Nadim Z. Baba

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.

Nonmetallic Prefabricated Dowels: A Review of Compositions, Properties, Laboratory, and Clinical Test Results

PURPOSE Prefabricated dowels have become popular, and a wide variety of systems are available. Recently, in response to a need for tooth-colored dowels, several nonmetallic dowels such as carbon-fiber epoxy resin, zirconia, glass fiber-reinforced epoxy resin, and ultra-high polyethelene fiber-reinforced dowels are available. With a plethora of different materials and systems currently available for use, an overview of the scientific literature on nonmetallic dowels is indicated. This article reviews the current literature dealing with the compositions, properties, and laboratory and clinical test results of nonmetallic prefabricated dowels. METHODS A comprehensive review of the literature was completed seeking evidence for the treatment of teeth with nonmetallic prefabricated dowels. A search of English language peer-reviewed literature was undertaken using MEDLINE and PubMed with a focus on clinical research articles published between 1996 and 2007. A hand search of relevant dental journals was also completed. RESULTS The literature demonstrates that in vitro investigations demonstrated favorable physical and mechanical properties of these dowels; however, clinically, there has been a wide range of reported failure percentages. CONCLUSION Since there is considerable variation in reported failure percentages, longer-term studies are needed that present data regarding all types of complications that have been identified in the literature.

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.

Gingival Displacement for Impression Making in Fixed Prosthodontics: Contemporary Principles, Materials, and Techniques

The clinical success and longevity of indirect restorations depend on the careful and accurate completion of several procedures. One of the challenging procedures is management of the gingival tissues and gingival esthetics. The goal for management of gingival tissues and gingival esthetics is to maintain the normal appearance of healthy gingival. Achieving this goal requires optimal health before treatment and minimal trauma during treatment. The best way of optimizing health and minimizing trauma is to avoid contacting the gingiva with restorative materials.

Time-saving method for the fabrication of a definitive cast for an implant- supported prosthesis

Conventional methods for fabricating an implant-supported overdenture or an implant-supported, fixed complete denture involve a series of patient visits. Because these visits occur in sequence, each visit depends on the accuracy of the previous visit and influences the accuracy of subsequent visits. Any procedural errors during these visits could compromise the fit of the definitive prosthesis. 1,2 The first step in achieving an accurately fitting, passive prosthesis requires capturing the 3-dimensional intraoral relationship of the implants with an impression. The accuracy of this impression procedure has an essential role in the prosthesis-implant adaptation. 3-5 Although several strategies have been suggested to enhance precision when making the definitive impression and cast for an implantsupported prosthesis, 6 it appears that absolute accuracy is currently not attainable. 7,8 A number of implant impression techniques have been described. 9,10 Most implant impression techniques have 1 feature in common, whereby impression material is present between the implant impression copings and the custom tray. The presence of this impression material produces resiliency in the system, and this lack of a rigid connection to the tray may result in an inaccurate cast. This article describes a time-saving, step-by-step technique designed to achieve 4 objectives with accuracy in a single clinical visit: (1) impression of the soft tissue, (2) impression and position of the implants, (3) registration of the maxillo-mandibular relationships, and (4) arrangement of the artificial teeth. The use of a verification jig 11 has confirmed the accuracy of this impression method.

Obstructive Sleep Apnea Management: An Overview of the Literature

PURPOSE Different approaches have been proposed to treat obstructive sleep apnea (OSA). This article reviews a synopsis of the available literature regarding the management of OSA. METHODS A comprehensive review of the literature on the management of OSA began with a search of English-language peer-reviewed manuscripts using PubMed and MEDLINE. The focus was on clinical research articles published between 1996 and 2016. A search of relevant dental journals was also completed. RESULTS OSA can be managed through behavior management, continuous positive airway pressure (CPAP), oral appliances, and other therapies. Clinicians may select treatment modalities based on the severity of clinical presentation and the patients symptoms. CONCLUSION Studies showed an enhancement in the quality of life in many patients who have been treated with oral appliances, and patients in general prefer oral appliances over CPAP therapy or any other treatments for OSA because of its convenience.Purpose Different approaches have been proposed to treat obstructive sleep apnea (OSA). This article reviews a synopsis of the available literature regarding the management of OSA. Methods A comprehensive review of the literature on the management of OSA began with a search of English-language peer-reviewed manuscripts using PubMed and MEDLINE. The focus was on clinical research articles published between 1996 and 2016. A search of relevant dental journals was also completed. Results OSA can be managed through behavior management, continuous positive airway pressure (CPAP), oral appliances, and other therapies. Clinicians may select treatment modalities based on the severity of clinical presentation and the patients symptoms. Conclusion Studies showed an enhancement in the quality of life in many patients who have been treated with oral appliances, and patients in general prefer oral appliances over CPAP therapy or any other treatments for OSA because of its convenience.

Materials and Processes for CAD/CAM Complete Denture Fabrication

Purpose of ReviewThe motive of this article is to single out the materials and processes available for the fabrication of CAD/CAM complete dentures.Recent FindingsCAD/CAM complete denture fabrication has become accessible for complete dentures with a variety of techniques available for the fabrication of the prostheses. The majority of the manufacturers use subtractive manufacturing for the fabrication of their dentures while only one manufacturer proposes an additive technique. Several digital systems are available for the fabrication of CAD/CAM dentures.SummaryThe integration of CAD/CAM technology into complete denture design and fabrication helps improve the quality of the dentures and simplify the laboratory work. Time-consuming laboratory procedures are reduced or eliminated allowing the dental technician to ensure reproducible, efficient, and accurate prostheses.

An Alternative Technique for the Fabrication of a Metal‐Reinforced Interim Implant‐Supported Fixed Prosthesis: A Clinical Report

Despite advancements in restorative materials and techniques, complications with implant-supported fixed prostheses such as veneer fracture and material wear are very common and present with varying frequencies. Following these complications, repair of this type of prosthesis can be time-consuming and costly even in the hand of experience clinicians. Several techniques have proposed using the existing framework to minimize the cost of the repair for the patient; however, while the repairs are being performed, the patient will have to either wear an interim complete denture or no prosthesis, which might cause some inconvenience to the patient. This article will present a technique for the fabrication of a metal-reinforced interim implant-supported fixed prosthesis for patients to wear while the existing prosthesis is being repaired.

Comparison of the Fit of Lithium Disilicate Crowns made from Conventional, Digital, or Conventional/Digital Techniques: Fit of Lithium Disilicate Crowns

PURPOSE To evaluate the fit of single crowns fabricated using conventional, digital, or cast digitization methods. MATERIALS AND METHODS One subject with a peg-shaped maxillary lateral incisor was selected in this study. Tooth preparation for an all-ceramic crown was performed and 10 conventional poly(vinyl siloxane) impressions, and 10 digital impressions using an intraoral scanner were made. Each working cast was scanned using a laboratory scanner and an intraoral scanner. Four groups were tested Group 1: conventional impressions. Group 2: cast laboratory scans. Group 3: cast scans using intraoral scanner. Group 4: direct intraoral scans. For group 1, heat-pressed glass ceramic crowns (IPS e.max Press) were fabricated using casts produced from the conventional impressions. For groups 2-4, crowns were milled using ceramic blocks (IPS e.max CAD). Ten crowns were fabricated for each group. Marginal and internal gaps were measured using a replica technique. Replicas were sectioned mesiodistally and buccolingually and were observed under a stereomicroscope. Three measurements were selected for each cut: occlusal, axial, and marginal. Statistical analysis was performed using two-way ANOVA and Tukey HSD tests. RESULTS For each replica, 6 measurements were made for the mesiodistal and the same for the buccolingual cuts, producing 12 measurement points per crown (4 measurements for marginal, 4 for axial, 4 for occlusal), 120 measurements for each group (40 measurements for marginal, 40 for axial, 40 for occlusal), and 480 measurements in total. Two-way ANOVA revealed location to be a significant factor (p = 0.001). No significant differences among groups (p = 0.456), and no interactions between groups and locations (p = 0.221) were found. Means for the occlusal site were significantly larger than other sites in most group combinations, while the difference between the marginal and axial sites was not significant. No significant differences among groups were found for each measurement. The marginal gaps ranged from 125.46 ± 25.39 μm for group 3 to 135.59 ± 24.07 μm for group 4. The smallest axial mean was in group 1 (98.10 ± 18.77 μm), and the largest was 127.25 ± 19.79 μm in group 4. The smallest occlusal mean was in group 2 (166.53 ± 36.51 μm), and the largest occlusal mean was in group 3 (203.32 ± 80.24 μm). CONCLUSIONS Ceramic crowns, which were made using all-digital approach or cast digitization by a laboratory or intraoral scanner had comparable fit to those produced by conventional approach.

Obstructive Sleep Apnea Management: An Overview of the Literature: Obstructive Sleep Apnea Management: Overview

PURPOSE Different approaches have been proposed to treat obstructive sleep apnea (OSA). This article reviews a synopsis of the available literature regarding the management of OSA. METHODS A comprehensive review of the literature on the management of OSA began with a search of English-language peer-reviewed manuscripts using PubMed and MEDLINE. The focus was on clinical research articles published between 1996 and 2016. A search of relevant dental journals was also completed. RESULTS OSA can be managed through behavior management, continuous positive airway pressure (CPAP), oral appliances, and other therapies. Clinicians may select treatment modalities based on the severity of clinical presentation and the patients symptoms. CONCLUSION Studies showed an enhancement in the quality of life in many patients who have been treated with oral appliances, and patients in general prefer oral appliances over CPAP therapy or any other treatments for OSA because of its convenience.Purpose Different approaches have been proposed to treat obstructive sleep apnea (OSA). This article reviews a synopsis of the available literature regarding the management of OSA. Methods A comprehensive review of the literature on the management of OSA began with a search of English-language peer-reviewed manuscripts using PubMed and MEDLINE. The focus was on clinical research articles published between 1996 and 2016. A search of relevant dental journals was also completed. Results OSA can be managed through behavior management, continuous positive airway pressure (CPAP), oral appliances, and other therapies. Clinicians may select treatment modalities based on the severity of clinical presentation and the patients symptoms. Conclusion Studies showed an enhancement in the quality of life in many patients who have been treated with oral appliances, and patients in general prefer oral appliances over CPAP therapy or any other treatments for OSA because of its convenience.