Journal of Prosthodontics-Implant Esthetic and Reconstructive Dentistry最新文献

Purpose: To synthesize evidence from systematic reviews on artificial intelligence (AI) applications in prosthodontics and implant dentistry, focusing on clinical applications, AI model performance, and quality of evidence.

Methods: A comprehensive search was conducted in PubMed (MEDLINE), Scopus, Web of Science, Embase, and The Cochrane Library databases, identifying systematic reviews published from 2018 to 2025. Inclusion criteria comprised systematic reviews evaluating AI in prosthodontics or implant dentistry, published in English. Narrative reviews and reviews from other dental specialties were excluded. Two reviewers independently performed study selection and data extraction, and the methodological quality of the included systematic reviews was assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR-2) tool. This umbrella review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD420251067048).

Results: Eleven systematic reviews were included. AI demonstrated substantial capability in prosthodontics for caries and fracture detection (with an accuracy of ∼82%-89%), automated tooth shade matching, and prosthesis design. In implant dentistry, AI algorithms accurately identified implant types on radiographs (∼95.6% pooled accuracy), optimized implant placement planning, and predicted treatment outcomes with moderate accuracy (62.4%-80.5%). Performance was strongest for radiographic identification and anatomic segmentation tasks in implant dentistry. It was more modest for preparation margin detection and objective shade matching in prosthodontics, as well as for multivariable prognosis and for detecting maxillary edentulous sites in implant dentistry. Convolutional neural networks (CNNs) consistently outperformed traditional algorithms in image-based tasks. However, AI prediction of long-term outcomes showed moderate performance due to data limitations and biological variability. Overall, although four reviews were rated as high quality, the majority exhibited low or critically low methodological quality, primarily due to a lack of a priori protocol registration and incomplete bias assessment.

Conclusion: AI applications in prosthodontics and implant dentistry may enhance diagnostic and planning workflows, especially for recognition and segmentation tasks. Nevertheless, most evidence comes from early-stage, retrospective, or highly controlled studies, highlighting the need for prospective clinical validation and higher-quality systematic reviews before routine clinical adoption can be recommended.

Purpose: To evaluate the impact of posterior occlusal morphology, build angulation, and support configuration on the occurrence of isolated islands in a three-dimensional (3D) printing slicing software when printing a full arch implant-supported prosthesis.

Materials and methods: Three maxillary implant-supported full-arch prostheses were designed with similar intaglio and anterior teeth and different posterior morphology based on cusp angulations, including shallow (10°), medium (20°), and steep (33°). Each digital file was transferred to slicing software and nested in different angulations (0°, 15°, 30°, 45°, and 90°), and supports were created using different configurations (thin, standard, and thick). The sliced file from each configuration was evaluated for the presence of isolated islands of print where the printed material was left unsupported. The effect of independent variables and number of isolated islands, time to print, number of layers, and volume of the resin to print were analyzed with a three-way ANOVA test with a significance level set at 5%.

Results: The mean number of isolated islands (minimum 0 and maximum 11.9) in the slicing software was significantly affected by all three investigated variables (p < 0.05). Steep occlusal morphology reduced the chance of developing islands after slicing. The standard and thick support configuration reduced the number of islands when compared with the thin support configuration. In terms of build angulation, 0° resulted in the highest number of islands, and 90° build angulation resulted in no islands. Increasing the thickness of support and steeper cusp angulation significantly increased the amount of resin required to print (p < 0.05). Increasing the build angulation significantly increased the time to print, number of layers, and amount of resin to print (p < 0.05).

Conclusions: Slicing software can produce isolated unsupported areas that have the potential to cause print failure of a full arch implant-supported prosthesis. Based on the present findings, shallower posterior occlusal anatomy, thinner supports, and 0° build angulation increased the chance of developing isolated islands in a slicing software.

Purpose: This study aimed to develop a novel and efficient digital workflow for designing and manufacturing 3D-printed definitive maxillofacial obturator prostheses based on multi-source data fusion and various digital techniques, as well as to evaluate its feasibility through a randomized self-controlled study.

Materials and methods: Participants with maxillary defects were recruited for the study. A digital impression was obtained by fusing intraoral scanning data and computed tomography (CT) images. The framework and artificial-teeth-obturator were designed separately using multiple dental design software programs, fabricated through additive manufacturing (AM), and finally assembled precisely into one unit with the help of specially designed auxiliary positioning and connecting structures. For comparison, a conventional prosthesis was also made for each participant. The adaptation of both conventional and digital prostheses was evaluated and compared using the silicone rubber lining method through deviation analysis. Additionally, the chairside impression time for both conventional and digital treatments were recorded and compared.

Results: The digital workflow for designing and manufacturing maxillofacial prosthesis was successfully realized. The chairside impression time was shortened (p < 0.001). The adaptation of the digital prosthesis, including framework (349.89 ± 121.56 µm), obturator (420.08 ± 166.01 µm), and the whole prosthesis (408.36 ± 118.05 µm), proved suitable for clinical application. No statistically significant difference was observed between the digital and conventional prostheses.

Conclusion: The newly established digital workflow for the fabrication of definitive maxillofacial obturator prostheses reduced chairside impression time and the number of appointments, featuring clinically acceptable adaptation. This approach has potential for future applications in the treatment of patients with maxillofacial defects.

Purpose: The cement interface is particularly important for successful zirconia-titanium base (Ti-base) restorations, as retention relies primarily on adhesive bonding. The aim of this in vitro study was to assess and compare the influence of a universal resin cement used with either a self-adhesive or adhesive bonding protocol versus adhesive resin cements on the retention of zirconia to Ti-base abutments, with and without autoclaving.

Materials and methods: Zirconia buildups were cemented to titanium-base abutments using RelyX Universal (RXU) as a self-adhesive resin cement, RXU with a primer (RXU/SUP), Panavia V5 (PV5) with primer, or multilink hybrid abutment (MHA) with primer. Half of the specimens were autoclaved. Push-out testing was performed, and data were statistically evaluated using the analysis of variance (ANOVA), Tukey honest significant difference test, and family-wise error rate method.

Results: Of the nonautoclaved groups, RXU/SUP showed the highest initial mean push-out load (1576.45 ± 195.86 N), followed by MHA (1268.10 ± 160.67 N), RXU (959.66 ± 139.24 N), and PV5 (905.84 ± 298.38 N). Autoclaving did not have a significant influence on cement push-out load when compared directly within cement pairs. The push-out load of RXU used as self-adhesive cement was similar to PV5 with primer. Retention of RXU/SUP and MHA groups was significantly higher than that of RXU or PV5.

Conclusion: In this in vitro study, RXU performed as well as PV5 groups and required the fewest preparation steps, suggesting it may be a good option for improving workflow efficiency. Results indicated a marginally positive effect of autoclaving between pairs, however, it was not significant.

Purpose: To describe the national panorama of outpatient procedures related to oral and maxillofacial prosthetic rehabilitation performed within the Brazilian Unified Health System between 2014 and 2024.

Materials and methods: An ecological, retrospective study was conducted based on secondary data from the Outpatient Information System of the Unified Health System, with analysis of production according to type of prosthesis, geographic distribution, approved values, and proportional rates per population.

Results: In the period analyzed, 17,052 procedures were recorded, with the highest volume in 2023. Ocular prostheses accounted for the largest contingent (10,854), followed by oculoplastic, mandibular, and nasal prostheses. The spatial distribution showed a concentration of care in the Southeast Region (11,674 procedures), with the state of São Paulo standing out. The proportional rates per million inhabitants ranged from 27.6 (Northeast) to 131.4 (Southeast). The financial values totaled R$3,383,613.34 in the period.

Conclusion: The national production of oral and maxillofacial prostheses has grown in recent years, with a predominance of ocular prostheses, a low supply of implant-supported prostheses, and regional concentration of care, indicating a need to expand and decentralize specialized services.

Purpose: To systematically review and meta-analyze clinical, in vitro, and finite-element studies assessing how ferrule height, width, and circumferential extent influence fracture resistance and survival of endodontically treated teeth.

Methods: This review followed PRISMA 2020 guidelines. Two reviewers conducted the screening, with a third resolving disagreements. Eligible designs included clinical studies, in vitro experiments, and finite-element analyses evaluating ferrule characteristics. Risk of bias was assessed using RoB 2, the Newcastle-Ottawa Scale, and CRIS/CONSORT-adapted criteria. Random-effects models were applied.

Results: Thirty-three primary studies (6 clinical, 18 in vitro, 9 finite-element) were included. Ferrule height ≥ 2 mm significantly improved fracture resistance (MD +165 N; 95% CI: 110-215). Ferrule presence increased clinical survival (RR 1.34; 95% CI: 1.12-1.59). Dentin thickness ≥ 1 mm and complete 360° ferrules provided the most favorable reinforcement, while partial ferrules with ≥ 2 opposing walls remained beneficial.

Conclusions: A ferrule height of 1.5-2.0 mm and dentin thickness ≥ 1 mm are associated with improved biomechanical and clinical outcomes. These findings should be interpreted within the context of variation in study designs and reporting quality. No restorative strategy matched the biomechanical reinforcement provided by a natural dentin ferrule.

Purpose: To investigate clinical outcomes and patient satisfaction of complete removable dentures fabricated with a hybrid workflow, utilized in a predoctoral dental clinic.

Materials and methods: Electronic chart records were reviewed for all patients who received complete dentures (CDs) fabricated utilizing the hybrid workflow from May 1, 2021, to December 31, 2024. Information on clinical outcomes and relevant patient factors was collected. Additionally, information on the need for a remake or reline of these prostheses was recorded. Finally, the Oral Health Impact Profile (OHIP) and the Oral Health Related Quality of Life (OHRQoL) score were recorded.

Results: A total of 213 completed OHIP-14 surveys were analyzed, with mean OHIP-14 scores of 9.23 (1 week), 7.02 (1 month), 6.90 (6 months), 6.97 (1 year), and 5.73 (2 years) (p < 0.05). Milled dentures met the threshold of clinical acceptability for all measured parameters across time points. Milled mandibular dentures showed poorer retention and stability than milled maxillary dentures, and the remake rate of milled maxillary immediate dentures was higher than that of milled dentures on healed ridges. Overall, 20% of milled immediate dentures and 4.8% of milled dentures on healed ridges required remakes, though only 5% of all immediate dentures needed remakes within 6 months. No significant trends were observed regarding patient gender, age, PDI classification, or opposing prosthesis type.

Conclusions: Digital dentures fabricated using a hybrid workflow in this study showed clinical acceptability and good patient satisfaction at 1 year, with higher patient satisfaction reported at 2 years. Milled mandibular dentures demonstrated lower retention and stability than maxillary dentures, and maxillary immediate dentures had higher remake rates than digital dentures made on well-healed ridges. Milled dentures are a reliable option for patients irrespective of gender, age, or PDI classification when fabricated by predoctoral dental students.

Marking dental prostheses and appliances enhances patient identification and the continuity of care. This article presents a technique using the Near Field Communication (NFC) technology. The low-cost miniature NFC chip, programmable through smartphones, can be embedded into dental prostheses or appliances to securely store and retrieve the patient's medical and dental information. This method allows immediate access to essential data in clinical and emergency situations, improves documentation, and provides a versatile solution for contemporary prosthodontic practice.

Purpose: The aim of this study was to assess the frequency of returns for maintenance among older adults who received complete dentures at the University of Iowa College of Dentistry. A secondary objective was to investigate associations between patient demographic characteristics, clinical factors, treatment variables, and the frequency of follow-up appointments.

Materials and methods: This retrospective cohort study evaluated 608 patients aged 65 years or older who received complete dentures between 2016 and 2021. De-identified data retrieved from electronic health records included follow-up appointments, age, gender, clinic type, provider type, insurance status, mental health condition, distance from the dental school, and number of prescribed medications. Adherence to follow-up appointments was categorized as "Never," "Once," "Intermittent," or "Always." Statistical analyses included Fisher's exact tests and a multinomial logistic regression model.

Results: Only 3.6% of patients consistently adhered to follow-up recommendations, while 6.7% never attended any follow-up appointments. Insurance type and provider level were significantly associated with follow-up adherence. Medicaid patients had the lowest follow-up rates. Patients treated by predoctoral students showed significantly higher follow-up attendance compared to those treated by faculty or graduate students (Once vs. Never OR = 5.70, p < 0.001). Gender, clinic type, and mental health status were not significantly associated with follow-up behavior.

Conclusion: Strict adherence to follow-up recommendations was rare. Patients treated by predoctoral students and those not on Medicaid demonstrated higher rates of follow-up attendance in this dental school sample.