Extraction force and its determinants for minimally invasive vertical tooth extraction

Factors influencing the bond strength of additively manufactured crown materials in dentistry: A systematic review of in vitro studies

OBJECTIVE

The purpose of this systematic review was to investigate how different interventions can impact the bond strength of additively manufactured crown materials after cementation.

DATA/SOURCES

Four online databases Ovid MEDLINE, Scopus, Web of Science and Google Scholar were searched up to January 2023. Inclusion criteria were English-language publications, full-text, and in vitro studies only. Exclusion criteria were studies that did not assess the bonding of an additively manufactured crown material to cement or did not conduct any bond strength tests. An assessment of risk of bias was done in accordance with a modified Consolidated Standards of Reporting Trials (CONSORT) checklist. Each study was analysed and compared based on the interventions and bond strength results.

STUDY SELECTION

Six studies satisfied the inclusion and exclusion criteria, five of which evaluated photopolymerised resin and one that tested zirconia manufacturing via 3D printing. All studies observed a low risk of bias. The interventions applied included the type of surface pretreatments, airborne-particle abrasion pressure, cement type, taper of crown, and artificial aging. Three studies compared the bonding performance to milled materials.

CONCLUSIONS

The bond strength of crown materials additively manufactured from photopolymers presented high values and are comparable to milled materials. The systematic review demonstrated there was no definite superior cement type, but airborne-particle abrasion with alumina was generally recommended. There is a clear gap in the literature regarding the bond strength of additively manufactured crowns. Therefore, further research is necessary to evaluate its clinical applicability for permanent restorations.

CLINICAL SIGNIFICANCE

Factors influencing the bond strength of additively manufactured crown materials should be evaluated so dental professionals can adopt procedures that promote the strongest bond.

A novel method for simulating ex vivo tooth extractions under varying applied loads

BACKGROUND

Tooth extraction is a common surgical procedure where the invasiveness of the surgery can affect the nature of the dentoalveolar remodelling which follows. However, there is very little biomechanical data relating the loading applied during tooth extraction to the outcomes of the procedure. The purpose of this pilot study is to present a novel ex vivo experimental method for measuring tooth extraction mechanics and to explore preliminary metrics for predicting extraction success.

METHODS

A custom experimental apparatus was developed in-house to extract central incisors from ex vivo swine mandible samples. Twenty-five (n = 25) incisors were extracted at different rates in displacement- and force-control, along with an intermittent ramp-hold scheme for a total of five schemes. Peak forces and extraction success were recorded for each test. Video analysis assisted in determining the instantaneous stiffnesses of the dental complex during continuous extractions, which were compared using the K-means clustering algorithm.

FINDINGS

Tooth extraction forces ranged from 102 N to 309 N, with higher-rate tests tending towards higher peak forces (141 N - 308 N) than the lower-rate tests (102 N-204 N) for displacement- and force-controlled schemes. The K-means algorithm clearly identified load rates among tests, indicating that higher-rate loading increased system stiffness relative to the lower-rate tests.

INTERPRETATION

The developed experimental method demonstrated a desirable degree of control. The preliminary results suggest the influence of load rate on the mechanical response of the dental complex and extraction outcome. Future work will further investigate the biomechanics of tooth extraction and relate them to tissue damage to improve future tooth extraction procedures.

Alveolar ridge preservation: A review of concepts and controversies

The loss of thickness and height of the alveolar process after tooth extraction is a significant impediment to implant placement, which limits the aesthetic results of many restorative treatments. Alveolar ridge preservation can reduce bone resorption. Knowing how beneficial this procedure is can help clinicians decide if it is worth doing. The purpose of this article is to present a contemporary review of the different approaches to preserving the dimensions of the alveolar ridge. We analyze the alveolar healing process, atraumatic extraction techniques, graft materials, and controversies.

Analysis of movements in tooth removal procedures using robot technology

Being one of the oldest en most frequently performed invasive procedures; the lack of scientific progress of tooth removal procedures is impressive. This has most likely to do with technical limitations in measuring different aspects of these keyhole procedures. The goal of this study is to accurately capture the full range of motions during tooth removal as well as angular velocities in clinically relevant directions. An ex vivo measuring setup was designed consisting of, amongst others, a compliant robot arm. To match clinical conditions as closely as possible, fresh-frozen cadavers were used as well as regular dental forceps mounted on the robot's end-effector. Data on 110 successful tooth removal experiments are presented in a descriptive manner. Rotation around the longitudinal axis of the tooth seems to be most dominant both in range of motion as in angular velocity. Buccopalatal and buccolingual movements are more pronounced in the dorsal region of both upper and lower jaw. This study quantifies an order of magnitude regarding ranges of motion and angular velocities in tooth removal procedures. Improved understanding of these complex procedures could aid in the development of evidence-based educational material.

A Multiclass Classification Model for Tooth Removal Procedures

Surprisingly little is known about tooth removal procedures. This might be due to the difficulty of gaining reliable data on these procedures. To improve our understanding of these procedures, machine learning techniques were used to design a multiclass classification model of tooth removal based on force, torque, and movement data recorded during tooth removal. A measurement setup consisting of, among others, robot technology was used to gather high-quality data on forces, torques, and movement in clinically relevant dimensions. Fresh-frozen cadavers were used to match the clinical situation as closely as possible. Clinically interpretable variables or “features” were engineered and feature selection took place to process the data. A Gaussian naive Bayes model was trained to classify tooth removal procedures. Data of 110 successful tooth removal experiments were available to train the model. Out of 75 clinically designed features, 33 were selected for the classification model. The overall accuracy of the classification model in 4 random subsamples of data was 86% in the training set and 54% in the test set. In 95% and 88%, respectively, the model correctly classified the (upper or lower) jaw and either the right class or a class of neighboring teeth. This article discusses the design and performance of a multiclass classification model for tooth removal. Despite the relatively small data set, the quality of the data was sufficient to develop a first model with reasonable performance. The results of the feature engineering, selection process, and the classification model itself can be considered a strong first step toward a better understanding of these complex procedures. It has the potential to aid in the development of evidence-based educational material and clinical guidelines in the near future.

Influence of Pre-Treatment and Artificial Aging on the Retention of 3D-Printed Permanent Composite Crowns

The aim of this in vitro study is to investigate the bonding properties of a 3D-printable permanent composite material in comparison to milled composite materials. The tested materials are 3D-printed BEGO VarseoSmile Crown plus (VA1_ab, VA1_nt, VA2_ab, VA2_nt), Vita Enamic (EN1, EN2), and 3M Lava Ultimate (UL1, UL2) (N = 64; n = 8). For this purpose, all crowns are luted to polymer tooth stumps #46 (FDI) using dual-curing luting composite, strictly according to the manufacturer’s instructions. VA1_ab and VA2_ab are additionally airborne-particle abraded. 4 groups (VA2_ab, VA2_nt, EN2, UL2) are artificially aged (1,200,000 cycles, 50 N, 10,000 thermocycles), whereby no specimen has failed. All 64 specimens undergo pull-off testing until retention loss. The mean forces of retention-loss is 786.6 ± 137.6 N (VA1_nt, *), 988.6 ± 212.1 N (VA2_nt, *, Ɨ), 1223.8 ± 119.2 N (VA1_ab, Ɨ, ǂ), 1051.9 ± 107.2 N (VA2_ab, *, Ɨ), 1185.9 ± 211.8 N (EN1, Ɨ, ǂ), 1485.0 ± 198.2 N EN2, ǂ), 1533.8 ± 42.4 N (UL1, ǂ), and 1521.8 ± 343.4 N (UL2, ǂ) (one-way ANOVA (Scheffé method); p < 0.05; *, Ɨ, ǂ: group distribution). No characteristic failure modes can be detected. In conclusion, all of the pull-off forces reflect retention values that seem to be sufficiently high for clinical use. Additional airborne-particle abrasion of VA does not result in significantly better retention but can be recommended.

Collagenase Administration into Periodontal Ligament Reduces the Forces Required for Tooth Extraction in an Ex situ Porcine Jaw Model

Minimally invasive exodontia is among the long-sought-for development aims of safe dental medicine. In this paper, we aim, for the first time, to examine whether the enzymatic disruption of the periodontal ligament fibers reduces the force required for tooth extraction. To this end, recombinantly expressed clostridial collagenase G variant purified from Escherichia coli was injected into the periodontal ligament of mesial and distal roots of the first and second split porcine mandibular premolars. The vehicle solution was injected into the corresponding roots on the contralateral side. Following sixteen hours, the treated mandibles were mounted on a loading machine to measure the extraction force. In addition, the effect of the enzyme on the viability of different cell types was evaluated. An average reduction of 20% in the applied force (albeit with a large variability of 50 to 370 newton) was observed for the enzymatically treated roots, reaching up to 50% reduction in some cases. Importantly, the enzyme showed only a minor and transient effect on cellular viability, without any signs of toxicity. Using an innovative model enabling the analytical measurement of extraction forces, we show, for the first time, that the enzymatic disruption of periodontal ligament fibers substantially reduces the force required for tooth extraction. This novel technique brings us closer to atraumatic exodontia, potentially reducing intra- and post-operative complications and facilitating subsequent implant placement. The development of novel enzymes with enhanced activity may further simplify the tooth extraction process and present additional clinical relevance for the broad range of implications in the oral cavity.

Precise extraction of impacted supernumerary tooth in the maxillary anterior region with a digital guide plate: A case report

RATIONALE

Removal of impacted supernumerary teeth requires precision and accuracy to prevent iatrogenic injury to important anatomical structures during dental surgery and to improve postoperative healing.

PATIENT CONCERNS

A 12-year-old girl visited our department for the assessment and management of her deviated front teeth.

DIAGNOSIS

Impacted supernumerary tooth extraction in the maxillary anterior region.

INTERVENTIONS

The digital guide plate was fabricated after the integration of cone beam computed tomography data with that obtained from scanning the patient's dental model. Impacted supernumerary tooth extraction was performed.

OUTCOMES

The use of the digital guide plate and planting instruments made the removal of the impacted supernumerary tooth less invasive, faster, and more accurate, whereas the wound was smaller, and the patient experience more comfortable.

LESSONS

Combining the digital guide plate with planting instruments offers a useful aid for the removal of impacted supernumerary teeth among the maxillary anterior region and is, thus, worth promoting.

Manufacturing a First Upper Molar Dental Forceps Using Continuous Fiber Reinforcement (CFR) Additive Manufacturing Technology with Carbon-Reinforced Polyamide

3D printing is an emerging and disruptive technology, supporting the field of medicine over the past decades. In the recent years, the use of additive manufacturing (AM) has had a strong impact on everyday dental applications. Despite remarkable previous results from interdisciplinary research teams, there is no evidence or recommendation about the proper fabrication of handheld medical devices using desktop 3D printers. The aim of this study was to critically examine and compare the mechanical behavior of materials printed with FFF (fused filament fabrication) and CFR (continuous fiber reinforcement) additive manufacturing technologies, and to create and evaluate a massive and practically usable right upper molar forceps. Flexural and torsion fatigue tests, as well as Shore D measurements, were performed. The tensile strength was also measured in the case of the composite material. The flexural tests revealed the measured force values to have a linear correlation with the bending between the 10 mm (17.06 N at 5000th cycle) and 30 mm (37.99 N at 5000th cycle) deflection range. The findings were supported by scanning electron microscopy (SEM) images. Based on the results of the mechanical and structural tests, a dental forceps was designed, 3D printed using CFR technology, and validated by five dentists using a Likert scale. In addition, the vertical force of extraction was measured using a unique molar tooth model, where the reference test was carried out using a standard metal right upper molar forceps. Surprisingly, the tests revealed there to be no significant differences between the standard (84.80 N ± 16.96 N) and 3D-printed devices (70.30 N ± 4.41 N) in terms of extraction force in the tested range. The results also highlighted that desktop CFR technology is potentially suitable for the production of handheld medical devices that have to withstand high forces and perform load-bearing functions.

Predictable immediate implant placement and restoration in the esthetic zone

This article describes a comprehensive step-by-step protocol for immediate implant placement and restoration in the esthetic zone. Clinical Considerations Immediate implant placement into fresh extraction sockets and immediate restoration have become widely accepted, demonstrating long-term success rates that are comparable with traditional delayed implant protocols. However, they are technique sensitive and require proper treatment planning as well as meticulous execution to be predictable and successful in the long term. This is particularly important in the esthetic zone, where even minor aberrations and mistakes can have devastating consequences, and especially in younger patients, where esthetic and functional outcomes should remain stable for years and possibly decades to come. The eight critical steps for predictable immediate implant placement include: provisional restoration of the failing tooth and presurgical phase, atraumatic tooth extraction, initial implant osteotomy, 3D bone graft packing, guided implant placement with a surgical guide, customized abutment insertion, provisional crown relining, and placement of a connective tissue graft from tuberosity. Immediate implant protocols in the esthetic zone require thorough planning and execution in the proper sequence. Each one of the critical steps discussed in this article has its own importance and challenges, which are critically assessed based on current scientific evidence.