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The accuracy of virtual dentofacial patients has been explored, but the accuracy of virtual patients established by using a straightforward and reliable method and the accuracy of different virtual patients are unclear. The purpose of this clinical study was to compare the accuracy of virtual dentofacial patients digitized by using registered-block impression, exposed anterior teeth, and cone beam computed tomography (CBCT) reconstruction methods based on 3-dimensional (3D) facial and dental images. From the 15 selected participants who needed CBCT scanning, 3 kinds of virtual dentofacial patients were established by using 3 registration methods based on digital dental casts: 3D facial images, CBCT data, and registered-block impression. Compared with actual measurement, 25 linear distances of all virtual dentofacial patients were selected and measured by using a software program, and 3 separate measurements were calculated by the same person. The 1-way analysis of variance (ANOVA) was used to compare the deviations among 3 kinds of virtual dentofacial patients (trueness) and the deviations within groups (precision). The 1-sample t test was used to compare the difference between the deviation and the ideal error of 0.00 (α=.05). Compared with the actual measurement, the trueness of the average deviations for registered-block impression (1.02 ±1.24 mm) was better than that of exposed anterior teeth (2.35 ±1.71 mm) and CBCT reconstruction (2.86 ±1.61 mm). The precision of the average deviations for registered-block impression (1.29 ±1.43 mm) was better than that of exposed anterior teeth (2.00 ±1.72 mm) and CBCT reconstruction (2.12 ±1.94 mm). Significant differences in trueness and precision were found among the 3 groups of virtual dentofacial patients (P <.01). Significant differences among the deviations of all linear distances and the ideal error of 0.00 were observed for all groups of virtual dentofacial patients (P <.05). The accuracy of registered-block impression was better than that of the exposed anterior teeth and CBCT reconstruction. The accuracy of exposed anterior teeth was lower than that of the other methods but could satisfy the requirements of clinical diagnostics and scientific methods. The accuracy of CBCT reconstruction was poor and could only be used for special situations that permitted low accuracy. [ABSTRACT FROM AUTHOR]

Additive manufacturing is emerging as an alternative method of fabricating dental restorations, but the support design needs to be optimized. The purpose of this in vitro study was to evaluate the 3-dimensional trueness and adaptations of zirconia crowns manufactured by stereolithography (SLA) with an occlusal full-supporting structure, compared with those SLA-printed with pillar supports, and those made by milling. A zirconia abutment was prepared, and an anatomic contour crown was designed. The crowns were manufactured by SLA and milling (n=6). For SLA manufacturing, a full-supporting base and pillar supports were designed. The 3-dimensional (3D) trueness of the fabricated crowns was characterized by 3D deviation analysis. The adaptations of crowns in the SLA-base and milling groups were measured by using a triple-scan method. Color-difference maps and the root mean square (RMS) values were used to characterize the 3D trueness. One-way analysis of variance (ANOVA) and Tukey post hoc test were used to analyze the difference in RMS values among the 3 groups, and Student t test was used to analyze the difference in cement-gap width between the milling group and the SLA group with the full-supporting base (α=.05). The 3D deviation analysis showed that in the external area, the RMS value of the SLA-pillar group was significantly higher than that of the SLA-base and the milling groups (P <.05). In the intaglio area, the milling group showed a lower RMS value than the 2 SLA groups (P <.05). The color-difference maps showed the SLA-base group had smaller positive errors at the cusp inclines than the SLA-pillar group. No statistically significant difference was found in adaptations between the SLA-base and milling groups (P >.05). The occlusal full-supporting base provided improved support in fabricating the crowns, and no remnants were left after removal. The zirconia crowns manufactured by SLA with an occlusal full-supporting structure had good external 3D trueness and clinically acceptable adaptation. [ABSTRACT FROM AUTHOR]

Although computer-aided design has become popular, restorations are typically designed from static occlusion and dynamically by using an average-value virtual articulator. Patient-specific motion recorded by using an intraoral scanner has rarely been used to design restorations, and its design ability has not been analyzed. The purpose of this clinical study was to record patient-specific motion by using an intraoral scanner and to analyze its ability to design the morphology of the wear facets on mandibular first molar crowns. An intraoral scanner was used to scan complete arch digital casts and to record patient-specific motion of 11 participants. Right and left mandibular first molars were selected as the target teeth. The complete crown preparations of the target teeth were virtually prepared on the digital mandibular casts by using the Geomagic Studio 2013 software program. High points were created by elevating the wear facets of the target teeth by 0.3 mm in the occlusal direction to generate digital wax patterns. The Dental System software program was used to design crowns with the anatomic coping design method. Occlusal adjustment with static occlusion (STA crown), with the average-value virtual articulator (DYN crown), and with patient-specific motion (FUN crown) was carried out. The crowns adjusted with these 3 methods were compared with the original wear facets. The mean value and root mean square (RMS) of 3D deviation were measured. One-way ANOVA was used to analyze the influence of the occlusal surface design methods on the morphology of the wear facets (α=.05). The STA crowns had the poorest results with the mean ±standard deviation 3D deviation value of 0.15 ±0.05 mm and RMS value of 0.19 ±0.04 mm. The best results occurred in the FUN group, with the mean ±standard deviation 3D deviation value of 0.05 ±0.06 mm and RMS value of 0.13 ±0.03 mm. Significant differences were found among the 3 groups (P <.01). Except for the RMS value between the STA and DYN groups, significant differences were found between groups from the pairwise comparisons. The occlusal surface of the crowns designed by using the patient-specific motion recorded with the intraoral scanner had the best coincidence with the morphology of the wear facets on the original teeth. [ABSTRACT FROM AUTHOR]

Restorations with knife-edge margins are more prone to margin chipping during the manufacturing process. Three-dimensional gel deposition shows potential for fabricating zirconia restorations with good margin quality, but studies on its performance in fabricating knife-edged crowns are lacking. The purpose of this in vitro study was to compare the 3-dimensional trueness, surface morphology, and margin quality of self-glazed zirconia and soft-milled zirconia crowns with knife-edge margins. An abutment with a knife-edge finish line design was prepared and scanned with a laboratory scanner. Anatomic contour crowns were designed and fabricated by 3-dimensional gel deposition and soft milling (n=5). The crowns were digitalized, and the scan data were superimposed on the computer-aided design (CAD) data for 3-dimensional deviation analysis. Surface morphology and margin quality were characterized with microscopic examination. The self-glazed zirconia crowns showed a smooth and glossy appearance. The soft-milled crowns showed traces left by the removal of support bars and numerous micropits of various sizes. In internal areas, no significant difference was found in root mean square values between the 2 groups (P ＞.05). For the external surface, self-glazed zirconia showed statistically lower root mean square values than the soft-milled crowns (P＜.05). When observed at ×5 magnification, all the self-glazed zirconia crowns showed smooth edges with no defects, whereas small or large margin defects were found in the soft-milled crowns. When characterized at ×200 magnification, minor margin flaws were observed in the self-glazed zirconia crowns. More and larger margin defects were found in the soft-milled crowns. Three-dimensional gel deposition forms a smoother and more homogeneous surface than soft milling. Knife-edged self-glazed zirconia crowns have good dimensional accuracy and margin quality. [ABSTRACT FROM AUTHOR]

Existing virtual articulators simulate mandibular movement by using various parameters and are used to design restorations. However, they are not able to reproduce actual patient movements, and the designs of occlusal wear facets by them and by personalized mandibular movement have not been compared. The purpose of this clinical study was to establish a clinical application protocol for a virtual articulator based on previous research and to evaluate the accuracy of the occlusal wear facets designed by it. The gypsum casts of 12 participants were scanned with a cast scanner as the original data. A single crown, 3-unit splinted crowns, a 5-unit fixed partial denture, and a fixed complete denture were virtually prepared on the digital mandibular casts by using the Geomagic Studio 2013 software program. High points were created at the wear facets, and corresponding digital wax patterns with occlusal interferences were generated. The exocad software program was used to design corresponding restorations with the copy method. Static (STA restoration) and dynamic (DYN restoration) occlusal adjustments were carried out with the built-in virtual articulator. The mandibular movements of participants were recorded by the novel virtual articulator system, and the occlusal surfaces of the digital wax patterns were adjusted (FUN restoration). The restorations adjusted with the 3 methods were compared with the original data. The mean value and root mean square (RMS) of 3D deviation and positive volumes (V+) in the occlusal direction were measured. Depending on the normality, 1-way ANOVA and the Kruskal-Wallis test were used to analyze the influence of occlusal surface design methods on the morphology of occlusal wear facets (α=.05). The mean deviation of the 4 kinds of STA restorations ranged from 0.19 mm to 0.22 mm, the DYN restorations from 0.13 mm to 0.17 mm, and the FUN restorations from 0.03 mm to 0.09 mm. A significant difference was found between the STA and FUN restorations of the 3-unit splinted crowns and 5-unit fixed partial dentures (Ρ =.013, Ρ =.021). The mean values of 3D deviation and V+ decreased from the STA group to the DYN group and then to the FUN group. The RMS and V+ were statistically similar (Ρ >.05). The preliminary results of the study indicate that the FUN 3-unit splinted crowns and 5-unit fixed partial dentures designed with the self-developed virtual articulator were better than the STA restorations. The FUN restorations were more coincident with the morphology of the wear facets on the original teeth. [ABSTRACT FROM AUTHOR]

Precise preparation of guiding planes is essential for removable partial dentures (RPDs). This report introduces a metal template fabricated by computer-aided design and computer-aided manufacturing (CAD-CAM) to help prepare guiding planes for RPDs. [ABSTRACT FROM AUTHOR]

A fully digital workflow for the design and manufacture of prostheses for maxillectomy defects was described. Three-dimensional images from spiral computed tomography and intraoral scanning were used to generate a three-dimensional digital cast of a maxillectomy defect. The obturator prosthesis was then designed on the digital cast by combining dental computer-aided design and reverse engineering software programs. The prosthesis was subsequently milled from polyetheretherketone or three-dimensional–printed from polylactic acid. [ABSTRACT FROM AUTHOR]

The triple-scan method for assessing the 3D adaptation of dental restorations has been introduced and reported to be reliable. However, the suitability of using a dental laboratory scanner in the triple-scan method has not been evaluated. The purpose of this in vitro study was to evaluate the suitability of the triple-scan method using a dental laboratory scanner to assess the 3D adaptation zirconia crowns. A zirconia abutment and a zirconia crown were fabricated, and the abutment was fixed in a custom-made base. The crown was seated onto the abutment with the interposition of light-body silicone impression material between them. The triple-scan method was performed by using a dental laboratory scanner, and the mean cement-gap thickness was calculated. The seating and digitalization process was repeated 10 times, and after each digitalization, the light-body silicone layer was stabilized by applying heavy-body silicone impression material over it. Cement-gap thickness was measured on cross-sections of the aligned scan data sets and of the physical silicone replica. The results were assessed by using the paired t test and the Bland-Altman method (α=.05). Mean 3D cement-gap thickness assessed by the triple-scan method reported small dispersion with a coefficient of variation of 5.6% for the occlusal area, 1.9% for the axial area, and 6.4% for the margin area. Cement gap thickness measured at corresponding locations in the aligned scan data sets and in the physical silicone replica reported no significant difference (P =.326) and good agreement. The cement gap was accurately duplicated in scan data sets. The triple-scan method by using a dental laboratory scanner is suitable for assessing the 3D adaptation of zirconia crowns. [ABSTRACT FROM AUTHOR]

This article describes a technique for fabricating removable complete dentures by using digital technology which aims to produce an individually designed, diagnostic, complete denture. This technology could reduce the number of appointments compared with traditional complete denture treatment and has a wide range of applications for different types of edentulous patients, including those with severe resorption of the alveolar ridge or a high occlusal force. Furthermore, the low cost of 3D printers, compared with expensive milling machines, may make the approach more accessible. [ABSTRACT FROM AUTHOR]

Abstract Statement of problem In computer-aided design and computer-aided manufacturing (CAD-CAM) dentistry, the correlation method is an efficient way to design complete crowns. However, the occlusal relationship and patient satisfaction with prostheses fabricated using this method remain unclear. Purpose The purpose of this clinical trial was to compare the occlusion of monolithic zirconia crowns designed using the correlation and library methods. Material and methods Twenty-three teeth of 21 participants received 2 monolithic zirconia crowns designed by using the correlation or the library method. Defective teeth were scanned using an intraoral scanner to obtain references and working casts from before and after the preparation. Before cementation, the occlusal relationship of both crowns and patient satisfaction were evaluated, and the occlusal adjustment time was recorded. Results The correlation method resulted in less lateral occlusal interference of the crowns than the library method (P <.01). The occlusal adjustment times of the correlation and library conditions were 455.8 ±357.1 seconds and 575.3 ±488.0 seconds, respectively (P >.05). Relative occlusal force was significantly higher in the correlation than in the library condition and was related to before preparation relative occlusal force (r =0.706, P <.01). The visual analog score before occlusal adjustment was higher in the correlation than in the library condition (P <.05). The occlusal contacts, occlusal contact distributions, and number of occlusal contacts did not differ between conditions (P >.05). Conclusions Better eccentric occlusion and reduced lateral occlusal interference were obtained when the correlation method was used to design crowns. The correlation method yielded higher relative occlusal force, which helped to restore the original occlusal force. [ABSTRACT FROM AUTHOR]

Statement of problem Limited information is available regarding the influence of object translucency on the scanning accuracy of a powder-free intraoral scanner. Purpose The purpose of this in vitro study was to evaluate the scanning accuracy of a confocal microscopy principle powder-free intraoral scanner on ceramic copings and to analyze the relationship between scanning accuracy and object translucency. Methods Six slice specimens (12×10 mm) and 6 offset copings (1.00-mm thickness) were made from different translucent homogeneous ceramic blocks (CEREC Blocs, S0-M to S5-M, highest to lowest translucency). The primary sintered zirconia offset coping was produced in the same way as the control. Optical parameters related to the translucency of each slice were measured with a spectrophotometer. Three-dimensional (3D) datasets of the surface morphology of offset copings were obtained by using the intraoral scanner. The same white wax resin bases were used for registration. Quantitative parameters of scanning trueness and precision were measured. One-way ANOVA was used to analyze the values of each parameter among the 6 ceramic blocks. Bivariate correlation was used to analyze the relationships between each parameter of scanning accuracy and translucency (α=.05). Results Translucent copings showed a positive 3D bias (S0-M to S5-M: 0.149 ±0.038 mm to 0.068 ±0.020 mm), a narrower collar diameter (Dd=−0.067 mm), larger convergence angle (ΔΦ=2.79 degrees), and larger curvature radius of the internal gingivoaxial corner (Δρ=0.236 mm). The smaller the percentage sum of scattering and absorption, the greater was the occurrence of scanning bias (r=−0.918) and curvature (r=−0.935) decrease. Conclusions Use of the tested powder-free intraoral scanner, higher translucency objects (greater translucency than S1-M/A1C) resulted in lower scanning accuracy and morphological changes. Therefore, more suitable methods of measurement are still required. [ABSTRACT FROM AUTHOR]

The effects of design parameters of polylactic acid (PLA) custom trays manufactured by fused deposition modeling (FDM) on the accuracy of partially edentulous definitive casts have not been thoroughly explored. The purpose of this in vitro study was to explore the effects of the impression gap and base thickness of FDM-printed PLA custom trays on the accuracy of maxillary and mandibular definitive casts with Kennedy class II, modification I partial edentulism and to optimize these 2 design parameters. Custom trays with a 1-mm, 2-mm, or 3-mm impression gap and 1-mm, 1.5-mm, or 2-mm base thickness were designed on a pair of maxillary and mandibular resin casts and printed with PLA materials by using an FDM printer. Two-step silicone impressions were made by using these custom trays or stock metal trays on resin casts. Digital scans of definitive casts from these impressions were aligned one by one with those of resin casts. Three-dimensional deviations of the tooth area, mucosal area, and overall area were analyzed by using root mean square (RMS) as a metric. Two-way and 1-way analyses of variance with the RMSs as the dependent variable were carried out (α=.05). The accuracy of definitive casts from custom trays with a 2.0-mm or 3.0-mm impression gap and 1.5-mm or 2.0-mm base thickness was significantly better than that of definitive casts from custom trays with a 1.0-mm impression gap or 1.0-mm base thickness and was not significantly different from that of definitive casts from stock metal trays. Considering the accuracy of definitive casts, the optimal base thickness of FDM-printed PLA custom trays was 1.5 mm or 2.0 mm and the optimal impression gap was 2.0 mm or 3.0 mm for Kennedy class II, modification I partial edentulism. [ABSTRACT FROM AUTHOR]

The layer thickness serves as a straightforward and controllable parameter to alter the mechanical properties of 3D-printed custom trays. However, how the printing layer thickness affects the mechanical properties of the trays is not fully understood. The purpose of this in vitro study was to investigate the effects and their underlying mechanisms and to optimize the mechanical properties through modulation of the printing layer thickness. Polylactic acid (PLA) specimens were 3D-printed with 5 layer thicknesses from 0.1 mm to 0.5 mm. The bond, flexural, and tensile strengths were measured by using a universal test machine. Postfracture interfaces were examined by means of scanning electron microscopy. Additionally, the printing dimensional accuracy was estimated by measuring the size deviations between the printed and virtual specimens, and the printing times were recorded. With increasing PLA printing layer thickness, the tensile bond strength first increased and then decreased, peaking at a thickness of 0.4 mm. While the flexural and tensile strengths decreased, the printing dimensional accuracy remained constant from 0.1 mm to 0.4 mm and then decreased at 0.5 mm. The printing time sharply decreased as printing layer thickness increased. Moderate layer thickness provided the best properties for 3D-printed custom trays. [ABSTRACT FROM AUTHOR]

Statement of Problem: Studies that have used digital methods to quantitatively evaluate physiological tooth displacement under occlusal force are sparse., Purpose: The purpose of this clinical study was to measure physiological posterior tooth displacement under occlusal force by intraoral scanning and reverse engineering technology by using implants as the reference., Material and Methods: A total of 14 participants received 15 implant-supported single mandibular first molar crowns. The surface data of maxillary and mandibular posterior teeth (U1 and L1) and the buccal occlusal data in the maximum intercuspal position (MIP) with habitual occlusal force were obtained by using an intraoral scanner (TRIOS 3, v20.1.2). The U1 and L1 data were segmented into single teeth, which were then aligned to the buccal occlusal data by using the "best-fit alignment" command to build the data under occlusal force (U2 and L2). U1 and L1 data were compared with U2 and L2 data to calculate the centroid and functional cusp vertex displacements and the long axis deflections of the second premolars and second molars, taking the first molar as the reference. The medians, and first quartile (Q 1 ), third quartile (Q 3 ) of the above data were reported, and the Shapiro-Wilk and Wilcoxon tests were used to analyze the differences (α=.05)., Results: Under occlusal force, the median (Q 1 , Q 3 ) centroid displacements of posterior teeth ranged from 61 (52, 101) μm to 146 (80, 186) μm; the functional cusp vertex displacements ranged from 82 (62, 117) μm to 146 (98, 189) μm, and the long axis deflections ranged from 0.45 (0.25, 0.87) degrees to 1.03 (0.52, 1.41) degrees. Mandibular second premolars displaced lingually, mesially, and apically; mandibular second molars displaced distally and apically; and maxillary second premolars and second molars displaced lingually and apically., Conclusions: A digital method taking implant-supported single crowns as the reference was used to demonstrate physiological posterior-tooth displacement under habitual occlusal force., (Copyright © 2023 Editorial Council for The Journal of Prosthetic Dentistry. Published by Elsevier Inc. All rights reserved.)