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Revilla-León M, Gómez-Polo M, Sailer I, Kois JC, Rokhshad R. An overview of artificial intelligence based applications for assisting digital data acquisition and implant planning procedures. J ESTHET RESTOR DENT 2024. [PMID: 38757761 DOI: 10.1111/jerd.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/29/2024] [Accepted: 04/30/2024] [Indexed: 05/18/2024]
Abstract
OBJECTIVES To provide an overview of the current artificial intelligence (AI) based applications for assisting digital data acquisition and implant planning procedures. OVERVIEW A review of the main AI-based applications integrated into digital data acquisitions technologies (facial scanners (FS), intraoral scanners (IOSs), cone beam computed tomography (CBCT) devices, and jaw trackers) and computer-aided static implant planning programs are provided. CONCLUSIONS The main AI-based application integrated in some FS's programs involves the automatic alignment of facial and intraoral scans for virtual patient integration. The AI-based applications integrated into IOSs programs include scan cleaning, assist scanning, and automatic alignment between the implant scan body with its corresponding CAD object while scanning. The more frequently AI-based applications integrated into the programs of CBCT units involve positioning assistant, noise and artifacts reduction, structures identification and segmentation, airway analysis, and alignment of facial, intraoral, and CBCT scans. Some computer-aided static implant planning programs include patient's digital files, identification, labeling, and segmentation of anatomical structures, mandibular nerve tracing, automatic implant placement, and surgical implant guide design.
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Affiliation(s)
- Marta Revilla-León
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA
- Research and Digital Dentistry, Kois Center, Seattle, Washington, USA
- Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Miguel Gómez-Polo
- Department of Conservative Dentistry and Prosthodontics, Complutense University of Madrid, Madrid, Spain
- Advanced in Implant-Prosthodontics, School of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - Irena Sailer
- Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - John C Kois
- Kois Center, Seattle, Washington, USA
- Department of Restorative Dentistry, University of Washington, Seattle, Washington, USA
- Private Practice, Seattle, Washington, USA
| | - Rata Rokhshad
- Topic Group Dental Diagnostics and Digital Dentistry, ITU/WHO Focus Group AI on Health, Berlin, Germany
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Kois JC, Zeitler JM, Revilla-León M. Use of an optical jaw tracking system to capture the envelope of function when designing interim and definitive prostheses: A dental technique. J Prosthet Dent 2024:S0022-3913(24)00240-3. [PMID: 38762385 DOI: 10.1016/j.prosdent.2024.03.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 03/13/2024] [Accepted: 03/14/2024] [Indexed: 05/20/2024]
Abstract
Jaw tracking systems can record mandibular motion for incorporation into programs used for designing dental prostheses. However, the protocol for data acquisition and design using the recorded mandibular motion is unclear. The envelope of function recorded in a patient with acceptable occlusal function provides important functional information that can be integrated into the design of dental prostheses. A protocol for recording a patient's digital data, including the envelope of function using a jaw tracker, for incorporation into the design procedures and a delivery protocol are described. This technique may simplify the delivery of prostheses by reducing the adjustments needed to the definitive prostheses.
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Affiliation(s)
- John C Kois
- Founder and Director, Kois Center, Seattle, Wash.; Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, University of Washington, Seattle, Wash.; and Private practice, Seattle, Wash
| | | | - Marta Revilla-León
- Affiliate Assistant Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; Faculty and Director, Research and Digital Dentistry, Kois Center, Seattle, Wash; and Adjunct Professor, Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Mass.
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Grande F, Lepidi L, Tesini F, Acquadro A, Valenti C, Pagano S, Catapano S. Investigation of the precision of a novel jaw tracking system in recording mandibular movements: A preliminary clinical study. J Dent 2024; 146:105047. [PMID: 38719134 DOI: 10.1016/j.jdent.2024.105047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/03/2024] [Accepted: 05/05/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES This preliminary study aimed to clinically assess the precision of a novel optical jaw tracking system (JTS) in registering mandibular movements (MMs) of protrusion and mediotrusion. METHODS Twenty healthy participants underwent recordings using Cyclops JTS (Itaka Way Med) for functional MMs of protrusion and laterotrusion by two trained clinicians. Each subject performed five registrations at different times according to a standardized pattern within one-month period. The angulations of protrusive and mediotrusive functional paths within the first 2 mm from the maximal intercuspal position (MIP) were calculated for each trace, using a data software for angle measurements. Descriptive statistics were used to assess the repeatability of the recordings for each participant and MM. Additionally, inferential statistics were carried out on standard deviation values obtained (α=0.05). RESULTS The overall precision for all the patients was 7.07±3.37° for the protrusion angle, 5.24±2.24° for right laterotrusion and 5.14±3.06° for left laterotrusion angles. The protrusion angle ranged from 3.08° to 13.57°, while the right and left laterotrusion ranged from 1.82° to 9.42° and from 1.58° to 10.59°, respectively. No statistically significant differences were observed between different functional MM types and gender (p > 0.05). CONCLUSIONS Recordings functional MMs of mediotrusion and protrusion using Cyclops JTS showed consistent repeatability, regardless of gender and functional MM type. The results revealed non-negligible variations that may be due to the patients' abilities to precisely reproduce jaw movements or to the operator's ability to consistently connect the kinesiograph. CLINICAL SIGNIFICANCE Capturing functional MMs digitally and importing the data into dental CAD software is essential for virtual waxing in prosthetic rehabilitations to design a functionalized adapted occlusion. Establishing the repeatability of MM recordings by a JTS is a crucial step in better understanding this novel JTS in the market. This process could facilitate the interpretation of cusp angles, aid in CAD dynamic technical modeling, and enhance clinical data communication between clinicians and technicians in a modern workflow.
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Affiliation(s)
- Francesco Grande
- PhD student at Politecnico of Turin, Turin Italy; University of Ferrara, Ferrara Italy.
| | - Luca Lepidi
- Adjunct Professor Gnathology, University of Ferrara, Ferrara Italy
| | | | | | | | - Stefano Pagano
- Chief-Professor Dental Materials, Oral Prosthodontic, University of Perugia, Perugia, Italy
| | - Santo Catapano
- Chief-Professor Dental Materials, Oral Prosthodontic, University of Ferrara, Ferrara, Italy
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Revilla-León M, Kois JC. True horizontal or gravity plane for transferring the maxillary cast into the virtual articulator by using an optical jaw tracking system. J Prosthet Dent 2024:S0022-3913(24)00275-0. [PMID: 38714458 DOI: 10.1016/j.prosdent.2024.03.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 03/25/2024] [Accepted: 03/27/2024] [Indexed: 05/09/2024]
Abstract
Different techniques of transferring the maxillary cast into the analog semi-adjustable articulator by using the true horizontal or gravity reference plane have been reported. However, procedures are required for recording this reference plane and transferring the maxillary cast into the virtual semi-adjustable articulator. In the present manuscript, a technique is described for registering the true horizontal or gravity plane in relationship to the natural head position of the patient by using an optical jaw tracking system. Additionally, the recorded true horizontal plane is used to transfer the maxillary cast into the virtual semi-adjustable articulator by using a dental computer-aided design program. This technique facilitates the maxillary cast transfer into the virtual articulator by using the true horizontal plane recorded with an optical jaw tracking system, maximizing the functionality of the optical jaw tracking device.
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Affiliation(s)
- Marta Revilla-León
- Affiliate Assistant Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash.; Director, Research and Digital Dentistry, Kois Center, Seattle, Wash.; and Adjunct Professor, Department of Prosthodontics, Tufts University, Boston, Mass.
| | - John C Kois
- Founder and Director, Kois Center, Seattle, Wash.; Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, University of Washington, Seattle, Wash.; and Private practice, Seattle, Wash
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Broll A, Rosentritt M, Schlegl T, Goldhacker M. A data-driven approach for the partial reconstruction of individual human molar teeth using generative deep learning. Front Artif Intell 2024; 7:1339193. [PMID: 38690195 PMCID: PMC11058210 DOI: 10.3389/frai.2024.1339193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/19/2024] [Indexed: 05/02/2024] Open
Abstract
Background and objective Due to the high prevalence of dental caries, fixed dental restorations are regularly required to restore compromised teeth or replace missing teeth while retaining function and aesthetic appearance. The fabrication of dental restorations, however, remains challenging due to the complexity of the human masticatory system as well as the unique morphology of each individual dentition. Adaptation and reworking are frequently required during the insertion of fixed dental prostheses (FDPs), which increase cost and treatment time. This article proposes a data-driven approach for the partial reconstruction of occlusal surfaces based on a data set that comprises 92 3D mesh files of full dental crown restorations. Methods A Generative Adversarial Network (GAN) is considered for the given task in view of its ability to represent extensive data sets in an unsupervised manner with a wide variety of applications. Having demonstrated good capabilities in terms of image quality and training stability, StyleGAN-2 has been chosen as the main network for generating the occlusal surfaces. A 2D projection method is proposed in order to generate 2D representations of the provided 3D tooth data set for integration with the StyleGAN architecture. The reconstruction capabilities of the trained network are demonstrated by means of 4 common inlay types using a Bayesian Image Reconstruction method. This involves pre-processing the data in order to extract the necessary information of the tooth preparations required for the used method as well as the modification of the initial reconstruction loss. Results The reconstruction process yields satisfactory visual and quantitative results for all preparations with a root mean square error (RMSE) ranging from 0.02 mm to 0.18 mm. When compared against a clinical procedure for CAD inlay fabrication, the group of dentists preferred the GAN-based restorations for 3 of the total 4 inlay geometries. Conclusions This article shows the effectiveness of the StyleGAN architecture with a downstream optimization process for the reconstruction of 4 different inlay geometries. The independence of the reconstruction process and the initial training of the GAN enables the application of the method for arbitrary inlay geometries without time-consuming retraining of the GAN.
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Affiliation(s)
- Alexander Broll
- Department of Prosthetic Dentistry, University Hospital Regensburg, Regensburg, Germany
- Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Martin Rosentritt
- Department of Prosthetic Dentistry, University Hospital Regensburg, Regensburg, Germany
| | - Thomas Schlegl
- Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
| | - Markus Goldhacker
- Faculty of Mechanical Engineering, Ostbayerische Technische Hochschule Regensburg, Regensburg, Germany
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Revilla-León M, Fernández-Estevan L, Barmak AB, Kois JC, Alonso Pérez-Barquero J. Accuracy of maximum intercuspal position located by using four intraoral scanners and an artificial intelligence-based program. J Prosthet Dent 2024:S0022-3913(24)00193-8. [PMID: 38604907 DOI: 10.1016/j.prosdent.2024.03.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 04/13/2024]
Abstract
STATEMENT OF PROBLEM Maxillary and mandibular scans can be articulated in maximum intercuspal position (MIP) by using an artificial intelligence (AI) based program; however, the accuracy of the AI-based program locating the MIP relationship is unknown. PURPOSE The purpose of the present clinical study was to assess the accuracy of the MIP relationship located by using 4 intraoral scanners (IOSs) and an AI-based program. MATERIAL AND METHODS Conventional casts of a participant mounted on an articulator in MIP were digitized (T710). Four groups were created based on the IOS used to record a maxillary and mandibular scan of the participant: TRIOS4, iTero, i700, and PrimeScan. Each pair of nonarticulated scans were duplicated 20 times. Three subgroups were created: IOS, AI-articulated, and AI-IOS-corrected subgroups (n=10). In the IOS-subgroup, 10 duplicated scans were articulated in MIP by using a bilateral occlusal record. In the AI-articulated subgroup, the remaining 10 duplicated scans were articulated in MIP by using an AI-based program (BiteFinder). In the AI-IOS-corrected subgroup, the same AI-based program was used to correct the occlusal collisions of the articulated specimens obtained in the IOS-subgroup. A reverse engineering program (Geomagic Wrap) was used to calculate 36 interlandmark measurements on the digitized articulated casts (control) and each articulated specimen. Two-way ANOVA and pairwise multiple comparison Tukey tests were used to analyze trueness (α=.05). The Levene and pairwise multiple comparison Wilcoxon rank tests were used to analyze precision (α=.05). RESULTS Significant trueness discrepancies among the groups (P<.001) and subgroups (P<.001) were found, with a significant interaction group×subgroup (P<.001). The Levene test showed significant precision discrepancies among the groups (P<.001) and subgroups (P=.005). The TRIOS4 and iTero groups obtained better trueness and lower precision than the i700 and PrimeScan systems. Additionally, the AI-articulated subgroup showed worse trueness and precision than the IOS and AI-IOS-corrected subgroups. The AI-based program improved the MIP trueness of the scans articulated by using the iTero and PrimeScan systems but reduced the MIP trueness of the articulated scans obtained by using the TRIOS4 and i700. CONCLUSIONS The trueness and precision of the maxillomandibular relationship was impacted by the IOS system and program used to locate the MIP.
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Affiliation(s)
- Marta Revilla-León
- Affiliate Assistant Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; Faculty and Director, Research and Digital Dentistry, Kois Center, Seattle, Wash; and Adjunct Professor, Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Mass.
| | - Lucía Fernández-Estevan
- Professor, Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
| | - Abdul B Barmak
- Associate Professor, Clinical Research and Biostatistics, Eastman Institute of Oral Health, University of Rochester Medical Center, Rochester, NY
| | - John C Kois
- Founder and Director, Kois Center, Seattle, Wash.; Affiliate Professor, Graduate in Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash.; and Private practice, Seattle, Wash
| | - Jorge Alonso Pérez-Barquero
- Associate Professor, Department of Dental Medicine, Faculty of Medicine and Dentistry, University of Valencia, Valencia, Spain
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Revilla-León M, Zeitler JM, Fry E, Kois JC. Digital workflow to measure the mandibular range of motion using different jaw tracking technologies. J Prosthet Dent 2024:S0022-3913(23)00836-3. [PMID: 38242763 DOI: 10.1016/j.prosdent.2023.12.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/21/2024]
Abstract
The analysis of the mandibular range of motion (ROM) includes the evaluation of maximum opening, deviation upon opening, and amplitude of the left and right excursive movements and protrusion. Conventionally, ROM assessment has been directly measured in the patient's mouth by using a ROM ruler. The development of jaw tracking systems, such as magnetometry and photometric devices, allows the digital assessment of the mandibular ROM. The present manuscript describes the clinical protocols for recording and measuring the mandibular ROM by using different jaw tracking systems.
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Affiliation(s)
- Marta Revilla-León
- Affiliate Assistant Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; Faculty and Director, Research and Digital Dentistry, Kois Center, Seattle, Wash; and Adjunct Professor, Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Mass.
| | | | - Elizabeth Fry
- Director, Clinical Operations, Kois Center, Seattle, Wash
| | - John C Kois
- Founder and Director, Kois Center, Seattle, Wash.; Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, University of Washington, Seattle, Wash.; and Private practice, Seattle, Wash
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Revilla-León M, Zeitler JM, Kois JC. Digital diagnostic occlusal equilibration combining an intraoral scanner, optical jaw tracking system, and dental design program: A dental technique. J Prosthet Dent 2024:S0022-3913(23)00818-1. [PMID: 38216378 DOI: 10.1016/j.prosdent.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/30/2023] [Accepted: 12/04/2023] [Indexed: 01/14/2024]
Abstract
Patients with aberrant occlusal patterns, including constricted mastication patterns or occlusal dysfunction, may require occlusal equilibration. Conventional diagnostic procedures involve diagnostic stone casts mounted in the articulator. During diagnostic procedures, occlusal equilibration methods are simulated on mounted stone casts to analyze the amount of dental structure that may need to be removed. A technique to virtually simulate an occlusal equilibration procedure is described. Digital data acquisition procedures include diagnostic casts acquired using an intraoral scanner and the repeatable reference position of the mandible or centric relation, excursive movements, and the mastication pattern captured using an optical jaw tracking system. The jaw tracker and dental design programs are used to simulate the occlusal equilibration.
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Affiliation(s)
- Marta Revilla-León
- Affiliate Assistant Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; Faculty and Director, Research and Digital Dentistry, Kois Center, Seattle, Wash; and Adjunct Professor, Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Mass.
| | | | - John C Kois
- Founder and Director, Kois Center, Seattle, Wash; Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; and Private practice, Seattle, Wash
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Revilla-León M, Zeitler JM, Kois JC. Implementing an optical jaw tracking system to locate centric occlusion: A dental technique. J Prosthet Dent 2024:S0022-3913(23)00767-9. [PMID: 38185592 DOI: 10.1016/j.prosdent.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/10/2023] [Accepted: 11/13/2023] [Indexed: 01/09/2024]
Abstract
Optical jaw tracking systems are designed to record the static maxillomandibular relationship and the mandibular motion of a patient, including excursive movements and mastication pattern. This digital data acquisition technology can be integrated into diagnostic and treatment planning procedures, as well as into designing dental prostheses. A step-by-step protocol to record a patient's digital data, including the repeatable reference position of the jaw or centric relation, by using an intraoral scanner, Kois deprogrammer, and optical jaw tracking system is described. The data are then processed in the software program of the jaw tracking system to locate centric occlusion.
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Affiliation(s)
- Marta Revilla-León
- Affiliate Assistant Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; Faculty and Director, Research and Digital Dentistry, Kois Center, Seattle, Wash; and Adjunct Professor, Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Mass.
| | | | - John C Kois
- Founder and Director, Kois Center, Seattle, Wash; Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, University of Washington, Seattle, Wash; and Private practice, Seattle, Wash
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Revilla-León M, Gómez-Polo M, Kois JC. A guide for selecting the intraoral scan extension when fabricating tooth- and implant-supported fixed dental prostheses. J ESTHET RESTOR DENT 2024; 36:85-93. [PMID: 37789708 DOI: 10.1111/jerd.13143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 09/19/2023] [Indexed: 10/05/2023]
Abstract
OBJECTIVES To describe a new classification for intraoral scans based on the scan extension and to introduce a decision guideline to choose the scan extension for fabricating tooth- and implant-supported fixed dental prostheses (FDPs). OVERVIEW Multiple operator- and patient-related factors have been identified that can decrease the scanning accuracy of intraoral scanners (IOSs), including scan extension. However, the decision criteria for selecting scan extension for fabricating tooth- and implant-supported restorations is unclear. Based on the extension of the intraoral digital scans, three types of scans can be defined: half-arch (anterior or posterior), extended half-arch, and complete-arch scan. Variables to consider when choosing the scan extension include the number and location of units being restored, as well as the extension and location of edentulous areas. Additionally, the accuracy of the virtual definitive cast and the accuracy of the maxillomandibular relationship captured by using IOSs should be differentiated. CONCLUSIONS A decision tree for selecting the scan extension is presented. The decision is based on the number and location of units being restored, and the extension and location of edentulous areas. Intraoral scans with reduced scan extension are indicated when fabricating tooth- and implant-supported crowns or short-span fixed prostheses, when the patient does not have more than one missing tooth in the area of the dental arch included in the scan. For the remaining clinical conditions, complete-arch intraoral scans are recommended. CLINICAL SIGNIFICANCE Scan extension is a clinician's decision that should be based on the number and location of units being restored and the extension and location of edentulous areas. Intraoral scans with a reduced scan extension is recommended, when possible.
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Affiliation(s)
- Marta Revilla-León
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA
- Kois Center, Seattle, Washington, USA
- Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Miguel Gómez-Polo
- Department of Conservative Dentistry and Prosthodontics, School of Dentistry, Complutense University of Madrid, Madrid, Spain
| | - John C Kois
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA
- Kois Center, Seattle, Washington, USA
- Private Practice, Seattle, Washington, USA
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Li J, Joda T, Revilla-León M, Saleh MHA, Chen Z, Wang HL. Recommendations for successful virtual patient-assisted esthetic implant rehabilitation: A guide for optimal function and clinical efficiency. J ESTHET RESTOR DENT 2024; 36:186-196. [PMID: 37792734 DOI: 10.1111/jerd.13142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/12/2023] [Accepted: 09/16/2023] [Indexed: 10/06/2023]
Abstract
OBJECTIVE Complete arch implant rehabilitation necessitates meticulous treatment planning and high-level collaboration between surgical and prosthetic dental teams. Emerging virtual technologies hold considerable promise in streamlining this process. The aim of this article is to extend recommendations to clinicians venturing into the virtual patient-assisted esthetic implant rehabilitation workflow. OVERVIEW This article summarizes recommendations for virtual patient-assisted esthetic implant rehabilitation in the following five aspects: three-dimensional data handling and superimposition, occlusion and virtual articulator integration in creating virtual patients, streamlined face- and prosthetic-driven surgical planning, reuse of presurgical data ("Copy & Paste"), and final impression for passive fitting of final restoration. To illustrate these principles, a case with complete-mouth implant rehabilitation completed within six visits using this virtual patient workflow is presented. CONCLUSION The virtual patient workflow serves as an invaluable tool to perform treatment planning, enhance efficiency, and ensure predictable outcomes in esthetic complete arch implant rehabilitation. CLINICAL SIGNIFICANCE Virtual workflows are increasingly prevalent in esthetic implant rehabilitation. Nevertheless, these workflows necessitate a distinct set of knowledge and tools divergent from conventional dentistry practices. This article offers guidelines and recommendations for dental clinicians who are new to this field.
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Affiliation(s)
- Junying Li
- Department of Biologic and Materials Sciences & Prosthodontics, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Tim Joda
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Marta Revilla-León
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA
- Kois Center, Seattle, Washington, USA
- Graduate Prosthodontics, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Zhaozhao Chen
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Li J, Fang X, Huang J, Zhang J, Wu J, Li G, Qian J, Yang H. Effect of a digital assessment system for the preclinical tooth preparation of metal-ceramic crowns: A pilot study. J Prosthet Dent 2023:S0022-3913(23)00691-1. [PMID: 37940472 DOI: 10.1016/j.prosdent.2023.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 10/08/2023] [Accepted: 10/10/2023] [Indexed: 11/10/2023]
Abstract
STATEMENT OF PROBLEM Tooth preparation is a fundamental aspect of prosthodontics and serves as a focal point in preclinical courses. Conventional pedagogy relies heavily on the expertise of instructors, whereas digital technology has the potential to offer instantaneous feedback. The efficacy of a digital assessment system in comparison with traditional teaching methods remains uncertain. PURPOSE The purpose of this study was to compare the training effects of traditional assessment and digital evaluation on tooth preparations for the metal-ceramic crowns performed by preclinical students on the convergence angle and tooth reduction. MATERIAL AND METHODS A total of 40 predoctoral students were randomly divided into the digital group and the traditional group to complete tooth preparation for a metal-ceramic crown on a left mandibular first molar. Students in the traditional group were taught by an experienced instructor, while the digital group students were trained by an objective digital assessment system without instructor guidance. Each student completed the tooth preparation in 20 min, received feedback according to the respective training methods, and later prepared another tooth. In this way, all students completed 4 tooth preparations in 2 weeks. All preparations were evaluated by an optical scanner. Parameters for comparing the digital group with the traditional group were the convergence angle and reduction at different stages. Questionnaires on the digital training system were answered by the students of the digital group. The t tests or Wilcoxon signed rank tests and chi-squared tests were used to analyze the differences between the 2 groups (α=.01). RESULTS A decreasing trend in convergence angle was seen in both groups, but the 2 groups were statistically similar (P>.01). After training, a decreasing trend was seen in under-reduction and overreduction on 5 surfaces in the digital group. Conversely, in the traditional group, a noteworthy increase was seen in under-reduction on the distal surface (P=.002). Nevertheless, no significant difference was found between the 2 groups (P>.01). According to the results of the questionnaire, over 80% of the students had a positive attitude toward the digital assessment system, and more than 80% of the students expressed their interest in the digital assessment system for tooth preparation training. CONCLUSIONS Traditional teaching and digital feedback provided similar training effects to improve the quality of tooth preparations for preclinical dental students.
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Affiliation(s)
- Junman Li
- Instructor, Yunnan Key Laboratory of Stomatology, The Second Clinical Division, Affiliated Stomatological Hospital, Kunming Medical University, Kunming, PR China
| | - Xin Fang
- Instructor, Yunnan Key Laboratory of Stomatology, Affiliated Stomatological Hospital, Kunming Medical University, Kunming, PR China
| | - Jinhui Huang
- Instructor, Yunnan Key Laboratory of Stomatology, Affiliated Stomatological Hospital, Kunming Medical University, Kunming, PR China
| | - Jun Zhang
- Instructor, Yunnan Key Laboratory of Stomatology, Affiliated Stomatological Hospital, Kunming Medical University, Kunming, PR China
| | - Jinyan Wu
- Instructor, Yunnan Key Laboratory of Stomatology, Department of Endodontics, Affiliated Stomatological Hospital, Kunming Medical University, Kunming, PR China
| | - Guiding Li
- Instructor, Yunnan Key Laboratory of Stomatology, Affiliated Stomatological Hospital, Kunming Medical University, Kunming, PR China
| | - Jie Qian
- Associate Professor, Department of Prosthodontics, Affiliated Stomatological Hospital, Kunming Medical University, Kunming, PR China
| | - Hefeng Yang
- Associate Professor, Yunnan Key Laboratory of Stomatology, Department of Prosthodontics, Affiliated Stomatological Hospital, Kunming Medical University, Kunming, PR China..
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Revilla-León M, Barmak AB, Tohme H, Yilmaz B, Kois JC, Gómez-Polo M. Factors that influence the accuracy of maxillomandibular relationship at maximum intercuspation acquired by using intraoral scanners: A systematic review. J Dent 2023; 138:104718. [PMID: 37775027 DOI: 10.1016/j.jdent.2023.104718] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 09/11/2023] [Accepted: 09/20/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE To review the factors that influence the accuracy of the maxillomandibular relationship at maximum intercuspation (MIP) acquired by using intraoral scanners (IOSs). MATERIAL AND METHODS A systematic search was performed using five databases: MEDLINE/PubMed, Cochrane, Embase, World of Science, and Scopus. A manual search was also completed. Studies assessing the factors that influence the MIP acquired by using IOSs were included and organized based on the analyzed factor. Studies were evaluated by applying the Joanna Briggs Institute Critical Appraisal Checklist. RESULTS Twenty-nine articles were included. Seven factors have been identified: IOS system, scan extension, edentulous areas, number, location, and extension of occlusal records, occlusal force, tooth mobility, and alignment methods. Nine studies evaluated the influence of IOS system. Four studies assessed the influence of the extension of the arch scan. Three studies evaluated the effect of edentulous spaces. Four studies agreed on the impact of the number, location, and extension of the occlusal records on the MIP accuracy. One study assessed the influence of the occlusal force, showing a smaller average interocclusal space with increased occlusal force. One study evaluated the influence of tooth mobility. Seven studies analyzed the influence of the alignment method on the MIP accuracy. CONCLUSIONS Most of the studies reported no difference on the MIP accuracy between half- and complete-arch scans. Areas with 2 or more missing teeth reduce the MIP accuracy. A bilateral and frontal record including 2 teeth or a bilateral posterior occlusal including at least 4-teeth is indicated for maximizing the MIP accuracy. CLINICAL IMPLICATIONS When a complete-arch intraoral scans is obtained, a bilateral and frontal record including 2 teeth or a bilateral posterior occlusal record including at least 4-teeth is recommended for maximizing the accuracy of the MIP. When a half-arch intraoral scan is acquired, a posterior occlusal record including at least 4-teeth is indicated for optimizing the accuracy of the MIP.
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Affiliation(s)
- Marta Revilla-León
- Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, WA, USA; Faculty & Director of Research and Digital Dentistry, Kois Center, Seattle, WA, USA; Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, MA, USA.
| | - Abdul B Barmak
- Eastman Institute of Oral Health, University of Rochester Medical Center, Rochester, NY, USA
| | - Hani Tohme
- Founder and Head of Digital, AI, and Evolving Technologies, Faculty of Dental Medicine, Saint Joseph University of Beirut, Beirut, Lebanon
| | - Burak Yilmaz
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Associate Professor, Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland; Adjunct Professor, Division of Restorative and Prosthetic Dentistry, The Ohio State University, Ohio, USA
| | - John C Kois
- Founder and Director Kois Center, Seattle, WA, USA; Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, University of Washington, Seattle, WA, USA; Private Practice, Seattle, WA, USA
| | - Miguel Gómez-Polo
- School of Dentistry, Complutense University of Madrid, Madrid, Spain
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14
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Nagy Z, Mikolicz A, Vag J. In-vitro accuracy of a novel jaw-tracking technology. J Dent 2023; 138:104730. [PMID: 37777084 DOI: 10.1016/j.jdent.2023.104730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/22/2023] [Accepted: 09/27/2023] [Indexed: 10/02/2023] Open
Abstract
OBJECTIVES As jaw-tracking systems integrate into digital prosthetic workflows, their accuracy remains underexplored. This study aimed to evaluate the in vitro accuracy of a novel digital jaw-tracking system (Modjaw, Villeurbanne, France) by comparing its precision and trueness to that of an industrial scanner. METHODS Upper and lower typodont models were scanned with an industrial-grade optical scanner (ATOS Q, Carl Zeiss GOM Metrology GmbH, Germany) to produce master scans. The models were placed in a phantom head with artificial joints to replicate five different intermaxillary relationships (IMRs). The 1, 2, 3, 4, and 5 mm IMR distances were stabilized by five silicone bites. The silicone bites were repositioned after each measurement. ATOS scanned the whole artificial joint with the models three times in each IMR to assess the precision of the repositioning (i.e., bite precision). The master scans were uploaded to Modjaw. Modjaw recorded the five IMR positions three times each to assess the precision of the Modjaw. Precision was calculated by aligning the scans within the same group, whereas Modjaw trueness was evaluated by aligning ATOS and Modjaw scans. The mean absolute distance (MAD) between aligned surfaces was calculated. The effect of IMR on the MAD was evaluated using a linear mixed model. RESULTS The mean bite precision across the IMRs was 7.6 ± 0.53 µm. Modjaw precision over the IMRS was 9.7 ± 1.76 µm, and the trueness was 10.8 ± 1.40 µm. Increased IMRs up to 4 mm significantly increased the MAD from 6.5 to 8.5 µm for the bite precision, 4.8 to 15.7 µm Modjaw precision, and 7.1 to 14.9 µm for trueness. CONCLUSIONS Modjaw excelled in accuracy, comparable to industrial scanners and superior to traditional methods. IMR elevation marginally deteriorates the accuracy. Future studies should extend to varied movements beyond centric relations and encompass the influence of intraoral scanners.
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Affiliation(s)
- Zsolt Nagy
- Department of Restorative Dentistry and Endodontics, Semmelweis University, Szentkirályi street 47, Budapest 1088, Hungary
| | - Akos Mikolicz
- Department of Restorative Dentistry and Endodontics, Semmelweis University, Szentkirályi street 47, Budapest 1088, Hungary
| | - Janos Vag
- Department of Restorative Dentistry and Endodontics, Semmelweis University, Szentkirályi street 47, Budapest 1088, Hungary.
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Kois JC, Zeitler JM, Barmak AB, Yilmaz B, Gómez-Polo M, Revilla-León M. Discrepancies in the occlusal devices designed by an experienced dental laboratory technician and by 2 artificial intelligence-based automatic programs. J Prosthet Dent 2023:S0022-3913(23)00551-6. [PMID: 37798183 DOI: 10.1016/j.prosdent.2023.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 08/10/2023] [Accepted: 08/15/2023] [Indexed: 10/07/2023]
Abstract
STATEMENT OF PROBLEM Artificial intelligence (AI) models have been developed for different applications, including the automatic design of occlusal devices; however, the design discrepancies of an experienced dental laboratory technician and these AI automatic programs remain unknown. PURPOSE The purpose of this in vitro study was to compare the overall, intaglio, and occlusal surface discrepancies of the occlusal device designs completed by an experienced dental laboratory technician and two AI automatic design programs. MATERIAL AND METHODS Virtually articulated maxillary and mandibular diagnostic casts were obtained in a standard tessellation language (STL) file format. Three groups were created depending on the operator or program used to design the occlusal devices: an experienced dental laboratory technician (control group) and two AI programs, namely Medit Splints from Medit (Medit group) and Automate from 3Shape A/S (3Shape group) (n=10). To minimize the discrepancies in the parameter designs among the groups tested, the same printing material and design parameters were selected. In the control group, the dental laboratory technician imported the articulated scans into a dental design program (DentalCAD) and designed a maxillary occlusal device. The occlusal device designs were exported in STL format. In the Medit and 3Shape groups, the diagnostic casts were imported into the respective AI programs. The AI programs automatically designed the occlusal device without any further operator intervention. The occlusal device designs were exported in STL format. Among the 10 occlusal designs of the control group, a random design (shuffle deck of cards) was used as a reference file to calculate the overall, intaglio, and occlusal discrepancies in the specimens of the AI groups by using a program (Medit Design). The root mean square (RMS) error was calculated. Kruskal-Wallis, and post hoc Dwass-Steel-Critchlow-Fligner pairwise comparison tests were used to analyze the trueness of the data. The Levene test was used to assess the precision data (α=.05). RESULTS Significant overall (P<.001), intaglio (P<.001), and occlusal RMS median value (P<.001) discrepancies were found among the groups. Significant overall RMS median discrepancies were observed between the control and the Medit groups (P<.001) and the control and 3Shape groups (P<.001). Additionally, significant intaglio RMS median discrepancies were found between the control and the Medit groups (P<.001), the Medit and 3Shape groups (P<.001), and the control and 3Shape groups (P=.008). Lastly, significant occlusal RMS median discrepancies were found between the control and the 3Shape groups (P<.001) and the Medit and 3Shape groups (P<.001). The AI-based software programs tested were able to automatically design occlusal devices with less than a 100-µm trueness discrepancy compared with the dental laboratory technician. The Levene test revealed significant overall (P<.001), intaglio (P<.001), and occlusal (P<.001) precision among the groups tested. CONCLUSIONS The use of a dental laboratory technique influenced the overall, intaglio, and occlusal trueness of the occlusal device designs obtained. No differences were observed in the precision of occlusal device designs acquired among the groups tested.
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Affiliation(s)
- John C Kois
- Founder and Director, Kois Center, Seattle, Wash; Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; Private practice, Seattle, Wash
| | | | - Abdul B Barmak
- Associate Professor, Clinical Research and Biostatistics, Eastman Institute for Oral Health (EIOH), Medical Center, University of Rochester, Rochester, NY
| | - Burak Yilmaz
- Associate Professor, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Associate Professor, Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland; Adjunct Professor, Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio
| | - Miguel Gómez-Polo
- Associate Professor, Department of Conservative Dentistry and Prosthodontics, School of Dentistry, Complutense University of Madrid, Madrid, Spain; Director, Specialist in Advanced Implant-Prosthesis Postgraduate Program, Complutense University of Madrid, Madrid, Spain
| | - Marta Revilla-León
- Affiliate Assistant Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash; Faculty and Director, Research and Digital Dentistry, Kois Center, Seattle, Wash; Adjunct Professor, Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Mass..
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