International Journal of Prosthodontics最新文献

Purpose: To determine and compare the accuracy and reliability of shade matching using the conventional and smartphone virtual methods.

Materials and methods: A phantom head with both maxillary central incisors removed was set up. A central incisor of various standard shades was inserted into the phantom head. Five undergraduate and five postgraduate students were asked to select the closest shade to match the central incisor using the Vita Classic shade guide. The procedure was then repeated using images taken by a smartphone. Each technique was repeated three times. Differences in accuracy of shade matching between the two techniques for every shade tab and between undergraduate and postgraduate dental students were compared using chi-square statistical analysis. The P value was set at .001. Differences in intra-rater and inter-rater reliability between the two techniques and among the three sessions were compared using paired t test and analysis of variance (ANOVA), respectively, with a P value of .05. The reliability of both techniques was further measured using Cohen kappa statistical test.

Results: The smartphone virtual shade-matching technique showed significantly higher accuracy in shade matching with most of the tested shade tabs than the conventional method (P < .001), irrespective of observers' clinical experience. Higher repeatability was found in the virtual technique than the conventional technique, with higher intra-rater and inter-rater reliability observed.

Conclusion: Smartphone virtual shade matching showed better accuracy and reliability than the conventional method and could be used as an alternative shade-matching method.

Purpose: To comparatively evaluate the amount of wear of natural enamel against a glazed full coverage monolithic zirconia crown and a polished monolithic zirconia crown at 6 and 12 months.

Materials and methods: Thirty subjects within the age range of 18 to 35 years participated in this study. The subjects received a total of 60 single crowns, which were divided into two groups: (1) 30 glazed monolithic zirconia crowns opposed by natural enamel (group A); and (2) 30 polished monolithic zirconia crowns opposed by natural enamel (group B). Each subject received a crown from both groups, placed bilaterally in endodontically treated maxillary or mandibular first molars. An impression was made of the opposing arch at 24 hours, 6 months, and 12 months. The resulting casts were scanned with a 3D optical scanner. The recall scans were superimposed and compared to baseline scans using 3D AutoCAD software. A control group was included to compare the wear values to natural enamel against natural enamel.

Results: No significant difference (P = .855) was found in enamel wear between groups A (42.80 μm) and B (42.50 μm) after 6 months of use. However, a significant difference (P < .05) in enamel wear was found between group A (81.87 μm) and group B (71.43 μm) after 12 months of use.

Conclusion: Glazed monolithic zirconia crowns cause more wear to the opposing enamel than polished monolithic zirconia crowns after 12 months of clinical use.

Purpose: To evaluate the stress distribution in endocrowns and post-and-core crowns used as abutments for a Kennedy Class I removable partial denture constructed with different framework materials.

Materials and methods: 3D models of a Kennedy Class I mandible were constructed. Cobalt-chromium (Co-Cr) and polyether ether ketone (PEEK) frameworks were simulated for Models 1 and 2, respectively. An endocrown and a fiber post-and-core crown for the mandibular left and right second premolar abutments, respectively, were simulated for both models. Lithium disilicate porcelain was defined for the crowns. A 200-N occlusal force was applied in the vertical and 30-degree oblique directions.

Results: The von Mises stresses were evaluated for the abutments and prostheses, and the principal stresses for the cortical bone under vertical and oblique loading. Endocrowns showed lower stress values than post-and-core crowns in both models. Post-and-core crowns generated the highest stress in Model 2 under vertical loading. The PEEK framework caused higher stress values on the abutments than Co-Cr. Compressive stresses were higher than tensile stresses in cortical bone. The highest compressive stress was observed around the left premolar cortical bone area in Model 1 under oblique loading. Oblique loading caused lower stress values than vertical loading, except for on the minor connectors and cortical bone.

Conclusion: From a biomechanical perspective, endocrowns may be more advantageous than post-and-core crowns when used as abutments for a Kennedy Class I removable partial denture. In addition, Co-Cr frameworks showed more favorable stress distribution on abutments than PEEK frameworks. Int J Prosthodont 2023;36:203-215. doi: 10.11607/ijp.7269.

Purpose: To compare the mechanical behavior (stress load dissipation and/or concentration) of posterior crowns made from Lava Ultimate (LU; 3M ESPE) and IPS e.max CAD (LD; Ivoclar Vivadent) using finite element analysis (FEA).

Materials and methods: A 3D model of a mandibular first molar was prepared by reducing the occlusal surface by 1 or 2 mm (according to group), the axial walls by 1.5 mm, and using a 0.8-mm-deep shoulder margin as a finish line. A convergence of 6 degrees between opposing walls was set. Subsequently, four 3D crown models were created according to two test groups with two different occlusal thicknesses: (1) LD with 1.0 mm (LD1); (2) LD with 2.0 mm (LD2); (3) LU with 1.0 mm (LU1); and (4) LU with 2.0 mm (LU2). FEA models were constructed using the software Femap (Siemens). A load of 200 N was applied in the axial and oblique (20 degrees) directions for each group, and stress dissipation was viewed using the NEi Nastran software.

Results: FEA results demonstrated that the LU crowns dissipated the occlusal load to the tooth structure, whereas the LD material concentrated the load inside the crowns. For the LU material, the lower the occlusal thickness, the higher the stress concentration inside the crown became, and the 2.0-mm occlusal thickness transferred lower stress to the tooth structure. The oblique, rather than the vertical, load caused an increase in the maximum stress concentration at the shoulder margin and axial walls.

Conclusion: The higher the Young's Modulus mismatch between the crown material and substrate, the higher the load stress concentration inside the material became. The 2-mm occlusal thickness acted by decreasing the load stress to the tooth substrate. Finally, the axial load delivered more favorable stress transmission to the tooth substrate. The crown material and the occlusal thickness appear to be two factors that affect the mechanical behavior of stress dissipation to the tooth structure.

Purpose: To evaluate changes in the periodontium of teeth restored with ultrathin (0.2 to 0.39 mm) ceramic laminate veneers (CLVs) placed subgingivally without a finish line compared to the same teeth before restorative treatment and to nonrestored antagonist teeth in healthy periodontium patients. Materials and Methods: A total of 73 CLVs were bonded onto the enamel surface of teeth without a finish line and with the cervical margin placed about 0.5 mm subgingivally. The gingival crevicular fluid was collected before bonding (baseline) and at 7, 180, and 365 days after bonding to quantify S mitis, P intermedia, and P gingivalis by quantitative polymerase chain reaction analysis. Visible plaque index (VPI), bleeding on probing (BOP), probing depth (PD), clinical attachment loss (CAL), gingival recession (GR), and marginal adaptation were evaluated from baseline to 365 days in both groups. Results: No statistically significant differences were observed in VPI, PD, or BOP at any time point in the intragroup or intergroup comparisons (P > .05). All restorations obtained the alpha concept for marginal adaptation (ie, the restoration margin remained ideal at all time points). There was a statistically significant difference for S mitis between 180 and 365 days (P = .03). No statistically significant difference was observed for P gingivalis at any time point (P > .05). Conclusion: The periodontium in the restored group showed a clinical behavior similar to baseline. Overcontouring of the ultrathin (up to 0.39 mm) CLV, similar to the cementoenamel junction convexity, did not contribute to plaque accumulation or changes in the oral microbiota of patients with a healthy periodontium and proper oral hygiene instruction.

Purpose: To compare the morphologic trueness of provisional and definitive restorations constructed with conventional custom impression techniques to those constructed with intra- and extraoral scanning (IEOS), which can digitally transfer the subgingival morphology of the provisional restoration to the definitive restoration.

Materials and methods: Provisional restorations were fabricated on typodonts in which implants were placed. In the conventional method, a customized impression coping was produced by using polymethyl methacrylate resin to transfer the subgingival contour of the provisional restoration. Impressions were taken with silicone impression material, and definitive restorations were made by CAM. The IEOS technique was performed as previously reported. In brief, three individually scanned stereolithography (STL) files were superimposed in CAD software to transfer the morphology of the provisional restoration to the definitive restoration. Definitive restorations were then made by CAM. The provisional and definitive restorations were both scanned by IOS. Scanned data files were superimposed with morphometry software, and the distortions were measured. Student t test was used for statistical analysis.

Results: The subgingival morphologies of definitive restorations prepared by the conventional method showed significant negative distortions compared to definitive restorations prepared by the IEOS technique.

Conclusion: The IEOS technique can more accurately transfer the subgingival contour of provisional restorations to definitive restorations compared to the conventional customized impression coping technique.

Purpose: To investigate if and how the positions of condyles in centric relation (CR) varied from each other using different CR records.

Materials and methods: Condylar positions in CR were repeatedly recorded by four licensed clinicians in 81 stomatognathically healthy, fully dentate subjects with six different types of CR records. The maxillary casts were mounted in articulators after individual facebow transfer, and the mandibular casts were mounted with a central bearing point (CBP) registration on the tip of the Gothic arch. Mean values from three registrations of the centric condylar positions with each of the six methods were calculated, and comparative calculations were made.

Results: The median spatial distances of the condylar positions between the CBP and all other CR records was 0.73 ± 0.24 mm (0 to 3.19 mm). The median spatial values between the condylar positions of the different CR records ranged from 0.48 to 0.79 mm. Statistically, the positions of almost all types of registration were slightly different from each other.

Conclusion: Different CR records reproduce slightly different positions of the mandible, which is especially true for CBP registration, whereas reproducibilities and SDs between registrations are similar. Unrefined wax-wafer registrations using bimanual manipulation have proven particularly successful with regard to precision and time requirements, as has CBP registration with regard to condylar position.

Purpose: To evaluate the extent to which dentists elaborate removable partial denture (RPD) design themselves and what they leave to the dental laboratory, as well as to assess the quality of information transferred to the technicians.

Materials and methods: Data were collected using a questionnaire, and the responses of 211 dentists were analyzed. The categorized variables were analyzed using chi-square test and Fisher exact test. The significance level was considered as the standard P < .05.

Results: More than half (59.0%) of the dentists reported making an accurate, clear design for the dental technician before fabrication of the metal-framework RPD; 191 dentists (91.0%) specified the abutment teeth, 70.8% chose the type of clasps, and 60.7% gave instructions for the major connectors. The respondents largely took into account periodontal hygiene considerations (82.4%), and about one-third (37.7%) reported they were sending clear, precise instructions to the lab. The denture design was sent to the technician mainly (65.0%) in both drawing and text form. About half of the dentists (55.6%) gave only guidelines and left more details to be defined by the dental technician. Most dentists took responsibility in case of esthetic problems, irrespective of whether the dentist or technician prepared the denture design.

Conclusion: Everyday practice concerning RPD design is far from the professional, legal, and ethical guidelines and rules relating to the duties and responsibilities of the dentist in relation to RPD design, and the situation therefore needs to be improved. Int J Prosthodont 2022;36:131-137. doi: 10.11607/ijp.7523.

Purpose: To compare the feasibility and accuracy of using intraoral scanners to digitize a maxillary defect model simulating various trismus conditions.

Materials and methods: Four intraoral scanners were used to digitize a maxillary defect model simulating four different degrees of trismus (mouth opening = 10, 20, 30, and 40 mm), and the scanned areas were compared. The scans were also superimposed on each other for precision analysis and on reference data for trueness analysis using 3D evaluation software. Two-way ANOVA was used to compare area, precision, and trueness among scanners and among conditions.

Results: The surface area for which 3D data were obtained by the intraoral scanners ranged from 2,672 to 6,613 mm². Significant differences were observed between the scanners (P < .001) and between the trismus conditions (P < .001), with a smaller scanned surface area in severe trismus (10 mm). Trueness ranged from 0.033 to 0.301 mm, and precision from 0.022 to 0.397 mm. Significant differences in trueness and precision values were found among the scanners (P = .001 and P = .001, respectively), but not the trismus conditions (P = .260 and P = .075, respectively).

Conclusion: Although trueness and precision differed between intraoral scanners, digitization of the maxillectomy model simulating various trismus conditions appears to be feasible from the perspective of accuracy with all of the scanners used. The smaller scanned surface area in the severe trismus condition was due to lack of data on the defect site in that condition.

Purpose: To compare the clinical outcomes of metal-ceramic vs metal-acrylic resin implant-supported fixed complete denture prostheses (IFCDPs).

Materials and methods: An electronic literature database search was conducted in the CINAHL, EMBASE, PubMed, and Web of Science databases. Additionally, a manual search of the literature was performed. Studies conducted in edentulous human subjects comparing clinical outcomes of metal-acrylic resin IFCDPs to those of metal-ceramic IFCDPs were included if quantitative outcomes for the following variables were reported: implant failure, prosthetic failure, incidence of peri-implantitis, incidence of peri-implant mucositis, incidence of peri-implant mucosal recession, prosthetic complications, and any patient-centered outcomes. Data from included studies were pooled to estimate effect size.

Results: Five studies met the inclusion criteria. A quantitative analysis was possible for risk of implant failure, prosthesis failure, and incidence of peri-implantitis. Meta-analysis showed no statistically significant differences in the risk of implant or prosthesis failure between the two groups. However, meta-analysis showed a significantly greater risk of developing peri-implantitis at the implant level in the metal-acrylic group when compared to the metal-ceramic group (risk difference = 0.069; 95% CI = 0.028 to 0.06; P = .001; fixed-effects model). Furthermore, descriptive analysis of the literature indicated a higher incidence of other biologic complications such as peri-implant mucositis and peri-implant mucosal recession, as well as prosthetic complications such as abrasion and veneer fracture, in metal-acrylic resin IFCDPs compared to metal-ceramic IFCDPs.

Conclusion: The available evidence suggests that a higher incidence of biologic and prosthetic complications, including a higher risk of peri-implantitis, are present with metal-acrylic resin IFCDPs compared to metal-ceramic IFCDPs.