Mathew T. Kattadiyil

Outcomes of root canal treatment and restoration, implant-supported single crowns, fixed partial dentures, and extraction without replacement: a systematic review

STATEMENT OF PROBLEM Dentists and patients are regularly confronted by a difficult treatment question: should a tooth be saved through root canal treatment and restoration (RCT), be extracted without any tooth replacement, be replaced with a fixed partial denture (FPD) or an implant-supported single crown (ISC)? PURPOSE The purpose of this systematic review was to compare the outcomes, benefits, and harms of endodontic care and restoration compared to extraction and placement of ISCs, FPDs, or extraction without tooth replacement. MATERIAL AND METHODS Searches performed in MEDLINE, Cochrane, and EMBASE databases were enriched by hand searches, citation mining, and expert recommendation. Evidence tables were developed following quality and inclusion criteria assessment. Pooled and weighted mean success and survival rates, with associated confidence intervals, were calculated for single implant crowns, fixed partial dentures, and initial nonsurgical root canal treatments. Data related to extraction without tooth replacement and psychosocial outcomes were evaluated by a narrative review due to literature limitations. RESULTS The 143 selected studies varied considerably in design, success definition, assessment methods, operator type, and sample size. Direct comparison of treatment types was extremely rare. Limited psychosocial data revealed the traumatic effect of loss of visible teeth. Economic data were largely absent. Success rates for ISCs were higher than for RCTs and FPDs, respectively; however, success criteria differed greatly among treatment types, rendering direct comparison of success rates futile. Long-term survival rates for ISCs and RCTs were similar and superior to those for FPDs. CONCLUSIONS Lack of comparative studies with similar outcomes criteria with comparable time intervals limited comparison of these treatments. ISC and RCT treatments resulted in superior long-term survival, compared to FPDs. Limited data suggested that extraction without replacement resulted in inferior psychosocial outcomes compared to alternatives. Long-term, prospective clinical trials with large sample sizes and clearly defined outcomes criteria are needed.

Comparison of treatment outcomes in digital and conventional complete removable dental prosthesis fabrications in a predoctoral setting

STATEMENT OF PROBLEM Scientific evidence is lacking regarding the clinical effectiveness of digital complete removable dental prostheses (CRDP). PURPOSE This prospective clinical study was conducted to compare clinical treatment outcomes, patient satisfaction, and dental student preferences for digitally and conventionally processed CRDP in a predoctoral setting. MATERIAL AND METHODS This clinical study rated and compared CRDP fabricated by predoctoral students, using a 2-appointment digital prosthesis fabrication process as opposed to the conventional 5-appointment process. Fifteen completely edentulous patients were treated in the predoctoral clinic at Loma Linda University School of Dentistry. Fifteen predoctoral (third- and fourth-year) dental students fabricated 2 sets of maxillary and mandibular CRDP for each patient. Each patient received 1 conventional set and 1 digital (AvaDent) set of CRDP. Faculty and patient ratings, patient and student preferences, and perceptions of the conventional versus digital prostheses were recorded and analyzed. The average treatment time for the fabrication of each type of prostheses was analyzed. RESULTS Significantly higher average scores were observed for digital dentures than for conventional dentures according to criteria evaluated by faculty (P=.007). Patients reported significantly higher overall average satisfaction scores with digital dentures (P=.001). Patients preferred the digital dentures (P<.01). Significantly higher scores were observed for the retention of the digital maxillary complete denture (P=.001) compared with that for the digital mandibular and conventional complete dentures. Students preferred digital prostheses compared with conventional prostheses (P<.05). The conventional process required significantly more clinical time for each patient than with the digital process of fabrication (P<.01). CONCLUSIONS The digital process proved to be an equally effective and more time-efficient option than the conventional process of prosthesis fabrication in the predoctoral program. The digital denture process was preferred and effectively used by predoctoral dental students under faculty supervision.

Intraoral scanning of hard and soft tissues for partial removable dental prosthesis fabrication

This article provides proof of concept for the use of intraoral scanning technology to record hard and soft tissue morphology for the fabrication of a cast partial removable dental prosthesis. An open source intraoral scanner was used to scan the hard and soft tissues to create a stereolithographic file that was subsequently imported into a computer-aided design software program for the digital/virtual design of a partial removable dental prosthesis framework. Computer-aided design and computer-aided manufacturing technology was then used to fabricate a resin framework that was trial placed to evaluate accuracy and for conventional investing and casting with a cobalt-chromium alloy. The cast framework and definitive prosthesis were judged to be clinically accurate in fit, stability, and retention.

Tooth Retention through Endodontic Microsurgery or Tooth Replacement Using Single Implants: A Systematic Review of Treatment Outcomes

INTRODUCTION Clinicians are regularly confronted with difficult choices. Should a tooth that has not healed through nonsurgical root canal treatment be treated through endodontic microsurgery or be replaced using a single implant? Acquiring complete, unbiased information to help clinicians and their patients make these choices requires a systematic review of the literature on treatment outcomes. The purpose of this systematic review was to compare the outcomes of tooth retention through endodontic microsurgery to tooth replacement using an implant supported single crown. METHODS Searches performed in PubMed, Cochrane Library, Web of Science, and EMBASE databases were enriched by citation mining. Inclusion criteria were defined. Sentinel articles were identified and included in the final selection of studies. Weighted survival and success rates for single implants and endodontic microsurgery were calculated. RESULTS The quality of the articles reporting on single implants and endodontic microsurgery was moderate. Data for single implants were much more plentiful than for endodontic microsurgery, but the endodontic microsurgery studies had a slightly higher quality rating. Single implants and endodontic microsurgery were not directly compared in the literature. Outcomes criteria were often unclear. At 4-6 years, single implants had higher survival rates than teeth treated with endodontic microsurgery. Qualitatively different success criteria precluded valid comparison of success rates. CONCLUSIONS Survival rates for single implants and endodontic microsurgery were both high (higher for single implants). Appraisal was limited by a lack of direct treatment comparisons. Long-term studies with a broad range of carefully defined outcomes criteria are needed.

Comparison of retention between maxillary milled and conventional denture bases: A clinical study.

Statement of problem Clinical studies comparing the retention values of milled denture bases with those of conventionally processed denture bases are lacking. Purpose The purpose of this clinical study was to compare the retention values of conventional heat‐polymerized denture bases with those of digitally milled maxillary denture bases. Material and methods Twenty individuals with completely edentulous maxillary arches participated in this study. Definitive polyvinyl siloxane impressions were scanned (iSeries; Dental Wings), and the standard tessellation language files were sent to Global Dental Science for the fabrication of a computer‐aided design and computer‐aided manufacturing (CAD‐CAM) milled denture base (group MB) (AvaDent). The impression was then poured to obtain a definitive cast that was used to fabricate a heat‐polymerized acrylic resin denture base resin (group HB). A custom‐designed testing device was used to measure denture retention (N). Each denture base was subjected to a vertical pulling force by using an advanced digital force gauge 3 times at 10‐minute intervals. The average retention of the 2 fabrication methods was compared using repeated ANOVA (&agr;=.05). Results Significantly increased retention was observed for the milled denture bases compared with that of the conventional heat‐polymerized denture bases (P<.001). Conclusions The retention offered by milled complete denture bases from prepolymerized poly(methyl methacrylate) resin was significantly higher than that offered by conventional heat‐ polymerized denture bases.

An update on computer-engineered complete dentures: A systematic review on clinical outcomes

STATEMENT OF PROBLEM Reports on computer-engineered complete dentures (CECDs) continue to increase. Systematic reviews on clinical outcomes and applications associated with CECDs are lacking in the literature. PURPOSE The purpose of this systematic review was to determine the clinical outcomes and applications of CECDs. MATERIAL AND METHODS Electronic searches of the English literature from January 1984 to May 2016 were performed in MEDLINE and Cochrane databases, with the results enriched by hand searches and citation mining to address 2 relevant population intervention comparison outcome (PICO) questions: What are the clinical outcomes associated with CECDs? Are there specific applications and significant advantages for CECDs? RESULTS A review of the selected articles on CECDs revealed significantly better retention and reduced clinical time for the milled CECDs compared with conventional complete dentures. An advantage associated with CECDs is the possibility of electronically archiving data using digital technology for rapid fabrication. Applications reported in the literature with CECDs were also identified. CONCLUSIONS A positive trend was seen in the outcomes with CECDs, although patient selection might have also contributed to favorable outcomes. Significantly reduced clinical time, improved retention, and digital archiving were the main advantages associated with CECDs.

An in vitro investigation into the physical properties of irreversible hydrocolloid alternatives

STATEMENT OF PROBLEM A number of manufacturers have introduced new products that are marketed as alternatives to irreversible hydrocolloid impression materials. However, there is a paucity of laboratory and clinical research on these products compared to traditional irreversible hydrocolloid. PURPOSE The purpose of this study was to evaluate the detail reproduction, gypsum compatibility, and linear dimensional change of 3 recently introduced impression materials designed as alternatives to irreversible hydrocolloid. MATERIAL AND METHODS The tested materials were Position Penta Quick, Silgimix, and AlgiNot. An irreversible hydrocolloid impression material, Jeltrate Plus Antimicrobial, served as the control. The parameters of detail reproduction, gypsum compatibility, and linear dimensional change were tested in accordance with ANSI/ADA Specifications No. 18 and 19. The gypsum compatibility was tested using a type III stone (Microstone Golden) and a type IV stone (Die-Keen Green). The data were analyzed using the Kruskal-Wallis rank test and the Mann-Whitney U test (α=.05). RESULTS The test materials demonstrated significantly (P<.001) better detail reproduction than the control material. Silgimix exhibited the best compatibility with Microstone, whereas AlgiNot and Position Penta Quick exhibited the best gypsum compatibility with Die-Keen. An incompatibility was observed over time between the Jeltrate control material and the Microstone gypsum material. For linear dimensional change, the mean dimension of the control material most closely approximated the distance between the lines on the test die, but it exhibited the greatest variability in measurements. All of the test materials exhibited linear dimensional change within the ADAs accepted limit of 1.0%. CONCLUSIONS The 3 new impression materials exhibited better detail reproduction and less variability in linear dimensional change than the irreversible hydrocolloid control. Gypsum compatibility varied with the brand of gypsum used, with an incompatibility identified between the control material (Jeltrate Plus Antimicrobial) and Microstone related to surface changes observed over time.

Digitally planned and fabricated mandibular fixed complete dentures. Part 2. Prosthodontic phase.

Part 1 of this patient report described a prosthetically driven protocol that used computer-aided engineering for the fabrication of a mandibular conversion denture and maxillary provisional complete denture using the AvaDent Digital Denture system. The report demonstrated that this system combined with NobelClinician implant-planning software can be used to efficiently convert a digital denture into an immediately loaded provisional implant-supported fixed complete denture (hybrid prosthesis). Part 2 of the patient report describes the technique and steps involved in the fabrication of a digitally planned and fabricated mandibular fixed complete denture with incorporated titanium milled bar opposed by a definitive computer-aided design/computer-assisted manufacture-milled maxillary complete denture.

Use of a Digitally Planned and Fabricated Mandibular Complete Denture for Easy Conversion to an Immediately Loaded Provisional Fixed Complete Denture. Part 1. Planning and Surgical Phase

This article describes a unique prosthetically driven protocol that uses computeraided engineering to develop sophisticated, scientific algorithms that guide the fabrication of a conversion denture using the AvaDent Digital Denture system (Global Dental Science). This system is combined with Nobel Clinician (Nobel Biocare) implant-planning software to optimize accuracy and to make it easier and faster to convert a denture to an immediately loaded provisional implant supported fixed complete denture following implant placement, using a NobelGuide surgical template.

In vitro comparison of the tensile bond strength of denture adhesives on denture bases.

STATEMENT OF PROBLEM With several denture adhesives available, it is important for dentists to make appropriate patient recommendations. PURPOSE The purpose of this study was to evaluate the tensile bond strength of denture adhesives on denture base materials at time intervals of up to 24 hours. MATERIAL AND METHODS Fixodent, Super Poligrip, Effergrip, and SeaBond denture adhesives were tested with 3 denture base materials: 2 heat-polymerized (Lucitone 199 and SR Ivocap) and 1 visible-light-polymerized (shade-stable Eclipse). Artificial saliva with mucin was used as a control. Tensile bond strength was tested in accordance with American Dental Association specifications at 5 minutes, 3 hours, 6 hours, 12 hours, and 24 hours after applying the adhesive. Maximum forces before failure were recorded in megapascals (MPa), and the data were subjected to a 2-way analysis of variance (α=.05). RESULTS All 4 adhesives had greater tensile bond strength than the control. Fixodent, Super Poligrip, and SeaBond had higher tensile bond strength values than Effergrip. All adhesives had the greatest tensile bond strength at 5 minutes and the least at 24 hours. The 3 denture bases produced significantly different results with each adhesive (P<.001). Lucitone 199 with the adhesives had the greatest tensile bond strength, followed by Ivocap and Eclipse. CONCLUSIONS All 4 adhesives had greater tensile bond strength than the control, and all 4 adhesives were strongest at the 5-minute interval. On all 3 types of denture bases, Effergrip produced significantly lower tensile bond strength, and Fixodent, Super Poligrip, and SeaBond produced significantly higher tensile bond strength. At 24 hours, the adhesive-base combinations with the highest tensile bond strength were Fixodent on Lucitone 199, Fixodent on Eclipse, Fixodent on Ivocap, and Super Poligrip on Ivocap.