Digital Treatment Planning: Limits and Possibilities

\Current Oral Health Reports

Abstract

Purpose of Review

This study set out to demonstrate how the digital approach to prosthetic dentistry is able to guarantee better opportunity both in terms of diagnosis and planning and from the point of view of final prosthetic restoration.

Recent Findings

In recent years, the digital approach to prosthetic dentistry has certainly improved the predictability of treatments, giving clinicians and technicians the opportunity to cooperate in the best possible way. A crucial point in prosthetic rehabilitation is the creation of a treatment plan that can be generated through an analysis of facial aesthetics and a consequent orientation of the arches in space, in order to guarantee a restoration that combines aesthetics and function.

Summary

The digital approach capable of combining facial scans, intra-oral scans, laboratory scans and CBCT, as well as mandibular movements, is able to guarantee superior predictability compared to the traditional approach due to the possibility of generating a virtual patient accessible by all the members of the rehabilitation team.
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Effect of LOCATOR attachments with different retentive forces on the stability of 2-implant-retained mandibular overdenture

The Journal of Prosthetic Dentistry

Available online 25 November 2019

The Journal of Prosthetic Dentistry

Abstract

Statement of problem

The LOCATOR system has been widely used for 2-implant-retained mandibular overdentures (2-MOs), but the influence of different LOCATOR attachments on the stability of 2-MOs has not been assessed.

Purpose

The purpose of this in vitro study was to investigate the stability of 2-MOs anchored by LOCATOR attachments with different retentive forces.

Material and methods

An edentulous mandibular test cast with 2 bone-level implants inserted in the left and right mandibular canine regions was used. Twelve overdentures were then fabricated and anchored on the cast, following the instructions of the LOCATOR system. By replacing inserts of the 12 overdentures, the stability of 3 groups of LOCATOR inserts with different retentive forces was evaluated: blue group, pink group, and transparent group. With artificial saliva used on the cast and overdentures, vertical forces of 40 N, 55 N, and 100 N were loaded on the occlusal surface of the left incisor, left canine, and left molar, respectively. Under each loading condition, the vertical displacements at the loading point and the vertical and horizontal displacements of overdentures at the right distal edge were measured at the same time. One-way ANOVA and the post hoc Tukey honestly significant difference (HSD) test were used to compare the stability of 2-MOs with different LOCATOR attachments (α=.05 for all tests).

Results

When a force of 40 N was applied to the incisor, the largest vertical movement of the incisor loading point appeared in the blue group (P<.05), and the displacements of the pink group showed significant difference from those of the transparent group (P>.05). When 55 N was loaded on the canine, the blue group showed the largest vertical displacements of both the loading point and the right distal edge of the overdentures (P<.05). No significant difference was found in the vertical displacements between the pink group and the transparent group (P>.05). When a force of 100 N was loaded on the molar point, the transparent group indicated a smaller movement in the vertical direction at the edge of the overdentures than the blue group (P<.05) or the pink group (P<.05).

Conclusion

LOCATOR attachments with different retentive forces had a significant effect on the denture stability of 2-MOs. Compared with the blue inserts, the pink and transparent inserts can offer greater stability for 2-MOs and could therefore be suggested for clinical situations.
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Can 3D imaging and digital software increase the ability to predict dental arch form after orthodontic treatment?

Highlights

Software analysis of scanned 3D cast helped predict posttreatment dental arch form.
Clinicians predict posttreatment dental arch form better by using digital software.
The software improved agreement between the primary and final wire forms.
The software omitted human visual errors and increased agreement between clinicians.
Dental arch form changes were not highly predictable during treatment.

Introduction

This study aimed to evaluate the ability of dental clinicians to predict posttreatment dental arch forms in patients with malocclusion with the aid of 3D imaging and digital software in comparison with a conventional method.

Methods

Pretreatment and posttreatment dental plaster casts of 100 patients (200 maxillary models and 200 mandibular models) were selected. Three orthodontists selected the best-fitted archwires among 5 commercially available preformed nickel-titanium archwires using 2 methods. In the conventional method, they fit the archwires to pretreatment casts, and in the digital method, they fit the scanned wire to a 3D digital model, using Ortho-Aid, a locally developed 3D software, using clinical bracket points as reference for wire fitness. The predicted posttreatment archwire in each method was compared with the best-fit archwire on the actual posttreatment model of each patient in both methods, and the level of agreement was calculated. The interobserver agreement between the 3 orthodontists in each method was evaluated using intraclass correlation coefficient and the Dahlberg formula.

Results

Orthodontists predicted the final treatment outcome in 50% of cases using the conventional method and 58% using the digital method. However, the range of method error was significantly higher in the conventional method (0.425-3.853 mm for the conventional vs 0.451-0.584 mm for the digital).

Conclusions

Although the clinicians’ ability to predict the final dental arch form after orthodontic treatment and the agreement between clinicians increased by the use of digital equipment, orthodontists can predict the final arch form in about 60% of patients.
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Wear resistance of 3D-printed denture tooth resin opposing zirconia and metal antagonists

The Journal of Prosthetic Dentistry

Available online 27 November 2019
The Journal of Prosthetic Dentistry

Abstract

Statement of problem

Additive manufacturing technology can be used for denture bases and also denture teeth. Therefore, the mechanical properties of 3D-printed resin denture teeth should be evaluated.

Purpose

The purpose of this in vitro study was to compare the wear resistance of 3D-printed denture tooth resin with that of conventionally prefabricated denture teeth.

Material and methods

Eighty substrate specimens were prepared with 5 kinds of resin denture teeth: 3D-printed denture tooth resin (DENTCA denture tooth resin; DENTCA, Inc), Artic 6 (Kulzer GmbH), Preference (Candulor AG), Premium 6 (Kulzer GmbH), and Surpass (GC Corp). The 3D-printed denture tooth specimens were made of methacrylate-based photopolymerized resin by stereolithography 3D printing. Antagonistic surfaces were made from zirconia by milling and from cobalt-chromium (Co-Cr) alloy by 3D printing and casting. The specimens were loaded at 49 N for 30 000 cycles under thermocycling conditions in a mastication simulator. Wear resistance was measured by calculating the volume of substance lost. Wear surface characteristics were observed by using a scanning electron microscope (SEM). Two-way ANOVA was used to analyze the data (α=.05).

Results

The influence of the resin denture teeth and the type of antagonist were both statistically significant. The wear volume loss of the 3D-printed denture tooth resin was higher than that of Artic 6 and Preference when opposing the zirconia and the metal antagonists (P<.05). The 3D-printed denture tooth resin did not show a significant difference from Premium 6 with the zirconia and the metal antagonists or Surpass with the zirconia antagonist. From the SEM images, the specimens of the 3D-printed denture tooth resin showed a relatively smooth surface with the zirconia antagonist and exhibited cracks when opposed by the metal antagonist.

Conclusions

The results suggest that 3D-printing by using resin materials provides adequate wear resistance for denture tooth use.
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Behavioral sciences in the promotion of oral health

International & American Associations for Dental Research
Alexandria, VA, USA – 2019 marks the Centennial of the Journal of Dental Research (JDR). Over the last century the JDR has been dedicated to the dissemination of new knowledge and information on all sciences relevant to dentistry and to the oral cavity and associated structures in health and disease. To celebrate, the JDR is featuring a yearlong, commemorative article and podcast series that highlights topics that have transformed dental, oral and craniofacial research over the past 100 years.
The importance and value of behavioral sciences in dentistry has long been recognized and over time behavioral sciences have expanded our understanding of oral health beyond ‘disease’ to a broader biopsychosocial concept of oral health. In the JDR Centennial article "Behavioral Sciences in the Promotion of Oral Health," Colman McGrath, University of Hong Kong, SAR, China, discusses how this broadened view has led dentistry away from a focus of ‘treatment’ to oral health ‘care.’
"Over the past 100 years, key oral health behaviors have been identified including diet, oral hygiene and dental services, and the relationship between individual factors and the broader environmental factors have been increasingly emphasized, leading to a united call for action in addressing oral health inequalities," said McGrath.
"More recently behavioral therapies, such as cognitive behavioral therapy, are increasingly being employed in dental practice in the management of dental anxiety, pain and psychosomatic dental and oral problems with promising results," said McGrath. "There is a need to consider training for dental professionals, resources and tools for implementation and a systematic approach of what interventions to use, how to employ them, when and for how long, in addition to determining the cost effectiveness and benefits of such approaches."
Accompanying the article, the JDR Centennial podcast "Behavioral Sciences in the Promotion of Oral Health," features a conversation between McGrath and Lois Cohen, Consultant, National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland, USA, moderated by JDR Associate Editor Falk Schwendicke of Charite University in Berlin, Germany.

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The December 2019 issue of the JDR also includes and Historical Highlight 13 on Germfree Animals for the Study of Dental Caries by JDR Associate Editor, Nicholas Jakubovics, Newcastle University, England.
The legacy of the JDR was honored during a celebration at the 97th General Session of the IADR, held in conjunction with the 48th Annual Meeting of the AADR and the 43rdAnnual Meeting of the Canadian Association for Dental Research, in Vancouver, British Columbia, Canada on June 19-22, 2019. For more information on the JDR Centennial, please visit: http://www.iadr.org/JDRcentennial.
Click here to view a PDF of this press release.
About the Journal of Dental Research
The IADR/AADR Journal of Dental Research (JDR) is a multidisciplinary journal dedicated to the dissemination of new knowledge in all sciences relevant to dentistry and the oral cavity and associated structures in health and disease. The JDR continues to rank #1 of 90 journals in Eigenfactor with a score of 0.021290, ranks #2 in Impact Factor of 90 journals in the "Dentistry, Oral Surgery & Medicine" category at 5.125 and ranks #2 of 90 in Article Influence with a score of 1.643.The JDR‘s 5-year Impact Factor has remained above 5 for the fourth year at 5.722, ranking #2 of 91 journals. With over 20,000 citations, the JDR also boasts the most citations in the "Dentistry, Oral Surgery & Medicine" category — 4,500 citations above the second ranked journal in the field.
International Association for Dental Research The International Association for Dental Research (IADR) is a nonprofit organization with over 10,000 individual members worldwide, with a Mission to drive dental, oral and craniofacial research to advance health and well-being worldwide. To learn more, visit http://www.iadr.org. The American Association for Dental Research (AADR) is the largest Division of IADR with 3,100 members in the United States. To learn more, visit http://www.iadr.org/aadr.

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Average Dentist Salary by State

Mean annual wage for dentists in every U.S. state
Rank State 2018 Average Salary 2017 Average Salary 2016 Average Salary 2015 Average Salary 2014 Average Salary 2013 Average Salary 5-Year Change
32 Alabama $171,900 $181,240 $183,480 $174,870 $173,220 $186,430 -8
2 Alaska $259,350 $237,140 $234,240 $217,120 $205,880 $208,650 24
20 Arizona $186,870 $175,310 $168,710 $155,940 $141,890 $154,260 21
37 Arkansas $165,480 $170,440 $185,170 $171,450 $160,520 $152,200 9
44 California $151,490 $157,890 $164,330 $170,490 $155,270 $147,750 3
28 Colorado $174,930 $168,110 $175,210 $178,710 $158,050 $143,910 22
6 Connecticut $213,390 $212,840 $205,310 $188,580 $183,460 $192,870 11
1 Delaware $264,440 $257,290 $236,130 $227,160 $224,830 $226,910 17
36 Florida $167,270 $166,610 $166,180 $170,270 $163,570 $153,260 9
27 Georgia $176,600 $181,690 $173,850 $177,540 $190,620 $189,550 -7
16 Hawaii $196,690 $174,070 $179,920 $154,880 $167,470 $152,810 29
31 Idaho $172,020 $187,800 $191,250 $191,140 $169,360 $154,810 11
33 Illinois $171,590 $161,270 $156,150 $149,400 $141,980 $133,260 29
24 Indiana $183,800 $185,820 $162,390 $146,760 $143,780 $157,930 16
19 Iowa $187,570 $193,130 $184,910 $185,270 $174,480 $171,610 9
25 Kansas $179,100 $185,600 $177,380 $182,340 $173,720 $152,040 18
40 Kentucky $154,230 $163,390 $176,730 $168,460 $150,950 $157,290 -2
49 Louisiana $124,020 $115,050 $126,030 $139,080 $148,240 $144,460 -14
11 Maine $203,920 $179,920 $191,200 $185,290 $203,890 $194,990 5
43 Maryland $151,950 $154,010 $165,140 $158,310 $159,830 $151,640 0
26 Massachusetts $177,410 $175,580 $188,020 $179,390 $175,280 $170,290 4
14 Michigan $197,490 $187,430 $172,270 $169,080 $161,040 $166,070 19
4 Minnesota $227,280 $210,320 $205,810 $193,320 $193,690 $193,100 18
42 Mississippi $153,810 $182,520 $172,600 $178,610 $152,490 $164,110 -6
17 Missouri $191,240 $180,350 $172,720 $166,000 $168,650 $165,930 15
34 Montana $170,260 $161,060 $176,050 $147,250 $130,390 $131,120 30
47 Nebraska $135,080 $148,230 $158,770 $153,460 $151,130 $162,710 -17
10 Nevada $210,710 $209,360 $210,690 $195,360 $144,770 $128,920 63
5 New Hampshire $226,300 $219,920 $220,480 $217,790 $218,230 $229,040 -1
35 New Jersey $169,990 $164,310 $151,750 $166,700 $156,640 $153,690 11
29 New Mexico $173,610 $167,720 $167,650 $170,570 $187,920 $175,020 -1
38 New York $164,520 $168,120 $170,300 $173,980 $164,030 $160,950 2
9 North Carolina $212,160 $225,890 $236,020 $211,370 $205,820 $187,210 13
8 North Dakota $212,380 $238,170 $202,240 $214,450 $183,600 $208,960 2
15 Ohio $197,150 $187,770 $193,430 $191,270 $186,100 $188,800 4
39 Oklahoma $156,060 $161,010 $168,820 $155,250 $147,820 $143,910 8
18 Oregon $190,690 $202,030 $192,280 $193,960 $169,110 $178,170 7
41 Pennsylvania $153,950 $138,200 $140,340 $150,620 $166,690 $164,890 -7
3 Rhode Island $254,190 $206,520 $162,070 $180,220 $183,180 $168,290 51
30 South Carolina $172,780 $192,800 $191,520 $195,350 $183,150 $169,390 2
13 South Dakota $198,170 $179,960 $160,480 $153,880 $164,590 $171,850 15
21 Tennessee $186,670 $184,760 $187,500 $176,080 $172,850 $190,380 -2
22 Texas $185,680 $172,890 $171,850 $171,870 $185,760 $186,520 0
46 Utah $138,970 $128,770 $127,480 $121,340 $112,990 $113,630 22
N/A Vermont N/A $174,090 $185,560 $180,970 $204,760 $215,410 #N/A
12 Virginia $199,870 $185,890 $177,640 $156,040 $158,780 $165,400 21
23 Washington $184,780 $187,110 $184,190 $182,990 $177,890 $194,390 -5
45 West Virginia $139,170 $160,350 $162,690 $163,610 $169,590 $177,740 -22
7 Wisconsin $213,210 $217,800 $210,300 $203,570 $178,180 $177,430 20
48 Wyoming $125,120 $143,210 $175,350 $171,340 $183,490 $176,920 -29
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