Digital design and 3D printing of an implant-supported prosthetic stent for protecting complete arch soft tissue grafts around dental implants: A dental technique.

A method for digital fabrication of an implant-supported soft tissue graft stent to protect, shape, and ensure intimate adaptation of the complete arch graft to the periosteum surrounding dental implants is described. To fabricate the stent, an extraoral scanner was used to convert the implant cast into digital data. Dental design software was then used to fabricate the stent, which is produced by 3-dimensional (3D) printing. Due to the lack of long-term biocompatible 3D printing material, the stent was duplicated in bisacryl resin. The patient reported more comfort and stability with the implant-supported stent than the conventional stent received following a previous debulking surgical procedure.

Fabrication of a definitive obturator from a 3D cast with a chairside digital scanner for a patient with severe gag reflex: a clinical report.

Patient gagging is a common problem during dental procedures such as maxillary impression making. This clinical report describes the use of a chairside intraoral scanner for a patient with a hypersensitive gag reflex. The technique proved to be a more comfortable alternative for the patient and an accurate method for the clinician to capture both hard and soft tissue detail for the fabrication of a definitive obturator.

Digital design of a surgical guide for placement of definitive implants before orthodontic treatment.

Interdisciplinary treatment planning is an essential part of orthodontic therapy for patients with partial edentulism, especially when dental implants are to serve initially as anchorage and ultimately as prosthetic abutments for the definitive fixed restoration. A technique is presented for designing and fabricating a computed tomography-based surgical guide to place definitive implants before orthodontic therapy. First, the diagnostic cast and the orthodontic tooth arrangement and diagnostic waxing cast are scanned with a 3-dimensional optical scanner. Three-dimensional renderings of these scans are then merged and superimposed onto the cone beam computed tomography (CBCT) image with implant planning software to develop definitive implant positions. A custom surgical guide is fabricated from these data.

Reinforcement of an existing implant-retained complete dental prosthesis for use in compensatory techniques by a patient missing an upper limb.

The purpose of this article is to describe the adaptation of a method suggested for prevention of fractures of partial removable dental prostheses to the reinforcement of an existing implant-retained fixed complete dental prosthesis (IRFCDP). The patient, an upper limb amputee, had subjected the original IRFCDP to parafunctional forces generated from use as a replacement hand in a compensatory technique commonly taught in rehabilitation. Advantages of the technique are that it provides an alternative to remaking the entire prosthesis, which was otherwise satisfactory; it adapts to a variety of situations involving anterior tooth reinforcement; and it offers a potential solution to anterior prosthetic tooth damage caused by other types of parafunction. It may also be adaptable to the reinforcement of other types of prostheses. A disadvantage is the possible need to provide a new interim prosthesis or modify an existing one while laboratory repair procedures are completed. Following reinforcement of the IRFCDP, no tooth damage was evident after one year of use. (J Prosthet Dent 2012;107:343-345).

Relationship of denture cast measurements to width of maxillary anterior teeth.

STATEMENT OF PROBLEM: When making complete dentures, clinicians may have difficulty with selection of properly sized denture teeth. PURPOSE: The purpose of this study was to determine if there are specific measurements made on an edentulous cast that could be useful to clinicians for selection of proper maxillary anterior denture tooth width. MATERIAL AND METHODS: Following Institutional Review Board approval, measurements were made on 50 maxillary and mandibular sets of complete denture casts and their marked and contoured occlusion rims and record bases consecutively submitted to a dental laboratory. The following 6 measurements were recorded for each set of casts: left mid-maxillary to right mid-maxillary, representing the distance between the respective residual ridge crest points adjacent to each canine eminence; left retromolar pad to right retromolar pad; incisive papilla to left hamular notch; incisive papilla to right hamular notch; left hamular notch to right hamular notch; and incisive papilla to vibrating line. These measurements were statistically compared with the control, the canine-to-canine distance as marked on the contoured maxillary occlusion rim to indicate the relaxed commissures. The casts were also classified as small, medium or large based upon the tooth width specified by the commercial mold guide for their respective canine-to-canine control measurement. The estimation bias was determined for each of the 6 measurements, and for those measurements for which the bias was significantly different from zero, a bias-correction was applied. St. Laurent's coefficient was used to describe the agreement between each (bias-corrected) measurement and the canine-to-canine control. A commercial guide was used to determine the accuracy of each of the 6 bias-corrected measurements in classifying denture teeth width as small, medium or large as compared to the same classification using the canine-to-canine control. RESULTS: The bias-corrected measurement from the left hamular notch mark to the right hamular notch mark, obtained by adding 10 mm, exhibited the greatest degree of agreement with the control. This measurement was also the only one of the 6 that correctly classified more than 50% of both the medium and large casts. None of the 6 measurements classified more than 30% of the small casts correctly. CONCLUSIONS: Of the 6 measurements considered here, the bias-corrected measurement from left hamular notch mark to right hamular notch mark was preferred for selecting denture teeth width.

Method for immediate fabrication of an occlusal device.

This article describes a method of in-office fabrication of an occlusal device for treatment of bruxism patients seeking a less costly alternative to laboratory-processed splints. This technique eliminates the need for mounted casts and the expense and delay associated with commercial laboratory involvement. It also minimizes patient and operator exposure to acrylic resin monomer and high temperatures associated with its polymerization reaction by use of a light-polymerized blue urethane dimethacrylate resin.

Dermal and mucosal reactions to an antimicrobial irreversible hydrocolloid impression material: a clinical report.

As an adjunct to infection control in dental impression procedures, several manufacturers have incorporated disinfectants into irreversible hydrocolloid impression materials. However, these compounds have been shown to be tissue irritants and capable of producing allergic reactions. An anonymous, self-administered questionnaire was distributed to 56 second-year dental students who had used an irreversible hydrocolloid containing a quaternary ammonium compound as an antimicrobial (Jeltrate Plus) to make impressions during a summer preclinical occlusion course. Within the limitations of this report, the incorporation of a quaternary ammonium compound into an irreversible hydrocolloid impression material resulted in a greater incidence of dermal and mucosal irritation.

Maxillomandibular relationship philosophies for prosthodontic treatment: a survey of dental educators.

STATEMENT OF PROBLEM: A variety of treatment philosophies persist concerning the need for coincidence of centric occlusion (CO) and maximum intercuspation (MI) in prosthodontic restoration; however, no consensus exists. PURPOSE: The purpose of this study was to determine the philosophies of dental educators throughout the United States at both the predoctoral and postdoctoral levels and to compare their attitudes toward desirable maxillomandibular relationships in defined clinical situations. MATERIAL AND METHODS: A survey was constructed with 5 clinical scenarios presented describing patients with a difference between maximum intercuspation and centric occlusion. The survey was mailed to 171 dentists involved in either predoctoral or postdoctoral dental programs in the United States; including 56 dental schools; the Army, Navy, and Air Force postdoctoral programs; 8 Department of Veterans Affairs postdoctoral programs; and 7 hospital-based programs. Descriptive statistics of the responses were provided. Chi-squared (alpha=.05) and Fisher's exact test analyses (alpha=.05) comparing predoctoral and postdoctoral program responses for each question were performed. RESULTS: Forty-three predoctoral dental school program responses were received. Forty-one postdoctoral program directors, including the dental school-based programs, 3 armed service branches, 2 Veterans Administration programs, and 1 hospital-based program responded to the survey. Fifteen respondents indicated that they represented both predoctoral and postdoctoral programs, and these data were deleted from the sample. Summarized results for each question reflect on whether the clinicians philosophically believed patients were better off with the elimination of an existing occlusal interference between MI and CO or not. There was no statistically significant difference seen between the predoctoral and postdoctoral responses. CONCLUSION: The controversy regarding the preferred mandibular position for treatment of dentulous and partially edentulous patients continues among dental educators at both the predoctoral and postdoctoral levels in the United States.