Compendium of continuing education in dentistry (Jamesburg, N.J. : 1995)最新文献

This article presents a case report describing a fully digital workflow for a dual-arch All-on-4® rehabilitation, highlighting the integration of intraoral and facial scanning, mandibular motion tracking, prosthetically driven implant planning, guided surgery, and computer-aided design/computer aided manufacturing (CAD/CAM)-fabricated fixed prostheses. The patient's diagnostic pathway included intraoral optical impressions, 3-dimensional (3D) facial scanning, and dynamic jaw-motion recording to verify a new vertical dimension of occlusion. A digital smile design established a fixed prosthesis 2 (FP2)-type prosthetic concept. Guided surgery was performed with 3D-printed templates; immediate loading was achieved using prefabricated polymethyl methacrylate provisionals. After a 3-month healing period, definitive digital impressions and passive-fit verification jigs were obtained. CAD/CAM titanium frameworks and zirconia superstructures were fabricated, characterized, and delivered as screw-retained prostheses. The workflow enabled precise implant placement, accurate passive fit, stable occlusion validated by functional motion capture, and highly esthetic outcomes, all within a minimally invasive treatment concept. This case demonstrates the effectiveness of a fully digital All-on-4 approach to optimize accuracy, efficiency, and patient satisfaction in a complex full-arch rehabilitation.

In July 2025, Congress enacted major reforms to higher education funding by passing the One Big Beautiful Bill Act (OBBBA), overhauling federal student loan programs, setting limits on federal borrowing, and abruptly ending the Graduate PLUS loan program. These changes may significantly impact access to dental education-especially for students from low-income or underserved backgrounds-and further worsen the ongoing shortage of oral health clinicians in rural and underserved areas, whose populations already face challenges to receiving adequate oral healthcare.

Three-dimensional (3D) smile design has become a valuable tool for full-mouth rehabilitation, enabling precise treatment planning, enhanced patient communication, and improved case acceptance. It also increases the treatment predictability and reproducibility of the patient-approved design. Advances in in-house computer-aided design/computer-aided manufacturing (CAD/CAM) technology and ceramic materials have further streamlined the process and reduced turnaround time while enabling clinicians to overcome limitations commonly associated with traditional pressable ceramics. This case report outlines the digital workflow for the esthetic and functional rehabilitation of a patient with severely worn dentition, utilizing in-house CAD/CAM technology to fabricate lithium-disilicate glass-ceramic restorations.

In 2007, approximately 26% of indirect restorations from one of the largest US dental laboratories were ceramic or resin-based. By 2013, this percentage had increased dramatically to 81%. The adoption of digital workflows (design and manufacturing) in dental laboratories has accelerated the trend toward non-metal indirect restorations. Currently, nearly half of practitioners use intraoral scanning, which facilitates the process of digital crown fabrication. Additionally, the introduction of in-office milling and 3D printing has expanded material options, including filled dental polymers for both provisional and definitive restorations. As fabrication technologies have advanced, material formulations have evolved in response, requiring clinicians to stay informed about changes in their properties.

The rehabilitation of completely edentulous patients has traditionally relied on the use of complete removable dentures, typically fabricated using polymethyl methacrylate (PMMA), despite this material's mechanical and biological limitations. An increasing trend is the shift in the fabrication of complete dentures from conventional methods to digital workflows, thereby reducing treatment time, improving adaptation, and increasing patient comfort and satisfaction. Additive manufacturing techniques, such as stereolithography and digital light processing, offer fast, cost-effective options, while subtractive milling from pre-polymerized PMMA blocks enables superior mechanical properties and precision. Nevertheless, each method presents unique advantages and drawbacks related to mechanical properties, esthetics, material waste, and other factors. Clinical studies have demonstrated favorable adaptation, reduced biofilm formation, and high mechanical properties with digital approaches. Despite some existing limitations, digital dentures are set to become standard in prosthodontics. Their integration suggests a change in paradigm, improving clinical efficiency and enhancing patient care quality.

Complex anterior open-bite malocclusions require a holistic, risk-stratified approach that extends beyond dental alignment to address the airway, facial form, function, biomechanics, and periodontium. This article outlines a contemporary airway-facially generated treatment planning (AFGTP) protocol that begins with airway screening and dentofacial analysis, incorporates functional and biomechanical planning, and integrates orthodontic execution using clear aligners and skeletal anchorage (temporary anchorage devices [TADs]) to achieve posterior intrusion and mandibular counterclockwise autorotation. A case example is shown that illustrates diagnosis (open bite, crowding, negative crown torque, and thin periodontal phenotype with early recessions), extraoral risk factors (gummy smile with high-lip mobility, asymmetric corridors, and lack of competent lip seal), and a digital workflow linking 2-dimensional/3-dimensional smile design to aligner planning. The treatment execution emphasized intrusion mechanics with TADs, torque control, curve-of-Spee management, and preservation of the anterior vertical position given the high display risk. Periodontal soft-tissue augmentation using connective tissue grafting via a tunneling technique supported stability in a thin phenotype. Radiographic follow-up demonstrated intrusion without adverse root or sinus changes and an improved facial balance.

The integration of artificial intelligence (AI) into clinical dentistry represents a paradigmatic shift toward precision-based oral healthcare. This article reviews the current applications of AI technologies in clinical dental practice, examining their impact on diagnostic accuracy, treatment planning, and patient outcomes. AI applications in dentistry span radiographic interpretation, caries detection, periodontal assessment, orthodontic treatment planning, oral pathology screening, and more. Machine learning algorithms and deep learning networks have demonstrated significant promise in enhancing diagnostic precision while reducing clinical time and improving workflow efficiency. Implementation challenges, however, including regulatory approval, cost considerations, and the need for comprehensive training, remain significant barriers. This review synthesizes current evidence regarding AI applications in dentistry, discusses clinical implications, and provides insights into future developments that may reshape oral healthcare delivery.

Reverse psychology, a technique that leverages a child's desire for autonomy to encourage cooperation, is increasingly being utilized in pediatric dentistry to manage anxiety and uncooperative behavior. This narrative review explores its application, efficacy, ethical considerations, and limitations in dental settings for children aged 4 to 12 years. Through examples like challenging a child to sit still or engage with dental tools, reverse psychology can prove effective for non-invasive procedures, particularly when combined with techniques like tell-show-do. Recent studies highlight its success in reducing mild to moderate anxiety, although its efficacy diminishes in invasive procedures or with highly anxious children. Ethical concerns include potential manipulation and the need for parental consent, while limitations involve cultural variability and inconsistent parental acceptance. Advances in integrating reverse psychology with digital tools, such as gamified apps, show promise for enhancing engagement. Further research is needed to optimize its use and evaluate long-term impacts on dental attitudes.

Nonsurgical endodontic retreatment (NS RETX) is a promising yet underutilized option for managing teeth with previous endodontic treatment failure. Understanding recent advancements in endodontics and their impact on retreatment outcomes is essential for clinicians advising patients who wish to retain their natural dentition. Advanced imaging tools such as cone-beam computed tomography improve detection and diagnosis, allowing for highly precise treatment planning. Factors affecting NS RETX prognosis include the presence of apical periodontitis, the quality of initial treatment, unmanaged complications, and the amount of remaining tooth structure. Contemporary techniques, including the use of dental operating microscopes, nickel-titanium rotary files, ultrasonic irrigation, and thermoplastic obturation methods, have significantly improved predictability of retreatment outcomes. Recent studies demonstrate higher survival and success rates with these modern approaches, underscoring the importance of prioritizing retreatment over extraction in cases of primary endodontic failure.

Infertility is a complex condition affecting both males and females. While the contributing causes are known to be multifactorial, the prevalence of infertility continues to rise. Recent research explores the potential relationship of periodontal disease and infertility. Periodontal disease, one of the most common oral diseases and the leading cause of tooth loss, is a low-grade, chronic infection leading to host inflammatory activation and, ultimately, destruction of oral hard and soft tissues. Periodontal disease has been associated with systemic inflammation and common chronic inflammatory diseases and conditions, including diabetes mellitus, obesity, rheumatoid arthritis, and cardiovascular diseases. This article reviews current evidence underscoring the association between periodontal disease and infertility, the proposed mechanisms of action of these associations, and implications for clinical practice. Focus on the relationship between oral and reproductive health highlights the importance of interprofessional, patient-centered treatment to provide comprehensive, whole-person healthcare to promote optimal overall wellness.