Walter Y.H. Lam

Long-term clinical evaluation of 211 two-unit cantilevered resin-bonded fixed partial dentures

OBJECTIVES This retrospective study aims to evaluate the long term clinical performance of two-unit cantilevered resin-bonded fixed partial dentures (RBFPDs) relating to their retention, success and survival rate. MATERIALS AND METHODS Prostheses that were placed at least four years previously were clinically reviewed to evaluate retention, success and survival rate. Additional information was also collected, including patients gender, age and satisfaction on their prosthesis, operators experience, prosthesis service life, root canal therapy if performed, abutment mobility, bone support, the presence of shim-stock contacts on the abutment or pontic in intercuspal position, and the presence of proximal axial contacts adjacent to the prosthesis. The date of any debonding with subsequent treatment was also recorded. RESULTS A total of 211 two-unit RBFPDs were placed in 153 patients, with a mean service life of 113.2±33.5 months. Twenty-eight prostheses debonded, resulting in a retention rate of 86.7 percent, and another five teeth were extracted with the prostheses, resulting in a success rate of 84.4 percent. 90.0 percent prostheses were functioning (survival rate) by means of rebonding at the time of review. The location of the replaced tooth had a significant effect on the retention of RBFPDs with posterior RBFPDs lower than anterior (p=0.020). Kaplan-Meier analysis revealed 5-, 10- and 15-year cumulative probability of surviving was 0.97, 0.91 and 0.84, respectively. CONCLUSIONS 211 two-unit RBFPDs were observed to have a success, retention and survival rate of 84.4, 86.7 and 90.0 percent, respectively, with a mean service life of 9.4 years. CLINICAL SIGNIFICANCE Based on the clinical results, two-unit RBFPD are shown to be a durable prosthesis over the long term with high patient satisfaction. The posterior prostheses, particularly in the lower arch appeared to have a higher failure rate, and improved design features should be considered.

A 2-part facebow for CAD-CAM dentistry

Converting the patients clinical information into the virtual world is a prerequisite for the computer-aided design and computer-aided manufacturing (CAD-CAM) of dental restorations. This article describes a modified facebow which facilitates the radiation-free registration of the maxillary teeth to a 3-dimensional face image for transfer to a virtual articulator. This facebow can be easily fabricated with minimal materials and adjusted to fit different patients; its error in tooth registration was demonstrated to be less than 1 mm.

A clinical technique for virtual articulator mounting with natural head position by using calibrated stereophotogrammetry

Accurate articulator-mounted casts are essential for occlusion analysis and for fabrication of dental prostheses. Although the axis orbital plane has been commonly used as the reference horizontal plane, some clinicians prefer to register the horizontal plane with a spirit level when the patient is in the natural head position (NHP) to avoid anatomic landmark variations. This article presents a digital workflow for registering the patients horizontal plane in NHP on a virtual articulator. An orientation reference board is used to calibrate a stereophotogrammetry device and a 3-dimensional facial photograph with the patient in NHP. The horizontal plane can then be automatically registered to the patients virtual model and aligned to the virtual articulator at the transverse horizontal axis level. This technique showed good repeatability with positional differences of less than 1 degree and 1 mm in 5 repeated measurements in 1 patient.

A fixed movable resin-bonded fixed dental prosthesis – A 16 years clinical report

PATIENTS This report describes the case of a 48-year-old female patient who initially received a 4-unit fixed-fixed (FF) resin-bonded fixed dental prosthesis (RBFDP) for replacement of mandibular left second premolar and first molar. Twenty-one months later, debond of the RBFDP was found at one of retainers. A new fixed-movable RBFDPs with a modified non-rigid connector as well as increased resistance form features was placed and successfully retained at the 16-year clinical review. DISCUSSION RBFDPs are a conservative tooth replacement option that requires minimum tooth preparation and retention by a resin cement to etched enamel. However debonding is the most frequently seen complication and has been attributed to the relative movement between abutment teeth during function that stress the bonding interface. This case report highlights the use of modified non-rigid connector which allows relative movement between abutment teeth and therefore a reduced stress on the bonding interface. CONCLUSION It is proposed that the use of modified non-rigid connectors that allow independent movement between the abutment teeth during function was responsible for the long term clinical success of fixed-movable RBFDPs.

The effect of surface treatments on dental zirconia: An analysis of biaxial flexural strength, surface roughness and phase transformation

OBJECTIVES This study investigates the effect of selected surface finishing techniques on the biaxial flexural strength, surface roughness and phase transformation of a zirconia dental restorative material. MATERIALS AND METHODS Fully-sintered zirconia discs (⌀19.5 mm × 0.85 mm) were treated on one side with a single or a combination of the following treatments: diamond and/or tungsten-carbide burs without water coolant in an air-turbine handpiece, air-particle abrasion, rubber-point polishing in a contra-angle handpiece, or no treatment (control). Biaxial flexural strength (BFS) (eleven groups, n = 10) was determined using a universal testing machine and surface roughness (thirteen groups, n = 6) was assessed using a profilometer. Results were analysed using one-way ANOVA and Student-Newman-Keuls Post-hoc test (α = 0.05) with Bonferroni correction. Specimens were observed under scanning electron microscopy (SEM) and x-ray diffraction (XRD) for their microstructure and crystalline phases respectively. RESULTS Grinding with diamond burs did not weaken zirconia (p > 0.0045) but produced rougher surfaces than the control group (p < 0.0038). Tungsten-carbide burs smoothened diamond ground specimens (p < 0.0038) for both grits of diamond. Specimens ground by tungsten-carbide burs have significantly reduced mean BFS (p < 0.0045) by up to two-thirds and SEM revealed fine surface cracks. Air-particle abrasion restored the mean BFS of tungsten-carbide ground specimens to control levels (p > 0.0045) and surface cracks were not observed. Phase transformation was not detected by XRD. CONCLUSIONS Dental zirconia ground dry with tungsten-carbide burs has a significantly reduced BFS and a smooth but defective surface. These defects may be removed and BFS restored by air-particle abrasion. CLINICAL SIGNIFICANCE The use of tungsten-carbide burs for grinding dental zirconia should be cautioned. Diamond grinding does not weaken zirconia but requires further polishing.

A randomized controlled trial of home bleaching of tetracycline-stained teeth

OBJECTIVES To investigate the effectiveness of two home bleaching modalities on whitening of tetracycline-stained teeth (TST). METHODS A randomized controlled trial on the bleaching effect of 15% carbamide peroxide gel loaded in tray and 6.5% hydrogen peroxide strip in subjects with TST was performed. Eligible subjects were judged independently by two assessors, and randomly assigned into the tray or the strip group. Lightness (L*), redness (a*) and yellowness (b*) were measured with colorimeter at baseline, one, two and three months. Any adverse reaction associated with bleaching were also recorded. Overall colour changes (ΔE) were analysed by one-sample and independent t-test/Wilcoxon test at significance level α=0.05. RESULT Twelve and fourteen participants were allocated to the tray and the strip group respectively. Both groups experienced noticeable and significant L*a*b* improvement at the end of the trial in comparison to the baseline (p<0.05). Significant improvement was observed in the first month for the tray group (p<0.05) and in the first two months for the strip group (p<0.05). While greater lightness improvement was observed in the tray group over the strip group in the first month (p=0.02), the reverse was noticed in the second month (p=0.01). There was no difference between two groups at the end of this trial (p<0.05) and no significant adverse reactions were observed. CONCLUSION Over a three-month period, 6.0% hydrogen peroxide strip performed equally well as the 15% carbamide peroxide tray delivery system in TST. CLINICAL SIGNIFICANCE Home bleaching systems produce noticeable tooth whitening effect in subjects with tetracycline-stained teeth.

Validation of a novel geometric coordination registration using manual and semi-automatic registration in cone-beam computed tomogram

Cartesian coordinates define on a physical cubic corner (CC) with the corner tip as the origin and three corresponding line angles as (x, y, z)-axes. In its image (virtual) domains such as these obtained by cone-beam computed tomography (CBCT) and optical surface scanning, a single coordinate can then be registered based on the CC. The advantage of using a CC in registration is simple and accurate physical coordinate measurement. The accuracy of image-to-physical (IP) and imageto-image (II) transformations, measured by target registration error (TRE), can then be validated by comparing coordinates of target points in the virtual domains to that of the physical control. For the CBCT, the registration may be performed manually using a surgical planning software SimPlant Pro (manual registration (MR)) or semi-automatically using MeshLab and 3D Slicer (semiautomatic registration (SR)) matching the virtual display axes to the corresponding (x-y-z)-axes. This study aims to validate the use of CC as a surgical stereotactic marker by measuring TRE in MR and SR respectively. Mean TRE is 0.56 +/0.24 mm for MR and 0.39 +/0.21 mm for SR. The SR results in a more accurate registration than the MR and point-based registration with 20 fiducial points. TRE of the MR is less than 1.0 mm and still acceptable clinically.

Image calibration and registration in cone-beam computed tomogram for measuring the accuracy of computer-aided implant surgery

Medical radiography is the use of radiation to “see through” a human body without breaching its integrity (surface). With computed tomography (CT)/cone beam computed tomography (CBCT), three-dimensional (3D) imaging can be produced. These imagings not only facilitate disease diagnosis but also enable computer-aided surgical planning/navigation. In dentistry, the common method for transfer of the virtual surgical planning to the patient (reality) is the use of surgical stent either with a preloaded planning (static) like a channel or a real time surgical navigation (dynamic) after registration with fiducial markers (RF). This paper describes using the corner of a cube as a radiopaque fiducial marker on an acrylic (plastic) stent, this RF allows robust calibration and registration of Cartesian (x, y, z)- coordinates for linking up the patient (reality) and the imaging (virtuality) and hence the surgical planning can be transferred in either static or dynamic way. The accuracy of computer-aided implant surgery was measured with reference to coordinates. In our preliminary model surgery, a dental implant was planned virtually and placed with preloaded surgical guide. The deviation of the placed implant apex from the planning was x=+0.56mm [more right], y=- 0.05mm [deeper], z=-0.26mm [more lingual]) which was within clinically 2mm safety range. For comparison with the virtual planning, the physically placed implant was CT/CBCT scanned and errors may be introduced. The difference of the actual implant apex to the virtual apex was x=0.00mm, y=+0.21mm [shallower], z=-1.35mm [more lingual] and this should be brought in mind when interpret the results.

Novel geometric coordination registration in cone-beam computed Tomogram

The use of cone-beam computed tomography (CBCT) in medical field can help the clinicians to visualize the hard tissues in head and neck region via a cylindrical field of view (FOV). The images are usually presented with reconstructed three-dimensional (3D) imaging and its orthogonal (x-, y- and z-planes) images. Spatial relationship of the structures in these orthogonal views is important for diagnosis of diseases as well as planning for treatment. However, the non-standardized positioning of the object during the CBCT data acquisition often induces errors in measurement since orthogonal images cut at different planes might look similar. In order to solve the problem, this paper proposes an effective mapping from the Cartesian coordinates of a cube physically to its respective coordinates in 3D imaging. Therefore, the object (real physical domain) and the imaging (computerized virtual domain) can be linked up and registered. In this way, the geometric coordination of the object/imaging can be defined and its orthogonal images would be fixed on defined planes. The images can then be measured with vector information and serial imagings can also be directly compared.