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A method is presented for obtaining a virtual 4-dimensional patient that replicates the intended esthetic treatment. The process involves facial and intraoral scanning to acquire records and software manipulation to enable a virtual waxing of the smile. Once the digital design is complete, patient information can be merged to generate an animated video of the projected rehabilitation, displaying movement and smile dynamics. This strategy provides a noninvasive and reliable diagnostic tool for predicting clinical outcomes.

The present clinical report describes the rehabilitation of a patient diagnosed with ectodermal dysplasia performed by an interdisciplinary team in a comprehensive approach aided by digital technology. The complexity of the treatment was related to predictability regarding timing and the type of approach. The patient was referred for treatment because of congenitally missing and abnormally shaped permanent teeth. The need for an interdisciplinary team involving orthodontic, periodontic, and prosthodontic specialists was identified. A virtual treatment plan was developed to guide tooth movement, placement of dental implants, and tooth preparation for indirect restorations. Therefore, each treatment phase could be communicated to the patient and treatment team in a predictable way.

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.

Objective To assess whether digital workflow gives better results than the conventional one in the single implant crowns, when analyzing the impression time, patient preference, time efficiency, and adjustment time. Material and methods MEDLINE, Embase, and Cochrane were searched and supplemented via hand search up to June 19, 2019. Only clinical trials assessing conventional versus digital workflows for single implant crowns were included. Impression time was evaluated using random effects meta-analysis, while patient preference, adjustment time, and time efficiency were reported descriptively. Results Among 1,334 publications identified, ten studies were included. The random effects models revealed statistically significant reduction in time in the digital impression group when compared to the conventional group by the mean meta-analysis (MD: 8.22 [95% CI: 5.48, 10.96]). Analysis from immediate digital impression versus conventional (MD: 3.84 [95% CI: 3.30, 4.39]) and regular digital impression versus conventional (MD:10.67 [95% CI: 5.70, 15.65]) showed statistically significant reduction in time on using the digital impression. Impression time in the digital process ranged between 6 min 39 s and 20 min, whereas for conventional, it was between 11.7 and 28.47 min. Patients showed greater preference for digital impression. Adjustment time in the digital process ranged between 1.96 and 14 min, whereas for conventional, it was between 3.02 and 12 min. Time efficiency in the digital process ranged between 36.8 and 185.4 min, whereas for conventional, it was between 55.6 and 332 min. Conclusion The digital workflow has demonstrated better clinical efficiency considering impression time, patient preference, and time efficiency. According to the adjustment time, different results were presented.

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.

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.

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.

Aim: The aim of this systematic review was to compare the survival rate and the marginal bone loss between short implants (≤7 mm) placed in the atrophic area and longer implants placed in the augmented bone area of posterior regions of maxillaries. Methods: Electronic search using three databases was performed up to May 2017 to identify Randomized Controlled Trials (RCT) assessing short implants survival with a minimal follow-up of 12 months post-loading. For the meta-analysis, a Risk Difference (RD) with the 95% Confidence Interval (CI) was used to pool the results of implant failure rate for each treatment group. For the marginal bone changes, Mean Differences (MD) with 95% CI were calculated. Results: Seven randomized controlled trials met the inclusion criteria, being included in qualitative and quantitative analyses. The RD between the short implant group and the control group was -0.02 (95% CI: -0.04 to 0.00), I2=0 and Chi2=3.14, indicating a favorable survival rate for short implant, but with no statistical significance (p=0.09). Discussion: For marginal bone loss, the mean difference was -0,13 (95%CI: -0.22 to -0.05), favoring the test group with statistical significance (p=0.002). The studies showed more heterogeneity for bone loss compared to survival rate. Short and longer implants showed similar survival rates after one year of loading, however the marginal bone loss around short implants was lower than in longer implants sites. Conclusion: Placement of implants ≤7 mm of length was found to be a predictable alternative for the rehabilitation of atrophic posterior regions, avoiding all the disadvantages intrinsic to bone augmentation procedures.

Medical and dental histories, clinical examination, study models, and photographs provide the data for a proper diagnosis and the treatment plan for esthetic dentistry. However, they do not offer all the information necessary to analyze the smile and create harmony with the lips and face without excessive intraoral adjustments. Dentolabial parameters vary according to lip dynamics and are influenced by both a static posed smile and a smile in motion as captured in video. This article describes a documentation protocol using smartphone videos to improve the analysis, smile design decisions, and elaboration of a 2D smile frame that will guide the 3D digital smile design project. The use of dynamic documentation of the smile (DDS) allows esthetic rehabilitative planning from a facial perspective, improvement of communication with the patient, integration between the specialists, and the predictable quality of the treatments.

New solutions need to be developed for cases in which implants that were placed years ago are now presenting prosthetic complications. A conical head screw design for a single-tooth abutment was developed to preserve the initial applied torque. The aim of this study was to assess the preload maintenance of different screw design sets (a conical head screw set and a flat head screw set) for single-tooth abutments in external hexagon implants, verifying whether reverse torque changes after mechanical loading at different crown/implant ratios and to understand if the use of the tested conical head screw set design can help clinicians solve loosening torque.Forty external hexagonal implants, 40 single-tooth abutments, 20 conical head screws, and 20 flat head screws were split into four groups with different crown/implant ratios (crown/implant ratio1 or crown/implant ratio1). The abutments were attached to the implants by applying a torque of 35 Ncm; the specimens were mechanically loaded for 1 million cycles, and the loosening torque was checked and recorded with a digital torque wrench. The Kruskal-Wallis test (P = .05) and Wilcoxon test were performed to assess the results.In all groups, at least one specimen kept 100% of the initial applied torque before mechanical loading (t0). After mechanical loading (t1), all specimens presented torque reduction. The Kruskal-Wallis test was performed, and the flat head screw t0 group presented lower torque maintenance and a significant difference (P.05) compared with the initial applied torque and with the conical head screw t0 group. The conical head screw t0 group presented a higher torque maintenance and no significant difference (P.05) compared with the initial applied torque. For the flat head screw, the crown/implant ratio affected the torque maintenance. For the conical head screw, the crown/implant ratio did not affect the torque maintenance (P.05).The conical head screw set presented a higher maintenance of applied preload than the flat head screw set. As far as reverse torque is concerned, the crown/implant ratio affects the torque maintenance only in association with a flat head screw set. The use of the tested conical head screw set can help clinicians solve loosening torque, mainly in a situation with a crown/implant ratio1.

Purpose To perform a systematic review on studies assessing clinical outcomes in patients rehabilitated with complete-arch fixed implant-supported prostheses according to the time of loading. Materials and methods Data obtained from patient and clinical outcomes, as implant failure, success rate, survival rate, biological complications, technical complications, mechanical complications, and marginal bone loss, were included on this review. The search was performed on databases PubMed, Scopus, and Cochrane. Cochrane Collaboration tool was used to assess the risk of bias of randomized controlled studies, and an adapted version of Newcastle-Ottawa scale was used for observational studies. All data were tabulated according to the time of loading: (1) immediate restoration/loading, (2) early loading, and (3) conventional loading. Results From a total of 4027 studies identified through the three databases, six of them were randomized controlled trials, five of them were prospective observational studies, and another five were retrospective observational studies. In total, 5954 implants, 1294 patients and 1305 full-arch fixed implant-supported prostheses were included in this review. There was a wide heterogeneity among clinical studies regarding the study design and treatment procedures. Thus, pooled estimates were not performed in order to avoid potential biases. The methodological assessment by the Modified Newcastle-Ottawa scale showed a moderate quality of observational studies. Regarding the RCTs studies, all of them presented at least one element of bias according to the Cochrane Collaboration tool for assessing risk of bias. Conclusion There is evidence of high survival-success implant rate (95-100%) for either loading protocols (immediate restoration/loading, early loading, and conventional loading). However, careful attention must be taken by clinician when interpreting the results reported in clinical studies. Future studies should be performed using standardized methodology in order to determine the true predictability regarding immediate, early, and conventional loading protocols.

This systematic review and meta-analysis aimed to evaluate the survival rate of ceramic and resin inlays, onlays, and overlays and to identify the complication types associated with the main clinical outcomes. Two reviewers searched PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials for articles published between 1983 through April 2015, conforming to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for systematic reviews. Clinical studies meeting the following criteria were included: 1) studies related to resin and ceramic inlays, onlays, and overlays; 2) prospective, retrospective, or randomized controlled trials conducted in humans; 3) studies with a dropout rate of less than 30%; and 4) studies with a follow-up longer than 5 y. Of 1,389 articles, 14 met the inclusion criteria. The meta-regression indicated that the type of ceramic material (feldspathic porcelain vs. glass-ceramic), study design (retrospective vs. prospective), follow-up time (5 vs. 10 y), and study setting (university vs. private clinic) did not affect the survival rate. Estimated survival rates for glass-ceramics and feldspathic porcelain were between 92% and 95% at 5 y ( n = 5,811 restorations) and were 91% at 10 y ( n = 2,154 restorations). Failures were related to fractures/chipping (4%), followed by endodontic complications (3%), secondary caries (1%), debonding (1%), and severe marginal staining (0%). Odds ratios (95% confidence intervals) were 0.19 (0.04 to 0.96) and 0.54 (0.17 to 1.69) for pulp vitality and type of tooth involved (premolars vs. molars), respectively. Ceramic inlays, onlays, and overlays showed high survival rates at 5 y and 10 y, and fractures were the most frequent cause of failure.

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)

Aim To systematically assess the current dental literature comparing the accuracy of computer-aided implant surgery when using different supporting tissues (tooth, mucosa, or bone). Material and Methods Two reviewers searched PubMed (1972 to January 2015) and the Cochrane Central Register of Controlled Trials (Central) (2002 to January 2015). For the assessment of accuracy, studies were included with the following outcome measures: (i) angle deviation, (ii) deviation at the entry point, and (iii) deviation at the apex. Results Eight clinical studies from the 1602 articles initially identified met the inclusion criteria for the qualitative analysis. Four studies (n = 599 implants) were evaluated using meta-analysis. The bone-supported guides showed a statistically significant greater deviation in angle (P

Purpose: The purpose of this study was to evaluate the behavior of mandibular canines acting as abutment teeth and indirect retainers of a Kennedy class II according to different designs: lingual rest and lingual rest associated with a reciprocal arm. Materials & methods: A resin cast with two simulated canine teeth was made in Ni-Cr alloy, representing a Kennedy class II mandibular arch. With the objective of simulating the resilience of the periodontal ligament, a polyurethane layer was added at the canine tooth's root. A metallic framework of Co-Cr alloy was fabricated with a T bar clasp and a lingual rest associated with a reciprocal arm. To obtain the second framework, the reciprocal arm was removed using a tungsten bur. Each framework was submitted to tensile force using a VersaTest machine. The magnitude and direction of canine movement during removal of the framework was measured using two dial gauges (mm). The axial tensile force required to remove the experimental framework (N) was also evaluated. The data were compared using the paired t-test with 95% confidence intervals. Differences were considered significant at P < .05. Results: The mean retentive force of the modified design framework with the reciprocal arm was significantly higher (P < .0001) than that of the framework with the lingual rest. The abutment teeth showed movement in the lingual and mesial directions, and this movement was less when associated with the reciprocal arm design. Conclusion: The reciprocal arm in association with a lingual rest in the framework decreased the movement of the abutment teeth when analyzed in the bucco-lingual and mesio-distal directions and contributed to increased retention by friction.

The process of tooth loss throughout life associated with severe occlusal wear may pose a challenge in the rehabilitation of partially edentulous arches. In these cases, many therapeutic procedures are necessary because each tooth must be restored to obtain the correct anatomical contour and recover the occlusal vertical dimension (OVD). A removable partial denture (RPD) with occlusal/incisal coverage, also known as an overlay RPD, is an alternative treatment option with fewer interventions, and, consequently, lower cost. This clinical report reviews the principles involved in the clinical indication for an overlay RPD, as well as the necessary planning and execution, to discuss the feasibility and clinical effectiveness of this treatment, identifying the indications, advantages, and disadvantages of this procedure through the presentation of a clinical case. The overlay RPD can be an alternative treatment for special situations involving partially edentulous arches in patients who need reestablishment of the OVD and/or realignment of the occlusal plane, and it can be used as a temporary or definitive treatment. The main advantages of this type of treatment are its simplicity, reversibility, and relatively low cost; however, further studies are needed to ensure the efficacy of this treatment option.

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.

Background Despite the existence of several studies validating the use of narrow diameter implants, most of them are based on pure Ti alloys. There is few clinical evidence of the success of TiZr narrow diameter implants (TiZr NDIs) regarding survival rate (SR) and marginal bone loss (MLB). Purpose The aim of this review was to systematically assess SR, as well as MBL of TiZr NDIs compared to commercially pure titanium narrow diameter implants (cpTi NDIs). Material and Methods The search was conducted in Medline/PubMed, Cochrane, Scopus, and Embase databases (year 2000 to November 2016). Cohort studies and randomized trials were included. Results Six clinical studies from the 3453 articles initially identified met the inclusion criteria. There were no statistically significant differences in SR when TiZr NDIs and cpTi NDIs were compared in the 1-year follow up (P = .5), or when comparing TiZr NDIs placed in posterior and anterior regions. There was no difference between groups regarding 1-year SR: −0.01 (95% CI, −0.05-0.03) and MLB: −0.01 mm (95% CI: −0.14-0.12). Conclusion It can be concluded that TiZr NDIs present similar success rates and peri-implant bone resorption to cpTi NDIs.

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.

Background Chemical modifications of the dental implant surface that improve the wettability result in a faster and better osseointegration. Purpose The aim of this randomized clinical trial was to evaluate the implant stability quotient (ISQ) of implants with similar designs, treated with 2 surfaces, sandblasted acid-etched (SAE) and hydrophilic SAE, within the initial 16 weeks of healing. Material and methods A total of 64 implants (32 SAE—control group and 32 modified SAE—test group) with the same design, length, and diameter (conical and compressive, 4.3 × 10 mm) were inserted into the posterior maxillae of 21 patients partially edentulous. The ISQ values were collected at post-surgery (T0), 1 week (T1), 2 weeks (T2), 3 weeks (T3), 5 weeks (T4), 8 weeks (T5), 12 weeks (T6), and 16 weeks (T7). Results None of the implants failed. Test group presented ISQ values higher than the control group (ANOVA—P

The aim of the present study was to perform a software-assisted radiographic assessment of the effect of platform-switching on marginal bone loss (MBL) around dental implants. Forty patients requiring a dental implant in non-grafted partially edentulous mandibles were enrolled and categorized into implants receiving a platform-matched abutment (control group) or implants with a platform-switched abutment (test group). Standardized digital periapical radiographs were taken at the time of implant placement (T0), at implant loading (T1) and 1-year after functional loading (T2). Software-assisted radiographic assessment of the MBL horizontal, vertical and area changes was performed and compared between time intervals (T1-T0, T2-T1 and T2-T0). Mean radiographic horizontal MBL (hMBL) and vertical MBL (vMBL) from implant placement to 1-year after implant loading (T2-T0) were significantly increased around platform-matched when compared to platform-switched abutments (1.04 mm vs 0.84 mm, p

Background There is no consensus on whether incisal coverage is a risk or a protective factor in preparations for ceramic veneers. Objective The aim of this systematic review and meta-analysis was to evaluate the survival rates of preparation designs for ceramic veneers with and without incisal coverage. Methods Primary clinical studies with the following characteristics were included: 1) studies related to ceramic laminate veneers and 2) prospective or retrospective studies conducted in humans. From the selected studies, the survival rates and failures rates for ceramic veneers were extracted according to preparation design, with or without incisal coverage. The Cochran Q test and the I 2 statistic were used to evaluate heterogeneity. Metaregression, meta-analysis were performed. Two reviewers searched in the MEDLINE (Pubmed) and Cochrane Central Register of Controlled Trials (Central) electronic databases, from 1977 to June 5, 2016, without language restrictions. Results Eight studies out of 1145 articles initially identified were included for risk of bias and systematic assessment. No study was identified for crystalline ceramic veneers. The estimated survival rate for laminate veneers with incisal coverage was 88% and 91% for those without incisal coverage. Incisal coverage presented an OR of 1.25. Conclusions Irrespective of the preparation designs, with or without incisal coverage, ceramic veneers showed high survival rates. As regard implications for future clinical research studies, randomized clinical studies are necessary to compare preparation designs with and without incisal coverage, and to provide clear descriptions of these preparation designs.

The digital smile design is a practical diagnosis method that can assist the clinician to visualize and measure dentogingival discrepancies. This clinical report aims to present the associated steps, from the diagnosis of the alterations diagnosis through to the final aesthetic result. A 37-years-old female patient presented as her main complaint the tooth form and colour discrepancies. Applying the digital smile design principle, the necessary measures for a harmonic smile correction could be accurately determined. The initial diagnosis led to a wax up of the master cast that was duplicated in acrylic resin directly in the mouth. This temporary restoration guided the periodontal surgery and the final pressed ceramic crown restoration. We conclude that the digital smile design concept seems to be a useful tool to achieve a satisfactory aesthetic result.

Purpose: The aim of this study was to perform a systematic review and meta-analysis based on clinical trials that evaluated the main outcomes of glass-ceramic and feldspathic porcelain laminate veneers. Materials and Methods: A systematic search was carried out in Cochrane and PubMed databases. From the selected studies, the survival rates for porcelain and glassceramic veneers were extracted, as were complication rates of clinical outcomes: debonding, fracture/chipping, secondary caries, endodontic problems, severe marginal discoloration, and influence of incisal coverage and enamel/dentin preparation. The Cochran Q test and the I2 statistic were used to evaluate heterogeneity. Results: Out of the 899 articles initially identified, 13 were included for analysis. Metaregression analysis showed that the types of ceramics and follow-up periods had no influence on failure rate. The estimated overall cumulative survival rate was 89% (95% CI: 84% to 94%) in a median follow-up period of 9 years. The estimated survival for glass-ceramic was 94% (95% CI: 87% to 100%), and for feldspathic porcelain veneers, 87% (95% CI: 82% to 93%). The meta-analysis showed rates for the following events: debonding: 2% (95% CI: 1% to 4%); fracture/chipping: 4% (95% CI: 3% to 6%); secondary caries: 1% (95% CI: 0% to 3%); severe marginal discoloration: 2% (95% CI: 1% to 10%); endodontic problems: 2% (95% CI: 1% to 3%); and incisal coverage odds ratio: 1.25 (95% CI: 0.33 to 4.73). It was not possible to perform meta-analysis of the influence of enamel/dentin preparation on failure rates. Conclusion: Glass-ceramic and porcelain laminate veneers have high survival rates. Fracture/ chipping was the most frequent complication, providing evidence that ceramic veneers are a safe treatment option that preserve tooth structure.

Harmony among the teeth, lips, and facial components is the goal of prosthodontic treatment, whether performed by conventional or digital workflow methods. This clinical report describes a facial approach to planning computer-guided surgery and immediate computer-aided designed and computer-aided manufactured (CAD-CAM) interim complete-arch fixed dental prostheses on immediately placed dental implants with a digital workflow. A single clinical appointment for data collection included dentofacial documentation with photographs and videos. On these photographs, facial reference lines were drawn to create a smile frame. This digital smile design and sagittal cephalometric analysis were merged with 3-dimensional scanned casts and a cone beam computed tomographic file in virtual planning software, thus guiding virtual waxing and implant positioning. Computer-guided implant surgery and CAD-CAM interim dental prostheses allowed esthetic and functional rehabilitation in a predictable manner and integrated with the patient's face.