Journal of Prosthetic Dentistry最新文献

Statement of problem: Robotic systems have shown promise for implant placement because of their accuracy in identifying surgical positions. However, research on the accuracy of patient calibration methods based on cone beam computed tomography (CBCT) and intraoral scanner (IOS) data registration is lacking.

Purpose: The purpose of this in vitro study was to develop a calibration method based on the registration of CBCT and IOS data of a robot-assisted system for implant placement, evaluate the accuracy of this calibration method, and explore the accuracy of robot-assisted surgery at different implant positions.

Material and methods: Twenty standardized, polyurethane, partially edentulous maxillary typodonts were divided into 2 groups: one group used a calibration method based solely on CBCT data (CBCT group), and the other used a calibration method based on the registration of CBCT and IOS data (IOS group). Four implants were planned for each typodont in the right second premolar, left central incisor, left first premolar, and left second molar positions. The robot performed the osteotomies and implant placement step by step according to the preoperative plan. The operating software program automatically measured the deviation between the planned and actual implant position. Two-way analysis of variance (ANOVA) and the least significant difference (LSD) post hoc test (α=.05) were used to analyze differences between the test groups.

Results: The angular deviation and 3-dimensional deviations at implant platform and apex between the 2 calibration methods did not significantly differ among the 4 implant positions (P>.05). The horizontal and depth deviations at the implant platform and apex levels between the 2 calibration methods did not significantly differ among the 4 implant positions (P>.05). In the anterior region (left central incisor), the CBCT group showed higher horizontal deviation at both the implant platform and apex compared with the IOS group (P<.05). Conversely, the IOS group had greater depth deviation at both the implant platform and apex than the CBCT group (P<.05). In the posterior region, with or without distal extension (right second premolar, left first premolar, and left second molar), no statistically significant differences were found between the 2 calibration methods (P>.05).

Conclusions: The calibration method that was based on the registration of CBCT and IOS data demonstrated high accuracy. No significant differences in the accuracy of the calibration methods for robot-assisted implant placement were found between the CBCT group and IOS group.

Statement of problem: Printed casts and dental devices and prostheses are increasingly being used, and the ecological impact of additive manufacturing should be considered in addition to the fabrication accuracy and surface properties of the printed object. To overcome the ecological drawbacks of alcohol postprocessing, water-washable, 3-dimensionally (3D) printable cast resins and postprocessing cleaning solutions that do not include alcohol have been introduced. However, whether using only water rather than chemical solvents would enable the surface smoothness and hardness required for accurate diagnostic and prosthetic procedures is unknown.

Purpose: The purpose of this in vitro study was to evaluate the effect of resin type (water-washable or nonwater washable) and postprocessing cleaning solution on the surface roughness and microhardness of 3D printed dental cast resins.

Material and methods: One hundred eight disk-shaped specimens (Ø10×2 mm) were additively manufactured (AM) from 3 dental cast resins: 2 water-washable (Epax (WW1) and Phrozen (WW2)) and 1 nonwater-washable resin (KeyModel Ultra resin-beige (NWW)) with a printer (n=36). Specimens in each resin type were divided into 3 groups for the application of postprocessing cleaning solution (water, 98% isopropyl alcohol [IPA] or methyl ether solvent) and polymerized after cleaning. The surface roughness (R_a, µm) and Vickers microhardness (HV) were measured. Laser microscope images were made of 1 specimen from each group.

Results: NWW-IPA (control group) had a similar R_a to WW2-water (P=.81) and WW2-methyl ether solvent (P=.511). NWW-IPA had lower HV than WW2-water (P<.001) and WW1-methyl ether solvent (P=.001). Solutions had no significant effect on the R_a of WW1 (P≥.554) and WW2 (P≥.805). WW1 had higher surface irregularities with water, whereas no significant difference was visually observed with IPA or methyl ether solvent. Solutions had a similar effect on the surface of WW2 when evaluated visually with the laser microscope.

Conclusions: Resin type and postprocessing cleaning solution affected the surface roughness and microhardness of 3D printed dental cast resins, except for the surface roughness of tested water-washable resins. Water or methyl ether solvent cleaned water-washable resin (WW2) had surface roughness and hardness similar to commonly used nonwater-washable cast resin.

Statement of problem: Though computer-aided design and computer-aided manufactured (CAD-CAM) denture bases have become popular, evidence on the ability of C. albicans cells to adhere to these denture bases is lacking.

Purpose: The purpose of this in vitro study was to evaluate the adherence of Candida albicans to differently manufactured acrylic resin denture bases.

Material and methods: Acrylic resin disks were fabricated using a total of 6 different fabrication methods (compression molding, injection molding, CAD-CAM milling, and rapid prototyping on 3 different printers with 3 different resins). Each material was evaluated for adherence of C. albicans using 2 different experimental methods - suspension in inoculated tryptic soy broth (TSB) or placed onto a uniform lawn of C. albicans on tryptone soya agar (TSA) with 5% sheep's blood. Attached cells were quantified by spiral plating and then used to re-inoculate sterile plates. Logarithmic transformation was completed to normalize data. For the broth suspension, the Kruskal-Wallis test was used to identify any differences between the 6 specimen types in terms of recovery, and the Dunn test was used for post hoc analysis. For the microbial lawn experiment, 1-way analysis of variance (ANOVA) and then the Tukey Honestly Significant Difference (HSD) post hoc test were used.

Results: Statistically significant differences were found between the numbers of adherent cells based on manufacturing method and between experimental designs (P<.05). All resins demonstrated growth with re-inoculation.

Conclusions: Though statistical significance was noted, neither experimental technique demonstrated what is likely a clinically significant preferential binding to any particular resin surface. Attached Candida cells are effective carriers of pathogens to uninfected surfaces. Further studies are indicated for potential virulence factors and differences in printed resins.

Statement of problem: Studies correlating occlusal morphology from 3-dimensional intraoral scans with both soft and hard tissue dynamic landmark tracking within the same participant population are lacking.

Purpose: The purpose of this clinical study was to use 3-dimensional intraoral scanning, computer-aided design, electrognathography, and artificial intelligence to investigate the relationships between anterior occlusion and arch parameters with hard and soft tissue displacements during speech production.

Material and methods: An artificial intelligence (AI) driven software program and electrognathography was used to record the phonetic activities in 62 participants for soft tissue (ST) and hard tissue (HT) displacement. Soft tissue displacement was quantified by the mean difference between subnasale and soft tissue pogonion peaks during phonetic expressions, and hard tissue displacement was directly measured with an electrognathograph. Intercanine and intermolar distances, arch perimeters, and horizontal and vertical overlap were measured from the intraoral scan data.

Results: ST and HT displacements were successfully estimated for fricative (ST=7.16 ±4.51 mm, HT=11.86 ±4.02 mm), sibilant (ST=5.11 ±3.49 mm, HT=8.24 ±3.31 mm), linguodental (ST=5.72 ±4.46 mm, HT=10.01 ±3.16 mm), and bilabial (ST=5.56 ±4.64 mm, HT=11.69 ±4.28 mm) phonetics. Vertical overlap correlated positively with hard tissue movement during all speech expressions except bilabial phonetics (ρ=.30 to.41, P<.05). Maxillary and mandibular arch perimeters showed negative correlations with soft tissue displacement during linguodental and bilabial speech (ρ=-.25 to -.41, P<.05) but were significantly correlated with hard tissue movement during all speech assessments (ρ=-.28 to -.44, P<.05). Maxillary intermolar distances negatively correlated with hard tissue phonetic expressions (ρ=-.24 to -.30, P<.05). Participant age positively correlated with soft tissue displacement during all speech patterns (ρ=.28 to.33, P<.05) and with weight increase (ρ=.27, P=.033), and hard tissue displacement (ρ=.25, P=.048) during maximum mouth opening significantly correlated with linguodental phonetics.

Conclusions: Within the study population, vertical overlap, maxillary intermolar distance, and dental arch perimeters correlated significantly with mandibular displacement during phonetic expression.

Tricho-dento-ossseous (TDO) syndrome is a rare form of ectodermal dysplasia (ED) characterized by defects in the hair, bones, nails, and teeth. Dental findings consistently seen in patients with TDO syndrome include amelogenesis imperfecta and taurodontism, but additional findings such as periapical abscesses, mandibular prognathism, and impacted teeth have been reported. Because of the rarity of this disorder, the prevalence is unknown and limited research is available regarding its dental management. This clinical report describes the fixed prosthodontic implant rehabilitation of an adult patient with TDO syndrome by using a facially driven fully digital workflow. The facially driven digital workflow streamlined the rehabilitation and allowed for functional, esthetic, and psychosocial improvements in a timely manner.

Statement of problem: Interim fixed prostheses are used provisionally to provide esthetics and maintain function until placement of the definitive prosthesis. Polymethyl methacrylate (PMMA) has been widely used as an interim material but has mechanical limitations that can be improved with the addition of nanomaterials such as graphene fibers (PMMA-G). However, studies on the biocompatibility of this material are lacking.

Purpose: The purpose of this in vitro study was to determine the biocompatibility and cytotoxic effects of PMMA compared with PMMA-G in periodontal ligament stem cells (PDLSCs) by measuring the viability and cell apoptosis of those cells subjected to different concentrations of both compounds by elution, as well as the surface characterization of these materials.

Material and methods: Sterile Ø20×15-mm specimens of PMMA and PMMA-G were covered with Dulbecco modified Eagle medium for 24 hours to be the subsequent eluent. PDLSCs were seeded in 6 plates of 96 wells at dilutions 1/1, 1/2, 1/4, and 1/8 for each material. Three plates for the cell viability assay with MTT and 3 plates for the cell apoptosis assay with Hoechst 33342 staining were used in turn to subdivide the measurements at 24, 48, and 72 hours. The Kruskal-Wallis test was used to compare the data obtained in the different dilutions at different times and the Mann-Whitney test to compare both materials. Topography and wetting were analyzed for surface characterization. The Student t test of paired measurements was used to compare the different surfaces for each parameter (α=.05 for all tests).

Results: In both the cell viability assay (MTT) and the cell apoptosis assay, the test did not identify statistically significant differences in PMMA and PMMA-G with respect to the control group in the different dilutions at different times (P>.05). When comparing both materials, no statistically significant differences (P=.268) were found in either trial. PMMA-G had lower roughness and kurtosis and higher wetting than PMMA.

Conclusions: Both PMMA and PMMA-G were found to be biocompatible materials with no significant differences between them after cell viability and apoptosis testing. PMMA-G had higher wettability and lower roughness than PMMA.

Statement of problem: How resin-based material and a light-activation protocol influence the mechanical properties of materials used to cement glass fiber post-and-cores in endodontically treated teeth is unclear.

Purpose: The purpose of this in vitro study was to evaluate the influence of immediate or 5-minute delayed light activation on the mechanical properties of dual-polymerizing resin cements and dual-polymerizing resin-core materials compared with bulk-fill composite resins.

Material and methods: Nine resin-based materials were tested: 4 dual-polymerizing resin-core materials, (Allcem Core; FGM, LuxaCore Z; DMG, Rebilda DC; VOCO, and (Clearfil DC Core Plus; KURARAY), 3 dual-polymerizing resin cements, (RelyX Universal; 3M ESPE, RelyX U200; 3M ESPE, and Allcem Dual; FGM), and 2 bulk-fill composite resins, (Opus Bulk Fill APS; FGM, and Filtek One Bulk Fill; 3M ESPE). The dual-polymerizing materials were light activated using both protocols. The postgel shrinkage (Shr), flexural strength (FS), elastic modulus (E), Knoop hardness (KH), degree of conversion (DC), and depth of polymerization (DoP) were measured (n=10). The data for Shr, FS, E, and DoP were analyzed using 2-way ANOVA, and for KH and DC using 2-way repeated measurement ANOVA and the Tukey HSD test (α=.05).

Results: A 5-minute delay before light-activation significantly reduced Shr for all materials (P<.001). Increasing the depth significantly reduced the KH for all materials (P<.001). Bulk-fill composite resins and dual-polymerizing resin-core had higher KH values than dual-polymerizing resin cements (P<.001).

Conclusions: Delayed 5-minute light-activation reduced postgel shrinkage and had no negative effect on mechanical properties. Dual-polymerizing resin-core materials exhibited higher KH values than dual-polymerizing resin cement and mechanical properties similar to those of bulk-fill composite resin.

Statement of problem: Evidence regarding stress evaluations of removable obturators with Aramany class I defects is lacking. Whether the stress distribution on Aramany class I prostheses can be improved by modifying the currently used designs is also unclear.

Purpose: The purpose of part II of this study was to evaluate the stress distribution in different designs of Aramany class I obturators using finite element analysis (FEA) and photoelastic stress analysis.

Material and methods: Four finite element and 8 photoelastic models, including 2 acrylic resin base obturators retained with 2 Adams clasps, 2 linear, 2 tripodal, and 2 fully tripodal design obturators, were used in this study. The frameworks were fabricated on the casts obtained from a modified printed model. Vertical and oblique loads were applied on 2 points (anterior and posterior) of the models. The quantitative measurement was done by measuring the fringe orders and von Mises values to compare the influences of occlusal forces on the obturator components and their supporting structures. The qualitative evaluation was done by visual color mapping to identify the stress concentration.

Results: In the photoelastic analysis, the anterior abutments of the tripodal showed the highest stress, followed by the fully tripodal obturators, while, in FEA, the anterior abutments of the linear design received the most in both vertical and oblique load. The central incisor received the most stress in photoelastic (3 or more fringe orders) and FEA (687.3 and 150.1 MPa for vertical and oblique loads, respectively), followed by the lateral incisors. Upon posterior loading, the base of the defect of the linear design demonstrated the most stress in photoelastic (3 or more fringes) and FEA (94.3 and 130.5 MPa for vertical and oblique loads, respectively). The acrylic resin base obturator retained with Adams clasps demonstrated the lowest stress distribution in abutments and their supporting bone upon anterior and posterior loads.

Conclusions: Upon vertical and oblique load application, the fully tripodal design was comparable with the tripodal in terms of stress distribution. Both designs were better than the linear in response to the same loading. The stress was concentrated at the anterior palatal part of the obturator, the base of the defect, and the junction of the metal and acrylic resin part of the prostheses upon anterior and posterior loading, respectively.