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Gehrke P, Rashidpour M, Sader R, Weigl P. A systematic review of factors impacting intraoral scanning accuracy in implant dentistry with emphasis on scan bodies. Int J Implant Dent 2024; 10:20. [PMID: 38691258 PMCID: PMC11063012 DOI: 10.1186/s40729-024-00543-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 04/23/2024] [Indexed: 05/03/2024] Open
Abstract
PURPOSE The purpose of this systematic review was to explore and identify the factors that influence the accuracy of intraoral scanning in implant dentistry, with a specific focus on scan bodies (ISBs). METHODS Following the PRISMA 2020 guidelines, this study conducted a thorough electronic search across MedLine, PubMed, and Scopus to identify relevant studies. Articles were screened based on titles, abstracts, and full texts for relevance. The Robins I tool assessed the risk of bias in various study types. Data extraction occurred based on predetermined parameters for studying specimens and assessing outcomes. RESULTS 16 studies met the specified criteria and were consequently included in the systematic review. Due to variations in variables and methods across the selected studies, statistical comparison of results was not feasible. Therefore, a descriptive review approach was chosen, acknowledging the substantial heterogeneity in the reviewed literature. CONCLUSIONS The precision of virtual scan results is contingent upon diverse characteristics of ISBs and implants. These factors encompass their placement within the dental arch, structural design, shape, material composition, color, and the manufacturing system, all of which contribute to scan accuracy. Additionally, considerations such as the intraoral scanner (IOS) type, scanning technique, use of scan aids, inter-implant distance, scan span, and the number of implants warrant evaluation. In the context of capturing implant positions, intraoral scanning with ISBs demonstrates comparable accuracy to traditional impression methods, particularly in single and short-span scenarios. However, the existing data lacks sufficient information on in vivo applications to formulate clinical recommendations.
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Affiliation(s)
- Peter Gehrke
- Department of Postgraduate Education, Master of Oral Implantology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt, Germany.
- Private Practice for Oral Surgery and Implant Dentistry, Bismarckstraße 27, 67059, Ludwigshafen, Germany.
| | - Mahsa Rashidpour
- Master of Oral Implantology, Center for Dentistry and Oral Medicine, Johann Wolfgang Goethe University, Frankfurt, Germany
- Private Practice for Implant dentistry and Prosthodontics, Tehran, Iran
| | - Robert Sader
- Department for Oral, Cranio-Maxillofacial and Facial Plastic Surgery, Medical Center of the Goethe University, Frankfurt, Germany
| | - Paul Weigl
- Head of Department of Postgraduate Education, Master of Oral Implantology, Center for Dentistry and Oral Medicine (Carolinum), Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60596, Frankfurt, Germany
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Espona J, Roig E, Ali A, Vidal C, Garcia-Font M, Roig M, Figueras O. Optical impressions assessment for overlay restorations with rubber dam: A clinical trial. J Dent 2024; 143:104825. [PMID: 38157974 DOI: 10.1016/j.jdent.2023.104825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 12/13/2023] [Accepted: 12/26/2023] [Indexed: 01/03/2024] Open
Abstract
OBJECTIVE The possibility of making impressions of teeth prepared with a rubber dam in place has been proposed; however, this requires trimming and rescanning the mesh, which has been described as a cause of accuracy loss. This study aims to clinically determine whether overlay restorations obtained from a scan with a rubber dam in place have equivalent marginal fit, contact points, and occlusal fit to the same type of restorations obtained from a scan without a rubber dam. MATERIAL AND METHODS Thirty patients who underwent overlay restoration of a molar with at least one neighbouring tooth were selected. After tooth preparation, two scans were performed: one without a rubber dam and the other with a rubber dam. Restorations were randomly created from one scan or another. The marginal fit, interproximal contact points, and occlusal fit were evaluated clinically. Two meshes, with and without rubber dams, were also compared. RESULTS No significant differences were observed in the clinical evaluation of the overlays made of the two meshes. The trueness of the mesh from the impression made with a rubber dam with respect to the mesh without a rubber dam was about 40 µm in the critical areas of the preparation (margins, intaglio, and interproximal contact points). CONCLUSIONS The results of this study show that under the conditions performed and with the equipment used, there are no significant clinical differences between overlay restorations made from a scan with a rubber dam and those made from a scan without a rubber dam. CLINICAL SIGNIFICANCE Scanning with a rubber dam in place may be a valid option for certain types of restorations under certain clinical conditions.
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Affiliation(s)
- José Espona
- Department of Restorative Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Elena Roig
- Department of Restorative Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain; Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain.
| | - Akram Ali
- Department of Restorative Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Carla Vidal
- Department of Restorative Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Marc Garcia-Font
- Department of Endodontics, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Miguel Roig
- Department of Restorative Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Oscar Figueras
- Department of Restorative Dentistry, Universitat Internacional de Catalunya, Barcelona, Spain
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Seshan RR, Karthikeyan HR, Rajan RM, Rajakumaran A, Varadan P, Gopal R. Comparative evaluation of the marginal fit of computer-aided design-computer aided manufacturing fabricated crowns from direct and indirect digital impression - A systematic review. JOURNAL OF CONSERVATIVE DENTISTRY AND ENDODONTICS 2024; 27:140-145. [PMID: 38463477 PMCID: PMC10923227 DOI: 10.4103/jcde.jcde_42_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 03/12/2024]
Abstract
The accuracy of the digital impression method is responsible for fabricating crowns with adequate marginal fit which in turn determines the postendodontic prognosis. This systematic review was undertaken to identify the influence of the two digital impression techniques in producing full coverage crowns with better marginal fit. This systematic review was conducted according to the Preferred Reporting Items for Systematic Review and Meta-analysis statement. A detailed search was done in electronic databases (PubMed, EBSCOhost, LILACS, Cochrane) along with hand searches of reference articles. In vivo crossover studies comparing the marginal fit of the computer-aided design-computer-aided manufacturing (CAD-CAM) fabricated crowns from direct and indirect digital impressions published from inception till July 2023 were included in this review. The quality assessment of the included articles was done based on a modified Cochrane collaboration tool for crossover studies. A total of 280 articles were identified, after duplicate removal, title and abstract screening, and full-text evaluation, 7 articles were included in this systematic review. The overall quality of evidence is moderate. The CAD-CAM crowns fabricated from direct digital impressions exhibited a better marginal fit than those crowns fabricated by indirect digital impressions. The overall quality of evidence is moderate. Further clinical studies has to be conducted for evaluating the latest technologies towards achieving the misfit of zero.
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Affiliation(s)
- R. Rakkesh Seshan
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Hari Raghavendar Karthikeyan
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - R. Mathan Rajan
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Arasappan Rajakumaran
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Preethi Varadan
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Rajeswari Gopal
- Department of Conservative Dentistry and Endodontics, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Bandiaky ON, Clouet R, Le Bars P, Soueidan A, Le Guehennec L. Marginal and internal fit of five-unit zirconia-based fixed dental prostheses fabricated with digital scans and conventional impressions: A comparative in vitro study. J Prosthodont 2023; 32:846-853. [PMID: 36627825 DOI: 10.1111/jopr.13639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 12/12/2022] [Accepted: 12/18/2022] [Indexed: 01/12/2023] Open
Abstract
PURPOSE This study aimed to compare the marginal and internal fit of five-unit zirconia-based fixed dental prostheses (FDPs) fabricated using digital scans and conventional impressions. MATERIALS AND METHODS Nine master models with three zirconia abutments were scanned with an intraoral scanner (test group), and nine conventional impressions (control group) of these same models were also made. The stone casts from these impressions were scanned with a laboratory extraoral scanner (D700, 3Shape, Copenhagen, Denmark). A total of 18 five-unit zirconia-based FDP frameworks (test group, n = 9; control group, n = 9) were manufactured. Marginal and internal fit (in μm) were evaluated using the replica method under micro-computed tomography. Analysis of variance (one-way ANOVA) and Kruskal-Wallis tests were used to compare continuous variables across two groups. A level of p < 0.05 was accepted as statistically significant. RESULTS The mean ± standard deviation of the marginal fit was 95.03 ± 12.74 μm in the test group and 106.02 ± 14.51 μm in the control group. The lowest marginal mean value was observed in the test group, with a statistically significant difference compared to the control group (F = 14.56, p < 0.05). The mean ± standard deviation of the internal fit was 103.61 ± 9.32 and 106.38 ± 7.64 μm, respectively, in the test and control groups, with no statistically significant difference (F = 1.56, p > 0.05). The mean values of both groups were clinically acceptable. CONCLUSIONS The five-unit zirconia-based FDPs fabricated with digital scans showed better fit than those in the conventional impression group. Within the limitations of this study, these results are encouraging, and continued progress in the digital field should allow for more accurate long-span restorations.
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Affiliation(s)
- Octave Nadile Bandiaky
- Nantes University, Oniris, Univ Angers, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, Nantes, France
| | - Roselyne Clouet
- Department of Prosthetic Dentistry, Nantes University, CHU Nantes, Nantes, France
| | - Pierre Le Bars
- Department of Prosthetic Dentistry, Nantes University, CHU Nantes, Nantes, France
| | - Assem Soueidan
- Department of Periodontology, Nantes University, Oniris, Univ Angers, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, Nantes, France
| | - Laurent Le Guehennec
- Department of Prosthodontics, Nantes University, Oniris, Univ Angers, CHU Nantes, INSERM, Regenerative Medicine and Skeleton, Nantes, France
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Aswal GS, Rawat R, Dwivedi D, Prabhakar N, Kumar V. Clinical Outcomes of CAD/CAM (Lithium disilicate and Zirconia) Based and Conventional Full Crowns and Fixed Partial Dentures: A Systematic Review and Meta-Analysis. Cureus 2023; 15:e37888. [PMID: 37213959 PMCID: PMC10199723 DOI: 10.7759/cureus.37888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/14/2023] [Indexed: 05/23/2023] Open
Abstract
Although CAD/CAM (computer-aided design/computer-aided manufacturing) restorations act as a favorable alternative to conventional metal-ceramic restorations for fixed dental prostheses, little is known about their intermediate and persistent clinical performance. This systematic review and meta-analysis aimed to assess the clinical performance in terms of biological, technical, and esthetic aspects and the survival and success ratios for single full crowns (SFCs) and fixed partial dentures (FPDs) fabricated by CAD/CAM and conventional techniques and according to the materials used (zirconia {ZC} and lithium disilicate {LD}). The population, intervention, control, outcome, and study design (PICOS) strategy was used to electronically search key terms in the PubMed, Cochrane Library, Embase, and Wiley Online databases for randomized control trials (RCTs) and cohort studies. The bias risks for RCTs and cohort studies were assessed using the Cochrane collaboration tool and the Newcastle-Ottawa Scale (NOS). Meta-analysis was performed using Rev5 from Cochrane. A total of 13 studies reporting on 1598 restorations in 1161 patients with a mean observation period of 3.6 years (minimum-maximum: 1-9.3 years) met the inclusion criteria. Meta-analysis of the included studies indicated that CAD/CAM manufacturing resulted in 1.17, 1.14, and 16.88 (95% CI: 0.64-2.17, 0.86-1.52, 7.59-37.56) higher biological, technical, and esthetic complications than conventional manufacturing of restorations. However, the difference was significant for esthetic complications only (p<0.00001). A significant difference was observed for all biological, technical, and aesthetic aspects between SFCs and FPDs (odds ratio {OR} = 2.61 vs. 1.78, 95% CI: 1.92-3.56 vs. 1.33-2.38; p<0.00001). The survival ratio of SFCs was 2.69 (95% CI: 1.98-3.65), significantly higher compared to the 1.76 (95% CI: 1.31-2.36) of FPDs (p<0.00001). The success ratio of FPDs at 1.18 (95% CI: 0.83-1.69) was significantly lower compared to SFCs at 2.36 (95% CI: 1.68-3.33). The clinical performance of LD with 2.42 (CI: 1.16-5.03) was significantly higher compared to ZC with 2.22 (CI: 1.78-2.77) (p<0.00001). The biological, technical, and aesthetic behaviors showed similar clinical outcomes between the CAD/CAM and conventional groups. LD could be a good alternative to zirconia, but its intermediate or persistent clinical performance needs to be evaluated. Overall, zirconia and CAD/CAM techniques must evolve further to outclass the conventional techniques used in the fabrication of SFCs and FPDs.
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Affiliation(s)
- Gunjan S Aswal
- Dentistry, The University of the West Indies, St. Augustine, TTO
| | - Renu Rawat
- Dentistry, The University of the West Indies, St. Augustine, TTO
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Baldi A, Comba A, Rozzi D, Rocha Pereira GK, Valandro LF, Michelotto Tempesta R, Scotti N. Does partial adhesive preparation design and finish line depth influence trueness and precision of intraoral scanners? J Prosthet Dent 2023; 129:637.e1-637.e9. [PMID: 36907802 DOI: 10.1016/j.prosdent.2023.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 01/06/2023] [Accepted: 01/06/2023] [Indexed: 03/12/2023]
Abstract
STATEMENT OF PROBLEM Intraoral scanners (IOSs) are widely used for partial-coverage adhesive restorations, but data on their performance in such preparations with complex geometries are sparse. PURPOSE The purpose of this in vitro study was to investigate whether the partial-coverage adhesive preparation design and finish line depth affect the trueness and precision of different IOSs. MATERIAL AND METHODS Seven partial-coverage adhesive preparation designs (4 different onlays, 2 endocrowns, and 1 occlusal veneer) were tested on copies of the same tooth placed in a typodont mounted on a mannequin. Each preparation was scanned 10 times with 6 different IOSs (total 420 scans) under the same light conditions. Trueness and precision, defined according to the International Organization for Standardization (ISO) 5725-1 standard, were analyzed with a best-fit algorithm by superimposition. The obtained data were analyzed by a 2-way analysis of variance to examine the effects of partial-coverage adhesive preparation design, IOS, and their interactions (α=.05). RESULTS Significant differences were found among different preparation designs and IOSs (P<.05) in terms of both trueness and precision. Significant differences were also found among mean positive and negative values (P<.05). Moreover, crosslinks observed between the preparation area and the adjacent teeth correlated with the finish line depth. CONCLUSIONS Complex partial adhesive preparation designs affect the trueness and precision of IOSs, resulting in significant differences among them. Interproximal preparations should take into account the IOS's resolution and placing the finish line close to adjacent structures should be avoided.
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Affiliation(s)
- Andrea Baldi
- PhD student, Department of Surgical Sciences, Dental School, Turin, Italy
| | - Allegra Comba
- Adjunct Professor, Department of Surgical Sciences, Dental School, Turin, Italy
| | - Davide Rozzi
- Lecturer, Department of Surgical Sciences, Dental School, Turin, Italy
| | - Gabriel Kalil Rocha Pereira
- Adjunct Professor, Department of Restorative Dentistry, Division of Prosthodontics, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | - Luiz Felipe Valandro
- Associate Professor, Department of Restorative Dentistry, Division of Prosthodontics, Federal University of Santa Maria (UFSM), Santa Maria, Brazil
| | | | - Nicola Scotti
- Associate Professor, Department of Surgical Sciences, Dental School, Turin, Italy.
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Morsy N, El Kateb M. Accuracy of intraoral scanners for static virtual articulation: A systematic review and meta-analysis of multiple outcomes. J Prosthet Dent 2022:S0022-3913(22)00608-4. [PMID: 36333175 DOI: 10.1016/j.prosdent.2022.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 09/26/2022] [Accepted: 09/27/2022] [Indexed: 11/05/2022]
Abstract
STATEMENT OF PROBLEM Static virtual articulation with intraoral scanners (IOSs) can eliminate the human errors related to conventional articulation methods and enhance accuracy. A systematic review and meta-analysis based on multiple accuracy outcomes can combine the available literature and provide an evidence-based conclusion. PURPOSE The purpose of this systematic review and meta-analysis was to investigate whether static virtual articulation with IOSs has acceptable accuracy for completely dentate and partially edentulous patients. MATERIAL AND METHODS An electronic search was conducted on the PubMed, Web of Science, and Scopus databases. In addition, a manual search through reference lists of selected articles was performed. Clinical and in vitro studies evaluating the accuracy of static virtual articulation with IOSs based on diagnostic accuracy, trueness, precision, and occlusion of fabricated fixed restorations were included. The pooled results included sensitivity, specificity, positive likelihood ratio (+LR), negative likelihood ratio (-LR), diagnostic odds ratios (DORs), mean values, and 95% confidence intervals (CIs). Results were presented as forest plots. The summary receiver operator characteristic (SROC) was displayed to summarize the diagnostic test performance. RESULTS The initial search resulted in a total of 5061 articles, of which 29 articles were included in the analysis. The virtual interocclusal records (VIRs) with IOSs showed acceptable pooled results for diagnostic accuracy (sensitivity: 0.76; specificity: 0.80; DOR: 14.77, area under the SROC (AUC): 0.87; cut off point Q∗: 80; +LR: 3.66; -LR: 0.31). The pooled data for trueness and precision were within the acceptable limits. The pooled mean (95% CI) for trueness based on linear deviations was 243.53 (144.90, 342.17). The pooled mean (95% CI) for precision based on 3D deviation of articulated models was 54.97 (43.49, 66.46). In addition, the included studies reported accurate occlusion for fixed restorations fabricated by using VIRs with IOSs. Moreover, most of the studies on trueness based on virtual occlusal contact area reported acceptable accuracy. CONCLUSIONS VIRs with IOSs had acceptable accuracy for static virtual articulation.
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Affiliation(s)
- Noha Morsy
- Lecturer of Fixed Prosthodontics, Department of Conservative Dentistry, Alexandria University, Alexandria, Egypt.
| | - Mohammed El Kateb
- Professor of Fixed Prosthodontics, Department of Conservative Dentistry, Alexandria University, Alexandria, Egypt
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García-Martínez I, Zarauz C, Morejón-Márquez B, Ferreiroa A, Pradíes G. Influence of customized over-scan body rings on the intraoral scanning effectiveness of a multiple implant edentulous mandibular model. J Dent 2022; 122:104095. [PMID: 35301081 DOI: 10.1016/j.jdent.2022.104095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/11/2022] [Accepted: 03/13/2022] [Indexed: 10/18/2022] Open
Affiliation(s)
- Irene García-Martínez
- Research Fellow, Department of Buccofacial Prostheses, Faculty of Dentistry, Complutense University of Madrid, Pza. Ramón y Cajal, s/n, 28040 Madrid, Spain
| | - Cristina Zarauz
- Research and Teaching Fellow, Division of Fixed Prosthodontics and Biomaterials, Clinic of Dental Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Genève 4, Switzerland.
| | - Belén Morejón-Márquez
- Research Fellow, Department of Buccofacial Prostheses, Faculty of Dentistry, Complutense University of Madrid, Pza. Ramón y Cajal, s/n, 28040 Madrid, Spain
| | - Alberto Ferreiroa
- Assistant Professor, Department of Buccofacial Prostheses, Faculty of Dentistry, Complutense University of Madrid, Pza. Ramón y Cajal, s/n, 28040 Madrid, Spain
| | - Guillermo Pradíes
- Professor and Associate Dean, Department of Buccofacial Prostheses, Faculty of Dentistry, Complutense University of Madrid, Pza. Ramón y Cajal, s/n, 28040 Madrid, Spain
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Bandiaky ON, Le Bars P, Gaudin A, Hardouin JB, Cheraud-Carpentier M, Mbodj EB, Soueidan A. Comparative assessment of complete-coverage, fixed tooth-supported prostheses fabricated from digital scans or conventional impressions: A systematic review and meta-analysis. J Prosthet Dent 2022; 127:71-79. [PMID: 33143901 DOI: 10.1016/j.prosdent.2020.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/29/2020] [Accepted: 09/29/2020] [Indexed: 11/22/2022]
Abstract
STATEMENT OF PROBLEM Intraoral scanners have significantly improved over the last decade. Nevertheless, data comparing intraoral digital scans with conventional impressions are sparse. PURPOSE The purpose of this systematic review and meta-analysis was to determine the impact of impression technique (digital scans versus conventional impressions) on the clinical time, patient comfort, and marginal fit of tooth-supported prostheses. MATERIAL AND METHODS The authors conducted a literature search based on the Population, Intervention, Comparison, and Outcome (PICO) framework in 3 databases to identify clinical trials with no language or date restrictions. The mean clinical time, patient comfort, and marginal fit values of each study were independently extracted by 2 review authors and categorized according to the scanning or impression method. The authors assessed the study-level risk of bias. RESULTS A total of 16 clinical studies met the inclusion criteria. The mean clinical time was statistically similar for digital scan procedures (784 ±252 seconds) and for conventional impression methods (1125 ±159 seconds) (P>.05). The digital scan techniques were more comfortable for patients than conventional impressions; the mean visual analog scale score was 67.8 ±21.7 for digital scans and 39.6 ±9.3 for conventional impressions (P<.05). The mean marginal fit was 80.9 ±31.9 μm and 92.1 ±35.4 μm for digital scan and conventional impressions, respectively, with no statistically significant difference (P>.05). CONCLUSIONS Digital scan techniques are comparable with conventional impressions in terms of clinical time and marginal fit but are more comfortable for patients than conventional impression techniques.
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Affiliation(s)
- Octave Nadile Bandiaky
- Graduate student, Graduate Prosthodontics, Department of Odontology, University of Dakar, Dakar, Senegal
| | - Pierre Le Bars
- Associate Professor, Division of Fixed Prosthodontics, CHU Nantes, Nantes, France
| | - Alexis Gaudin
- Associate Professor Biostatistics, UMR 1246 INSERM SPHERE "MethodS in Patients-Centered Outcomes and HEalth ResEarch", Universities of Nantes and Tours, Nantes, France
| | - Jean Benoit Hardouin
- Associate Professor of Endodontics and Restorative Dentistry, Department of Endodontics and Restorative Dentistry, University of Nantes, Nantes, France
| | | | - Elhadj Babacar Mbodj
- Professor, Clinic of Fixed and Removable Prosthodontics, Department of Odontology, University of Dakar, Dakar, Senegal
| | - Assem Soueidan
- Professor of Periodontology, Department of Periodontology, Rmes U1229, University of Nantes, Nantes, France.
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Nagata K, Fuchigami K, Okuhama Y, Wakamori K, Tsuruoka H, Nakashizu T, Hoshi N, Atsumi M, Kimoto K, Kawana H. Comparison of digital and silicone impressions for single-tooth implants and two- and three-unit implants for a free-end edentulous saddle. BMC Oral Health 2021; 21:464. [PMID: 34556111 PMCID: PMC8458793 DOI: 10.1186/s12903-021-01836-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022] Open
Abstract
Background The use of intraoral scanners (IOS) has facilitated the use of digital workflows for the fabrication of implant-supported prostheses not only for single missing teeth, but also for multiple missing teeth. However, the clinical application of IOS and computer-aided design/manufacturing (CAD/CAM) in implant-supported prosthodontics remains unclear. This study aimed to compare the accuracy of digital and silicone impressions for single-tooth implants for bounded edentulous spaces and two-unit and three-unit implant-supported fixed dental prostheses for free-end edentulous spaces. Methods This study enrolled 30 patients (n = 10 for each of the three groups) with an average age of 61.9 years. Conventional silicone-based and digital IOS-based impressions were made for all patients, and the implant superstructures were fabricated. We measured the scan-body misfit and compared the accuracy of the impressions for single-unit, two-unit, and three-unit implant prostheses with a bounded edentulous space by superimposing the standard triangulated language (STL) data obtained from IOS over the STL data of the plaster model used for final prosthesis fabrication. The scan bodies of the superimposed single-molar implant, two-unit implant prosthesis without teeth on the mesial side, two-unit implant prosthesis without teeth on the distal side, three-unit implant prosthesis without teeth on the mesial side, and three-unit implant prosthesis without teeth on the distal side were designated as A, B1, B2, C1, and C2, respectively. The misfit for each scan body was calculated and the accuracies were compared using the Tukey–Kramer method. Results The average scan-body misfit for conditions A, B1, B2, C1, and C2 was 40.5 ± 18.9, 45.4 ± 13.4, 56.5 ± 9.6, 50.7 ± 14.9, and 80.3 ± 12.4 μm, respectively. Significant differences were observed between the accuracies of A and B2, A and C2, and C1 and C2 (P < 0.001). Conclusions IOS and CAD/CAM can find clinical applications for implant-supported prostheses of up to three units for a bounded edentulous saddle. The use of IOS could render implant treatment easier, benefiting both the surgeons and patients. Prosthesis maladjustment may lead to peri-implantitis and prosthetic fracture. Therefore, further validation of the accuracy of IOS impressions is required in patients with multiple missing teeth in long-span implant prostheses.
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Affiliation(s)
- Koudai Nagata
- Department of Oral and Maxillofacial Implantology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, 238-8580, Japan
| | - Kei Fuchigami
- Department of Oral and Maxillofacial Implantology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, 238-8580, Japan
| | - Yurie Okuhama
- Department of Oral and Maxillofacial Implantology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, 238-8580, Japan
| | - Kana Wakamori
- Department of Oral and Maxillofacial Implantology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, 238-8580, Japan
| | - Hayato Tsuruoka
- Department of Oral and Maxillofacial Implantology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, 238-8580, Japan
| | - Toshifumi Nakashizu
- Department of Dental Laboratory, Kanagawa Dental University Hospital, Yokosuka, Japan
| | - Noriyuki Hoshi
- Division of Prosthodontics and Oral Implantology, Department of Oral Interdisciplinary Medicine, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - Mihoko Atsumi
- Division of Prosthodontics and Oral Implantology, Department of Oral Interdisciplinary Medicine, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - Katsuhiko Kimoto
- Division of Prosthodontics and Oral Implantology, Department of Oral Interdisciplinary Medicine, Graduate School of Dentistry, Kanagawa Dental University, Yokosuka, Japan
| | - Hiromasa Kawana
- Department of Oral and Maxillofacial Implantology, Kanagawa Dental University, 82 Inaoka-cho, Yokosuka, 238-8580, Japan.
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Li L, Chen H, Li W, Wang Y, Sun Y. Design of wear facets of mandibular first molar crowns by using patient-specific motion with an intraoral scanner: A clinical study. J Prosthet Dent 2021; 129:710-717. [PMID: 34426014 DOI: 10.1016/j.prosdent.2021.06.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 06/29/2021] [Accepted: 06/29/2021] [Indexed: 11/24/2022]
Abstract
STATEMENT OF PROBLEM Although computer-aided design has become popular, restorations are typically designed from static occlusion and dynamically by using an average-value virtual articulator. Patient-specific motion recorded by using an intraoral scanner has rarely been used to design restorations, and its design ability has not been analyzed. PURPOSE The purpose of this clinical study was to record patient-specific motion by using an intraoral scanner and to analyze its ability to design the morphology of the wear facets on mandibular first molar crowns. MATERIAL AND METHODS An intraoral scanner was used to scan complete arch digital casts and to record patient-specific motion of 11 participants. Right and left mandibular first molars were selected as the target teeth. The complete crown preparations of the target teeth were virtually prepared on the digital mandibular casts by using the Geomagic Studio 2013 software program. High points were created by elevating the wear facets of the target teeth by 0.3 mm in the occlusal direction to generate digital wax patterns. The Dental System software program was used to design crowns with the anatomic coping design method. Occlusal adjustment with static occlusion (STA crown), with the average-value virtual articulator (DYN crown), and with patient-specific motion (FUN crown) was carried out. The crowns adjusted with these 3 methods were compared with the original wear facets. The mean value and root mean square (RMS) of 3D deviation were measured. One-way ANOVA was used to analyze the influence of the occlusal surface design methods on the morphology of the wear facets (α=.05). RESULTS The STA crowns had the poorest results with the mean ±standard deviation 3D deviation value of 0.15 ±0.05 mm and RMS value of 0.19 ±0.04 mm. The best results occurred in the FUN group, with the mean ±standard deviation 3D deviation value of 0.05 ±0.06 mm and RMS value of 0.13 ±0.03 mm. Significant differences were found among the 3 groups (P<.01). Except for the RMS value between the STA and DYN groups, significant differences were found between groups from the pairwise comparisons. CONCLUSIONS The occlusal surface of the crowns designed by using the patient-specific motion recorded with the intraoral scanner had the best coincidence with the morphology of the wear facets on the original teeth.
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Affiliation(s)
- Linlin Li
- Doctoral student, Faculty of Prosthodontics, Center of Digital Dentistry, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Research Center of Engineering and Technology for Digital Dentistry of Ministry of Health & Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, PR China
| | - Hu Chen
- Attending Doctor, Faculty of Prosthodontics, Center of Digital Dentistry, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Research Center of Engineering and Technology for Digital Dentistry of Ministry of Health & Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, PR China
| | - Weiwei Li
- Postdoctoral, Faculty of Prosthodontics, Center of Digital Dentistry, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Research Center of Engineering and Technology for Digital Dentistry of Ministry of Health & Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, PR China
| | - Yong Wang
- Professor, Faculty of Prosthodontics, Center of Digital Dentistry, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Research Center of Engineering and Technology for Digital Dentistry of Ministry of Health & Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, PR China
| | - Yuchun Sun
- Professor, Faculty of Prosthodontics, Center of Digital Dentistry, Peking University School and Hospital of Stomatology & National Engineering Laboratory for Digital and Material Technology of Stomatology & Research Center of Engineering and Technology for Digital Dentistry of Ministry of Health & Beijing Key Laboratory of Digital Stomatology, National Clinical Research Center for Oral Diseases, Beijing, PR China.
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12
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Lim JH, Mangal U, Nam NE, Choi SH, Shim JS, Kim JE. A Comparison of Accuracy of Different Dental Restorative Materials between Intraoral Scanning and Conventional Impression-Taking: An In Vitro Study. MATERIALS 2021; 14:ma14082060. [PMID: 33921830 PMCID: PMC8073328 DOI: 10.3390/ma14082060] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 11/16/2022]
Abstract
The properties of underlying substrates influence the quality of an intraoral scan, but few studies have compared the outcomes using common restorative materials. In this study, we aimed to compare the accuracy of digital and conventional impressions recorded for four different dental materials as the substrates. Experimental crowns were produced with a metallic surface (gold or cobalt-chromium alloy (Co-Cr)) or without a metallic surface (zirconia or PMMA (polymethyl methacrylate)). A conventional impression was made in the conventional group (CON group), and gypsum models were subsequently scanned with a tabletop scanner. An intraoral scanner was used to scan the crowns either after applying a powder spray to reduce the surface reflectivity (IOS-P group) or without the powder spray (IOS group). The scans were assessed in three dimensions for precision and trueness. The accuracy did not differ between the CON and IOS groups for the non-metallic crowns. However, it was statistically different for the Co-Cr metallic crown, reducing trueness observed between groups as CON > IOS > IOS-P. The study evidences the differences in outer surface accuracy observed with a change in the substrate material to be imaged using an oral scanner and with the impression method. These findings suggest that the restoration material present in the oral cavity should be considered when selecting an impression-taking method.
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Affiliation(s)
- Jung-Hwa Lim
- Oral Research Science Center, Department of Prosthodontics, Yonsei University College of Dentistry, Seoul 03722, Korea; (J.-H.L.); (N.-E.N.)
| | - Utkarsh Mangal
- Institute of Craniofacial Deformity, Department of Orthodontics, Yonsei University College of Dentistry, Seoul 03722, Korea; (U.M.); (S.-H.C.)
| | - Na-Eun Nam
- Oral Research Science Center, Department of Prosthodontics, Yonsei University College of Dentistry, Seoul 03722, Korea; (J.-H.L.); (N.-E.N.)
| | - Sung-Hwan Choi
- Institute of Craniofacial Deformity, Department of Orthodontics, Yonsei University College of Dentistry, Seoul 03722, Korea; (U.M.); (S.-H.C.)
| | - June-Sung Shim
- Department of Prosthodontics, Yonsei University College of Dentistry, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Korea;
| | - Jong-Eun Kim
- Department of Prosthodontics, Yonsei University College of Dentistry, Yonsei-ro 50-1, Seodaemun-gu, Seoul 03722, Korea;
- Correspondence: ; Tel.: +82-2-2228-3166
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13
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Shi S, Li N, Jin X, Huang S, Ma J. A Digital Esthetic Rehabilitation of a Patient with Dentinogenesis Imperfecta Type II: A Clinical Report. J Prosthodont 2020; 29:643-650. [PMID: 32803808 PMCID: PMC7589272 DOI: 10.1111/jopr.13237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 11/30/2022] Open
Abstract
A 19‐year‐old female affected by dentinogenesis imperfecta type II (DI‐II), a genetic disease that affects the structural integrity of the dentin, presented with a chief complaint of discolored teeth. For this patient, digital techniques, including digital smile design (DSD), the ARCUSdigma axiograph and computer‐aided design/computer‐aided manufacturing (CAD/CAM), were extensively used in all phases of the rehabilitation process. Compared to traditional analog methods, these digital techniques could reduce the constant confirmation of occlusion, promote communication between clinicians and dental technicians, achieve accurate occlusion with relatively high efficiency, and improve the efficacy of esthetic rehabilitation in the treatment of this patient with DI‐II.
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Affiliation(s)
- Shi Shi
- Institute of Stomatology, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, PR China
| | - Ning Li
- Department of Prosthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, PR China
| | - Xiaoting Jin
- Department of Prosthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, PR China
| | - Shengbin Huang
- Department of Prosthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, PR China
| | - Jianfeng Ma
- Department of Prosthodontics, School and Hospital of Stomatology, Wenzhou Medical University, Wenzhou, PR China
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Al-Haj Husain N, Özcan M, Molinero-Mourelle P, Joda T. Clinical Performance of Partial and Full-Coverage Fixed Dental Restorations Fabricated from Hybrid Polymer and Ceramic CAD/CAM Materials: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9072107. [PMID: 32635470 PMCID: PMC7408958 DOI: 10.3390/jcm9072107] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/28/2020] [Accepted: 07/01/2020] [Indexed: 12/11/2022] Open
Abstract
The aim of this systematic review and meta-analysis was to evaluate the clinical performance of tooth-borne partial and full-coverage fixed dental prosthesis fabricated using hybrid polymer and ceramic CAD/CAM materials regarding their biologic, technical and esthetical outcomes. PICOS search strategy was applied using MEDLINE and were searched for RCTs and case control studies by two reviewers using MeSH Terms. Bias risk was evaluated using the Cochrane collaboration tool and Newcastle–Ottawa assessment scale. A meta-analysis was conducted to calculate the mean long-term survival difference of both materials at two different periods (≤24, ≥36 months(m)). Mean differences in biologic, technical and esthetical complications of partial vs. full crown reconstructions were analyzed using software package R (p < 0.05). 28 studies included in the systematic review and 25 studies in the meta-analysis. The overall survival rate was 99% (0.95–1.00, ≤24 m) and dropped to 95% (0.87–0.98, ≥36 m), while the overall success ratio was 88% (0.54–0.98; ≤24 m) vs. 77% (0.62–0.88; ≥36 m). No significance, neither for the follow-up time points, nor for biologic, technical and esthetical (88% vs. 77%; 90% vs. 74%; 96% vs. 95%) outcomes was overserved. A significance was found for the technical/clinical performance between full 93% (0.88–0.96) and partial 64% (0.34–0.86) crowns. The biologic success rate of partial crowns with 69% (0.42–0.87) was lower, but not significant compared to 91% (0.79–0.97) of full crowns. The esthetical success rate of partial crowns with 90% (0.65–0.98) was lower, but not significant compared to 99% (0.92–1.00) of full crowns.
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Affiliation(s)
- Nadin Al-Haj Husain
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland;
- Correspondence:
| | - Mutlu Özcan
- Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center for Dental and Oral Medicine, University of Zurich, 8032 Zurich, Switzerland;
| | - Pedro Molinero-Mourelle
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland;
| | - Tim Joda
- Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, 4058 Basel, Switzerland;
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Does ambient light affect the accuracy and scanning time of intraoral scans? J Prosthet Dent 2020; 125:924-931. [PMID: 32487348 DOI: 10.1016/j.prosdent.2020.03.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 03/22/2020] [Accepted: 03/23/2020] [Indexed: 11/20/2022]
Abstract
STATEMENT OF PROBLEM Intraoral scanners (IOSs) are based on light-optical imaging methods. However, little is known about whether the ambient light in dental practices influences the accuracy and scanning time of the IOS. PURPOSE The purpose of this in vitro study was to investigate the influence of different illuminations on the accuracy of 4-unit and complete-arch scans of 6 IOSs. In addition, the required scanning time was evaluated. MATERIAL AND METHODS A reference structure was attached to the first premolars (P) and second molars (M) in both quadrants (L/R) of a maxillary model. The resulting measured distances were M1-P1, M2-P2, P1-P2, and M1-M2. The investigation included 6 IOSs: TRIOS 3 (TRI), Cerec Omnicam (OC), iTero Element (ITE), CS 3600 (CS), Planmeca Emerald (EME), and GC Aadva (AAD). With each IOS, 17 scans at different illuminances (100, 500, 1000, and 5000 lux) were performed (N = 408). The precision and trueness for all distances were determined, and the scanning time was recorded. For statistical analyses, the Levene tests (precision) and 1-way analysis of variance with the post hoc Tukey honestly significant difference and Games-Howell tests (trueness) were calculated. RESULTS Illuminance significantly influenced the trueness of 4-unit scans for OC, EME, and AAD. TRI, OC, ITE, and CS demonstrated comparable results. AAD (>96 ±22 μm; 1000 lux) and EME (>248 ±88 μm; 500 lux) revealed greater deviations. For complete-arch scans, illuminance did not influence TRI and AAD, but significant variations were detected for ITE, CS, EME, and AAD. The least deviations were achieved with TRI and OC. The scanning time was extended for all IOSs except ITE at more than 500 lux. The shortest scanning times with OC and EME were recorded at 100 lux; with TRI, CS, and AAD at 500 lux; and with ITE at both 100 and 5000 lux. At all illuminances, the fastest scans were obtained with TRI. CONCLUSIONS Ambient light was found to influence the accuracy and scanning time of IOSs. This influence varies depending on the device. For 4-unit scans, the effect was not clinically relevant, but for complete-arch scans, accuracy and scanning time can be improved with appropriate lighting.
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Marginal and internal fit of CAD-CAM composite resin and ceramic crowns before and after internal adjustment. J Prosthet Dent 2020; 123:500-505. [PMID: 31307805 DOI: 10.1016/j.prosdent.2019.01.010] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 01/11/2019] [Accepted: 01/11/2019] [Indexed: 11/21/2022]
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Zubizarreta-Macho Á, Ferreiroa A, Agustín-Panadero R, Rico-Romano C, Lobo-Galindo AB, Mena-Álvarez J. Endodontic re-treatment and restorative treatment of a dens invaginatus type II through new technologies. J Clin Exp Dent 2019; 11:e570-e576. [PMID: 31346380 PMCID: PMC6645261 DOI: 10.4317/jced.55840] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 05/01/2019] [Indexed: 12/11/2022] Open
Abstract
Background The complex anatomy of dens invaginatus makes access cavity to root canal system difficult, which has an impact on the prognosis of these teeth. A novel technique, based on new technologies, is proposed to make access cavity conservative and guided with minimal dental structure lost. Material and Methods This case report shows the root canal retreatment and the endodontic surgery of a dens invaginatus type II in a left lateral upper incisor previously treated which was affected by a chronic apical abscess and an apical fracture. A Cone Beam Computed Tomography was performed to better diagnosis the dental anatomy. An intraoral scan was performed to get a digital 3D model. A computer-guided implant planning software was used to plan the access cavity and design the splint guided. Finally, the clinical crown was restored by a resin nanoceramic veneer made by a chairside system made up of an intraoral scanning unit and a grinding unit. Last, the authors carried through the endodontic surgery to extract the apical fractured fragment. Results Follow-up appointments at 6, 12 and 18 months showed a radiographic reduction of the periapical lesion and absence of clinical signs. Conclusions The splint guide allowed a guided and conservative access cavity to root canal system. It facilitates the root canal retreatment and improves the prognosis of the teeth with dental malformations. Key words:CAD-CAM, Cone-Beam Computed Tomography, dens in dente, dens invaginatus, dental pulp cavity, endodontics.
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Affiliation(s)
- Álvaro Zubizarreta-Macho
- DDS, PhD. Associate professor. Department of Endodontics. Faculty of Health Sciences. Alfonso X el Sabio University. Madrid. Spain
| | - Alberto Ferreiroa
- DDS, PhD. Associate professor. Department of Dental Prosthesis. Faculty of Dentistry. Complutense University. Madrid. Spain
| | - Rubén Agustín-Panadero
- DDS, PhD.Adjunct Professor. Department of Dental Medicine. Faculty of Medicine and Dentistry. University of Valencia. Spain
| | - Cristina Rico-Romano
- DDS, PhD. Associate professor. Department of Endodontics. Faculty of Health Sciences. Alfonso X el Sabio University. Madrid. Spain
| | - Ana-Belén Lobo-Galindo
- DDS, MS. Associate professor. Department of Endodontics. Faculty of Health Sciences. Alfonso X el Sabio University. Madrid. Spain
| | - Jesús Mena-Álvarez
- DDS, PhD. Head Director. Department of Endodontics. Faculty of Health Sciences. Alfonso X el Sabio University. Madrid. Spain
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