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Clinical Oral Implants Research Oct 2018Working Group 5 was assigned the task to review the current knowledge in the area of digital technologies. Focused questions on accuracy of linear measurements when...
OBJECTIVES
Working Group 5 was assigned the task to review the current knowledge in the area of digital technologies. Focused questions on accuracy of linear measurements when using CBCT, digital vs. conventional implant planning, using digital vs. conventional impressions and assessing the accuracy of static computer-aided implant surgery (s-CAIS) and patient-related outcome measurements when using s-CAIS were addressed.
MATERIALS AND METHODS
The literature was systematically searched, and in total, 232 articles were selected and critically reviewed following PRISMA guidelines. Four systematic reviews were produced in the four subject areas and amply discussed in the group. After emendation, they were presented to the plenary where after further modification, they were accepted.
RESULTS
Static computer-aided surgery (s-CAIS), in terms of pain & discomfort, economics and intraoperative complications, is beneficial compared with conventional implant surgery. When using s-CAIS in partially edentulous cases, a higher level of accuracy can be achieved when compared to fully edentulous cases. When using an intraoral scanner in edentulous cases, the results are dependent on the protocol that has been followed. The accuracy of measurements on CBCT scans is software dependent.
CONCLUSIONS
Because the precision intraoral scans and of measurements on CBCT scans and is not high enough to allow for the required accuracy, s-CAIS should be considered as an additional tool for comprehensive diagnosis, treatment planning, and surgical procedures. Flapless s-CAIS can lead to implant placement outside of the zone of keratinized mucosa and thus must be executed with utmost care.
Topics: Computer-Aided Design; Cone-Beam Computed Tomography; Consensus; Databases, Factual; Dental Implantation, Endosseous; Dental Impression Technique; Dental Prosthesis, Implant-Supported; Humans; Imaging, Three-Dimensional; Mouth, Edentulous; Patient Care Planning; Patient Reported Outcome Measures; Reproducibility of Results; Software; Surgery, Computer-Assisted
PubMed: 30328201
DOI: 10.1111/clr.13309 -
Clinical Oral Implants Research Oct 2018This systematic review and meta-analysis were conducted to assess and compare the accuracy of conventional and digital implant impressions. The review was registered on... (Meta-Analysis)
Meta-Analysis
AIM
This systematic review and meta-analysis were conducted to assess and compare the accuracy of conventional and digital implant impressions. The review was registered on the PROSPERO register (registration number: CRD42016050730).
MATERIAL AND METHODS
A systematic literature search was conducted adhering to PRISMA guidelines to identify studies on implant impressions published between 2012 and 2017. Experimental and clinical studies at all levels of evidence published in peer-reviewed journals were included, excluding expert opinions. Data extraction was performed along defined parameters for studied specimens, digital and conventional impression specifications and outcome assessment.
RESULTS
Seventy-nine studies were included for the systematic review, thereof 77 experimental studies, one RCT and one retrospective study. The study setting was in vitro for most of the included studies (75 studies) and in vivo for four studies. Accuracy of conventional impressions was examined in 59 studies, whereas digital impressions were examined in 11 studies. Nine studies compared the accuracy of conventional and digital implant impressions. Reported measurements for the accuracy include the following: (a) linear and angular deviations between reference models and test models fabricated with each impression technique; (b) three-dimensional deviations between impression posts and scan bodies respectively; and (c) fit of implant-supported frameworks, assessed by measuring marginal discrepancy along implant abutments.) Meta-analysis was performed of 62 studies. The results of conventional and digital implant impressions exhibited high values for heterogeneity.
CONCLUSIONS
The available data for accuracy of digital and conventional implant impressions have a low evidence level and do not include sufficient data on in vivo application to derive clinical recommendations.
Topics: Computer-Aided Design; Databases, Factual; Dental Implantation; Dental Implants; Dental Impression Materials; Dental Impression Technique; Dental Marginal Adaptation; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Models, Dental; Treatment Outcome
PubMed: 30328182
DOI: 10.1111/clr.13273 -
Clinical Oral Implants Research Oct 2018To identify clinical studies evaluating efficiency and/or effectiveness of digital technologies as compared to conventional manufacturing procedures for the fabrication...
Is the use of digital technologies for the fabrication of implant-supported reconstructions more efficient and/or more effective than conventional techniques: A systematic review.
OBJECTIVE
To identify clinical studies evaluating efficiency and/or effectiveness of digital technologies as compared to conventional manufacturing procedures for the fabrication of implant-supported reconstructions.
MATERIALS AND METHODS
A systematic search from 1990 through July 2017 was performed using the online databases Medline, Embase, and Cochrane-Central-Register-of-Controlled-Trials. Literature on efficiency and/or effectiveness during the impression session, the manufacturing process, and the delivery session were included.
RESULTS
In total, 12 clinical studies were included. No meta-analysis was performed due to a large heterogeneity of the study protocols. Nine publications reported on posterior single implant crowns (SIC) and three on full-arch reconstructions. Mean impression time with intraoral scanners ranged between 6.7 and 19.8 min, whereas the range for conventional impressions was 8.8 and 18.4 min. In a fully digital workflow (FD-WF) for posterior SIC, mean fabrication time ranged between 46.8 and 54.5 min (prefabricated abutment) and 68.0 min (customized abutment). In a hybrid workflow (H-WF) including a digitally customized abutment and a manual veneering, mean fabrication time ranged between 132.5 and 158.1 min. For a conventional porcelain-fused-to-metal-crown, a mean time of 189.8 min was reported. The mean time for the delivery of posterior SIC ranged between 7.3 and 7.4 min (FD-WF), 10.5 and 12.5 min (H-WF), and 15.3 min (conventional workflow, C-WF). The FD-WF for posterior SIC was more effective than the H-/C-WF.
CONCLUSIONS
The implementation of the studied digital technologies increased time efficiency for the laboratory fabrication of implant-supported reconstructions. For posterior SIC, the model-free fabrication, the use of prefabricated abutments, and the monolithic design was most time efficient and most effective.
Topics: Computer-Aided Design; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Humans
PubMed: 30306680
DOI: 10.1111/clr.13300 -
The Journal of Prosthetic Dentistry Feb 2019The accuracy of the virtual images used in digital dentistry is essential to the success of oral rehabilitation.
STATEMENT OF PROBLEM
The accuracy of the virtual images used in digital dentistry is essential to the success of oral rehabilitation.
PURPOSE
The purpose of this systematic review was to estimate the mean accuracy of digital technologies used to scan facial, skeletal, and intraoral tissues.
MATERIAL AND METHODS
A search strategy was applied in 4 databases and in the non-peer-reviewed literature from April through June 2017 and was updated in July 2017. Studies evaluating the dimensional accuracy of 3-dimensional images acquired by the scanning of hard and soft tissues were included.
RESULTS
A total of 2093 studies were identified by the search strategy, of which 183 were initially screened for full-text reading and 34 were considered eligible for this review. The scanning of facial tissues showed deviation values ranging between 140 and 1330 μm, whereas the 3D reconstruction of the jaw bone ranged between 106 and 760 μm. The scanning of a dentate arch by intraoral and laboratorial scanners varied from 17 μm to 378 μm. For edentulous arches, the scanners showed a trueness ranging between 44.1 and 591 μm and between 19.32 and 112 μm for dental implant digital scanning.
CONCLUSIONS
The current digital technologies are reported to be accurate for specific applications. However, the scanning of edentulous arches still represents a challenge.
Topics: Computer-Aided Design; Dental Impression Technique; Dental Prosthesis Design; Dimensional Measurement Accuracy; Humans; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Models, Dental; Mouth Rehabilitation; Patient Care Planning
PubMed: 30017156
DOI: 10.1016/j.prosdent.2018.01.015 -
The Cochrane Database of Systematic... Apr 2018Edentulism is relatively common and is often treated with the provision of complete or partial removable dentures. Clinicians make final impressions of complete dentures... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Edentulism is relatively common and is often treated with the provision of complete or partial removable dentures. Clinicians make final impressions of complete dentures (CD) and removable partial dentures (RPD) using different techniques and materials. Applying the correct impression technique and material, based on an individual's oral condition, improves the quality of the prosthesis, which may improve quality of life.
OBJECTIVES
To assess the effects of different final-impression techniques and materials used to make complete dentures, for retention, stability, comfort, and quality of life in completely edentulous people.To assess the effects of different final-impression techniques and materials used to make removable partial dentures, for stability, comfort, overextension, and quality of life in partially edentulous people.
SEARCH METHODS
Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 22 November 2017), the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Register of Studies, to 22 November 2017), MEDLINE Ovid (1946 to 22 November 2017), and Embase Ovid (21 December 2015 to 22 November 2017). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases, however the search of Embase was restricted by date due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL.
SELECTION CRITERIA
We included randomised controlled trials (RCTs) comparing different final-impression techniques and materials for treating people with complete dentures (CD) and removable partial dentures (RPD). For CD, we included trials that compared different materials or different techniques or both. In RPD for tooth-supported conditions, we included trials comparing the same material and different techniques, or different materials and the same technique. In tooth- and tissue-supported RPD, we included trials comparing the same material and different dual-impression techniques, and different materials with different dual-impression techniques.
DATA COLLECTION AND ANALYSIS
Two review authors independently, and in duplicate, screened studies for eligibility, extracted data, and assessed the risk of bias for each included trial. We expressed results as risk ratios (RR) for dichotomous outcomes, and as mean differences (MD) or standardised mean differences (SMD) for continuous outcomes, with 95% confidence intervals (CI), using the random-effects model. We constructed 'Summary of findings' tables for the main comparisons and outcomes (participant-reported oral health-related quality of life, quality of the denture, and denture border adjustments).
MAIN RESULTS
We included nine studies in this review. Eight studies involved 485 participants with CD. We assessed six of the studies to be at high risk of bias, and two to be at low risk of bias. We judged one study on RPD with 72 randomised participants to be at high risk of bias.Overall, the quality of the evidence for each comparison and outcome was either low or very low, therefore, results should be interpreted with caution, as future research is likely to change the findings.Complete denturesTwo studies compared the same material and different techniques (one study contributed data to a secondary outcome only); two studies compared the same technique and different materials; and four studies compared different materials and techniques.One study (10 participants) evaluated two stage-two step, Biofunctional Prosthetic system (BPS) using additional silicone elastomer compared to conventional methods, and found no evidence of a clear difference for oral health-related quality of life, or quality of the dentures (denture satisfaction). The study reported that BPS required fewer adjustments. We assessed the quality of the evidence as very low.One study (27 participants) compared selective pressure final-impression technique using wax versus polysulfide elastomeric (rubber) material. The study did not measure quality of life or dentures, and found no evidence of a clear difference between interventions in the need for adjustments (RR 0.81, 95% CI 0.38 to 1.70). We assessed the quality of the evidence as very low.One study compared two stage-two step final impression with alginate versus silicone elastomer. Oral health-related quality of life measured by the OHIP-EDENT seemed to be better with silicone (MD 7.20, 95% CI 2.71 to 11.69; 144 participants). The study found no clear differences in participant-reported quality of the denture (comfort) after a two-week 'confirmation' period, but reported that silicone was better for stability and chewing efficiency. We assessed the quality of the evidence as low.Three studies compared single-stage impressions with alginate versus two stage-two step with elastomer (silicone, polysulfide, or polyether) impressions. There was no evidence of a clear difference in the OHIP-EDENT at one month (MD 0.05, 95% CI -2.37 to 2.47; two studies, 98 participants). There was no evidence of a clear difference in participant-rated general satisfaction with dentures at six months (MD 0.00, 95% CI -8.23 to 8.23; one study, 105 participants). We assessed the quality of the evidence as very low.One study compared single-stage alginate versus two stage-two step using zinc-oxide eugenol, and found no evidence of a clear difference in OHIP-EDENT (MD 0.50, 95% CI -2.67 to 3.67; 39 participants), or general satisfaction (RR 3.15, 95% CI 0.14 to 72.88; 39 participants) at six months. We assessed the quality of the evidence as very low.Removable partial denturesOne study randomised 72 participants and compared altered-cast technique versus one-piece cast technique. The study did not measure quality of life, but reported that most participants were satisfied with the dentures and there was no evidence of any clear difference between groups for general satisfaction at one-year follow-up (low-quality evidence). There was no evidence of a clear difference in number of intaglio adjustments at one year (RR 1.43, 95% CI 0.61 to 3.34) (very low-quality evidence).
AUTHORS' CONCLUSIONS
We conclude that there is no clear evidence that one technique or material has a substantial advantage over another for making complete dentures and removable partial dentures. Available evidence for the relative benefits of different denture fabrication techniques and final-impression materials is limited and is of low or very low quality. More high-quality RCTs are required.
Topics: Dental Impression Materials; Dental Impression Technique; Denture Design; Denture Retention; Denture, Partial, Removable; Dentures; Humans; Mouth, Edentulous; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 29617037
DOI: 10.1002/14651858.CD012256.pub2 -
Implant Dentistry Dec 2017The objective was to provide a comprehensive systematic review about the accuracy of digital implant impression in comparison with the conventional implant impression... (Review)
Review
PURPOSE
The objective was to provide a comprehensive systematic review about the accuracy of digital implant impression in comparison with the conventional implant impression approach.
MATERIALS AND METHODS
PubMed, Google Scholar and Cochrane databases were used to classify the related articles with no year limitation in 3 stages by 2 reviewers. Finally, 10 articles were included based on inclusion and exclusion criteria.
RESULTS
Five articles supported the use of intraoral scanners in implant dentistry. The two in vivo pilot studies showed that digital scanning is not reliable and could not be used in clinical routine.
CONCLUSION
Because each study included in this review has its unique methodology and design, it is therefore early to conclude whether to use digital scanners for clinical practice or not. More well-conducted in vitro and clinical trials studies are recommended to investigate the accuracy of intraoral scanners.
Topics: Computer-Aided Design; Dental Implants; Dental Impression Materials; Dental Impression Technique; Humans; Models, Dental
PubMed: 29095786
DOI: 10.1097/ID.0000000000000683 -
The Journal of Prosthetic Dentistry Feb 2018Limited evidence is available comparing digital versus conventional impressions from the point of view of patient preference. (Comparative Study)
Comparative Study Review
STATEMENT OF PROBLEM
Limited evidence is available comparing digital versus conventional impressions from the point of view of patient preference.
PURPOSE
The purpose of this systematic review was to identify and summarize the available literature related to patient-centered outcomes for digital versus conventional impression techniques.
MATERIAL AND METHODS
The databases Medline, Cochrane, Science Direct, Scopus, and Embase were electronically searched and complemented by hand searches. All published papers available on the databases from 1955 to July 2016 were considered for title and abstract analysis.
RESULTS
A total of 2943 articles were initially identified through database searches, of which only 5 met the inclusion criteria for qualitative analysis. Four studies comparing patient-reported outcome measures (PROMs) between conventional and digital impressions revealed that the digital technique was more comfortable and caused less anxiety and sensation of nausea. Only 1 study reported no difference between the techniques regardless of patient comfort. Two studies reported a shorter procedure for the conventional technique, whereas 3 studies reported a shorter procedure for the digital technique.
CONCLUSIONS
A lack of clinical studies addressing patient outcomes regarding digital prosthodontic treatments was observed among the included articles. However, current evidence suggests that patients are more likely to prefer the digital workflow than the conventional techniques.
Topics: Computer-Aided Design; Dental Impression Technique; Dental Prosthesis Design; Humans; Time Factors; Treatment Outcome
PubMed: 28967407
DOI: 10.1016/j.prosdent.2017.07.007 -
European Journal of Oral Implantology 2017The use of intraoral scanners (IOS) for making digital implant impressions is increasing. However, there is a lack of evidence on the accuracy of IOS compared with... (Review)
Review
AIM
The use of intraoral scanners (IOS) for making digital implant impressions is increasing. However, there is a lack of evidence on the accuracy of IOS compared with conventional techniques. Therefore, the aim of this systematic review was to collect evidence on the accuracy of digital implant impression techniques, as well as to identify the main factors influencing the accuracy outcomes.
MATERIALS AND METHODS
Two reviewers searched electronic databases in November, 2016. Controlled vocabulary, free-text terms, and defined inclusion and exclusion criteria were used. Publications in English language evaluating the accuracy outcomes of digital implant impressions were identified. Pooled data were analysed qualitatively and pertinent data extracted.
RESULTS
In total, 16 studies fulfilled the inclusion criteria: one in vivo and 15 in vitro studies. The clinical study concluded that angular and distance errors were too large to be acceptable clinically. Less accurate findings were reported by several in vitro studies as well. However, all in vitro studies investigating the accuracy of newer generation IOS indicated equal or even better results compared with the conventional techniques. Data related to the influence of distance and angulation between implants, depth of placement, type of scanner, scanning strategy, characteristics of scanbody and reference scanner, operator experience, etc were analysed and summarised. Linear deviations (means) of IOS used in in vitro studies ranged from 6 to 337 µm. Recent studies indicated small angle deviations (0.07-0.3°) with digital impressions. Some studies reported that digital implant impression accuracy was influenced by implant angulation, distance between the implants, implant placement depth and operator experience.
CONCLUSIONS
According to the results of this systematic review and based on mainly in vitro studies, digital implant impressions offer a valid alternative to conventional impressions for single- and multi-unit implant-supported restorations. Further in vivo studies are needed to substantiate the use of currently available IOS, identify factors potentially affecting accuracy and define clinical indications for specific type of IOS. Data on Data on accuracy OF digital records, as well as accuracy of printed or milled models for implant-supported restorations, are of high relevance and are still lacking. Conflict-of-interest and funding statement: The authors state there is no conflict of interest.
Topics: Computer-Aided Design; Dental Implants; Dental Impression Technique; Humans; Image Processing, Computer-Assisted
PubMed: 28944372
DOI: No ID Found -
BMC Oral Health Sep 2017The continuous development in dental processing ensures new opportunities in the field of fixed prosthodontics in a complete virtual environment without any physical... (Review)
Review
BACKGROUND
The continuous development in dental processing ensures new opportunities in the field of fixed prosthodontics in a complete virtual environment without any physical model situations. The aim was to compare fully digitalized workflows to conventional and/or mixed analog-digital workflows for the treatment with tooth-borne or implant-supported fixed reconstructions.
METHODS
A PICO strategy was executed using an electronic (MEDLINE, EMBASE, Google Scholar) plus manual search up to 2016-09-16 focusing on RCTs investigating complete digital workflows in fixed prosthodontics with regard to economics or esthetics or patient-centered outcomes with or without follow-up or survival/success rate analysis as well as complication assessment of at least 1 year under function. The search strategy was assembled from MeSH-Terms and unspecific free-text words: {(("Dental Prosthesis" [MeSH]) OR ("Crowns" [MeSH]) OR ("Dental Prosthesis, Implant-Supported" [MeSH])) OR ((crown) OR (fixed dental prosthesis) OR (fixed reconstruction) OR (dental bridge) OR (implant crown) OR (implant prosthesis) OR (implant restoration) OR (implant reconstruction))} AND {("Computer-Aided Design" [MeSH]) OR ((digital workflow) OR (digital technology) OR (computerized dentistry) OR (intraoral scan) OR (digital impression) OR (scanbody) OR (virtual design) OR (digital design) OR (cad/cam) OR (rapid prototyping) OR (monolithic) OR (full-contour))} AND {("Dental Technology" [MeSH) OR ((conventional workflow) OR (lost-wax-technique) OR (porcelain-fused-to-metal) OR (PFM) OR (implant impression) OR (hand-layering) OR (veneering) OR (framework))} AND {(("Study, Feasibility" [MeSH]) OR ("Survival" [MeSH]) OR ("Success" [MeSH]) OR ("Economics" [MeSH]) OR ("Costs, Cost Analysis" [MeSH]) OR ("Esthetics, Dental" [MeSH]) OR ("Patient Satisfaction" [MeSH])) OR ((feasibility) OR (efficiency) OR (patient-centered outcome))}. Assessment of risk of bias in selected studies was done at a 'trial level' including random sequence generation, allocation concealment, blinding, completeness of outcome data, selective reporting, and other bias using the Cochrane Collaboration tool. A judgment of risk of bias was assigned if one or more key domains had a high or unclear risk of bias. An official registration of the systematic review was not performed.
RESULTS
The systematic search identified 67 titles, 32 abstracts thereof were screened, and subsequently, three full-texts included for data extraction. Analysed RCTs were heterogeneous without follow-up. One study demonstrated that fully digitally produced dental crowns revealed the feasibility of the process itself; however, the marginal precision was lower for lithium disilicate (LS2) restorations (113.8 μm) compared to conventional metal-ceramic (92.4 μm) and zirconium dioxide (ZrO2) crowns (68.5 μm) (p < 0.05). Another study showed that leucite-reinforced glass ceramic crowns were esthetically favoured by the patients (8/2 crowns) and clinicians (7/3 crowns) (p < 0.05). The third study investigated implant crowns. The complete digital workflow was more than twofold faster (75.3 min) in comparison to the mixed analog-digital workflow (156.6 min) (p < 0.05). No RCTs could be found investigating multi-unit fixed dental prostheses (FDP).
CONCLUSIONS
The number of RCTs testing complete digital workflows in fixed prosthodontics is low. Scientifically proven recommendations for clinical routine cannot be given at this time. Research with high-quality trials seems to be slower than the industrial progress of available digital applications. Future research with well-designed RCTs including follow-up observation is compellingly necessary in the field of complete digital processing.
Topics: Computer-Aided Design; Dental Prosthesis Design; Dental Prosthesis, Implant-Supported; Humans; Workflow
PubMed: 28927393
DOI: 10.1186/s12903-017-0415-0 -
PloS One 2017Oral submucous fibrosis (OSF) is an insidious chronic condition characterized by restricted mouth opening. Prosthetic rehabilitation is challenging for OSF patients as... (Review)
Review
BACKGROUND
Oral submucous fibrosis (OSF) is an insidious chronic condition characterized by restricted mouth opening. Prosthetic rehabilitation is challenging for OSF patients as obtaining a good impression requires adequate mouth opening. The aim of the present review is to systematically present the data from case reports published in the English-language literature.
METHOD
A comprehensive search of the literature databases (PubMed, Medline, SCOPUS, Web of Science and Google Scholar) along with the references of published articles on prosthetic rehabilitation in OSF patients published to date was conducted. Keywords included a combination of 'Oral submucous fibrosis', 'prosthesis', 'dentures' and/or 'restricted mouth opening'. Citations from selected references and bibliographic linkages taken from similar cases were included in this review. The inclusion criteria selected for case reports on prosthetic rehabilitation in OSF patients, and cases of restricted mouth opening due to causes other than OSF were excluded from the study.
RESULTS
A total of 21 cases were identified and analysed from 17 papers published in the English-language literature. Of these, 9 cases employed the sectional denture technique, 4 cases emphasized the need-based treatment approach in which conventional methods were modified, and 4 cases used mouth exercising devices. Finally, 1 case each involved, flexible denture, oral screen prosthesis, oral stents, surgery in conjunction with dentures.
CONCLUSION
Prosthetic rehabilitation in OSF patients is a multifaceted approach and should be patient specific, although sectional dentures have achieved the best results.
Topics: Denture Design; Dentures; Humans; Oral Submucous Fibrosis
PubMed: 28877246
DOI: 10.1371/journal.pone.0184041