Journal of Prosthetic Dentistry最新文献

Statement of problem: Sleep apnea is prevalent among patients after a stroke and can complicate recovery, particularly in those with dysphagia. While studies have investigated sleep apnea in patients after a stroke in acute-care settings, its prevalence and impact of those in convalescent rehabilitation remain largely unknown.

Purpose: The purpose of this clinical study was to investigate the prevalence and severity of sleep apnea among patients after a stroke in convalescent rehabilitation and to explore the relationship between the severity of sleep apnea and dysphagia.

Material and methods: In total, 196 patients after a stroke hospitalized in a rehabilitation hospital in Chiba Prefecture, Japan were enrolled in this study. The participants had suffered a stroke and had been admitted for post-stroke rehabilitation after being discharged from acute-care hospitals. An overnight sleep test was administered with WatchPAT, which measured the apnea-hypopnea index (AHI), minimum SpO₂ (MinSpO₂), and 3% oxygen desaturation index (ODI3%). Functional oral intake level was assessed with the Functional Oral Intake Scale (FOIS). Statistical analyses were conducted by using multiple regression followed by the 2-sample t test, Kruskal-Wallis tests, and the chi-squared test (α=.05).

Results: Among the initial 196 participants enrolled, 140 participants (78 men and 62 women; mean age, 73.3 ±12.4 years) underwent a sleep test, with only 91 completing it. Out of the 91 participants, 85 (93.4%) had sleep apnea, and the prevalence increased to 95.7% specifically among participants with dysphagia. Significant differences in Japan Coma Scale scores (P<.001) and modified Rankin Scale scores (P<.001) were observed between the tube-dependent (FOIS 1 to 3) and total oral diet (FOIS 4 to 7) groups. Multiple regression analysis revealed a significant association between AHI and BMI (P=.020), and AHI and FOIS (P=.007), adjusted for age, sex, and confounding factors.

Conclusions: This study revealed a high prevalence of sleep apnea among patients after a stroke in convalescent rehabilitation, as well as a significant correlation between the severity of sleep apnea and dysphagia. Clinicians should consider sleep apnea management as a critical component of post-stroke rehabilitation, given its potential for improving swallowing function.

Statement of problem: Analysis of the cost and time efficiency of removable complete dentures (RCDs) fabricated using conventional and computer-aided design and computer-aided manufacturing (CAD-CAM) processes remains limited.

Purpose: The purpose of this systematic review was to evaluate the time efficiency and cost of conventional, hybrid, and completely digital workflows throughout the entire process of RCD fabrication.

Material and methods: Article selection followed the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines and was registered with the international prospective register of systematic reviews (PROSPERO). The bibliographic search covered the PubMed and Cochrane databases using keywords related to removable complete dentures, digital workflows, and economic factors and covered articles from January 2010 to June 2024. In total, 1188 articles were identified and assessed. A bottom-up search identified an additional 10 articles through cited works. Data on cost and time analyses were reported in a qualitative synthesis.

Results: The qualitative synthesis included 8 articles published between 2015 and 2024 showing that digital and hybrid workflows generally reduced both clinical and laboratory time and overall costs compared with conventional workflows. The hybrid protocol required significantly less clinical time, with reductions ranging from approximately 1 to 4 hours. Hybrid and completely digital workflows reduced laboratory manufacturing time by approximately 6 to 7 hours compared with conventional workflows. Cost analyses revealed that digital and hybrid workflows were more profitable and cost effective than conventional workflows.

Conclusions: The findings suggest that digital and hybrid workflows for RCD fabrication are more time efficient and cost effective than conventional methods.

Abutment screw loosening is the most common complication in single implant-supported crowns, typically remedied by simply reattaching the restoration, preferably using a new abutment screw. The internal aspect of the implant along with any other components should be decontaminated before reconnection. This clinical report provides information on the appropriate management of the decontamination process, as well as evidence of the foreign material found within the implant body.

Statement of problem: The machining accuracy and marginal integrity of monolithic zirconia crowns with minimal invasive preparations may impact the long-term survival rate of tooth and periodontal health, but studies on the effect of machining method are lacking.

Purpose: The purpose of this in vitro study was to digitally evaluate the machining accuracy and margin quality of monolithic zirconia crowns fabricated using gel deposition and conventional soft milling processes by comparing 2 different margin types.

Material and methods: A total of 40 monolithic zirconia crowns were produced using gel deposition (Self-glazed Zirconia Group, SGG, n=20) and soft milling (Milled Zirconia Group, MG, n=20). Each group was further divided into 2 subgroups with different margin designs (chamfer and feather-edge). The trueness and fit of crowns were compared using root mean square (RMS) values. Furthermore, the margin quality was examined before and after final sintering with a scanning electron microscope (SEM). The Scheirer-Ray-Hare and 2-way ANOVA test analysis nonparametric and parametric data, respectively (α=.05).

Results: The trueness analysis revealed that SGG had significantly lower RMS values for both the cameo and intaglio areas compared with MG (P<.001). In addition, crowns with a feather-edge margin exhibited significantly lower marginal RMS values than those with a chamfer margin (P<.01) according to the fit assessment. Followed by milling processes, SGG exhibited a constantly homogeneous microstructure compared with MG. Marginal defects were detected in both groups except for the SGG with the chamfer margin.

Conclusions: SGG exhibited better accuracy associated with ductile-regime machining than MG, and SGG with chamfer margins displayed flaw-free margin areas. Moreover, the feather-edge margin showed improved marginal fit compared with the chamfer margin.

Conventional impression and jaw relation recording techniques for complete arch implant-supported fixed dental prostheses are complicated, but intraoral scanning offers alternatives to conventional procedures. This article presents a novel digital workflow for recording the relative positions of implants and jaw relation for complete arch implant-supported fixed dental prostheses.

Denture retention in edentulous patients following resection for mucormycosis or carcinoma is challenging because of the lack of bony support. Traditional dentures are often unsatisfactory, and implants require complex bone grafting. This clinical report presents a novel approach using 3-dimensionally (3D) printed intramucosal inserts and a digitally fabricated hollow denture. The process involved conventional impressions, digital designing, and 3D printing of both the hollow denture and the custom intramucosal inserts based on mucosal thickness. This approach led to improved retention, functionality, and esthetics, offering a minimally invasive alternative with fewer complications to traditional dentures and implants.

Digital workflows have revolutionized denture fabrication, offering greater customization and rapid production. This clinical report describes 2 treatment approaches using digital techniques to address prosthetic challenges. The first patient had a large maxillary defect after mucormycosis surgery, necessitating a combination of digital and conventional methods for obturator fabrication because of computer-aided design software program limitations. For the second patient, digital workflows were combined with the conventional neutral zone technique to improve denture stability and retention, effectively addressing the challenge of severely resorbed arches. These treatment approaches demonstrate the potential of digital workflows in prosthodontics and highlight the need for further technological advancements.

The Scientific Investigation Committee of the American Academy of Restorative Dentistry offers this review of select 2023 dental literature to briefly touch on several topics of interest to modern restorative dentistry. Each committee member brings discipline-specific expertize in their subject areas that include (in order of appearance here): prosthodontics; periodontics, alveolar bone, and peri-implant tissues; dental materials and therapeutics; occlusion and temporomandibular disorders; sleep-related breathing disorders; oral medicine, oral and maxillofacial surgery, and oral radiology; and dental caries and cariology. The authors have focused their efforts on presenting information likely to influence the daily dental treatment decisions of the reader with an emphasis on current innovations, new materials and processes, emerging technology, and future trends in dentistry. With the overwhelming volume of literature published daily in dentistry and related disciplines, this review cannot be comprehensive. Instead, its purpose is to inform and update interested readers and provide valuable resource material for those willing to subsequently pursue greater detail on their own. Our intent remains to assist colleagues in navigating the tremendous volume of newly minted information produced annually. Finally, we hope readers find this work helpful in providing evidence-based care to patients seeking healthier and happier lives. (J Prosthet Dent 2024;132:■■■-■■■).