Minimally invasive prosthodontic correction of pseudo class III malocclusion by implementing a systematic digital workflow: A clinical report

This clinical report describes the digital workflow for implementing different virtual and digital aids for the restoration of tooth wear and loss of occlusal vertical dimension (OVD). This conservative approach was implemented in an adult with pseudo class III malocclusion by using computer-aided design and computer-aided manufacturing (CAD-CAM) monolithic lithium disilicate ceramic restorations.     

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近年来数字化技术在牙颌面畸形诊治中的应用得到很快发展,数字化牙争板、数字化截骨导板的应用,虚拟正颌手术的培训也越来越多。本文就正颌手术数字化导板的技术发展、临床操作流程、适应证选择方面进行分析总结,为临床实际应用提供参考依据。     

Restorative material options for CAD/CAM restorations

Advances in adhesive dentistry and technological developments using dental computer-aided design (CAD)/computer-aided manufacturing (CAM) systems have provided alternative esthetic restorations to conventional laboratory processed restorations. Restorative materials for CAD/CAM-generated restorations must be able to withstand the rigors of the milling process, while providing clinical longevity once cemented. The esthetic restorative materials currently available for use with the Cerec System provide dentists with ceramic and polymer options for inlays, onlays, veneers, and crowns.     

数字化全口义齿的临床应用和研究进展

数字化技术利用高精度三维扫描、智能辅助设计软件和多轴数控切削或3D打印技术,可以制作出精度可靠、功能适宜的修复体.然而,由于全口义齿操作的复杂性,数字化技术在全口义齿修复领域的研发进度相对缓慢.本文将从数字化全口义齿的研究现状以及临床应用两个方面,阐述目前数字化全口义齿在口腔修复临床和技工室应用和研发的进展情况.     

An In Vitro Comparison of Vertical Marginal Gaps of CAD/CAM Titanium and Conventional Cast Restorations

Purpose: To determine if there was a significant difference between the vertical marginal openings of cast restorations, computer-aided design, and computer-aided machining restorations.
Materials and Methods: Ten working dies were created from a single master die and used to fabricate ten restorations in each of the following groups: computer-aided design/computer-assisted machining (CAD/CAM), WAX/CAM, and WAX/CAST. The CAD/CAM titanium restorations were fabricated using the scanning and crown design modules of the KaVo Everest system. The WAX/CAM titanium restorations were fabricated using the double scan technique with the KaVo Everest system. The WAX/CAST high noble copings were fabricated using the conventional lost wax casting technique. The restorations were seated on the master die, and high-resolution digital photographs were made of the marginal area on all four sides. The vertical marginal opening was then measured using a calibrated digital software program. One-way ANOVA and Tukey's post hoc tests were used to determine the presence of statistically significant differences.
Results: The vertical margin openings were CAD/CAM: 79.43 ± 25.46 μm; WAX/CAM: 73.12 ± 24.15 μm; WAX/CAST: 23.91 ± 9.80 μm. There was a statistically significant difference between the WAX/CAST group and the remaining groups.
Conclusions: There was no difference between the vertical marginal gaps of the CAD/CAM and WAX/CAM. The WAX/CAST technique resulted in smaller vertical marginal gaps than either CAD/CAM or WAX/CAM.     

A fully digital approach to replicate functional and aesthetic parameters in implant-supported full-arch rehabilitation

Purpose

The aim of this technical procedure was to use a fully digital technique (FDT) for full-arch implant support rehabilitation. The FDT was used to transfer the provisional restoration parameters to definitive restorations using intraoral scanners.

个性化桩核修复体计算机辅助设计初探

目的 探索桩核修复体的计算机辅助设计(CAD)路线,确定合适的三维设计方法 ,以期为桩核修复体的计算机辅助制作(CAM)提供必要的前提.方法 制作1副含有离体牙的石膏模型,在牙体预备后用层析成像技术获取三维数字模型.根据桩核修复体的临床设计原则,在正向工程软件唐龙CAD-CAM口腔修复系统的平台上,利用三维点云、曲线和曲面的编辑工具,分别完成桩的根管部分、桩的髓腔部分和核的设计.根据前牙、前磨牙和磨牙桩核修复体的不同形态要求对各曲面进行连接、裁剪等操作,形成修复体的三维形态.结果 完成了14个牙位桩核修复体的三维设计,其与扫描得到的三维数字模型贴合良好,具有良好的固位形,同时可为最终全冠修复体提供充足的修复空间.结论 本项研究设计的桩核修复体的三维形态符合临床要求,可用于桩核修复体CAM.     

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??With the rapid development of dental digital technique??the restorative clinical practice is unprecedentedly changing. From digital impression-take??artificial intelligence computer-aided diagnosis and design??it sets up the bridge for the visual analysis and the communication between dentists and patients. Computer-aided manufacturing??especially additive manufacturing??will provide the quality assurance of the all ceramic restorations. This paper briefly introduces the digital technique used in the restorative dentistry to offer a reference for dentists.     

Predictable Outcomes with Porcelain Laminate Veneers: A Clinical Report

This clinical report describes how to achieve predictable outcomes for anterior teeth esthetic restorations with porcelain laminate veneers by associating the digital planning and design of the restoration with interim restorations. The previous digital smile design of the restoration eliminates the communication barrier with the patient and assists the clinician throughout patient treatment. Interim restorations (diagnostic mock‐ups) further enhance communication with the patient and prevent unnecessary tooth reduction for conservative tooth preparation. Adequate communication between patient and clinician contributes to successful definitive restorations and patient satisfaction with the final esthetic outcome.     

Trial insertion procedure for milled lithium disilicate restorations in the precrystallized state

A treatment protocol with lithium disilicate restorations and a computer-aided design and computer-aided manufacturing (CAD/CAM) fabrication process is proposed for the restoration of teeth in the esthetic zone. The technique involves trial insertion of restorations at the precrystallized stage, allowing verification of the marginal fit and evaluation of the internal adaptation and overall esthetic plan to ensure an optimal clinical result for the definitive restorations. Furthermore, this procedure allows most adjustments to the lithium disilicate ceramic to be made before crystallization and minimizes potential surface and subsurface damage to the definitive restorations.     

Integrating hinge axis approximation and the virtual facial simulation of prosthetic outcomes for treatment with CAD-CAM immediate dentures: A clinical report of a patient with microstomia

This clinical report describes a digital workflow using extraoral digital photographs and volumetric datasets from cone beam computed tomography (CBCT) imaging to create a 3-dimensional (3D), virtual patient with photorealistic appearance. In a patient with microstomia, hinge axis approximation, diagnostic casts simulating postextraction alveolar ridge profile, and facial simulation of prosthetic treatment outcome were completed in a 3D, virtual environment. The approach facilitated the diagnosis, communication, and patient acceptance of the treatment of maxillary and mandibular computer-aided design and computer-aided manufacturing (CAD-CAM) of immediate dentures at increased occlusal vertical dimension.     

Validity and reliability of digital diagnostic measurements on digital three-dimensional dental models

Digital three-dimensional dental models are widely used for orthodontic diagnosis. The aim of this clinical study was to assess the validity and reliability of digital diagnostic measurements on digital three-dimensional dental models. Two types of digital three-dimensional dental models and a plaster dental model were made of 10 volunteers. Digital measurements of the tooth width were compared with the physical measurements of the plaster models. None of the digital diagnostic measurements appeared to differ significantly from the physical measurements.     

Digital radiography in dentistry: what it should do for you

Digital radiology will become an important part of dental practice. Manufacturers should develop more sophisticated tools, including software for digital subtraction; image processing routines for the diagnosis of caries, periodontitis and periapical disease; tools for three-dimensional viewing of the teeth and supporting structures; and analysis of bone trabecular pattern for early detection of systemic disease. Hardware improvements should include increased dynamic range and sensitivity to radiation, and improved resolution. Sensors should be made the size of film, and components should be interchangeable across manufacturers. The true opportunity offered by digital imaging, computer-aided diagnosis, should continue to develop with particular attention to development of tools that add value for solving diagnostic problems and ease of use for the dentist and patient.     

数码摄影在特殊色牙瓷修复比配色中的应用

目的:研究数码摄影在特殊色牙患者瓷修复比配色中的应用,探讨其对提高颜色匹配性所起的作用及存在的问题.方法:随机选取口腔修复中50例特殊色牙患者,进行数码摄影结合肉眼视觉比色,最终修复体由患者本人和医师对其进行美观效果满意度评价,应用课题组自行开发的Dental ImgShop图像处理软件采集得到相应的修复体和邻牙或对侧同名牙颜色指标(L*a*b*值),计算饱和度(Cab)和色相角(hab°),应用SAS 6.12软件包进行配对t检验,并计算色差△E值.结果:对最终修复体形态、颜色分布、切端半透明度等方面评价,患者总体满意度为98%,医师满意度为94%.特殊色牙的色度总体分布为L*值54.50～92.29,a*值-0.97～8.12,b*值-0.73～20.85,饱和度(Cab)0.85～21.34,色相角(hab°)29.73°～89.20°;最终修复体与其比较.L*a*b*值,Cab及hab°均无统计学差异,P值分别为0.19、0.54、0.34、0.08和0.57(P均＞0.05);△E在0.136～3.45(平均为0.948),其中仅有3例E≥2,在临床不可接受范围.结论:利用数码摄影结合视觉比色能全面、逼真记录和传达特殊色牙的颜色,操作更简便快捷,解决了特殊色牙患者口腔修复比配色困难的问题,达到了更佳的美观效果.     

A fully digital workflow to register maxillomandibular relation using a jaw motion tracer for fixed prosthetic rehabilitation: A technical report

Objective

This technique aimed to describe a fully digital workflow to register maxillomandibular relation for fixed prosthetic rehabilitation.

Clinical Considerations

Mandibular kinematics could be reproduced in a four-dimensional (4D) virtual patient based on the intraoral scan, facial scan, cone beam computed tomography, and jaw motion trajectory, which helped record centric relation and determine a proper occlusal vertical dimension in a virtual environment. The therapeutic position could be exported directly to the dental computer-aided design software for digital waxing design with a facial scan. The 4D virtual patient was also used to verify the functional and esthetic outcomes of provisional restorations.

Conclusions

This novel approach digitized the process of determination, delivery, and double-check of maxillomandibular relation, thus contributing to the establishment of a completely digital workflow for fixed prosthetic rehabilitation.

Clinical Significance

Registration of maxillomandibular relation, including centric relation and occlusal vertical dimension is critical to the success of prosthetic rehabilitation. Traditional procedures are complex and time-consuming, and heavily rely on the clinical experience of dentists. A fully digital approach to creating a 4D virtual patient and registering the maxillomandibular relation is established, which guides to determine a proper occlusal vertical dimension in centric relation. Digital delivery and double-check can simplify the conventional procedure and ensure that the determined maxillomandibular relation is reliable.     

Three-point sectional-cast digital method for transferring the interocclusal relationship for full-mouth rehabilitation of worn dentition

For full-mouth rehabilitation of worn dentition, “diagnostic” interim restorations are required to reestablish the interocclusal relationship. It is important but challenging to transfer the interocclusal relationship and to map the basic form and contour of interim restorations to the final restorations. Alignment of interim restorations and working casts is difficult when using digital workflows because of a lack of consistent hard tissue reference points. The digital workflow presented in this study used a “3-point sectional-cast digital cross-mounting method” to transfer the interocclusal relationship during full-mouth rehabilitation. An intermediate cast was made with three interim restorations: one on an incisor and two on molars. The interocclusal relationship and occlusal morphologies of the diagnostic interim prostheses were transferred and aligned to working casts using the 3-point sectional casts.     

CAD-CAM approach to designing and fabricating a low-maintenance metal-acrylic resin implant-supported fixed complete dental prosthesis: A clinical report

The metal-acrylic resin implant-supported fixed complete dental prosthesis (IFCDP) is a reliable restorative option. However, clinical complications and laboratory fabrication concerns are associated with these restorations. Maintenance and repair lead to increased chair time, but recently introduced computer-aided design and computer-aided manufacturing (CAD-CAM) materials and technology can improve efficiency and mitigate complications. In this clinical report, the existing design principles and CAD-CAM materials were combined to fabricate a metal-acrylic resin IFCDP that minimized individual tooth fracture and facilitated efficient resurfacing of worn surfaces.     

Financial considerations regarding acquisition of the Siemens Cerec computer reconstruction system.

There has been much interest in the in-office fabrication of ceramic posterior restorations using computer-aided design and computer-aided manufacture (CAD-CAM) units. One concern that practitioners have concerning the use of one of these systems is the initial expense of the CAD-CAM unit for the office. This article deals with the financial implications involved when considering the purchase or lease of a CEREC (CAD-CAM) unit.     

Financial Considerations Regarding Acquisition of the Siemens Cerec Computer Reconstruction System

There has been much interest in the in-office fabrication of ceramic posterior restorations using computer-aided design and computer-aided manufacture (CAD-CAM) units. One concern that practitioners have concerning the use of one of these systems is the initial expense of the CAD-CAM unit for the office. This article deals with the financial implications involved when considering the purchase or lease of a CEREC (CAD-CAM) unit.     

数字外科技术在眼眶重建中的应用

目的 探讨数字外科技术在眼眶损伤重建中的临床应用价值.方法 对7例眼眶缺损患者采用CT扫描获取眶区数据,通过反求与快速原型、计算机辅助设计-计算机辅助制作(CAD-CAM)数字外科技术进行术前设计,在手术达到骨折精确复位的同时完成眼眶重建,并结合坚固内固定及Medpor 填充方法解决眶骨折变形、眼球内陷及复视等问题.结果 7例眼眶缺损患者均重建了眼眶形态,获得了理想的眶周轮廓恢复,4例眼球内陷得到矫治,2例复视术后无复发.结论 数字外科技术为眼眶重建的手术设计与实施提供了精确手段,可有效减少并发症,明显改善面部形态.