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Different digital tools have been used in clinical practice to assist in the planning and rehabilitation of patients. Some applications (apps) and software programs used in esthetic planning allow simulation of the smile design, improving communication between patients and professionals. Nonetheless, they are usually difficult to use, time-consuming, unattractive to present to the patient, and complicated to link with the 3D workflow. This article presents a new 3D digital smile design app for esthetic planning, smile simulation, chairside 3D virtual wax pattern, and trial restoration performed with portable devices. In this technique description, a facial frontal photograph, a facial scan standard tessellation language (STL) file, and a maxillary intraoral scan STL file were uploaded to the app. The files were calibrated to each other to allow a 3D facially driven smile design project. The definitive maxillary 3D digital waxing of facial templates was exported to a 3D printer as an STL file. The printed resin templates were directly placed in the mouth with flowable composite resin for an immediate trial restoration without the need for casts, silicone guides, or autopolymerizing resin. The workflow presented in this article linked the 3Dapp project to a printer and allowed straightforward chairside trial restorations.

Objectives: This systematic review aimed to answer the following focused question: Do the currently available imaging techniques provide accuracy in the assessment of peri-implant buccal bone thickness? Methods: A search strategy was conducted in eight electronic databases, followed by an additional manual search in grey literature and references of selected articles. Studies evaluating the accuracy of imaging techniques to measure peri-implant buccal bone thickness were included. Individual risk of bias was assessed by the Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2). Meta-analysis was performed to evaluate CBCT accuracy. The overall effect size was determined by means of the Z-test. Q test was used to evaluate the homogeneity of effect sizes among studies and I2 was applied to determine the variance within studies. Results: After an initial screening, 83 studies were further selected for full reading and 13 of them were considered eligible for this review. In sum, the accuracy of Cone-beam Computed Tomography (CBCT), of ultrasound, and of computed tomography were assessed. There was no statistically significant difference between CBCT and the gold standard (p=0.81). The mean difference between measurements of bone thickness obtained by CBCT and the goldstandard was -0.0.3mm [95%CI -0.29;0.253mm]. Conclusion: CBCT showed acceptable accuracy for assessing peri-implant bone. No meaningful conclusion could be drawn about other techniques.

The purpose of this study was to assess the accuracy of high-frequency ultrasound (US) in the measurement of peri-implant bone defects in comparison with cone-beam computed tomography (CBCT) and micro-computed tomography (µCT). Bone defects were mechanically created around dental implants inserted into porcine ribs (n = 10). The bone samples were scanned by CBCT, µCT and US. Linear dimensions of the peri-implant defects were determined for supra-alveolar component, intra-bony component and width. The accuracy of measurements was evaluated with repeated-measures analysis of variance and the intra-class correlation coefficient at p ≤ 0.05. US underestimated the measurements for the supra-alveolar and intra-bony components in comparison to CBCT and µCT, and there were no statistically significant differences in the measurements of width. The intra-class correlation coefficient of US ranged from 0.96 to 0.98, whereas that for CBCT ranged from 0.77 to 0.97. US was accurate in measuring the width of peri-implant defects, although vertical measurements were underestimated by approximately 1 mm in comparison to those of CBCT and µCT.

Applied Sciences 11(12), 5494 (2021). doi:10.3390/app11125494 special issue: "Special Issue "Ultrasound Technology in Industry and Medicine" / Special Issue Editor: Prof. Dr. Krzysztof Opieli��ski, Guest Editor", Published by MDPI, Basel

Aim and objective This case report presents the integration of a digital facially driven prosthetic plan to the computer-assisted implant planning for rehabilitation of edentulous arches. Background Diagnosis of edentulous arches is hampered by the lack of intraoral references. However, a digital facial profile analysis facilitates the treatment plan, taking into consideration the harmony among teeth, lips, and face to restore a pleasant smile. Case description The first appointment consisted of digital documentation including intraoral scans, facial scans, and photographs. Based on these data, a smile frame was created to guide the digital wax-up. Cone-beam computed tomography (CBCT) scans were merged to facial and intraoral scans to perform the virtual surgical planning. Integration between facial, intraoral, and bone tissues were used as a reference to define implant position and prosthetic planning. The digital planning was integrated into the surgical procedure using stackable templates, and an immediate loading was performed. The interim prosthesis was manufactured based on the digital wax-up. With digital data, quality control could be performed to evaluate the esthetic outcome of the treatment. Conclusion An esthetic and functional rehabilitation was possible using the respective digital workflow to define harmony between a smile and facial tissues. Clinical significance A digital treatment implant planning can be conducted considering patient's individual needs to improve the esthetic outcome. How to cite this article Creagh J, Bohner L, Sesma N, et al. Integrating a Facially Driven Treatment Planning to the Digital Workflow for Rehabilitation of Edentulous Arches: A Case Report. J Contemp Dent Pract 2020;21(12):1393–1397.

Objective The aim of this report is to present an interdisciplinary approach with novel concepts to virtually plan and achieve esthetics and function. Clinical considerations Despite the advancements in the digital workflow applied to restorative dentistry, the final outcomes are commonly not similar to initial planning. To overcome this major limitation, three concepts are proposed: guided dentistry, digital quality control and "copy-paste" dentistry. Guided dentistry consists of simulations in 3D software and also includes the manufacture of guides/appliances to assist dentists in all clinical steps. Digital quality control involves the use of intraoral scanners and 3D software to compare the real outcomes with the pre-operative simulations after every procedure. "Copy-paste" dentistry is a consequence of the previous two concepts. Using the capacity of the software to overlap files, the original project can be maintained and adapted to achieve results more comparable with the initial design. The proposed method associates facially driven treatment planning and periodontal and restorative procedures to perform the patient's dental rehabilitation. Conclusion Through a guided workflow and digital control of clinical steps, the final outcomes obtained were equivalent and closer to the initial design. Clinical significance In interdisciplinary cases, the treatment plan needs to address individual requirements and to coordinate sequential clinical stages. It is challenging to meet these demands in a conventional process. The proposed concepts engage technological resources to orientate the procedures and to provide assessment in each step. This approach enables the development of a complete and accurate functional-esthetic rehabilitation. Ultimately, the technique presented is reproducible and the results reflect the established plan.

Ectodermal dysplasia (ED) refers to a heterogeneous group of genetic diseases of the skin, skin appendages, and teeth. People with ED experience a poorer oral health-related quality of life (OHRQoL) compared to the general population. The aim of this study was to examine the OHRQoL of people with ED and to measure their objective physical oral health to confirm or disprove evidence of poorer oral health in this population. To determine OHRQoL, the German version of the 14-item Oral Health Impact Profile (OHIP-14G) was used. All the participants in the study were clinically examined, and the measured parameters were recorded using the Physical Oral Health Index (PhOX). In total, 10 male and 11 female participants, with an average age of 22.0 &plusmn, 9.0 years, were included in this study. The OHIP-14G summary score was 23.9 (&plusmn, 15.2) points (range: 0&ndash, 56 points). The PhOX summary score was 61.2 (&plusmn, 5.1) points (range: 22&ndash, 80 points). The findings indicated that both the OHRQoL and physical oral health of the participants were highly impaired and that their objective and subjective oral health were worse than those of the general population in Germany.

Objective Despite all advantages provided by the digital workflow, its application in clinical practice is still more focused on device manufacturing and clinical execution than on treatment planning and communication. The most challenging phases of treatment, comprehensive planning, diagnosis, risk assessment, and decision-making, are still performed without significant assistance from digital technologies. This article proposes a new dental software classification based on the digital workflow timeline, considering the moment of patient's case acceptance as key in this classification, and presents the ideal software tools for each phase. Clinical considerations The proposed classification will help clinicians and dental laboratories to choose the most appropriate software during the treatment planning phase and integrate virtual plans with other software platforms for digitally guided execution. A dento-facial interdisciplinary planning platform virtually simulates interdisciplinary clinical procedures and assists in the decision-making process. Conclusions The suggested classification assists professionals in different phases of the digital workflow and provides guidelines for improvement and development of digital technologies before treatment plan acceptance by the patient. Clinical significance Three-dimensional interdisciplinary simulations allow clinicians to visualize how each dental procedure influences further treatments. With this treatment planning approach, predictability of different procedures in restorative dentistry, orthodontics, implant dentistry, periodontal, and oral maxillofacial surgery is improved.

Hemifacial microsomia (HFM) is also known as malformation of the first and second branchial arches (BAs), oculoauriculovertebral dysplasia syndrome, and Goldenhar syndrome. Possibilities resulting from CAD/CAM may be a valuable tool to existing procedures to treat these abnormalities. The aim of this study was to report a case where the planning and implementation of an intraorally inserted 2-part patient-specific mandible implant was used for the treatment of HFM esthetic remained problem after orthognathic surgery. A 20-year-old female patient who continued to suffer from the esthetic defect of the unilateral hypoplastic mandible after completion of the orthognathic surgery attended for consultation. Using CT scan and the software Geomagic Freeform (3D Systems, USA), a 2-piece titanium implant was designed and printed to restore the osseous frame of the basal border of the mandible. The base was made of solid polished titanium to minimize soft tissue abrasion. Due to its split design, the implant could be placed anatomically exactly at the mandibular margin via an intraoral access and to avoid damage of the mental nerve. There were no postoperative complications such as infections, soft tissue reactions to the implant, sensitivity disorders, or dehiscence. The occlusion was regular. A measurement of the postoperative x-rays showed a clear increase in bony symmetry. No postoperative pain or trismus was seen. Functionally, the therapy ended with the completion of wound healing and the jaw was fully resilient again. A combined treatment using PSI and additional autogenous fat grafting may represent a valid treatment option for the treatment of facial asymmetry in patients with HFM.

(1) Background: The aim of the study was to investigate the oral health&ndash, related quality of life (OHRQoL) of patients with oral lichen planus (OLP) and to evaluate differences between the various clinical forms of OLP. Specifically, the differences in OHRQoL, physical pain levels and eating restriction were assessed, (2) Methods: One hundred and twelve patients with clinical and histological features of OLP from the Department of Cranio-Maxillofacial Surgery of the M&uuml, nster University Hospital participated in this prospective study. OHRQoL was analysed by using the German short version of the Oral Health Impact Profile (OHIP-14). Physical pain levels and restriction in eating were rated on visual analogue scales (VAS). The statistical analysis was performed using the Mann&ndash, Whitney U-Test and the chi-squared test with a significance level at p = 0.05, (3) Results: Group 1 consisted of patients with reticular OLP (n = 50) and group 2 of patients with atrophic, erosive-ulcerative or bullous OLP (n = 62). The average OHIP-14 score was 13.54 points and differed significantly between the two groups. There were significant differences in the domains &ldquo, physical pain&rdquo, &ldquo, psychological discomfort&rdquo, physical disability&rdquo, and &ldquo, social disability&rdquo, The VAS &ldquo, score and &ldquo, restriction in eating&rdquo, score varied significantly between the clinical forms. Positive correlations were found between the OHIP-14 total scores and the VAS scores, (4) Conclusion: The OHRQoL is significantly limited in patients with OLP, especially, patients with erosive-ulcerative OLP are affected.

Statement of problem A consensus on the accuracy of additively manufactured casts in comparison with those fabricated by using conventional techniques for fixed dental prostheses is lacking. Purpose The purpose of this systematic review was to determine the accuracy of additively manufactured casts for tooth- or implant-supported fixed dental prostheses in comparison with that of gypsum casts. Material and methods This study adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CDR42020161006). Eight databases were searched in December 2019 and updated in September 2020. Studies evaluating the dimensional accuracy of additively manufactured casts for fixed dental prostheses in comparison with that of gypsum casts were included. An adapted checklist for reporting in vitro studies (Checklist for Reporting In vitro Studies guidelines) was used to assess the risk of bias. Results Eight studies evaluating tooth-supported fixed dental prosthesis casts and 7 studies evaluating implant-supported fixed dental prosthesis casts were eligible for this review. Gypsum casts showed greater accuracy (trueness and precision) in most studies, although additively manufactured casts also yielded highly precise data. One study was associated with a low risk of bias, 9 with a moderate risk of bias, and 5 with a high risk of bias. Conclusions In vitro studies showed that additively manufactured casts and gypsum casts share similar accuracy within the acceptable range for the fabrication of casts. The quality of scanned data, additive manufacture technology, printing settings, and postprocessing procedures plays an essential role in the accuracy of additively manufactured casts. Clinical studies are required to confirm these findings.

A fundamental step for cell growth and differentiation is the cell adhesion. The purpose of this study was to determine the adhesion of different cell lineages, adipose derived stromal cells, osteoblasts, and gingival fibroblast to titanium and zirconia dental implants with different surface treatments. Primary cells were cultured on smooth/polished surfaces (titanium with a smooth surface texture (Ti-PT) and machined zirconia (ZrO2-M)) and on rough surfaces (titanium with a rough surface texture (Ti-SLA) and zirconia material (ZrO2-ZLA)). Alterations in cell morphology (f-actin staining and SEM) and in expression of the focal adhesion marker were analysed after 1, 7, and 14 days. Statistical analysis was performed by one-way ANOVA with a statistical significance at p = 0.05. Cell morphology and cytoskeleton were strongly affected by surface texture. Actin beta and vimentin expressions were higher on rough surfaces (p &lt, 0.01). Vinculin and FAK expressions were significant (p &lt, 0.05) and increased over time. Fibronectin and laminin expressions were significant (p &lt, 0.01) and did not alter over time. Strength of cell/material binding is influenced by surface structure and not by material. Meanwhile, the kind of cell/material binding is regulated by cell type and implant material.

A new mutation of 2019-nCoV emerged and has been spreading worldwide. Dental practices are an important person-to-person transmission route. In this regard, preventive measures are required to avoid the cross contamination among professionals and patients. This report brings recommended measures for dental assistance during the pandemic phase. The clinical protocol applied at the Department of Oral Maxillofacial and Surgery, such as at the Department of Radiology, Hospital University Münster, is described. A management protocol was applied to prevent the transmission route of 2019-nCoV. Patients infected with 2019-nCoV are treated only in emergency situations. The use of protective equipment and dental office isolation were the major points to avoid the contact between infected and non-infected patients. Preventive measures should be taken in order to reduce the spread of 2019-nCoV infection.

(1) Background: Chronic non-bacterial osteomyelitis (CNO) is an autoinflammatory bone disease of finally unknown etiology, which can occur alone or related with syndromes (chronic recurrent multifocal osteomyelitis—CRMO; synovitis, acne, pustulosis, hyperostosis and osteitis syndrome—SAPHO). The involvement of the mandible is rather rare. (2) Methods: We carried out a systematic literature search on CNO with mandibular involvement, according to the “Preferred Reporting Items for Systematic Reviews and Meta-Analyses” (PRISMA) guidelines, considering the different synonyms for CNO, with a special focus on therapy. (3) Results: Finally, only four studies could be included. A total of 36 patients were treated in these studies—therefore, at most, only tendencies could be identified. The therapy in the included works was inconsistent. Various therapies could alleviate the symptoms of the disease. A complete remission could only rarely be observed and is also to be viewed against the background of the fluctuating character of the disease. The success of one-off interventions is unlikely overall, and the need for long-term therapies seems to be indicated. Non-steroidal anti-inflammatory drugs (NSAIDs) were not part of any effective therapy. Surgical therapy should not be the first choice. (4) Conclusions: In summary, no evidence-based therapy recommendation can be given today. For the future, systematic clinical trials on therapy for CNO are desirable.

Background Myositis ossificans describes a heterotopic bone formation within a muscle. Thereby myositis ossificans is classified in two different groups: myositis ossificans progressiva (MOP) which describes a genetic autosomal dominant rare disease and myositis ossificans traumatica (MOT). The exact pathogenesis of MOT is unclear. The aim of this article was to analyse and interpret the existing literature reporting MOT of masticatory muscles and compare the results with our own clinical experience with MOT. Risk-factors, etiology, clinical features, diagnostic imaging, as well as different treatment options were evaluated and recommendations for the prevention, diagnosis, and therapy of MOT of the masticatory muscles were given. Methods Following the PRISMA-Guidelines, a systematic search within the PubMed/Medline database with a view to record literature of MOT of the masticatory muscles was performed. Furthermore, the database of our own clinic was screened for cases of MOT. Results In total, 63 cases of MOT of the masticatory muscles which were reported in English-based literature were included in this study. Overall, 25 female and 37 male patients could be analysed whereas one patient’s gender was unknown. Complication of wisdom-tooth infection (n = 3) as well as the results of dental procedures like dental extraction (n = 7), mandibular nerve block (n = 4), periodontitis therapy (n = 1) were reported as MOT cases. From the 15 reported cases that appeared after dental treatment like extraction or local anesthesia the medial pterygoid (n = 10) was the most affected muscle. Hereof, females were more affected (n = 9) than males (n = 6). The most reported clinical symptom of MOT was trismus (n = 54), followed by swelling (n = 17) and pain (n = 13). One clinical case provided by the authors was detected. Conclusions Dental procedures, such as local anesthesia or extractions, may cause MOT of the masticatory musculature. Demographical analyses demonstrate that females have a higher risk of developing MOT with respect to dental treatment. The most important treatment option is surgical excision. Subsequent physical therapy can have beneficial effects. Nevertheless, a benefit of interpositional materials and drugs as therapy of MOT of the masticatory muscles has not yet been proven. Myositis ossificans progressiva has to be excluded. Electronic supplementary material The online version of this article (10.1186/s13005-018-0180-6) contains supplementary material, which is available to authorized users.

To evaluate the effect of blasting and bonding on abutment surface to prevent screw loosening in Morse taper connections.Twenty-eight Morse taper connection implants were divided into 4 groups: no treatment (G1), blasting (G2), bonding (G3), and blasting + bonding (G4). In groups G2 and G4, the abutments were blasted with aluminum oxide granules; in groups G3 and G4, the conical abutment region was covered with a thin layer of bond thread lock agent. In all implants, the abutment-implant joint was tightened at a torque of 35 Ncm. The specimens were submitted to the mechanical cycling, under an oblique load for 1.0 × 10 cycles. The torque was measured with a digital torque meter. Data were analyzed by the t test, one-way analysis of variance, and Tukey tests (95%).The loosening strength was significantly higher in group G4 (35.83 ± 3.02 Ncm). There was no significant difference among groups G1 (25.86 ± 1.96 Ncm), G2 (25.86 ± 3.29 Ncm), and G3 (26.14 ± 2.12 Ncm).The association of blasting and bonding on abutment surface can be used to prevent screw loosening in Morse taper implants.

Background: Ectodermal dysplasia describes a heterogeneous group of hereditary, congenital malformations involving developmental dystrophies of ectodermal structures. The aim of this study was to analyse the oral health-related quality of life (OHRQoL) in people with ectodermal dysplasia and to evaluate the influence of different variables. Methods: The study was designed as an anonymous epidemiological survey study among people with ectodermal dysplasia to evaluate oral symptoms, satisfaction with the health system and their respective OHRQoL using the validated German version of the OHIP-14 (Oral Health Impact Profile) questionnaire. Results: When asked about oral symptoms, 110 of the participants provided responses, of which 109 (99.09%) described oral symptoms. The average age of the female participants at the time of diagnosis was 17.02 years (range: 0 to 48 years), the average age of men was 5.19 years (range: 0 to 43 years). The average OHIP-14 overall score for female participants was 12.23 points (SD: 12.39), for male participants an average OHIP score of 11.79 points was recorded (SD: 11.08 points). Difficulty in finding a dentist (p = 0.001), and the dissatisfaction with the health system (p = 0.007) showed a negative impact on the OHRQoL. Conclusion: People with ectodermal dysplasia rate their OHRQoL worse than is usually prevalent in the normal German population (4.09 points), women are diagnosed with &ldquo, ectodermal dysplasia&rdquo, later than men. Participants who reported difficulties in finding a dentist for treatment exhibited higher OHIP values. Likewise, dissatisfaction with the health system demonstrated a negative impact on the oral health-related quality of life.

Purpose Implants in the anterior region are challenging, and literature reporting outcomes of narrow-diameter implants (NDIs) in anterior sites is scarce. This systematic review summarized evidence of functional and esthetic performance of anterior single crowns supported by NDIs. Materials and methods Ten databases were searched to find studies evaluating anterior single crowns supported by NDIs. Risk of bias was assessed, and random-effects meta-analyses were applied to analyze mean differences in survival, success, and marginal bone level (MBL). The review was registered in the PROSPERO database (CRD42018089886). Results Twenty-one studies meeting the screening criteria were included for qualitative analysis, and three for meta-analysis. A total of 892 NDIs, placed in 736 patients, were analyzed. Follow-up duration varied from 12 months to 14 years (mean: 40 months), and 16 failures (implant loss) were recorded. Fixed-effect meta-analysis (I2 = 0%) of survival rate revealed a risk difference of 0.02 (95% CI: -0.03 to 0.08), between NDIs and controls (regular-diameter implants), without differences between groups (P = .39). Success rates ranged from 84.2% to 100% (mean: 95.2%). Random-effects meta-analysis (I2 = 56%) of MBL indicated a mean difference of 0.02 mm (95% CI: -0.21 to 0.25), without differences between groups (P = .87). Conclusion Single crowns supported by NDIs are a predictable treatment, since their survival rate and MBL are comparable to those supported by regular-diameter implants. Due to data shortage reporting esthetic outcomes, more studies are needed to evaluate the long-term performance of the single crowns supported by NDIs in the anterior region.

Background The primary purpose of this study was to collect data on the oral health-related quality of life (OHRQoL) of individuals with x-linked hypophosphatemia (XLH). It was also designed to gather information on the period of diagnosis, oral symptoms, orthodontic therapy, and satisfaction with dental care and the healthcare system. Methods A questionnaire was developed to evaluate the OHRQoL consisting of open-ended questions and the standardised German version of the Oral Health Impact Profile-14 (OHIP-14). Results The questionnaires from 43 participants were analysed, including 32 females (74.41%) and 11 males (25.59%). The mean OHIP-14 total score for the combined genders was 10.30 points (range: 0–37 points). For the combined genders, the mean period of time that elapsed between the first signs of the illness and the diagnosis was 5.52 years (range: 0–49 years). In total, 77.50% of the participants described oral symptoms, such as tooth mineralisation defects (n = 26), abscess or fistula formation (n = 21), dysgnathia (n = 9) and temporomandibular dysfunction (n = 2). The correlation between the participants’ satisfaction with the healthcare system and the OHIP-14 values was weak (− 0.21), and it was not statistically significant (p = 0.199). Conclusions The majority of the study participants reported oral involvement in the context of XLH, especially dental hard tissue mineralisation disorders, abscess formation and fistula formation. Those individuals affected by XLH with oral manifestations exhibited a tendency toward a worse OHRQoL than those without oral symptoms. In Germany, the OHIP-14 scores for these XLH patients were worse than those values that were obtained from the general population. Electronic supplementary material The online version of this article (10.1186/s13005-019-0192-x) contains supplementary material, which is available to authorized users.

Journal of Clinical Medicine 8(10), 1539 (2019). doi:10.3390/jcm8101539, Published by MDPI, Basel

Objective: To evaluate the surface roughness of resin composite and ceramic material after immersion in mouthwashes. Methodology: Thirty specimens of resin composite and ceramic material were prepared with a stainless steel matrix (6 mm × 2 mm). The samples of each material were divided into three groups (n = 10), according to the mouthwashes: Distilled water (DW), chlorhexidine (CL) 0.12%, and cetylpyridinium chloride (CC). Specimens were individually submitted to the immersion cycle in 15 mL of mouthwash for 30 days, three times per day, for 1 min/cycle. Surface roughness measurements were performed at three different time intervals: Before the first cycle (T0), after 7 (T1), and 30 days (T2) of immersion. Data were analyzed by the two-way ANOVA and Tukey tests (P ≤ 0.05). Results: There was no statistically significant difference in surface roughness of resin composite among mouthwashes (DW - 1.4 ± 0.13 μm; CL - 1.16 ± 0.13 μm; CC - 1.18 ± 0.13 μm). Surface roughness was statistically significantly lower after 30 days (T2-0.56 ± 0.60 μm) compared with the initial period (T0-1.63 ± 0.60 μm) and after 7 days (T1-1.57 ± 0.60 μm). For ceramic material, CC (3.75 ± 0.60 μm) caused a higher level of surface roughness compared with DW (2.57 ± 0.60 μm) and CL (3.39 ± 0.60 μm). There was no statistically significant difference among the different time intervals (T0-3.05 ± 0.18 μm; T1-3.41 ± 0.18 μm; T2-3.26 ± 0.18 μm). Conclusion: Mouthwashes did not promote a significant change in surface roughness of composite resin. Cetylpyridinium chloride promoted an increase in surface roughness of dental ceramic.

Objective The aim of this review was to update the literature with regard to the digital methods available by CEREC Chairside system to register and design the occlusion, to report their efficacy and technical innovations in the field of Restorative Dentistry. A search strategy was performed using the key-words: “virtual articulator,” or “CAD-CAM and occlusal recording,” or “CAD-CAM and occlusion register,” or “CAD-CAM and occlusal contacts,” or “CAD-CAM and prosthesis.” Material and Methods Inclusion criteria comprised studies evaluating the use of digital methods available by CEREC System for occlusal registration and design during prosthodontics treatment. PubMed and Cochrane library and reference lists were searched up to January 2016. Results The search resulted in 280 articles after removing duplicates. Subsequently, 233 records were excluded and 49 studies were selected for reading in full. Eleven articles were considered eligible for the systematic review (4 in vitro and 7 clinical studies). Conclusion Scientific evidence suggests that digital methods were accurate to register and design the occlusion of dental prostheses. Nevertheless, further clinical studies are required to establish a conclusion with regard to its accuracy in prosthodontics treatment. Clinical Significance Digital technologies allow the design of occlusal surfaces of CAD-CAM fabricated prostheses using innovative approaches. This systematic review aimed to update the literature to help dentists determine the most appropriate digital method to register and design the occlusal surface of CAD-CAM crowns. (J Esthet Restor Dent 28:208–220, 2016)

The aim of this study was to assess trabecular bone morphology via magnetic-resonance imaging (MRI) using microcomputed tomography (&micro, CT) as the control group. Porcine bone samples were scanned with T1-weighted turbo spin echo sequence imaging, using TR 25 ms, TE 3.5 ms, FOV 100 &times, 100 &times, 90, voxel size 0.22 &times, 0.22 &times, 0.50 mm, and scan time of 11:18. &micro, CT was used as the control group with 80 kV, 125 mA, and a voxel size of 16 &micro, m. The trabecular bone was segmented on the basis of a reference threshold value and morphological parameters. Bone volume (BV), Bone-volume fraction (BvTv), Bone specific surface (BsBv), trabecular thickness (TbTh), and trabecular separation (TbSp) were evaluated. Paired t-test and Pearson correlation test were performed at p = 0.05. MRI overestimated BV, BvTv, TbTh, and TbSp values. BsBv was the only parameter that was underestimated by MRI. High statistical correlation (r = 0.826, p &lt, 0.05) was found for BV measurements. Within the limitations of this study, MRI overestimated trabecular bone parameters, but with a statistically significant fixed linear offset.

Three-dimensional (3D) mini plate systems are used in the treatment of mandibular fractures. The system is advantageous in comparison to conventional plates due to the stabilization of tension and compression areas, improved initial stability, and biomechanical behavior. The aim of this retrospective study was to evaluate the use of a 3D miniplate system for the treatment of patients with mandibular fractures. Patients with mandibular fractures treated with a 3D plate system at the Department of Oral and Maxillofacial Surgery, University Hospital M&uuml, nster, during a period of 5 years, were included in this study. Mandibular fracture conditions and minor and major post-operative complications were reported. In total, 336 patients and 391 mandibular fractures were assessed. The most common fracture site was anterior mandible, and 155 cases involved a tooth-bearing area. Minor complications were seen in 8.03% of cases, whereas only 1.49% of patients suffered from major complications. The treatment of mandible fractures using 3D miniplates resulted in fracture reduction with a low complication rate.

For the guided regeneration of periimplant hard and soft tissues, human adipose-derived stromal cells (hADSC) seem to be a promising source for mesenchymal stromal cells. For this, the proliferation and differentiation of hADSC were evaluated on titanium and zirconia dental implants with different surface treatments. Results were compared to edaphic cells as human osteoblasts (hOB) and human gingival fibroblasts (HGF). Primary cells were cultured on (1) titanium implants with a polished surface (Ti-PT), (2) sandblasted and acid-etched titanium (Ti-SLA), (3) sandblasted and alkaline etched zirconia (ZrO2-ZLA) and (4) machined zirconia (ZrO2-M). The cell proliferation and differentiation on osteogenic lineage were assessed after 1, 7 and 14 days. Statistical analysis was performed by one-way ANOVA and a modified Levene test with a statistical significance at p = 0.05. PostHoc tests were performed by Bonferroni-Holm. Zirconia dental implants with rough surface (ZrO2-ZLA) showed the highest proliferation rates (p = 0.048). The osteogenic differentiation occurred early for zirconia and later for titanium implants, and it was enhanced for rough surfaces in comparison to polished/machined surfaces. Zirconia was more effective to promote the proliferation and differentiation of hADSCs in comparison to titanium. Rough surfaces were able to improve the biological response for both zirconia and titanium.

The purpose of this study was to determine the buccal bone dimensions surrounding dental implants using a high-frequency ultrasound (US) scanner and cone-beam computed tomography (CBCT). Dental implants (n = 10) inserted in the maxilla of dry skulls were scanned using US (28 MHz, bandwidth 84%, aperture 6 mm, focal depth 13.2 mm) and CBCT (70 kV, 6.3 mA, voxel size 0.18 mm). The bone level and buccal bone thickness were determined on the buccal-lingual diameter of the implant. As a control group, the evaluated site was represented by a stone block containing the dental implant, and measurements were performed using an optical microscope. Statistical analysis was performed using a mixed linear regression model at a significance level of p0.05. There was no statistical difference among groups for the two measurements. For ultrasound, the mean discrepancy was 0.38 mm for bone thickness and 0.68 mm for bone level. For CBCT, the mean discrepancy was 0.51 mm for bone thickness and 0.09 mm for bone level. High-frequency ultrasound was able to measure buccal bone dimensions surrounding dental implants.

Publisher's version (útgefin grein), Objectives: Working Group 2 was convened to address topics relevant to prostho-dontics and dental implants. Systematic reviews were developed according to fo -cused questions addressing (a) the number of implants required to support fixed full- arch restorations, (b) the influence of intentionally tilted implants compared to axial positioned implants when supporting fixed dental prostheses (FDPs), (c) implant placement and loading protocols, (d) zirconia dental implants, (e) zirconia and metal ceramic implant supported single crowns and (f) zirconia and metal ceramic implant supported FDPs.Materials and methods: Group 2 considered and discussed information gathered in six systematic reviews. Group participants discussed statements developed by the authors and developed consensus. The group developed and found consensus for clinical recommendations based on both the statements and the experience of the group. The consensus statements and clinical recommendations were presented to the plenary (gathering of all conference attendees) and discussed. Final versions were developed after consensus was reached.Results: A total of 27 consensus statements were developed from the systematic re -views. Additionally, the group developed 24 clinical recommendations based on the combined expertise of the participants and the developed consensus statements.Conclusions: The literature supports the use of various implant numbers to support full- arch fixed prostheses. The use of intentionally tilted dental implants is indicated when appropriate conditions exist. Implant placement and loading protocols should be considered together when planning and treating patients. One- piece zirconia den -tal implants can be recommended when appropriate clinical conditions exist although two- piece zirconia implants should be used with caution as a result of insufficient data. Clinical performance of zirconia and metal ceramic single implant supported crowns is similar and each demonstrates significant, though different, complications.Zirconia ceramic FDPs are less reliable than metal ceramic. Implant supported mono -lithic zirconia prostheses may be a future option with more supporting evidence.

Background: The aim of this study was to analyze data on oral health-related quality of life (OHRQoL) in people with Marfan syndrome and to obtain information on the diagnosis period, orthodontic treatment, and oral symptoms. Methods: A questionnaire was developed consisting of open questions and the standardized German version of the OHIP-14 (Oral Health Impact Profile) questionnaire for the evaluation of OHRQoL. The age of diagnosis, time period from the first signs of the disease to diagnosis, and OHIP-values were compared between male and female participants. Additionally, the OHIP-values between participants who were orthodontically treated and those who were not treated were assessed. The statistical analysis was performed using the Mann&ndash, Whitney test with a significance level at p = 0.05. Results: A total of 51 questionnaires were evaluated, which included 34 female and 17 male participants. Overall, 84% of respondents reported oral symptoms. Male respondents tended to diagnose the disease earlier (p = 0.00), with a smaller period between the first symptom and the diagnosis (p = 0.04). The OHIP-14 score was gender-neutral at 13.65 &plusmn, 13.53 points. Conclusion: In Marfan syndrome, many years (12.01 &plusmn, 11.61) elapse between the onset of first symptoms and correct diagnosis of the disease. People with Marfan syndrome have a worse OHRQoL than do the general population.

Background: The aim of this study was to examine the current dental care situation in Germany from the perspective of those affected by a rare disease, especially concerning their satisfaction with the German dental health care system, and thus assess the relationship between their perspective and their oral health-related quality of life (OHRQoL). Methods: A questionnaire regarding their experiences with the dental assistance and the health care system, such as the OHIP-14, was sent to the member associations of the organization of self-help groups for rare diseases ACHSE e.V. The correlation between OHIP-14 values and patient&rsquo, s perspective was statistically analyzed by the non-parametric Tau de Kendall test (p &lt, 0.05). Results: There was a statistically significant correlation between the OHIP score and the patient&rsquo, s perspective regarding dental assistance and health care system (p &lt, 0.05). For those surveyed who were satisfied with the support of the health care system, an average OHIP score of 8.54 &plusmn, 10.45 points (range: 0&ndash, 48) was determined. The group that did not feel sufficiently supported by the health care system had an average OHIP score of 16.07 &plusmn, 13.43 points (range: 0&ndash, 56). Discussion: The majority of respondents with rare diseases are dissatisfied with the German health care system and its support with regard to dental care.

OBJECTIVES: Working Group 5 was assigned the task to review the current knowledge in the area of digital technologies. Focused questions on accuracy of linear measurements when using CBCT, digital vs. conventional implant planning, using digital vs. conventional impressions and assessing the accuracy of static computer-aided implant surgery (s-CAIS) and patient-related outcome measurements when using s-CAIS were addressed. MATERIALS AND METHODS: The literature was systematically searched, and in total, 232 articles were selected and critically reviewed following PRISMA guidelines. Four systematic reviews were produced in the four subject areas and amply discussed in the group. After emendation, they were presented to the plenary where after further modification, they were accepted. RESULTS: Static computer-aided surgery (s-CAIS), in terms of pain & discomfort, economics and intraoperative complications, is beneficial compared with conventional implant surgery. When using s-CAIS in partially edentulous cases, a higher level of accuracy can be achieved when compared to fully edentulous cases. When using an intraoral scanner in edentulous cases, the results are dependent on the protocol that has been followed. The accuracy of measurements on CBCT scans is software dependent. CONCLUSIONS: Because the precision intraoral scans and of measurements on CBCT scans and is not high enough to allow for the required accuracy, s-CAIS should be considered as an additional tool for comprehensive diagnosis, treatment planning, and surgical procedures. Flapless s-CAIS can lead to implant placement outside of the zone of keratinized mucosa and thus must be executed with utmost care. ispartof: CLINICAL ORAL IMPLANTS RESEARCH vol:29 pages:436-442 ispartof: location:Denmark status: published

Bone grafting provides ideal conditions to the patient's rehabilitation with dental implants. In addition, prototyped tridimensional models allow the surgical procedure to be simulated and enable important anatomic structures to be visualized. To present a bone defect rehabilitated with xenogenic bone preshaped on a stereolithographic model and the follow-up after 7 years of treatment. The present case report describes a bone defect rehabilitated with a lyophilized bone block preshaped on a stereolithographic model. The patient, a 56-year-old woman, was referred to the dental office presenting a bone defect in the anterior maxilla. Bone regeneration intervention was performed with xenogenic grafting and barrier membrane. The follow-up of the postoperative period and after 7 years is presented. After 7 years, the tomographic exam showed the maintenance of bone at the grafted site, representing the long-term success of the treatment.

Statement of problem The accuracy of the virtual images used in digital dentistry is essential to the success of oral rehabilitation. Purpose The purpose of this systematic review was to estimate the mean accuracy of digital technologies used to scan facial, skeletal, and intraoral tissues. Material and methods A search strategy was applied in 4 databases and in the non–peer-reviewed literature from April through June 2017 and was updated in July 2017. Studies evaluating the dimensional accuracy of 3-dimensional images acquired by the scanning of hard and soft tissues were included. Results A total of 2093 studies were identified by the search strategy, of which 183 were initially screened for full-text reading and 34 were considered eligible for this review. The scanning of facial tissues showed deviation values ranging between 140 and 1330 μm, whereas the 3D reconstruction of the jaw bone ranged between 106 and 760 μm. The scanning of a dentate arch by intraoral and laboratorial scanners varied from 17 μm to 378 μm. For edentulous arches, the scanners showed a trueness ranging between 44.1 and 591 μm and between 19.32 and 112 μm for dental implant digital scanning. Conclusions The current digital technologies are reported to be accurate for specific applications. However, the scanning of edentulous arches still represents a challenge.

The internal and marginal adaptation of a computer-aided design and computer-aided manufacturing (CAD-CAM) prosthesis relies on the quality of the 3-dimensional image. The quality of imaging systems requires evaluation.The purpose of this in vitro study was to evaluate and compare the trueness of intraoral and extraoral scanners in scanning prepared teeth.Ten acrylic resin teeth to be used as a reference dataset were prepared according to standard guidelines and scanned with an industrial computed tomography system. Data were acquired with 4 scanner devices (n=10): the Trios intraoral scanner (TIS), the D250 extraoral scanner (DES), the Cerec Bluecam intraoral scanner (CBIS), and the Cerec InEosX5 extraoral scanner (CIES). For intraoral scanners, each tooth was digitized individually. Extraoral scanning was obtained from dental casts of each prepared tooth. The discrepancy between each scan and its respective reference model was obtained by deviation analysis (μm) and volume/area difference (μm). Statistical analysis was performed using linear models for repeated measurement factors test and 1-way ANOVA (α=.05).No significant differences in deviation values were found among scanners. For CBIS and CIES, the deviation was significantly higher (P.05) for occlusal and cervical surfaces. With regard to volume differences, no statistically significant differences were found (TIS=340 ±230 μm; DES=380 ±360 μm; CBIS=780 ±770 μm; CIES=340 ±300 μm).Intraoral and extraoral scanners showed similar trueness in scanning prepared teeth. Higher discrepancies are expected to occur in the cervical region and on the occlusal surface.

Statement of problem Limited evidence is available comparing digital versus conventional impressions from the point of view of patient preference. Purpose The purpose of this systematic review was to identify and summarize the available literature related to patient-centered outcomes for digital versus conventional impression techniques. Material and methods The databases Medline, Cochrane, Science Direct, Scopus, and Embase were electronically searched and complemented by hand searches. All published papers available on the databases from 1955 to July 2016 were considered for title and abstract analysis. Results A total of 2943 articles were initially identified through database searches, of which only 5 met the inclusion criteria for qualitative analysis. Four studies comparing patient-reported outcome measures (PROMs) between conventional and digital impressions revealed that the digital technique was more comfortable and caused less anxiety and sensation of nausea. Only 1 study reported no difference between the techniques regardless of patient comfort. Two studies reported a shorter procedure for the conventional technique, whereas 3 studies reported a shorter procedure for the digital technique. Conclusions A lack of clinical studies addressing patient outcomes regarding digital prosthodontic treatments was observed among the included articles. However, current evidence suggests that patients are more likely to prefer the digital workflow than the conventional techniques.

The aim of this study was to determine the accuracy of linear measurements around dental implants when using CBCT unit devices presenting different exposure parameters.Dental implants (n = 18) were installed in the maxilla of human dry skulls, and images were obtained using two CBCT devices: G1-Care Stream 9300 (70 kVp, 6.3 mA, voxel size 0.18 mm, field of view 8 × 8 cm; Carestream Health, Rochester, NY) and G2-R100 VeraviewThere was no statistical difference for the mean values of bone thickness on Point A (CG: 4.85 ± 2.25 mm, G1: 4.19 ± 1.68 mm, G2: 4.15 ± 1.75 mm), Point B (CG: 1.50 ± 0.84 mm, G1: 1.61 ± 1.27 mm; G2: 1.68 ± 0.82 mm) and Point C (CG: 1.78 ± 1.33 mm, G1: 1.80 ± 1.09 mm; G2: 1.64 ± 1.11 mm). G1 and G2 differed in bone thickness by approximately 0.76 mm for Point A, 0.36 mm for Point B and 0.08 mm for Point C. A lower intraclass variability was identified for CG (Point A = 0.20 ± 0.25; Point B = 0.15 ± 0.20; Point C = 0.06 ± 0.05 mm) in comparison with G1 (Point A = 0.56 ± 0.52; Point B = 0.48 ± 0.50; Point C = 0.47 ± 0.56 mm) and G2 (Point A = 0.57 ± 0.51; Point B = 0.46 ± 0.46; Point C = 0.36 ± 0.31 mm).CBCT devices showed acceptable accuracy for linear measurements around dental implants, despite the exposure parameters used.

Objective The aim of this study was to systematically review the literature regarding diagnostic accuracy of imaging techniques in detecting peri-implant bone defects. Study Design The search was performed in 8 electronic databases from April to May 2016 and updated in September 2016. Studies that assessed imaging techniques to detect peri-implant bone defects were analyzed. Results The search yielded 680 articles published from 1991 to 2016. Of these, 12 studies were considered eligible for this review. The selected studies evaluated the use of cone beam computed tomography (CBCT), intraoral radiography (IR), computed tomography, and panoramic radiography. The sensitivity for CBCT was 59%, whereas the specificity was 67%. For IR, the sensitivity was 60%, and the specificity was 59%. Area under the curve values in receiver operating characteristic (ROC) analysis were 69% for CBCT and 63% for IR. For CBCT, the highest value for positive predictive value was 0.94, negative predictive value was 0.98, positive likelihood ratio was 21.3, and negative likelihood ratio was 1.28. For IR, the highest positive predictive value was 1.0, negative predictive value 1.0, positive likelihood ratio 50.0, and negative likelihood ratio 0.70. The highest diagnostic odds ratio was 80 for CBCT and 4.45 for IR. No conclusion could be drawn for additional techniques. Conclusions Both CBCT and IR showed a clinically acceptable performance for assessing peri-implant bone defects.