A bibliometric analysis of scientific literature in digital dentistry from low- and lower-middle income countries

OBJECTIVE

Bibliometric analysis and citation counts help to acknowledge influence of publications. The aim of this study was to conduct bibliometric and citation analysis of top-cited articles, from low- and lower-middle income countries, on use and application of digital technology in dentistry.

METHODOLOGY

A search strategy based on "Digital Dentistry", "Low Income Countries", and "Lower-Middle Income Countries" was used in October 2023 using Scopus database to retrieve articles relevant to digital dentistry, with citation count of 10 or more. From 44 included articles, bibliometric information was analyzed on SPSS version 23. Network analysis based on co-citations, keywords, and number of citations was conducted on VOS software (version 1.6.20).

RESULTS

Most relevant articles were published in 2021 (n = 8), with 52.3% original articles, out of which 40.9% were in vitro studies. India had the highest number of articles (n = 24), with most publications in The Journal of Indian Prosthodontic Society (n = 4), and in the domain of General Dentistry (n = 15, 34.1%). Co-authorship network analysis was not significant, but country-wise co-authorship analysis revealed India with the greatest link strength (4.0). Highest occurring keyword was 3D printing (link strength 5.0), and the citation analysis revealed Journal of Prosthetic Dentistry with the most number of published documents (3), having a citation count of 275. Bibliographic coupling for sources revealed Journal of Indian Prosthodontic Society to have the highest link strength of 15.33.

CONCLUSION

This analysis uncovers interesting bibliometric and citation based information including key thematic trends, emphasizing crucial role of technologies like 3D printing, CAD/CAM, and CBCT in digital dentistry. The study underscores the imperative for increased original research efforts in low- and lower middle-income countries.

Access Cavity Preparation and Localization of Root Canals Using Guides in 3D-Printed Teeth with Calcified Root Canals: An In Vitro CBCT Study

Pulp canal obliteration (PCO) is a significant complication in endodontics that can occur due to various factors. Cone beam computed tomography (CBCT) is a useful diagnostic tool for identifying root canal anatomy and variations, and guided endodontics is emerging as an alternative treatment solution for teeth with partially or entirely obliterated pulpal canals. However, the accuracy of CBCT-guided 3D-printed guides on different materials and layer thicknesses is not well understood. Therefore, this study aimed to evaluate the accuracy of guides prepared using CBCT images on 3D-printed teeth with stereolithography (SLA) using three different materials and two different layer thicknesses. This study found that 3D-printed guides were accurate and reliable for accessing 3D-manufactured obliterated teeth and reaching the apical area. No significant differences in distance or angle measurements were found when different guide materials were used, suggesting that materials can be selected based on availability and cost. These findings contribute to the knowledge base regarding the effectiveness of 3D printing technology in guided endodontics and can help to identify the most suitable materials and techniques for this application.

Challenges and Future Perspectives for Additively Manufactured Polylactic Acid Using Fused Filament Fabrication in Dentistry

Additive manufacturing (AM), which is also called rapid prototyping/3D printing/layered manufacturing, can be considered as a rapid conversion between digital and physical models. One of the most used materials in AM is polylactic acid (PLA), which has advantageous material properties such as biocompatibility, biodegradability, and nontoxicity. For many medical applications, it is considered as a leading biomaterial. In dentistry, in addition to its uses in dental models (education, teaching, simulation needs), it can be used for therapeutic objectives and tissue engineering. The fused filament fabrication (FFF) technique, also called fused deposition modeling (FDM), is widely used as an AM technique to perform complex and functional geometries directly from CAD files. In this review, the objective was to present the different challenges and future perspectives of this additively manufactured material by using FFF in dentistry areas. Some suggestions for future directions to extend to more dental applications (support structures, lattice structures, etc.) and to consider more criteria (sustainability, uncertainty etc.) will be discussed. Advanced studies such as machine learning (ML) techniques will be suggested to reduce the failure cases when using the additively manufactured PLA by FFF in dentistry.

Fracture Load of 3D-Printed Interim Three-Unit Fixed Dental Prostheses: Impact of Printing Orientation and Post-Curing Time

The fracture resistance of 3-unit interim fixed dental prostheses (IFDPs) fabricated using digital light processing (DLP) additive technology with different printing parameters is neglected. Therefore, this study investigates the effect of different printing orientations and different post-curing times on the fracture resistance of 3-unit IFDPs fabricated from two three-dimensional (3D) printed resins, NextDent, C&B (CB), ASIGA, and DentaTOOTH. A 3-unit dye was scanned, and an IFDP was designed. A total of 300 specimens (150/materials, n = 10) were printed and divided into three groups according to printing orientations (0°, 45°, 90°) per material. Each orientation was subdivided into five groups (n = 10) considering the post-curing time (green state as control, 30, 60, 90, and 120 min). All specimens underwent thermocycling (5000 cycles). Each specimen was fitted onto the die and loaded until fracture using a universal testing machine with a loading rate of 1 m/min. Data were analyzed using ANOVA and post hoc Tukey test (α = 0.05). The result showed that printing orientation had a significant effect on the fracture load for both ASIGA and NextDent materials (p < 0.05). The highest fracture load was recorded with 45° orientation, followed by 0° orientation and 90° orientation showed the lowest values per respective post-curing time. Post-curing time increased the fracture load (p < 0.05). Post-curing time had a positive effect on the fracture load. As the post-curing time increased, the fracture resistance load increased (p < 0.05), with 90 and 120 min showing the highest fracture load. The 0° and 45° printing orientations have a high fracture load for 3D-printed IFDPs, and an increased post-curing time is recommended.

Modular Digital and 3D-Printed Dental Models with Applicability in Dental Education

Background and Objectives: The ever more complex modern dental education requires permanent adaptation to expanding medical knowledge and new advancements in digital technologies as well as intensification of interdisciplinary collaboration. Our study presents a newly developed computerized method allowing virtual case simulation on modular digital dental models and 3D-printing of the obtained digital models; additionally, undergraduate dental students' opinion on the advanced method is investigated in this paper. Materials and Methods: Based on the digitalization of didactic dental models, the proposed method generates modular digital dental models that can be easily converted into different types of partial edentulism scenarios, thus allowing the development of a digital library. Three-dimensionally printed simulated dental models can subsequently be manufactured based on the previously obtained digital models. The opinion of a group of undergraduate dental students (n = 205) on the proposed method was assessed via a questionnaire, administered as a Google form, sent via email. Results: The modular digital models allow students to perform repeated virtual simulations of any possible partial edentulism cases, to project 3D virtual treatment plans and to observe the subtle differences between diverse teeth preparations; the resulting 3D-printed models could be used in students' practical training. The proposed method received positive feedback from the undergraduate students. Conclusions: The advanced method is adequate for dental students' training, enabling the gradual design of modular digital dental models with partial edentulism, from simple to complex cases, and the hands-on training on corresponding 3D-printed dental models.

Fracture load assessment of digitally fabricated post and prefabricated fibre post in endodontically treated teeth

BACKGROUND

Endodontically treated teeth are structurally more susceptible to root fractures. Proper tooth restorations with digitally fabricated or fibre post following endodontic therapy is essential to restore function and esthetics.

OBJECTIVE

The aim of this in vitro study is to evaluate the fracture load of digitally fabricated and prefabricated fibre posts in endodontically treated teeth.

METHODS

Sixty extracted human single rooted teeth were selected. The crowns were sectioned at the cement-enamel junction to standardize the remaining root length at 15 mm from the apices. Cleaning, shaping and obturation was done using conventional step back technique to an ISO K-file size 40. The roots were divided into two groups of 30 samples each: Group S: teeth reinforced with digitally fabricated posts; Group F: teeth reinforced with fibre posts. Each group was further divided into three subgroups (S7, S9, S12, F7, F9, F12) based on lengths 7, 9 and 12 mm at which the posts were cemented. Composite resin core was fabricated and prepared to receive a complete metal crown. Universal testing machine was used to measure the compressive load required to fracture the teeth.

RESULTS

The highest fracture resistance of 1532N was observed with fibre posts at 12 mm of post space length followed by digitally fabricated post 1398N at 12 mm, but the difference was not statistically significant.

CONCLUSION

The highest fracture resistance was observed in the teeth restored with fibre posts with 12 mm length and the lowest with digitally fabricated post with 7 mm length. As the length of post increases irrespective of type of post fracture resistance increased.

Comparative evaluation of fracture resistance of anterior provisional restorations fabricated using conventional and digital techniques - An in vitro study

Aim

Comparative evaluation of the fracture resistance of anterior provisional crowns fabricated by conventional and digital techniques.

Settings and Design

Department of Prosthodontic, PGIDS, Rohtak, An in-vitro - Comparative study.

Materials and Methods

Thirty recently extracted maxillary central incisors were handpicked. Tooth preparation was done according to the principles of tooth preparation. A single-step impression technique was used for impression making of the prepared tooth and stone models were poured. Extracted teeth were divided into 3 groups (n = 10 each) based on provisional crown fabrication technique. A bis-acryl-based (Protemp 4 3M ESPE) resin was used to fabricate the provisional crowns by the conventional indirect technique. The rest of the stone models (20) were scanned using lab scanner (Dentsply Sirona InLab EOS X5). CAD/CAM provisional material (Dentsply Sirona multilayer PolyMethyl Methacrylate) PMMA disc was used for fabrication of provisional restoration through milling technique. 3D printed temporary provisional material (NextDent C&B resin) was utilized for 3D printed provisional crowns. Cementation of provisional crowns was done using eugenol free temporary luting cement (Templute, Prime dental). All cemented provisional crowns were subjected to load under Universal Testing Machine. The maximum load to produce fracture for each specimen was recorded in Newton (N).

Statistical Analysis Used

Shapiro-Wilk test was employed to test the normality of data. Kruskal- Wallis Test was used to compare the mean fracture resistance between all the groups. For intergroup comparison Mann-Whitney U Test was used.

Results

The mean fracture resistance of group I (Conventional technique) was found to be 558.8459700 ± 22.33 N; for group II (CAD/CAM technique) 960.8427200 ± 37.49 N and for group III (3D Printed technique) 1243.1774000 ± 68.18 N. Group I had the least fracture resistance value while group III showed maximum value.

Conclusion

Provisional crowns fabricated using 3-D printing technique showed higher fracture resistance followed by CAD/CAM technique and conventional technique. Additive manufacturing of provisional crowns using 3-D printing technique could be considered a reliable and conservative method for the fabrication of stronger provisional restorations.

3D printed versus commercial models in undergraduate conservative dentistry training

INTRODUCTION

The treatment of carious lesions is one of the most fundamental competencies in daily dental practice. However, many commercially available training models lack in reality regarding the simulation of pathologies such as carious lesions. 3D printed models could provide a more realistic simulation. This study provides an exemplary description of the fabrication of 3D printed dental models with carious lesions and assesses their educational value compared to commercially available models in conservative dentistry.

MATERIALS AND METHODS

A single-stage, controlled cohort study was conducted within the context of a curricular course. A stereolithographic model was obtained from an intraoral scan and then printed using fused deposition modelling. These models were first piloted by experts and then implemented and compared against commercial models in a conservative dentistry course. Experts and students evaluated both models using a validated questionnaire. Additionally, a cost analysis for both models was carried out.

RESULTS

Thirteen dentists and twenty-seven 5th year dental students participated in the study. The 3D printed models were rated significantly more realistic in many test areas. In particular, the different tactility and the distinction in colour was rated positively in the 3D printed models. At 28.29€ (compared to 112.36€), the 3D printed models were exceptionally cost-efficient.

CONCLUSIONS

3D printed dental models present a more realistic and cost-efficient alternative to commercial models in the undergraduate training of conservative dentistry.

Physical and Mechanical Properties of 3D-Printed Provisional Crowns and Fixed Dental Prosthesis Resins Compared to CAD/CAM Milled and Conventional Provisional Resins: A Systematic Review and Meta-Analysis

Newly introduced provisional crowns and fixed dental prostheses (FDP) materials should exhibit good physical and mechanical properties necessary to serve the purpose of their fabrication. The aim of this systematic literature review and meta-analysis is to evaluate the articles comparing the physical and mechanical properties of 3D-printed provisional crown and FDP resin materials with CAD/CAM (Computer-Aided Designing/Computer-Aided Manufacturing) milled and conventional provisional resins. Indexed English literature up to April 2022 was systematically searched for articles using the following electronic databases: MEDLINE-PubMed, Web of Science (core collection), Scopus, and the Cochrane library. This systematic review was structured based on the guidelines given by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The focused PICO/PECO (Participant, Intervention/exposure, Comparison, Outcome) question was: ‘Do 3D-printed (P) provisional crowns and FDPs (I) have similar physical and mechanical properties (O) when compared to CAD/CAM milled and other conventionally fabricated ones (C)’. Out of eight hundred and ninety-six titles, which were recognized after a primary search, twenty-five articles were included in the qualitative analysis, and their quality analysis was performed using the modified CONSORT scale. Due to the heterogeneity of the studies, only twelve articles were included for quantitative analysis. Within the limitations of this study, it can be concluded that 3D-printed provisional crown and FDP resin materials have superior mechanical properties but inferior physical properties compared to CAD/CAM milled and other conventionally fabricated ones. Three-dimensionally printed provisional crowns and FDP materials can be used as an alternative to conventional and CAD/CAM milled long-term provisional materials.

Physical, mechanical and anti-biofilm formation properties of CAD-CAM milled or 3D printed denture base resins: In Vitro analysis

PURPOSE

To investigate surface characteristics (roughness and contact angle), anti-biofilm formation, and mechanical properties (mini-flexural strength) of computer-aided design and computer-aided manufacturing (CAD-CAM) PMMA polymer, and three-dimensional (3D) printed resin for denture base fabrication compared with conventional heat polymerized denture base resins.

MATERIALS AND METHODS

A total of 60 discs and 40 rectangular specimens were fabricated from one CAD-CAM (AvaDent), one 3D printed (Cosmos Denture), and two conventional heat polymerized (Lucitone 199 and VipiWave) materials for denture base fabrication. Roughness was determined by Ra value; the contact angle was measured by the sessile drop method; the biofilm formation inhibition behavior was analyzed through C. albicans adhesion, while mini-flexural strength test was done using a three-point bending test. The data were analyzed using descriptive and analytical statistics (α = 0.05).

RESULTS

The CAD-CAM PMMA group showed the lowest C. albicans adhesion (log CFU/mL: 3.74 ±0.57) and highest mini-flexural strength mean (114.96 ±16.23 MPa). 3D printed specimens presented the highest surface roughness (Ra: 0.317 ±0.151 μm) and lowest mini-flexural strength values (57.23 ±9.07 MPa). However, there was no statistical difference between CAD-CAM PMMA and conventional groups for roughness, contact angle, and mini-flexural strength.

CONCLUSIONS

CAD-CAM milled materials present surface and mechanical properties similar to conventional resins and show improved behavior preventing C. albicans adhesion. Nevertheless, 3D printed resins present decreased mini-flexural strength. This article is protected by copyright. All rights reserved.

The Value of Three-Dimensional Modeling on Repositioning and Soft Tissue Filling in Microsurgical Reconstruction of Secondary Mandibular Defects: A Retrospective Study

Purpose

Secondary mandibular defect reconstruction is a challenging operation. It is performed rather rarely, as in most of the cases a primary reconstruction is preferable. Restoration of function and symmetry, in secondary reconstruction of mandibular defects, requires accurate repositioning of segments and appropriate soft tissue filling. The purpose of this study is to estimate the value of three-dimensional (3D) digital modeling to meet the above requirements, in secondary microsurgical reconstruction of mandibular defects.

Methods

Five cases of mandibular defects, with various degrees of asymmetry and dysfunction, were restored secondarily, with fibula flaps, after virtual reconstruction on a 3D model derived from their computed tomography, with the utilization of CAD-CAM software. Software reproduced symmetrical 3D models by mirroring the healthy side. Occlusion was restored by fine adjustments on 3D models and finally a reconstruction plate was pre-bent on them, prior to its sterilization for use in surgery. Three out of the five cases received an osteo-cutaneous flap, while in the other two patients, an osseous flap was used. Lower face symmetry, mouth opening, and main patient’s complaints were evaluated pre- and postoperatively to assess the value of the 3D modeling.

Results

All flaps survived. Hematoma occurred in two patients and was resolved after evacuation. In two patients, a fistula observed, was attributed to screw loosening, and treated after a surgical debridement and screw replacement. Intraoral exposure in the posterior part of the fibula flap was recorded in one patient, possibly from wound dehiscence due to tension of the intraoral tissue, and successfully covered with an ipsilateral nasolabial flap. The resulting symmetry and function were satisfactory in all the patients.

Conclusion

Secondary mandibular defects are often related with cosmetic disfigurement, misalignment of mandibular segments, and mandibular malfunction. For the correction of mandibular continuity, symmetry, and restoration of function, preoperative 3D modeling may be an important tool, according to our results.

Mechanical Properties, Cytotoxicity, and Fluoride Ion Release Capacity of Bioactive Glass-Modified Methacrylate Resin Used in Three-Dimensional Printing Technology

Background: Clinically, three-dimensional (3D) printing technology is becoming a popular and efficient dental processing technology. Recently, there has been an increasing demand for dental materials that exhibit bioactive properties. The present study aimed to evaluate the mechanical properties, cytotoxicity, and fluoride ion release capacity of 3D-printed dental resins modified with bioactive glass. Materials and methods: The resin FotoDent splint used in the production of removable orthodontic splints, was modified by the addition of two types of bioactive glasses that are capable of releasing fluoride ions. The novel materials used for the production of dental splints were examined for their mechanical, physical, and biological properties (fracture resistance, sorption, solubility, elution of nonpolymeric substances, and release of fluoride ions over time) and cytotoxic effects on cell cultures. Results: Initially, the fracture toughness of the 3D-printed resin was found to be 55 MPa, but after modification with glass, the resistance was reduced to about 50 MPa. Sorption and solubility values of the materials (19.01 ÷ 21.23 µg/mm³ and 0.42 ÷ 1.12 µg/mm³, respectively) complied with the safety limits imposed by ISO standard. Modified resins were capable of releasing fluoride ions, and the maximum releasing effect was observed after 14 days of incubation. Both the modified resins, after four days of contact with human gingival fibroblasts, exhibited moderate cytotoxic properties. Conclusions: The experimental results showed that modification of methacrylate resin, used in 3D printing technology, with bioactive glasses produces novel dental materials that possess desirable bioactive properties. The findings of this study indicate the potential ability of modified polymethacrylate resins to release fluoride ions in the oral cavity environment. The modified materials are characterized with a moderate decrease in physical properties and mild cytotoxicity on direct contact with human fibroblasts.

3D Printing and Shaping Polymers, Composites, and Nanocomposites: A Review

Sustainable technologies are vital due to the efforts of researchers and investors who have allocated significant amounts of money and time to their development. Nowadays, 3D printing has been accepted by the main industry players, since its first establishment almost 30 years ago. It is obvious that almost every industry is related to technology, which proves that technology has a bright future. Many studies have shown that technologies have changed the methods for developing particular products. Three-dimensional printing has evolved tremendously, and currently, many new types of 3D printing machines have been introduced. In this paper, we describe the historical development of 3D printing technology including its process, types of printing, and applications on polymer materials.

A 3D Printer Guide for the Development and Application of Electrochemical Cells and Devices

3D printing is a type of additive manufacturing (AM), a technology that is on the rise and works by building parts in three dimensions by the deposit of raw material layer upon layer. In this review, we explore the use of 3D printers to prototype electrochemical cells and devices for various applications within chemistry. Recent publications reporting the use of Fused Deposition Modelling (fused deposition modeling®) technique will be mostly covered, besides papers about the application of other different types of 3D printing, highlighting the advances in the technology for promising applications in the near future. Different from the previous reviews in the area that focused on 3D printing for electrochemical applications, this review also aims to disseminate the benefits of using 3D printers for research at different levels as well as to guide researchers who want to start using this technology in their research laboratories. Moreover, we show the different designs already explored by different research groups illustrating the myriad of possibilities enabled by 3D printing.

The digital alveolar cast: A revised approach to an old concept

An alveolar cast is recommended for the fabrication of specific fixed dental prostheses. The analog workflow for such casts is labor-intensive, time-consuming, and highly skill dependent. Advancements in digital technologies are bringing new, efficient, and streamlined protocols for dental practice. This article presents a digital workflow for the fabrication of an alveolar cast by using computer-aided design and computer-aided manufacturing (CAD-CAM)technologies.

Tribological performance of the pair human teeth vs 3D printed zirconia: An in vitro chewing simulation study

This study aims to evaluate the tribological performance of the pair human teeth/robocasted zirconia, with a special focus on the enamel wear mechanisms. Zirconia pieces produced by robocasting (RC) and unidirectional compression (UC) were compared in terms of crystalline structure, density, porosity, hardness and toughness. Chewing simulation tests were performed against human dental cusps. The cusps wear was quantified and the wear mechanisms identified. Although most of the properties of UC and RC samples are similar, differences were observed for surface roughness and porosity. Although the samples did not suffer wear, the antagonist cusps worn in a similar way. In conclusion, robocasting seems a promising technique to produce customized zirconia dental pieces, namely in what concerns the overall tribological behaviour.

Digital Manufacturing for Microfluidics

The microfluidics field is at a critical crossroads. The vast majority of microfluidic devices are presently manufactured using micromolding processes that work very well for a reduced set of biocompatible materials, but the time, cost, and design constraints of micromolding hinder the commercialization of many devices. As a result, the dissemination of microfluidic technology-and its impact on society-is in jeopardy. Digital manufacturing (DM) refers to a family of computer-centered processes that integrate digital three-dimensional (3D) designs, automated (additive or subtractive) fabrication, and device testing in order to increase fabrication efficiency. Importantly, DM enables the inexpensive realization of 3D designs that are impossible or very difficult to mold. The adoption of DM by microfluidic engineers has been slow, likely due to concerns over the resolution of the printers and the biocompatibility of the resins. In this article, we review and discuss the various printer types, resolution, biocompatibility issues, DM microfluidic designs, and the bright future ahead for this promising, fertile field.

Three-dimensional Printing in Reconstructive Oral and Maxillofacial Surgery

Three-dimensional (3D) printing involves the process of constructing a 3D solid object from a digital file. Charles Hull was the first to introduce 3D printer in 1983 by using the technique of stereolithography.¹ Since the 1990s 3D printing has gained attention in the field of medicine where more precision is required and has largely replaced the traditional technique in prosthetic works.^2,3.