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Journal of Prosthodontic Research Jan 2022This study comprehensively reviewed the current status of the digital workflow of removable partial dentures (RPDs) and summarized information about the fabrication...
PURPOSE
This study comprehensively reviewed the current status of the digital workflow of removable partial dentures (RPDs) and summarized information about the fabrication methods and material properties of the dental framework, artificial teeth, and denture base.
STUDY SELECTION
We performed a systematic review of the literature published in online databases from January 1980 to April 2020 regarding RPD fabrication and materials used in the related digital technology. We selected eligible articles, retrieved information regarding digital RPDs, and conducted qualitative/quantitative analyses. In this paper, the computer-aided design/computer-aided manufacturing (CAD/CAM) framework, artificial teeth, and denture base materials are reported.
RESULTS
A variety of materials, such as cobalt-chromium alloy, titanium, zirconia, and polyether ether ketone, are used for dental CAD/CAM frameworks. The mechanical strength of the metal materials used for the CAD/CAM framework was superior to that of the cast framework. However, the fitness and surface roughness of the framework and clasp fabricated using a selective laser melting (SLM) method were not superior to those obtained via cast fabrication. Most material properties and the surface roughness of poly methyl methacrylate (PMMA) discs used for digital RPDs were superior to those of heat-cured PMMA.
CONCLUSION
The use of a CAD/CAM framework and PMMA disc for digital RPDs offers numerous advantages over conventional RPDs. However, technical challenges regarding the accuracy and durability of adhesion between the framework and denture base remain to be solved. In digital fabrication, human technical factors influence the quality of the framework.
Topics: Computer-Aided Design; Denture Bases; Denture, Partial, Removable; Humans; Tooth, Artificial; Workflow
PubMed: 33504722
DOI: 10.2186/jpr.JPR_D_20_00117 -
Clinical and Experimental Dental... Feb 2022The purpose of this systematic review and meta-analysis was to compare implant-supported removable partial dentures (ISRPDs) with distal extension removable partial... (Meta-Analysis)
Meta-Analysis Review
Implant-supported removable partial dentures compared to conventional dentures: A systematic review and meta-analysis of quality of life, patient satisfaction, and biomechanical complications.
OBJECTIVES
The purpose of this systematic review and meta-analysis was to compare implant-supported removable partial dentures (ISRPDs) with distal extension removable partial dentures (DERPDs) in terms of patient-reported outcome measures (PROMs: patients' quality of life and satisfaction) and to determine mechanical and biological complications associated with ISRPDs.
MATERIAL AND METHODS
An electronic search was performed on four databases to identify studies treating Kennedy class I or II edentulous patients and which compared ISRPDs with DERPDs in terms of PROMS and studies, which evaluated mechanical and biological complications associated ISRPDs. Two authors independently extracted data on quality of life, patient satisfaction, and biomechanical complications from these studies. The risk of bias was assessed for each study, and for PROMs, the authors performed a meta-analysis by using a random-effects model.
RESULTS
Thirteen articles were included based on the selection criteria. The difference in mean scores for quality of life (30.5 ± 1.8; 95% confidence interval [CI], 24.9-36.1) and patient satisfaction (-20.8 ± 0.2; 95% CI, -23.7 to -17.8) between treatments with conventional and implant-supported removable dentures was statistically significant (p < .05). Implant-supported removable dentures improved patients' overall quality of life and satisfaction. Some mechanical and biological complications, such as clasp adjustment, abutment or implant loosening, marginal bone resorption, and peri-implant mucositis, were noted in ISRPDs during patient follow-up. Studies assessing PROMs were very heterogeneous (I = 65%, p = .85; I = 75%, p = .88).
CONCLUSIONS
ISRPDs significantly improved quality of life and patient satisfaction. Some mechanical and biological complications have been associated with ISRPDs treatment, requiring regular monitoring of patients to avoid the occurrence of these complications.
Topics: Dental Implants; Dental Prosthesis, Implant-Supported; Denture, Partial, Removable; Humans; Patient Satisfaction; Quality of Life
PubMed: 35014207
DOI: 10.1002/cre2.521 -
Journal of Prosthodontic Research Jan 2022This study comprehensively reviewed the current status of digital workflows in fabricating removable partial dentures (RPDs) using evidence from clinical trials and case...
PURPOSE
This study comprehensively reviewed the current status of digital workflows in fabricating removable partial dentures (RPDs) using evidence from clinical trials and case reports.
STUDY SELECTION
We performed a systematic review of the literature on the materials and fabrication of RPDs using digital technologies published in online databases from 1980 to 2020. We selected eligible articles from the search results, retrieved information on digital RPDs from these, and conducted a qualitative analysis. We report evidence from clinical papers and case reports, digital impression-taking methods, and maxillomandibular relationship (MMR) records.
RESULTS
A case report electronically published in 2019 introduced a clasp-retained RPD fabricated via a full-digital workflow without a gypsum definitive cast. Computer-aided design and computer-aided manufacturing of double-crown-retained RPDs with nonmetal materials were described in some case reports. Intraoral scanners were used to obtain digital impressions and MMR records in the fabrication of digital RPDs, which have potential advantages for reducing the number of clinical appointments and simplifying laboratory procedures. Evidence from clinical trials is scarce; a randomized controlled trial reported higher patient satisfaction with digital clasp-retained RPDs than with conventional RPDs.
CONCLUSIONS
Full-digital RPDs can be fabricated without a gypsum definitive cast. However, the indication for full-digital RPDs is limited to cases with Kennedy Class III/IV partially edentulous arches with several missing teeth. Challenges in digital impression-taking and MMR recording remain to be solved to extend these indications. More evidence from clinical trials is required to evaluate the efficacy and usefulness of digital RPDs.
Topics: Computer-Aided Design; Denture, Partial, Removable; Humans; Mouth, Edentulous; Randomized Controlled Trials as Topic
PubMed: 33504721
DOI: 10.2186/jpr.JPR_D_20_00116 -
The Journal of Prosthetic Dentistry Mar 2023Providing a removable partial denture (RPD) can be a complex, time-consuming, and error-prone procedure. Computer-aided design and computer-aided manufacturing (CAD-CAM)... (Review)
Review
STATEMENT OF PROBLEM
Providing a removable partial denture (RPD) can be a complex, time-consuming, and error-prone procedure. Computer-aided design and computer-aided manufacturing (CAD-CAM) techniques have shown promising clinical outcomes; however, the influence of manufacturing techniques on the properties of RPD components is unclear.
PURPOSE
The purpose of this systematic review was to determine the accuracy and mechanical properties of RPD components fabricated with conventional and digital methods.
MATERIAL AND METHODS
This study followed the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) and was registered on the international prospective register of systematic reviews (PROSPERO) database (CRD42022353993). An electronic search was conducted on PubMed/MEDLINE, Scopus, Web of Science, and the Cochrane Library in August 2022. Only in vitro studies comparing the digital with the lost-wax casting technique were included. The quality of the studies was assessed by using the methodological index for nonrandomized studies (MINORS) scale.
RESULTS
Of the 17 selected studies, 5 evaluated the accuracy of RPD components as well as the mechanical properties, 5 studies evaluated only the component accuracy, and another 7 evaluated only the mechanical properties. The accuracy was similar regardless of the technique, with discrepancies within clinically acceptable values (50 to 426.3 μm). The surface roughness was higher for 3D-printed clasps and lower for milled clasps (P<.05). The metal alloy significantly influenced the porosity, with the highest number of pores obtained by casting for Ti clasps and by rapid prototyping for Co-Cr clasps.
CONCLUSIONS
In vitro studies showed that the digital technique provided similar accuracy to that of the conventional technique within a clinically acceptable range. The manufacturing technique influenced the mechanical properties of RPD components.
PubMed: 36870892
DOI: 10.1016/j.prosdent.2023.01.032 -
Journal of Prosthodontics : Official... Feb 2023To perform a systematic review that provides an overview of the current literature on fatigue behavior of removable partial denture (RPD) clasp materials based on... (Review)
Review
PURPOSE
To perform a systematic review that provides an overview of the current literature on fatigue behavior of removable partial denture (RPD) clasp materials based on different retentive areas.
MATERIALS AND METHODS
The review followed the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines. Electronic searches were done via PubMed, Scopus, and OVID for studies reporting on RPD clasps and the fatigue failure of clasp materials. Inclusion criteria were English language with full text and in vitro studies only. Exclusion criteria were studies that did not assess the fatigue of RPD clasp materials. A quality assessment and selection of full-text articles were performed according to Consolidated Standards of Reporting Trials criteria.
RESULTS
A total of 182 articles were initially identified and screened. After applying inclusion and exclusion criteria, 15 articles were selected for the final analysis. Seven of the included studies utilized a vertical insertion/removal testing approach. Ten studies used the constant deflection test. Three studies used untapered specimens, and 12 studies used tapered specimens. Ten studies performed post-test analysis.
CONCLUSIONS
Cobalt-chromium (CoCr) is the strongest material in terms of fatigue in relation to the undercut depth and the modern, digitally manufactured RPD clasp materials also exhibit comparable fatigue behavior. Recent RPD clasp materials such as polyetheretherketone (PEEK) or laser sintered CoCr, however, require further study in terms of their fatigue behavior. In order to improve the quality of future studies, a standardized and calibrated fatigue testing method is needed with standardized specimen size and shape, which will reduce the risk of bias and enable meta-analysis for bulk comparison between studies.
Topics: Chromium Alloys; Dental Clasps; Denture Retention; Denture, Partial, Removable; Materials Testing
PubMed: 35405767
DOI: 10.1111/jopr.13519 -
BMC Oral Health Sep 2023Digital technologies have recently been introduced into the fabrication of removable partial dentures (RPDs). However, it is still unclear whether the digitally... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Digital technologies have recently been introduced into the fabrication of removable partial dentures (RPDs). However, it is still unclear whether the digitally fabricated RPDs fit better than conventionally cast ones in the rest region. The aim of this study was to evaluate the fit accuracy in the rest region of RPDs fabricated by digital technologies and compare it to those made by conventional lost-wax (CLW) technique.
METHODS
A comprehensive search was conducted in Cochrane Library, PubMed, EMbase, Web of Science and SpringerLink. Studies published up to August 2022 were collected. Two authors analyzed the studies independently and assessed the risk of bias on the modified methodological index for non-randomized studies (MINORS) scale. The mean values of gap distance between rests and corresponding rest seats of each study were extracted as outcome. A random-effects model at a significance level of P < 0.05 was used in the global comparison and subgroup analysis was carried out.
RESULTS
Overall, 11 articles out of 1214 complied with the inclusion criteria and were selected, including 2 randomized controlled trials (RCTs), 1 non-randomized clinical trial and 8 in vitro studies. Quantitative data from Meta-analysis revealed that fit accuracy in the rest region of RPDs fabricated with CLW showed no statistically significant difference with digital techniques (SMD = 0.33, 95%CI (-0.18, 0.83), P = 0.21). Subgroup analysis revealed a significantly better fit accuracy of CLW-fabricated RPDs in the rest region than either additive manufacturing (AM) groups or indirect groups (P = 0.03, P = 0.00), in which wax or resin patterns are milled or printed before conventional casting. While milled RPDs fit significantly better than cast ones in the rest region (P = 0.00). With digital relief and heat treatment, hybrid manufactured (HM) clasps obtained better fit accuracy in the rest region (P < 0.05). In addition, finishing and polishing procedure had no significant influence in the fit accuracy in all groups (P = 0.83).
CONCLUSIONS
RPDs fabricated by digital technologies exhibit comparable fit accuracy in rest region with those made by CLW. Digital technologies may be a promising alternative to CLW for the fabrication of RPDs and additional studies are recommended to provide stronger evidence.
TRIAL REGISTRATION
CRD42020201313.
Topics: Humans; Denture, Partial, Removable; Digital Technology; Research Design; Rest; Dental Casting Technique
PubMed: 37715159
DOI: 10.1186/s12903-023-03348-6 -
BioMed Research International 2021This systematic review is aimed at investigating the biomechanical stress that develops in the maxillofacial prostheses (MFP) and supporting structures and methods to...
AIM
This systematic review is aimed at investigating the biomechanical stress that develops in the maxillofacial prostheses (MFP) and supporting structures and methods to optimize it. . A literature survey was conducted for full-text English articles which used FEA to examine the stress developed in conventional and implant-assisted MFPs from January 2010 to December 2020.
RESULTS
87 articles were screened to get an update on the desired information. 74 were excluded based on a complete screening, and finally, 13 articles were recruited for complete reviewing. . The MFP is subjected to stress, which is reflected in the form of compressive and tensile strengths. The stress is mainly concentrated the resection line and around the apices of roots of teeth next to the defect. Diversity of designs and techniques were introduced to optimize the stress distribution, such as modification of the clasp design, using materials with different mechanical properties for dentures base and retainer, use of dental (DI) and/or zygomatic implants (ZI), and free flap reconstruction before prosthetic rehabilitation.
CONCLUSION
Using ZI in the defective side of the dentulous maxillary defect and defective and nondefective side of the edentulous maxillary defect was found more advantageous, in terms of compression and tensile stress and retention, when compared with DI and free flap reconstruction.
Topics: Animals; Biomechanical Phenomena; Finite Element Analysis; Humans; Imaging, Three-Dimensional; Maxilla; Maxillofacial Prosthesis; Stress, Mechanical
PubMed: 34447852
DOI: 10.1155/2021/6419774 -
Quintessence International (Berlin,... 2021Objective: To analyze the loss of abutment teeth for double crown-retained removable partial dentures (DC-RPDs) compared to clasp-retained removable partial dentures... (Meta-Analysis)
Meta-Analysis
Objective: To analyze the loss of abutment teeth for double crown-retained removable partial dentures (DC-RPDs) compared to clasp-retained removable partial dentures (C-RPDs). Method and materials: A search was conducted in the Ovid MEDLINE, Embase, Web of Science databases, and a manual search. The search was conducted based on the PICO framework with inclusion and exclusion criteria. After extracting the data of selected studies, a meta-analysis was performed to estimate abutment loss with 95% confidence interval (CI). The statistical significance was defined as P < .05, and the heterogeneity of the data was assessed based on the chi-squared test and I2 statistics. Risk of bias assessment was conducted using Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. Results: A total of 4,692 records were identified from electronic databases and 38 studies were included for quantitative synthesis of 3,393 subjects with 13,552 abutment teeth. A total of 1,226 abutment teeth were lost with > 4,016 RPDs. Seven studies were compounded for > 668 C-RPDs (mean follow-up time ≤ 5 years) and six studies for 893 C-RPDs (mean follow-up time < 5 years), where the estimates of abutment loss were 5% (95% CI 2% to 8%) and 8% (95% CI 5% to 13%), respectively. The data were not significantly different (P = .1), and were heterogenous between the studies (τ2 ≥ 0.34, I2 ≥ 87.38%). Thirteen studies were compounded for 1,223 DC-RPDs (mean follow-up time ≤ 5 years) and eight studies for 1,033 DC-RPDs (mean follow-up time > 5 years), where the estimates of abutment loss were 6% (95% CI 5% to 8%) and 12% (95% CI 8% to 18%), respectively. The data were heterogenous (τ2 ≥ 0.17, I2 ≥ 75.86%), and were significantly different between the studies (P = .005). Overall, C-RPDs were not significantly different from DC-RPDs in abutment loss (P ≥ .3). A significant predictor for abutment loss was follow-up time with DC-RPDs (P = .005), where the risk of abutment loss per year was 18% (P = .0001). In contrast, follow-up time was not a significant factor for C-RPDs (P = .1). None of the included studies were at high risk of bias. Conclusion: Within the limitations of the current systematic review and meta-analysis, abutment loss was not significantly different between C-RPDs and DC-RPDs. A significant predictor was follow-up time for DC-RPDs, whereas this factor was not significant for C-RPDs. Further research is needed to investigate critical factors for abutment loss with RPDs.
Topics: Crowns; Dental Abutments; Denture Retention; Denture, Partial, Removable; Follow-Up Studies; Humans
PubMed: 33491387
DOI: 10.3290/j.qi.b912671 -
The Journal of Prosthetic Dentistry Mar 2023Dental agenesis is a condition in which the absence of teeth causes debilitating problems, primarily in speech, mastication, and esthetics. The optimal removable... (Review)
Review
STATEMENT OF PROBLEM
Dental agenesis is a condition in which the absence of teeth causes debilitating problems, primarily in speech, mastication, and esthetics. The optimal removable prosthetic management for the condition is unclear.
PURPOSE
The purpose of this systematic review was to evaluate the spectrum of removable prosthetic techniques with regard to the type of edentulism and to provide clinical guidance for practicing dentists.
MATERIAL AND METHODS
An electronic and manual search was conducted in the PubMed, Scopus, and Google Scholar databases. Publications of case reports and series written in English without data restrictions that reported on removable prosthodontic management of patients with oligodontia, hypodontia, or anodontia were included.
RESULTS
A total of 59 articles comprising 83 case reports were analyzed. In patients with anodontia, the most common treatment option was an acrylic resin complete denture. Hypodontia and oligodontia were commonly managed by using either a partial denture or overdenture. Irreversible hydrocolloid or alginate was the most accepted material for the preliminary impressions and elastomeric materials for definitive impressions. The tooth arrangements were modified to simulate natural dentition and improve esthetics. Modifications of conventional acrylic resin dentures have been proposed for improved denture adaptation. Good retention is essential to the long-term success of prosthetic treatment and may be achieved with a denture reline or with retention clasps. The active growth of the patients means constant maintenance, including denture renewals or repairs, emphasizing the need for long-term follow-up care.
CONCLUSIONS
Prosthodontic rehabilitation at an early age has been shown to significantly impact the overall quality of life for a child with tooth agenesis.
PubMed: 36922297
DOI: 10.1016/j.prosdent.2023.02.005 -
Clinical Oral Investigations Sep 2018The aim of the present study was a systematic review and subsequent meta-analysis on biological complications of removable prostheses in the moderately reduced dentition. (Meta-Analysis)
Meta-Analysis
OBJECTIVES
The aim of the present study was a systematic review and subsequent meta-analysis on biological complications of removable prostheses in the moderately reduced dentition.
MATERIALS AND METHODS
A systematic literature search in established medical databases (MEDLINE, EMBASE, BIOSIS, SciSearch, Cochrane, FIZ Technik Web) and a hand search of relevant dental journals was conducted. The search terms were relevant MeSH terms, free search terms, and combinations of the two. The search included randomized controlled trials, prospective and retrospective studies with data on biological complications of removable dental prostheses in the moderately reduced dentition with at least 15 participants, an observation period of at least 2 years, and a drop-out rate of less than 25%. The selection of relevant publications was carried out at the title, abstract, and full-text level by at least two of the authors involved. The publications included were tabulated and analyzed.
RESULTS
Of the original 12,994 matches, 1923 were analyzed by title, 650 by abstract, and 111 according to the full text. A total of 42 publications were ultimately included. The following parameters were evaluated.
TOOTH LOSS
Results varied, depending on the observation period, between 0 and 18.1% for clasp-retained removable dental prostheses (RDPs), between 5.5 and 29% for attachment-retained RDPs, and between 5.5 and 51.7% for double crown-retained RDPs.
CARIES
Results varied, depending on the observation period, between 0 and 32.7% for clasp-retained RDPs, between 1.8 and 29% for attachment-retained RDPs, and between 1.8 and 16.4% for double crown-retained RDPs.
ENDODONTIC TREATMENT
Results varied, depending on the observation period, between 3.5 and 19.2% for clasp-retained RDPs, between 6.9 and 16.4% for attachment-retained RDPs, and between 0.6 and 13.9% for double crown-retained RDPs.
TOOTH FRACTURE
Results varied, depending on the observation period, between 1.7 and 5.3% for clasp-retained RDPs, between 12.7 and 40% for attachment-retained RDPs, and between 0.4 and 4.4% for double crown-retained RDPs.
TOOTH MOBILITY
There were no changes or improvements for clasp-retained RDPs. The better the pre-treatment and supportive care is, the smaller the differences are. For double crown-retained RDPs, a slight increase was found in one study. The results for the parameters probing depth and radiological bone loss were inconclusive.
GINGIVAL RECESSION
Gingival recession seemed to be favored by a mandibular sublingual bar. Compared to fixed restorations, removable restorations seemed to be associated with a more pronounced need for dental treatment. Stringent pre-treatment and supportive care reduced the complication rates.
CONCLUSIONS
Heterogeneous study designs and data analyses rendered a meta-analysis impossible, so that an evaluation at the highest level of evidence could not be performed.
CLINICAL RELEVANCE
Within the limitations of this study, it would be correct to state that removable dental prostheses require intensive maintenance. Suitable pre-treatment and supportive care can lower the complication rates, in the absence of which they constitute trigger factors for (additional) biological complications.
Topics: Dental Prosthesis Retention; Denture, Partial, Removable; Humans; Jaw, Edentulous, Partially
PubMed: 29959596
DOI: 10.1007/s00784-018-2522-y