Accepted: 11/21/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES To quantify the neighboring and antagonist teeth migration of a single posterior tooth-missing site within 3 months using digital scanning and measuring techniques. MATERIALS AND METHODS Intraoral scans (IOS) were made in 40 patients presenting a single posterior tooth-missing gap and receiving implant therapy. IOS were obtained at the day of and three months after implant surgery rendering a digital baseline model (BM) and a digital follow-up model (FM). Digital models were superimposed using the implant scan body as reference. Antagonist models were processed by the best fit alignment. Dimensional change between anatomical landmarks on neighboring teeth and that of featuring points on antagonistic teeth were measured using a three-dimensional analysis software. The Mann-Whitney U test was applied to compare the tooth-moving distance between the mesial and distal neighboring teeth. The Kruskal-Wallis one-way ANOVA was used to test the difference in dimensional change in tooth-missing site among age subgroups. RESULTS The mean dimensional change in the tooth-missing site was -37.62 ± 106.36 μm (median: -28.33 μm, Q25 -72.65/Q75 38.97) mesial-distally and -67.91 ± 42.37 μm (median: -61.50 μm, Q25 -88.25/Q75 -36.75) occlusal-gingivally. Eighteen out of 40 mesial neighboring teeth and 24 out of 40 distal neighboring teeth showed migration towards the implants. When patients were grouped according to age, the mesial-distal reduction in the tooth-missing site was significantly larger in patients younger than 30 years compared with those older than 50 years (p < .05). CONCLUSIONS The dimensions of posterior tooth-missing sites decreased over an observation period of 3 months.
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Affiliation(s)
- Danni Guo
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
| | - Shaoxia Pan
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Yongsheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, China
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Lakha T, Kheur M, Mühlemann S, Kheur S, Le B. Ultrasound and CBCT analysis of blood flow and dimensions of the lingual vascular canal: A case control study. J Oral Biol Craniofac Res 2020; 11:40-46. [PMID: 33344160 DOI: 10.1016/j.jobcr.2020.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/24/2020] [Accepted: 11/06/2020] [Indexed: 11/16/2022] Open
Abstract
Objective To assess the correlation between the diameter of the mandibular lingual vascular canal (MLVC) as determined on CBCT examination to blood flow and arterial diameter as determined by ultrasound Doppler analysis (USG) in dentate and edentulous patients. Methods 20 subjects were equally distributed into two groups based on the status of their dentition. Group 1 included dentate subjects (DE) and Group 2 included edentulous subjects (ED).The subjects from both the groups underwent CBCT scan for the assesement of the diameter of the MLVC.Similarly, USG was done to assess the diameter of the sublingual artery anastomosis and blood flow in the anterior mandible. Data was analysed using Karl Pearson's Correlation coefficient test and Student's unpaired 't' test. Results Irrespective of the status of the dentition and age, a positive correlation was noted between the diameter of foramen on CBCT examination and the diameter of anastomosing artery as studied by the USG (r = 0.290).Similarly, a positive correlation was observed between the diameter of foramen on CBCT and the volume of blood entering the mandible (r = 0.447).A positive correlation (r = 0.138) was observed between the diameter of the anastomosing artery and the volume of blood entering the mandible. Conclusion The anterior mandible has a rich vascular supply independent of age and status of the dentition.The dimensions and location of MVLC could be assessed on a CBCT prior to implant placement so that the operating surgeon has an idea about the vascularity of the region. Further studies with higher sample size should be undertaken to confirm these findings.
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Affiliation(s)
- Tabrez Lakha
- Department of Prosthodontics and Implantology, M.A.Rangoonwala College of Dental Sciences and Research Center, Pune, India
| | - Mohit Kheur
- Department of Prosthodontics and Implantology, M.A.Rangoonwala College of Dental Sciences and Research Center, Pune, India
| | - Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Supriya Kheur
- Head of the Department, Department of Oral Pathology and Microbiology, D.Y.Patil Vidyapeeth, D.Y. Patil Dental College, Pune, India
| | - Bach Le
- Department of Oral and Maxillofacial Surgery, The Herman Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA
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Schätzle M, Mühlemann S, Hersberger-Zurfluh M, Bussmann T, Näf P, Patcas R. [Prosthetic implants used as orthodontic anchor-age - Introducing a complete digital workflow for clinical use]. Swiss Dent J 2020; 130:887-892. [PMID: 33161691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The aim of this case report was to introduce the clinical use of a prosthetic soft tissue level implant and a completely digitized workflow for the production of an individualized suprastructure fixated on prosthetic implants for orthodontic anchorage reinforcement. A prosthetic soft tissue level implant was placed in the palatal region for orthodontic anchorage reinforcement. Based on an intraoral optical scan taken after implant osseointegration, the orthodontic suprastructure was manufactured entirely by means of computeraided design and manufacturing (CAD/CAM). The individualized suprastructure was subsequently loaded in direct manner. The prosthetic implant was then removed in a noninvasive manner, similar to palatal implants.The analysis included clinical and laboratory fabrication steps. The placement of prosthetic implant in the palatal region proved to be a painless, easy and fast procedure, and provided absolute anchorage during the entire intended orthodontic treatment. Its noninvasive removal did not cause any adverse patient reactions. The digitally constructed suprastructure did not require any chairside adaptation at delivery and was successfully used for the intended orthodontic treatment.The reported case presents the successful placement, loading and removal of a prosthetic soft tissue level implant for orthodontic anchorage use in the palatal region. The described digital and modelfree workflow provides a feasible and streamlined treatment modality for the fabrication of individualized orthodontic suprastructures by means of CAD/CAM for the use as orthodontic anchorage reinforcement. This proof of principle should be substantiated with further largerscaled investigations.
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Affiliation(s)
- Marc Schätzle
- Klinik für Kieferorthopädie und Kinderzahnmedizin, Zentrum für Zahnmedizin, Universität Zürich
| | - Sven Mühlemann
- Klinik für Rekonstruktive Zahnmedizin, Zentrum für Zahnmedizin, Universität Zürich
| | | | | | | | - Raphael Patcas
- Klinik für Kieferorthopädie und Kinderzahnmedizin, Zentrum für Zahnmedizin, Universität Zürich
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15
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Zürcher A, Hämmerle C, Thoma D, Mühlemann S. Time efficiency and quality of outcomes in a centralized digital workflow for the fabrication of implant crowns. Clin Oral Implants Res 2020. [DOI: 10.1111/clr.37_13643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Anina Zürcher
- Clinic of Reconstructive Dentistry, Zurich, Switzerland
| | | | - Daniel Thoma
- Clinic of Reconstructive Dentistry, Zurich, Switzerland
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16
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Steinmeier S, Wiedemeier D, Hämmerle CHF, Mühlemann S. Accuracy of remote diagnoses using intraoral scans captured in approximate true color: a pilot and validation study in teledentistry. BMC Oral Health 2020; 20:266. [PMID: 32977794 PMCID: PMC7517740 DOI: 10.1186/s12903-020-01255-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intraoral scans (IOS) provide three-dimensional images with approximate true colors representing a possible tool in teledentistry for remote examination. The aim of the present cross-sectional validation study was, therefore, to evaluate the levels of agreement between remote diagnoses derived from IOS and diagnoses based on clinical examinations for assessing dental and periodontal conditions. METHODS The test sample comprised 10 patients representing different clinical conditions. Following the acquisition of IOS (Trios, 3Shape), a full-mouth dental and periodontal examination was done and periapical radiographs were taken. Ten dentists were asked to perform dental and periodontal scorings for each of the ten patients on a tablet computer presenting the IOS. Scores included diagnosis of gingivitis/periodontitis, and evaluated presence as well as amount of plaque and calculus, and presence of teeth exhibiting gingival recession, furcation involvement, erosion, tooth wear, stain, and non-carious cervical lesion, as well as presence of decayed, filled, and crowned teeth and implants. In a second round of assessments, the periapical radiographs were provided and the dentists were able to change the scores. The time for the remote assessment was recorded. The agreement between remote and clinical scorings (reference) was then analyzed descriptively. RESULTS The mean time for the tele assessment was 3.17 min and the additional consultation of the radiographs accounted for another 1.48 min. The sensitivity and specificity values were 0.61 and 0.39 for gingivitis and 0.67 and 0.33 for periodontitis, with no relevant changes when radiographs were provided for the diagnosis of periodontitis (0.72 and 0.28). The agreement for dichotomized dental and periodontal indices ranged between 78 and 95%. With the provision of radiographs, the remote examiners were able to detect existing filled teeth, crowned teeth, and implants, whereas the detection of decayed teeth (70%) was not improved. CONCLUSIONS The remote examination using IOS was effective in detecting dental findings, whereas periodontal conditions could not be assessed with the same accuracy. Still, remote assessment of IOS would allow a time-efficient screening and triage of patients. Improvement of the image quality of IOS may further allow to increase the accuracy of remote assessments in dentistry. According to the Swiss Regulation this investigation is not a clinical trial and therefore no registration in a WHO-registry is needed.
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Affiliation(s)
- Sabrina Steinmeier
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
| | - Daniel Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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17
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Zuiderveld EG, van Nimwegen WG, Meijer HJA, Jung RE, Mühlemann S, Vissink A, Raghoebar GM. Effect of connective tissue grafting on buccal bone changes based on cone beam computed tomography scans in the esthetic zone of single immediate implants: A 1-year randomized controlled trial. J Periodontol 2020; 92:553-561. [PMID: 32918332 PMCID: PMC8246894 DOI: 10.1002/jper.20-0217] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 08/01/2020] [Accepted: 08/04/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Connective tissue grafting has a beneficial effect on the peri-implant mucosa, but the effect of grafting the buccal mucosa on buccal bone thickness (BBT) has not been investigated, although BBT is proposed to be a key factor for the soft-tissue contour. The aim of this trial was to assess the outcome of a connective tissue graft (CTG) in the esthetic zone of single immediate implants on the change of BBT according to cone beam computed tomography (CBCT) scan analysis. METHODS In a 1-year randomized controlled trial, 60 patients received an immediately placed implant and provisionalization, either combined with CTG (test group) or without CTG (control group). CBCTs were taken preoperatively (Tpre ) and 1 year after definitive restoration (T2 ). Any change in BBT was assessed at different implant levels. Additionally, the change in mid-buccal mucosal level (MBML) and approximal marginal bone level were assessed. RESULTS Fifty-five patients were available for statistical analysis (test group, n = 28; control group, n = 27). At T2 , the average change in BBT was significantly larger in the test group (-0.84 ± 0.61 mm) than in the control group (-0.46 ± 0.54 mm, P = 0.02). A MBML gain of 0.07 ± 0.85 mm in the test and a MBML loss -0.52 ± 1.16 mm in the control group was observed at T2 . Average loss of marginal bone was 0.05 ± 0.33 mm and 0.01 ± 0.38 mm, respectively. CONCLUSIONS The application of CTG in the esthetic zone of immediately placed and provisionalized implants is accompanied with more loss of BBT, but at the same time better maintains the mid-buccal mucosal level.
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Affiliation(s)
- Elise G Zuiderveld
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Wouter G van Nimwegen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Implant Dentistry, Dental School, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zürich, Zürich, Switzerland
| | - Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zürich, Zürich, Switzerland
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Mühlemann S, Lakha T, Jung RE, Hämmerle CHF, Benic GI. Prosthetic outcomes and clinical performance of CAD‐CAM monolithic zirconia versus porcelain‐fused‐to‐metal implant crowns in the molar region: 1‐year results of a RCT. Clin Oral Implants Res 2020; 31:856-864. [DOI: 10.1111/clr.13631] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Sven Mühlemann
- Clinic of Reconstructive DentistryCenter of Dental MedicineUniversity of Zurich Zurich Switzerland
| | - Tabrez Lakha
- Clinic of Reconstructive DentistryCenter of Dental MedicineUniversity of Zurich Zurich Switzerland
- Department of Prosthetic DentistryM.A. Rangoonwala College of Dental Sciences & Research Centre Pune India
| | - Ronald E. Jung
- Clinic of Reconstructive DentistryCenter of Dental MedicineUniversity of Zurich Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Reconstructive DentistryCenter of Dental MedicineUniversity of Zurich Zurich Switzerland
| | - Goran I. Benic
- Clinic of Reconstructive DentistryCenter of Dental MedicineUniversity of Zurich Zurich Switzerland
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Fickl S, Francisco H, Gurzawska-Comis K, Milinkovic I, Mühlemann S, Sanz Sánchez I, Torsello F, Van de Valde T. The Why, What, How and What if-The method to present your research and clinical cases. Clin Oral Implants Res 2020; 31:777-783. [PMID: 32596850 DOI: 10.1111/clr.13625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND During the fourth Summer Camp (SC) held by the European Association of Osseointegration (EAO), 20 junior representatives from various European and non-European universities and associations were selected to partake in oral presentation and communication skill development. AIMS The aim of the EAO Summer Camp (EAO SC) was to identify new methods of enhancing participants' abilities to engage, influence and lead in a professional environment, on both a clinical and scientific level. MATERIALS AND METHODS Four different groups were assigned to discuss one of two topics: (1) an Implant Register and (2) Digital Dentistry. The method that was used during the EAO SC, for training presentation skills, was the 4MAT learning model. The 4MAT learning model is a framework for creating an engaged, dynamic and more involved style of training by accurately visualizing the learning process that each learner goes through. RESULTS AND CONCLUSIONS All four groups, including each participant, presented outcomes in the format of 4MAT learning model answering four key questions, the Why, the What, the How and the What if. After the event, each group prepared a written summary of the thought processes. The outcome of the summer camp, for the chosen participants, was gaining skills to engage and influence in a professional environment, both clinically and scientifically. It was also expected from participants to share gained knowledge in their own respective environments after the EAO Summer Camp had ended. In conclusion, most of participants gained a valuable insight into presentation skills and also demonstrated their enthusiasm by presenting their experience at universities, institutes and clinics.
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Affiliation(s)
- Stefan Fickl
- Division of Periodontology, University of Wuerzburg, Würzburg, Germany
| | - Helena Francisco
- Oral Surgery and Implant Dentistry Department, Faculty of Dental Medicine, University of Lisbon, Lisbon, Portugal
| | - Katarzyna Gurzawska-Comis
- Department of Oral Surgery, The School of Dentistry, University of Birmingham, Birmingham, UK, Birmingham, UK
| | - Iva Milinkovic
- Department of Periodontology and Oral Medicine, School of Dental Medicine, Belgrade, Serbia
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ignacio Sanz Sánchez
- Etiology and Therapy of Periodontal and Peri-implant Diseases (ETEP) Research Group, Faculty of Dentistry, University Complutense of Madrid, Madrid, Spain
| | - Ferruccio Torsello
- Department of Periodontics and Prosthodontics, George Eastman Dental Hospital, Rome, Italy
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Mühlemann S, Sandrini G, Ioannidis A, Jung RE, Hämmerle CHF. The use of digital technologies in dental practices in Switzerland: a cross-sectional survey. Swiss Dent J 2019; 129:700-707. [PMID: 31169009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The aim of this cross-sectional survey was to identify the extent of digital technology infiltrating dental practices for the management and the treatment of patients. A survey (68 questions) was mailed to all members of the Swiss Dental Association (SSO). An online as well as postal answer was offered in order to maximise the response rate. The survey was mailed in June 2016 and answers were collected till the end of 2016. The total number of completed surveys was 1,238, which resulted in a response rate of 40%. Most dentists (97%) owned a private computer device and 74% used it for both, private and professional life. 69% of the dental offices had a homepage (69%), whereas a limited number (10%) used social media. The location of the practice influenced the extent of online presence. For patient administration a software application was used in 95% of the practices. The management of appointments was mainly organized by a digital agenda (73%). Patient’s dental history was recorded digitally in half of the practices (53%), whereas in one third (38%) also dental/ endodontic/periodontal charts were recorded digitally. One quarter of the dentists (24%) used an additional dental software for patient treatment/ planning other than the administration software. In 23% of the dental practices a chairside CAD/CAM system was available. The survey demonstrated that i) the younger the dentist, ii) the more recent the opening of the practice, iii) the greater the patient catchment area, and iv) the more treatment rooms, the higher the grade of digitalisation of the dental practice.
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Affiliation(s)
- Sven Mühlemann
- Center of Dental Medicine, Clinic of Reconstructive Dentistry, University of Zurich, Switzerland
- Equally contributed
| | - Gloria Sandrini
- Center of Dental Medicine, Clinic of Reconstructive Dentistry, University of Zurich, Switzerland
- Equally contributed
| | - Alexis Ioannidis
- Center of Dental Medicine, Clinic of Reconstructive Dentistry, University of Zurich, Switzerland
| | - Ronald E. Jung
- Center of Dental Medicine, Clinic of Reconstructive Dentistry, University of Zurich, Switzerland
| | - Christoph H. F. Hämmerle
- Center of Dental Medicine, Clinic of Reconstructive Dentistry, University of Zurich, Switzerland
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Mühlemann S, Benic G, Hämmerle C, Tabrez L, Jung R. Fabrication outcomes and clinical performance of CAD‐CAM monolithic translucent zirconia implant crowns in the molar region‐ a randomized controlled clinical study. Clin Oral Implants Res 2019. [DOI: 10.1111/clr.43_13508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Sven Mühlemann
- Clinic for Fixed and Removable Prosthodontics and Material Science, Switzerland
| | - Goran Benic
- Clinic for Fixed and Removable Prosthodontics and Material Science, Switzerland
| | - Christoph Hämmerle
- Clinic for Fixed and Removable Prosthodontics and Material Science, Switzerland
| | - Lakha Tabrez
- Clinic for Fixed and Removable Prosthodontics and Material Science, Switzerland
| | - Ronald Jung
- Clinic for Fixed and Removable Prosthodontics and Material Science, Switzerland
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Fischer KR, Testori T, Wachtel H, Mühlemann S, Happe A, Del Fabbro M. Soft tissue augmentation applying a collagenated porcine dermal matrix during second stage surgery: A prospective multicenter case series. Clin Implant Dent Relat Res 2019; 21:923-930. [PMID: 31309705 DOI: 10.1111/cid.12817] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/14/2019] [Accepted: 06/16/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The achievement and preservation of an adequate amount of soft tissue around implants is a critical factor for the prognosis of the treatment. PURPOSE To evaluate the effectiveness of a porcine dermal matrix applied during second stage implant surgery for horizontal soft tissue augmentation and preservation of dimensional stability. MATERIALS AND METHODS Twenty patients (mean age 50.2 ± 11.9 [SD] years) candidate to implant therapy and requiring soft tissue augmentation were recruited in four centers. Augmentation was performed in 24 cases. A porcine dermal matrix was placed into a buccal split-thickness pouch during uncovering surgery. Silicone impressions were taken before surgery (T0), 2 weeks later at suture removal (T2), 6 months (T3), and 24 months (T4) post augmentation. Dimensional changes of soft tissue were evaluated using superimposition of digitalized study casts. RESULTS Nineteen patients (23 implants) could be evaluated at 6 months and 13 patients (17 implants) at 24 months. After 6-month follow-up, there was a significant dimensional gain respect to baseline, averaging 0.83 ± 0.64 mm (P < .01). This did not change significantly at 24 months (0.77 ± 0.65 mm, P = .19). The gain was >0.5 mm in 65.2% and 64.7% of the cases, respectively. Soft tissue shrinkage averaged 34.2% ± 77.0% from T2 to T3 (P < .01) and did not change thereafter (P = .39). Shrinkage was more consistent in the posterior mandible than in the maxilla, but not significantly (P = .23 at 6-month and .36 at 24-month). No adverse events occurred. CONCLUSION Within the limitations of this prospective case series, the use of a porcine dermal matrix may provide consistent soft tissue augmentation that maintains up to 24-month follow-up, although graft shrinkage may occur in the first 6 months, depending on the location of surgery.
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Affiliation(s)
- Kai R Fischer
- Department for Periodontology, Faculty of Health, Witten/Herdecke University, Witten, Germany.,Division for Periodontology & Peri-Implant Disease, University of Zurich, Zürich, Switzerland
| | - Tiziano Testori
- Department of Periodontics and Oral Medicine, University of Michigan, School of Dentistry, Ann Arbor, Michigan.,IRCCS Orthopedic Institute Galeazzi, Milan, Italy.,Private Practice, Como, Italy
| | - Hannes Wachtel
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Medicine Charité, University of Berlin, Berlin, Germany.,Private Practice, München, Germany
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, University of Zurich, Switzerland
| | - Arndt Happe
- Department of Oral and Maxillofacial Plastic Surgery and Implantology, University of Cologne, Köln, Germany.,Private Practice, Münster, Germany
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical and Dental Sciences, Università degli Studi di Milano, Milan, Italy.,Dental Clinic, IRCCS Orthopedic Institute Galeazzi, Milan, Italy
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Pan S, Guo D, Zhou Y, Jung RE, Hämmerle CHF, Mühlemann S. Time efficiency and quality of outcomes in a model‐free digital workflow using digital impression immediately after implant placement: A double‐blind self‐controlled clinical trial. Clin Oral Implants Res 2019; 30:617-626. [DOI: 10.1111/clr.13447] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/09/2019] [Accepted: 04/09/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Shaoxia Pan
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital StomatologyBeijing P.R. China
| | - Danni Guo
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital StomatologyBeijing P.R. China
| | - Yongsheng Zhou
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, National Clinical Research Center for Oral Diseases, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital StomatologyBeijing P.R. China
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine University of Zurich Zurich Switzerland
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Sailer I, Mühlemann S, Kohal RJ, Spies BC, Pjetursson BE, Lang NP, Gotfredsen KL, Ellingsen JE, Francisco H, Özcan M, Hassan B, Pardo GE, Bardaji JA, Kraus RD, Wennerberg A. Reconstructive aspects: Summary and consensus statements of group 3. The 5 th EAO Consensus Conference 2018. Clin Oral Implants Res 2019; 29 Suppl 18:237-242. [PMID: 30306691 DOI: 10.1111/clr.13302] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/23/2018] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The tasks of this working group were to evaluate the existing evidence on the efficiency and efficacy of the digital and conventional workflows for the fabrication of fixed implant reconstructions, to assess the performance of all-ceramic fixed implant reconstructions and, finally, to evaluate the outcomes of internally and externally connected implant abutments and reconstructions. METHODS Four reviews were available analyzing the current literature on the respective topics. One review dealt with the efficiency and efficacy of digital and conventional fabrication workflows. Two reviews analyzed the outcomes of all-ceramic fixed implant reconstructions, one focusing on single-implant reconstructions and the other evaluating multiple-unit implant fixed dental prostheses (FDPs). The fourth review evaluated the clinical outcome on external, respectively, internal implant-abutment connections. These reviews were the basis for the discussions within the group and at the plenary sessions. RESULTS The present consensus report gives the consensus statements, the clinical recommendations, and the implications for future research as discussed and approved by the plenum of the consensus conference. The four manuscripts by Mühlemann et al., Rabel et al., Pieralli et al., and Pjetursson et al. are published as part of the journal supplement of the present EAO consensus conference.
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Affiliation(s)
- Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Material Science, University of Zurich, Zurich, Switzerland
| | - Ralf J Kohal
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Benedikt C Spies
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, CC 3 Dental and Craniofacial Sciences, Charité University of Berlin, Berlin, Germany
| | - Bjarni E Pjetursson
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland
| | - Niklaus P Lang
- Clinic of Fixed and Removable Prosthodontics and Material Science, University of Zurich, Zurich, Switzerland
| | - Klaus L Gotfredsen
- Department of Oral Rehabilitation, University of Copenhagen, Copenhagen, Denmark
| | - Jan E Ellingsen
- Department of Prosthetic Dentistry, Institute of Clinical Dentistry, Faculty of Dentistry, University of Oslo, Oslo, Norway
| | | | - Mutlu Özcan
- Clinic of Fixed and Removable Prosthodontics and Material Science, University of Zurich, Zurich, Switzerland
| | - Bassam Hassan
- Department of Dentistry, Acibadem International Medical Centre, Amsterdam, The Netherlands
| | - Guillem E Pardo
- Private Practice, Alicante, Spain.,Universidad Miguel Hernández, Alicante, Spain
| | - Javier A Bardaji
- Private Practice, Valencia, Spain.,Universidad Católica de Valencia, Valencia, Spain
| | - Riccardo D Kraus
- Clinic of Fixed and Removable Prosthodontics and Material Science, University of Zurich, Zurich, Switzerland
| | - Ann Wennerberg
- Department of Prosthodontics, Institute of Odontology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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Mühlemann S, Kraus RD, Hämmerle CHF, Thoma DS. Is the use of digital technologies for the fabrication of implant-supported reconstructions more efficient and/or more effective than conventional techniques: A systematic review. Clin Oral Implants Res 2019; 29 Suppl 18:184-195. [PMID: 30306680 DOI: 10.1111/clr.13300] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To identify clinical studies evaluating efficiency and/or effectiveness of digital technologies as compared to conventional manufacturing procedures for the fabrication of implant-supported reconstructions. MATERIALS AND METHODS A systematic search from 1990 through July 2017 was performed using the online databases Medline, Embase, and Cochrane-Central-Register-of-Controlled-Trials. Literature on efficiency and/or effectiveness during the impression session, the manufacturing process, and the delivery session were included. RESULTS In total, 12 clinical studies were included. No meta-analysis was performed due to a large heterogeneity of the study protocols. Nine publications reported on posterior single implant crowns (SIC) and three on full-arch reconstructions. Mean impression time with intraoral scanners ranged between 6.7 and 19.8 min, whereas the range for conventional impressions was 8.8 and 18.4 min. In a fully digital workflow (FD-WF) for posterior SIC, mean fabrication time ranged between 46.8 and 54.5 min (prefabricated abutment) and 68.0 min (customized abutment). In a hybrid workflow (H-WF) including a digitally customized abutment and a manual veneering, mean fabrication time ranged between 132.5 and 158.1 min. For a conventional porcelain-fused-to-metal-crown, a mean time of 189.8 min was reported. The mean time for the delivery of posterior SIC ranged between 7.3 and 7.4 min (FD-WF), 10.5 and 12.5 min (H-WF), and 15.3 min (conventional workflow, C-WF). The FD-WF for posterior SIC was more effective than the H-/C-WF. CONCLUSIONS The implementation of the studied digital technologies increased time efficiency for the laboratory fabrication of implant-supported reconstructions. For posterior SIC, the model-free fabrication, the use of prefabricated abutments, and the monolithic design was most time efficient and most effective.
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Affiliation(s)
- Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Riccardo D Kraus
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Fischer KR, Mühlemann S, Jung RE, Friedmann A, Fickl S. Dimensional Evaluation of Different Ridge Preservation Techniques with a Bovine Xenograft: A Randomized Controlled Clinical Trial. INT J PERIODONT REST 2019; 38:549-556. [PMID: 29889920 DOI: 10.11607/prd.3636] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The objectives of this study were to determine the quantitative changes after different ridge preservation techniques (primary aim) and to assess the possibility of placing a dental implant, the bone quality, and the need for bone augmentation (secondary aim). A total of 35 patients who required extraction of at least one tooth (incisor, canine, or premolar) provided 35 single-gap extraction sites. After minimally invasive tooth removal, the sockets were randomly scheduled for one of four treatment modalities: placement of a deproteinized bovine bone mineral (DBBM; Endobon, Biomet 3i) covered with a soft tissue punch from the palate (T1); placement of DBBM alone (T2); placement of DBBM covered with a resorbable collagen membrane (OsseoGuard, Biomet 3i) (T3); or no additional treatment (T4). Silicone impressions were taken before and 6 months after extraction for quantitative-volumetric evaluation (primary outcome). The possibility of placing an implant, bone quality, and need for further bone augmentation were also noted (secondary outcomes). During the study period, no adverse events were observed. No statistically significant difference was found between the four treatments regarding the primary and secondary outcome parameters (P > .05). However, T4 showed double the buccal contour change, with the highest variance compared to the other three groups (T1 -0.874 ± 0.713; T2 -0.968 ± 0.344; T3 -1.26 ± 0.942; T4 -2.15 ± 1.349). Although no statistically significant difference was found between the four treatment modalities, placement of DBBM resulted in only half the contour change (< 1 mm) compared to control sites (> 2 mm). Ridge preservation with a DBBM with or without soft tissue punch should be considered in esthetically demanding cases and delayed or late implant placement.
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Wachtel A, Zimmermann T, Sütel M, Adali U, Abou-Emara M, Müller WD, Mühlemann S, Schwitalla AD. Bacterial leakage and bending moments of screw-retained, composite-veneered PEEK implant crowns. J Mech Behav Biomed Mater 2018; 91:32-37. [PMID: 30529984 DOI: 10.1016/j.jmbbm.2018.11.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
Due to its elastic modulus close to bone, the high-performance material PEEK (polyetheretherketone) represents an interesting material for implant-supported dental prostheses. Besides a damping effect of masticatory forces, it might have a sealing effect against bacterial leakage of the implant-abutment interface (IAI). So far, PEEK has only been used for provisional implant crowns. Therefore, the aim of the study was the evaluation of the bacterial tightness of screw-retained PEEK crowns on titanium implants with conical IAI during masticatory simulation and subsequent bending moment testing. Ten screw-retained implant crowns in the shape of an upper central incisor consisting of a PEEK crown framework veneered with composite were connected to NobelActive RP titanium implants (4.3 × 11.5 mm, Nobel Biocare AB, Göteborg, Sweden) with a tightening torque of 15 Ncm. Prior to tightening, the interior of the implant was inoculated with a bacterial suspension of Enterococcus faecium. The specimens were overmolded with indicating agar (Kanamycin-Aesculin-Azid-Agar (KAAA), Oxoid Limited, Basingstoke United Kingdom), that turns black in contact with E. faecium. The specimens were subjected to a cyclic masticatory simulation whereby a force of 50 N cm was applied at an angle of 30° to the implant axis for 1.2 million cycles. Afterwards, the specimens were subjected to a static loading test according to ISO 14801:2007 to determine the bending moment. During masticatory simulation neither a loosening of the implant screws nor any damage to the veneer or the PEEK framework occurred. Furthermore, no bacterial leakage could be observed in any of the specimens. The average maximum bending moment was measured at 352.13 ± 48.96 N cm. Regarding masticatory forces, PEEK implant crowns seem to be applicable as definitive implant-supported restorations. Furthermore, the bacterial tightness of the IAI of screw-retained one-piece PEEK implant crowns is advantageous compared to superstructures of conventional materials. Further studies are necessary to substantiate the clinical significance of these findings.
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Affiliation(s)
- Andreas Wachtel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Tycho Zimmermann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Mona Sütel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Ufuk Adali
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Mohamad Abou-Emara
- Beuth University of Applied Sciences, Luxemburger Str. 10, 13353 Berlin, Germany
| | - Wolf-Dieter Müller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Sven Mühlemann
- University of Zurich, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Plattenstrasse 11, 8032 Zürich, Switzerland
| | - Andreas Dominik Schwitalla
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
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Thoma DS, Sailer I, Mühlemann S, Gil A, Jung RE, Hämmerle CHF. Randomized controlled clinical study of veneered zirconia abutments for single implant crowns: Clinical, histological, and microbiological outcomes. Clin Implant Dent Relat Res 2018; 20:988-996. [DOI: 10.1111/cid.12674] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 07/19/2018] [Accepted: 08/21/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zürich Switzerland
| | - Irena Sailer
- Division Prothèse Fixe et Biomateriaux; Clinique Universitaire de Medecine Dentaire, Université de Genève; Geneva Switzerland
| | - Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zürich Switzerland
| | - Alfonso Gil
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zürich Switzerland
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zürich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zürich Switzerland
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Gil A, Mühlemann S, Brandenberg F, Sailer I, Jung R, Hämmerle C, Thoma DS. Randomized controlled clinical study of veneered zirconia abutments for single implant crowns- clinical, histological and microbiological outcomes. Clin Oral Implants Res 2018. [DOI: 10.1111/clr.36_13356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ioannidis A, Mühlemann S, Özcan M, Hüsler J, Hämmerle CHF, Benic GI. Ultra-thin occlusal veneers bonded to enamel and made of ceramic or hybrid materials exhibit load-bearing capacities not different from conventional restorations. J Mech Behav Biomed Mater 2018; 90:433-440. [PMID: 30447557 DOI: 10.1016/j.jmbbm.2018.09.041] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2018] [Revised: 09/25/2018] [Accepted: 09/25/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The objective of this study was to test whether or not the load-bearing capacity of occlusal veneers bonded to enamel and made of ceramic or hybrid materials does differ from those of porcelain-fused-to-metal or lithium disilicate glass ceramic crowns. MATERIAL AND METHODS In 80 human molars occlusal enamel was removed without extending into the dentin in order to mimic substance defects caused by attrition. The restorations were digitally designed at a standardized thickness of either 0.5 mm or 1.0 mm. For each thickness, 4 test groups were formed each including a different restorative material: "0.5-ZIR": 0.5 mm thick zirconia (Vita YZ HT); "1.0-ZIR": 1.0 mm thick zirconia (Vita YZ HT); "0.5-LDC": 0.5 mm thick lithium disilicate ceramic (IPS e.max Press); "1.0-LDC": 1.0 mm thick lithium disilicate ceramic (IPS e.max Press); "0.5-HYC": 0.5 mm thick PICN (Vita Enamic); "1.0-HYC": 1.0 mm thick PICN (Vita Enamic); "0.5-COC": 0.5 mm thick tooth shaded resin composite (Lava Ultimate) and "1.0-COC": 1.0 mm thick tooth shaded resin composite (Lava ultimate). Each group consists of 10 specimens. Two additional groups of 10 specimens each were used as controls and exhibited conventional crown preparations. In one group the crowns were made of lithium-disilicate ceramic ("CLD": IPS e.max CAD) and the other group consisted of porcelain-fused to metal crowns ("PFM"). All restorations were cemented onto the prepared teeth following the manufacturer's instruction of the corresponding luting cement. Subsequently, they were thermo-mechanically aged and then loaded until fracture. Load-bearing capacities (Fmax) between the groups were compared applying the Kruskal-Wallis test (p < 0.05) and pairwise group comparisons using the Dunn's method. RESULTS Median values (and quartiles) for the load-bearing capacity amounted to (Fmax) 2'407 (1'670; 2'490) N for the CLD group and to 2'033 (1'869; 2'445) N for the PFM group. For the 0.5 mm thick restorations Fmax reached the highest median value in group 0.5-HYC 2'390 (1'355; 2'490) N, followed by 0.5-COC 2'200 (1'217; 2'492) N and 0.5-LDC 1'692 (1'324; 2'355) N. No results were obtained for group 0.5-ZIR due to the impracticability to fabricate ultra-thin specimens. The distribution of the values for the 1.0 mm thick restorations was 2'489 (2'426; 2'491) N for 1.0-COC, 2'299 (2'156; 2'490) N for 1.0-ZIR, 2'124 (1'245; 2'491) N for 1.0-HYC, and 1'537 (1'245; 1'783) N for 1.0-LDC. The differences of the medians between the test and the control groups did not reach statistical significance for the 0.5 mm thick specimens (KW: p = 0.6952 and p = 0.6986). Within the groups exhibiting 1.0 mm thickness, however, significant different medians were found: 1.0-LDC < 1.0-ZIR and 1.0-LDC < 1.0-COC (KW: p < 0.0209). CONCLUSIONS Regarding their maximum load-bearing capacity, minimally invasive occlusal veneers made of ceramic and hybrid materials can be applied to correct occlusal tooth wear and thus replace conventional crown restorations.
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Affiliation(s)
- Alexis Ioannidis
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Switzerland.
| | - Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Switzerland
| | - Mutlu Özcan
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Switzerland
| | - Jürg Hüsler
- Department of Mathematical Statistics, University of Bern, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Switzerland
| | - Goran I Benic
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Switzerland
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Mühlemann S, Greter EA, Park JM, Hämmerle CHF, Thoma DS. Precision of digital implant models compared to conventional implant models for posterior single implant crowns: A within-subject comparison. Clin Oral Implants Res 2018; 29:931-936. [PMID: 30168207 DOI: 10.1111/clr.13349] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/03/2018] [Accepted: 07/17/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To calculate the precision of the implant analog position in digital models generated from different computer-assisted design and computer-assisted manufacturing (CAD-CAM) systems compared to gypsum models acquired from conventional implant impressions. MATERIALS AND METHODS In five patients in need of a single implant crown, a within-subject comparison was performed applying four different manufacturing processes for the implant model. Each implant was scanned with three different intraoral scanners: iTero Cadent (ITE), Lava True Definition (LTD), and Trios 3Shape (TRI). All digital implant models were fabricated using the corresponding certified CAD-CAM workflow. In addition, a conventional impression was taken (CON) and a gypsum model fabricated. Three consecutive impressions were acquired with each impression system. Following fabrication, all implant models were scanned. The datasets were aligned by a repeated best-fit algorithm and the precision for the implant analog and the adjacent teeth was measured. The precision served as a measure for reproducibility. RESULTS Mean precision values of the implant analog in the digital models were 57.2 ± 32.6 µm (ITE), 88.6 ± 46.0 µm (TRI), and 176.7 ± 120.4 µm (LTD). Group CON (32.7 ± 11.6 µm) demonstrated a statistically significantly lower mean precision value for the implant position in the implant model as compared to all other groups representing a high reproducibility. The mean precision values for the reference ranged between 31.4 ± 3.5 µm (TRI) and 39.5 ± 16.5 µm (ITE). No statistical significant difference was calculated between the four treatment groups. CONCLUSIONS The conventional implant model represented the greatest reproducibility of the implant position. Digital implant models demonstrated less precision compared to the conventional workflow.
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Affiliation(s)
- Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Elena A Greter
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ji-Man Park
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Korea
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Mühlemann S, Benic GI, Fehmer V, Hämmerle CHF, Sailer I. Randomized controlled clinical trial of digital and conventional workflows for the fabrication of zirconia-ceramic posterior fixed partial dentures. Part II: Time efficiency of CAD-CAM versus conventional laboratory procedures. J Prosthet Dent 2018; 121:252-257. [PMID: 30037692 DOI: 10.1016/j.prosdent.2018.04.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 04/19/2018] [Accepted: 04/19/2018] [Indexed: 10/28/2022]
Abstract
STATEMENT OF PROBLEM Clinical trials are needed to evaluate the digital and conventional fabrication technology for providing fixed partial dentures (FPDs). PURPOSE The purpose of the second part of this clinical study was to compare the laboratory production time for tooth-supported, 3-unit FPDs by means of computer-aided design and computer-aided manufacturing (CAD-CAM) systems and a conventional workflow. In addition, the quality of the 3-unit framework of each treatment group was evaluated clinically. MATERIAL AND METHODS For each of 10 participants, a 3-unit FPD was fabricated. Zirconia was used as the framework material in the CAD-CAM systems and included Lava C.O.S. CAD software (3M) and centralized CAM (group L); CARES CAD software (Institut Straumann AG) and centralized CAM (group iT); and CEREC Connect CAD software (Dentsply Sirona) and centralized CAM (group C). The noble metal framework in the conventional workflow (group K) was fabricated by means of the traditional lost-wax technique. All frameworks were evaluated clinically before veneering. The time for the fabrication of the cast, the 3-unit framework, and the veneering process was recorded. In addition, chairside time during the clinical appointment for the evaluation of the framework was recorded. The paired Wilcoxon test together with appropriate Bonferroni correction was applied to detect differences among treatment groups (α=.05). RESULTS The total effective working time (mean ±standard deviation) for the dental technician was 220 ±29 minutes in group L, 217 ±23 minutes in group iT, 262 ±22 minutes in group C, and 370 ±34 minutes in group K. The dental technician spent significantly more time in the conventional workflow than in the digital workflow, independent of the CAD-CAM systems used (P<.001). CONCLUSIONS Irrespective of the CAD-CAM system, the overall laboratory time for the dental technician was significantly less for a digital workflow than for the conventional workflow.
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Affiliation(s)
- 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.
| | - 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
| | - Irena Sailer
- Professor, Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
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Mühlemann S, Bernini JM, Sener B, Hämmerle CH, Özcan M. Effect of Aging on Stained Monolithic Resin-Ceramic CAD/CAM Materials: Quantitative and Qualitative Analysis of Surface Roughness. J Prosthodont 2018; 28:e563-e571. [PMID: 29999570 DOI: 10.1111/jopr.12949] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2018] [Indexed: 11/29/2022] Open
Abstract
PURPOSE The aim of this in vitro study was to measure the effect of staining and artificial aging on the surface roughness of commercially available resin-ceramic computer-aided design and computer-aided manufacturing (CAD/CAM) materials both quantitatively and qualitatively and to compare it to feldspathic material. MATERIALS AND METHODS Test specimens (n = 15 per material) were prepared of CAD/CAM ingots from a resin nanoceramic (Lava Ultimate, LVU), a polymer-infiltrated ceramic (Vita Enamic, ENA), and a resin nanoceramic (Cerasmart, CER). In the staining protocol, test specimens were (i) roughened in a standardized manner and (ii) stained with the manufacturer's recommended staining kit by means of photo-polymerization (Bluephase Polywave). The control specimens were prepared out of a feldspathic ceramic (Vita Mark II,VM2) and stained in a ceramic furnace. As negative control of each group, 15 specimens were prepared and polished in a standardized manner. Surface roughness (Ra) was measured after finishing procedures and after simulation of clinical service up to 5 years by means of toothbrushing. After each year of aging, one specimen per group was randomly selected for scanning electron microscopy (SEM) analysis. Kruskal-Wallis test and paired post-hoc test were applied to detect differences between treatment groups (alpha = 0.05). RESULTS The mean roughness measurements of the stained CAD/CAM materials were 0.14 ± 0.04 μm (ENA), 0.15 ± 0.03 μm (LVU), 0.22 ± 0.03 μm (VM2), and 0.26 ± 0.12 μm (CER). In the polished CAD/CAM materials the measurements were 0.01 ± 0.01 μm (CER), 0.02 ± 0.01 μm (LVU), 0.02 ± 0.00 μm (VM2), and 0.03 ± 0.01μm (ENA). Irrespective of the restoration material, the applied staining protocol resulted in a higher surface roughness compared to the polished specimens (p < 0.001). After 5 years of simulated aging the mean surface roughness in the stained CAD/CAM materials were 0.22 ± 0.03 μm (VM2), 0.24 ± 0.09 μm (ENA), 0.25 ± 0.06 μm (CER), and 0.37 ± 0.09 μm (LVU). Aging had a significant effect on surface roughness in groups ENA and LVU (p < 0.001). SEM analysis showed that the staining layer on resin-ceramic CAD/CAM materials was partially removed over time. CONCLUSIONS The applied staining protocol significantly increased surface roughness of CAD/CAM materials. Instability of the staining layer on resin-ceramic CAD/CAM materials could be anticipated over time as a consequence of toothbrushing, whereas feldspathic ceramic did not suffer from such aging effect.
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Affiliation(s)
- Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Joëlle M Bernini
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Beatrice Sener
- Clinic of Preventive Dentistry, Periodontology and Cariology, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph Hf Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Mutlu Özcan
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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van Nimwegen WG, Raghoebar GM, Zuiderveld EG, Jung RE, Meijer HJA, Mühlemann S. Immediate placement and provisionalization of implants in the aesthetic zone with or without a connective tissue graft: A 1-year randomized controlled trial and volumetric study. Clin Oral Implants Res 2018; 29:671-678. [PMID: 29806181 PMCID: PMC6099353 DOI: 10.1111/clr.13258] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2018] [Indexed: 11/29/2022]
Abstract
Objective To volumetrically compare peri‐implant mid‐facial soft tissue changes in immediately placed and provisionalized implants in the aesthetic zone, with or without a connective tissue graft. Material and methods Sixty patients were included. All implants were placed immediately after extraction. After randomization, in one group, a connective tissue graft (test group, n = 30) was inserted at the buccal aspect of the implant. The other group (control group, n = 30) received no connective tissue graft. Clinical parameters, digital photographs and conventional impressions were obtained before extraction (Tpre) and at 12 months following definitive crown placement (T12). The casts were digitized by a laboratory scanner, and a volumetric analysis was performed between Tpre and T12. Results Twenty‐five patients in each group were available for analysis at T12. Volumetric change, transformed to a mean (±SD) change in thickness, was −0.68 ± 0.59 mm (test) and −0.49 ± 0.54 mm (control) with a non‐significant difference between groups (p = .189). The mid‐facial mucosa level was significantly different between both groups (p = .014), with a mean (±SD) change of +0.20 ± 0.70 mm (test) and −0.48 ± 1.13 mm (control). The Pink Esthetic Score was similar between both groups. Conclusions The use of a CTG in immediately placed and provisionalized implants in the aesthetic zone did not result in less mucosal volume loss after 12 months, leading to the assumption that a CTG cannot fully compensate for the underlying facial bone loss, although a significantly more coronally located mid‐facial mucosa level was found when a CTG was performed.
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Affiliation(s)
- Wouter G van Nimwegen
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Elise G Zuiderveld
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ronald E Jung
- Department of Fixed and Removable Prosthodontics and Dental Material Science, School of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Implant Dentistry, Dental School University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, Zurich, Switzerland
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Mühlemann S, Benic GI, Fehmer V, Hämmerle CHF, Sailer I. Clinical quality and efficiency of monolithic glass ceramic crowns in the posterior area: digital compared with conventional workflows. Int J Comput Dent 2018; 21:215-223. [PMID: 30264050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
PURPOSE The aim of this clinical study was to test whether or not digital workflows for the fabrication of crowns render different clinical outcomes from the conventional pathway with respect to (1) crown quality, and (2) time efficiency. MATERIAL AND METHODS For each of the 10 patients in need of one tooth-supported crown, five monolithic crowns were produced out of lithium disilicate reinforced glass ceramic. Four different optical impression and associated computer-aided design/computer-aided manufacturing (CAD/CAM) systems were used for crown fabrication (digital workflows): (1) Lava C.O.S. scanner and Lava C.O.S. and CARES CAD software, centralized CAM (group L); (2) Cadent iTero scanner, CARES CAD software and centralized CAM (group iT); (3) Cerec Bluecam, Cerec Connect CAD software, followed by laboratory-based CAM (group CiL); and (4) centralized CAM (group CiD). The conventional crown (group K) was fabricated based on a conventional silicone impression followed by a conventional wax-up and heat press technique. The examiners were blinded and evaluated the crowns clinically at the bisque-bake stage (initial try-in), and subsequently after finalization by a dental technician (final try-in). For the assessment of crown quality, modified United States Public Health Service (USPHS) criteria were used. Treatment times were recorded for clinical evaluation and adjustment. The quality ratings were analyzed descriptively. For both the continuous and ordinal outcomes, the non-parametric paired Wilcoxon test was applied, together with an appropriate Bonferroni correction to evaluate the differences between treatment groups. The results of the statistical analysis were interpreted globally at the significance level P = 0.05. RESULTS The clinical evaluation during the initial and final try-ins demonstrated similar clinical outcome measures for crowns generated with the four digital workflows and the conventional workflow. No statistically significant differences of crown quality in any state were found between groups (P > 0.005). The total clinical treatment times measured were: 456 ± 240 s for L; 655 ± 374 s for iT; 783 ± 403 s for CiL; 556 ± 285 s for CiD; and 833 ± 451 s for K. No statistically significant differences in treatment times were found between the groups (P > 0.05). CONCLUSIONS Within the limitations of the present study, the monolithic ceramic crowns resulting from the four different CAD/CAM systems did not differ from the conventionally produced crowns with respect to the clinical quality rating and the treatment time efficiency.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Benic GI, Mühlemann S, Fehmer V, Hämmerle CH, Sailer I. Randomized controlled within-subject evaluation of digital and conventional workflows for the fabrication of lithium disilicate single crowns. Part I: digital versus conventional unilateral impressions. J Prosthet Dent 2016; 116:777-782. [DOI: 10.1016/j.prosdent.2016.05.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 05/26/2016] [Accepted: 05/27/2016] [Indexed: 11/28/2022]
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Zeltner M, Sailer I, Mühlemann S, Özcan M, Hämmerle CHF, Benic GI. Randomized controlled within-subject evaluation of digital and conventional workflows for the fabrication of lithium disilicate single crowns. Part III: marginal and internal fit. J Prosthet Dent 2016; 117:354-362. [PMID: 27677220 DOI: 10.1016/j.prosdent.2016.04.028] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/26/2016] [Accepted: 04/28/2016] [Indexed: 10/20/2022]
Abstract
STATEMENT OF PROBLEM Trials comparing the overall performance of digital with that of conventional workflows in restorative dentistry are needed. PURPOSE The purpose of the third part of a series of investigations was to test whether the marginal and internal fit of monolithic crowns fabricated with fully digital workflows differed from that of crowns fabricated with the conventional workflow. MATERIAL AND METHODS In each of 10 participants, 5 monolithic lithium disilicate crowns were fabricated for the same abutment tooth according to a randomly generated sequence. Digital workflows were applied for the fabrication of 4 crowns using the Lava, iTero, Cerec inLab, and Cerec infinident systems. The conventional workflow included a polyvinyl siloxane impression, manual waxing, and heat-press technique. The discrepancy between the crown and the tooth was registered using the replica technique with polyvinyl siloxane material. The dimensions of the marginal discrepancy (Discrepancymarginal) and the internal discrepancy in 4 different regions of interest (Discrepancyshoulder, Discrepancyaxial, Discrepancycusp, and Discrepancyocclusal) were assessed using light microscopy. Post hoc Student t test with Bonferroni correction was applied to detect differences (α=.05). RESULTS Discrepancymarginal was 83.6 ±51.1 μm for the Cerec infinident, 90.4 ±66.1 μm for the conventional, 94.3 ±58.3 μm for the Lava, 127.8 ±58.3 μm for the iTero, and 141.5 ±106.2 μm for the Cerec inLab workflow. The differences between the treatment modalities were not statistically significant (P>.05). Discrepancyshoulder was 82.2 ±42.4 μm for the Cerec infinident, 97.2 ±63.8 μm for the conventional, 103.4 ±52.0 μm for the Lava, 133.5 ±73.0 μm for the iTero, and 140.0 ±86.6 μm for the Cerec inLab workflow. Only the differences between the Cerec infinident and the Cerec inLab were statistically significant (P=.036). The conventionally fabricated crowns revealed significantly lower values in Discrepancycusp and Discrepancyocclusal than all the crowns fabricated with digital workflows (P<.05). CONCLUSIONS In terms of marginal crown fit, no significant differences were found between the conventional and digital workflows for the fabrication of monolithic lithium disilicate crowns. In the occlusal regions, the conventionally manufactured crowns revealed better fit than the digitally fabricated crowns. Chairside milling resulted in less favorable crown fit than centralized milling production.
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Affiliation(s)
- Marco Zeltner
- Postgraduate student, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Irena Sailer
- Professor, Division of Fixed Prosthodontics and Biomaterials, University Center of Dental Medicine, University of Geneva, Geneva, 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
| | - Mutlu Özcan
- Professor, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, 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
| | - 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.
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Fehmer V, Mühlemann S, Hämmerle CHF, Sailer I. Criteria for the selection of restoration materials. Quintessence Int 2016; 45:723-30. [PMID: 25126642 DOI: 10.3290/j.qi.a32509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Selection of the appropriate material for dental restoration has become more and more difficult owing to the increasing variety of restoration materials. A decision flow chart is presented to guide the treatment team (dentist and dental technician) in the selection of the restoration material. This material selection is based on the available interocclusal space, esthetic aspects (eg, brightness value or translucency of the neighboring teeth), as well as clinical evidence extracted from survival rates.
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Thoma DS, Mühlemann S, Jung RE. Critical soft-tissue dimensions with dental implants and treatment concepts. Periodontol 2000 2014; 66:106-18. [DOI: 10.1111/prd.12045] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2013] [Indexed: 11/30/2022]
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Mühlemann S, Truninger TC, Stawarczyk B, Hämmerle CHF, Sailer I. Bending moments of zirconia and titanium implant abutments supporting all-ceramic crowns after aging. Clin Oral Implants Res 2013; 25:74-81. [DOI: 10.1111/clr.12192] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2013] [Indexed: 11/29/2022]
Affiliation(s)
- Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Thomas C. Truninger
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Bogna Stawarczyk
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Irena Sailer
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; University of Zurich; Zurich Switzerland
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Thoma DS, Martin IS, Mühlemann S, Jung RE. Systematic review of pre-clinical models assessing implant integration in locally compromised sites and/or systemically compromised animals. J Clin Periodontol 2012; 39 Suppl 12:37-62. [PMID: 22533946 DOI: 10.1111/j.1600-051x.2011.01833.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim was to systematically search the dental literature for pre-clinical models assessing implant integration in locally compromised sites (part 1) and systemically compromised animals (part 2), and to evaluate the quality of reporting of included publications. METHODS A Medline search (1966-2011) was performed, complimented by additional hand searching. The quality of reporting of the included publications was evaluated using the 20 items of the ARRIVE (Animals in Research In Vivo Experiments) guidelines. RESULTS One-hundred and seventy-six (part 1; mean ARRIVE score = 15.6 ± 2.4) and 104 (part 2; 16.2 ± 1.9) studies met the inclusion criteria. The overall mean score for all included studies amounted to 15.8 ± 2.2. Housing (38.3%), allocation of animals (37.9%), numbers analysed (50%) and adverse events (51.4%) of the ARRIVE guidelines were the least reported. Statistically significant differences in mean ARRIVE scores were found depending on the publication date (p < 0.05), with the highest score of 16.7 ± 1.6 for studies published within the last 2 years. CONCLUSIONS A large number of studies met the inclusion criteria. The ARRIVE scores revealed heterogeneity and missing information for selected items in more than 50% of the publications. The quality of reporting shifted towards better-reported pre-clinical trials within recent years.
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Affiliation(s)
- Daniel S Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, University of Zurich, Zurich, Switzerland.
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Sailer I, Mühlemann S, Zwahlen M, Hämmerle CHF, Schneider D. Cemented and screw-retained implant reconstructions: a systematic review of the survival and complication rates. Clin Oral Implants Res 2012; 23 Suppl 6:163-201. [DOI: 10.1111/j.1600-0501.2012.02538.x] [Citation(s) in RCA: 192] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Irena Sailer
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Switzerland
| | - Sven Mühlemann
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine; University of Bern; Bern; Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Switzerland
| | - David Schneider
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; University of Zurich; Switzerland
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Heydecke G, Zwahlen M, Nicol A, Nisand D, Payer M, Renouard F, Grohmann P, Mühlemann S, Joda T. What is the optimal number of implants for fixed reconstructions: a systematic review. Clin Oral Implants Res 2012; 23 Suppl 6:217-28. [DOI: 10.1111/j.1600-0501.2012.02548.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Guido Heydecke
- Department of Prosthetic Dentistry, Center for Dental and Oral Medicine; University Hospital Hamburg-Eppendorf; Martinistr. 52; 20246; Hamburg; Germany
| | - Marcel Zwahlen
- Institute for Social- and Preventive Medicine; University of Bern; Finkenhubelweg 11; 3012; Bern; Switzerland
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Bianchi V, Farisello P, Baldelli P, Meskenaite V, Milanese M, Vecellio M, Mühlemann S, Lipp HP, Bonanno G, Benfenati F, Toniolo D, D'Adamo P. Cognitive impairment in Gdi1-deficient mice is associated with altered synaptic vesicle pools and short-term synaptic plasticity, and can be corrected by appropriate learning training. Hum Mol Genet 2008; 18:105-17. [PMID: 18829665 DOI: 10.1093/hmg/ddn321] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The GDI1 gene, responsible in human for X-linked non-specific mental retardation, encodes alphaGDI, a regulatory protein common to all GTPases of the Rab family. Its alteration, leading to membrane accumulation of different Rab GTPases, may affect multiple steps in neuronal intracellular traffic. Using electron microscopy and electrophysiology, we now report that lack of alphaGDI impairs several steps in synaptic vesicle (SV) biogenesis and recycling in the hippocampus. Alteration of the SV reserve pool (RP) and a 50% reduction in the total number of SV in adult synapses may be dependent on a defective endosomal-dependent recycling and may lead to the observed alterations in short-term plasticity. As predicted by the synaptic characteristics of the mutant mice, the short-term memory deficit, observed when using fear-conditioning protocols with short intervals between trials, disappeared when the Gdi1 mutants were allowed to have longer intervals between sessions. Likewise, previously observed deficits in radial maze learning could be corrected by providing less challenging pre-training. This implies that an intact RP of SVs is necessary for memory processing under challenging conditions in mice. The possibility to correct the learning deficit in mice may have clinical implication for future studies in human.
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Affiliation(s)
- Veronica Bianchi
- Dulbecco Telethon Institute at DIBIT-San Raffaele Scientific Institute, Milan, Italy
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