Accuracy of inlay and onlay restorations based on 3D printing or milling technique - a pilot study.

PURPOSE: To evaluate and compare the accuracy of 3D printing versus CAD/CAM milling in the fabrication of inlay/onlay restorations based on pilot experiments. MATERIAL AND METHODS: Different shaped inlay/onlay cavities were prepared on six extracted and root canal treated human molar teeth. Digital impressions were taken with a CEREC AC Omnicam© intraoral scanner. Based on the same impression data, nano-ceramic restorations were performed using milling (M group) and composite restorations (from material not for clinical use) using Multijet 3D printing technology (3D group). The accuracy was evaluated by measuring the marginal and internal gaps based on x-ray microtomography 3D imaging scans. The internal fit was evaluated using a replica technique with A-silicone impressions and weighing. RESULTS: The 3D group restorations showed better marginal and internal fit values. The mean internal gap values of the 3D group restorations were 40-60% lower compared to the M group restorations, the difference being statistically significant at most measuring points (p⟨0.05, t-test). CONCLUSIONS: The accuracy of the Multijet 3D printing is at least at the same level as the milling technique in the fabrication of dental inlay/onlay restorations. Additional investigations are needed to develop the 3D printing process and suitable materials for dental applications.

Predictors for future clinically significant pain in patients with temporomandibular disorder: A prospective cohort study.

BACKGROUND: Up to 30% of patients with temporomandibular disorder (TMD) run the risk of progressing to chronic pain with significant disability. This prospective cohort study assessed the effects of baseline pain and general health and psychosocial factors on the presence of clinically significant pain in patients with TMD pain at 1 year after initial consultation. METHODS: 263 primary care patients with TMD pain were included. At the baseline, patients completed a pain questionnaire including a wide range of putative prognostic factors, which were assessed using validated self-report scales. The outcome, clinically significant pain at 1 year was defined as grades IV and III and grades II and I with any disability points on the Graded Chronic Pain Scale (GCPS). Multivariable logistic regression was used to study the association between the outcome and each predictor variable. RESULTS: At 1 year, 26.9% of the patients reported clinically significant pain. The number of previous healthcare visits (OR 1.19, 95% CI 1.02-1.39), pain intensity/dysfunction of other pain conditions (OR 1.35, 95% CI 1.07-1.69), the number of other pain conditions (OR 1.31, 95% CI 0.98-1.74), the number of disability days (OR 1.05, 95% CI 1.00-1.12), and perceived ability to control pain (OR 0.79, 95% CI 0.61-1.01) were associated with the outcome. The area under the curve (AUC) for the whole model indicated acceptable discriminative ability (0.74, 95% CI 0.66-0.82). CONCLUSIONS: Reporting several previous healthcare visits and comorbid pains with high pain intensity and disability signal increased risk for poor prognosis of TMD pain. SIGNIFICANCE: About 27% of primary care TMD pain patients reported clinically significant pain at 1 year after initial consultation. Reporting several previous healthcare visits and comorbid pains with high pain intensity and disability were associated with poor prognosis of TMD pain.

Primary care-based facial pain unit in Vantaa: the first experiences 2003­2009.

As an attempt to tackle the challenge in serving facial pain patients, the first primary care-based facial pain unit was founded in 2003 as part of public dental primary care of Vantaa, Finland. Data were collected, consisting of sex, age, sources of referrals, reasons for seeking care, diagnoses made, therapeutic procedures, and numbers of visits to dentists and phone consultations. To describe the development of the present pain management system, we divided the observation periods into two parts: 2003-2006 and 2007-2009 and compared frequencies of the studied parameters between the two follow-up periods. During 2003-2006, 370 patients were examined and the number of visits was 659, corresponding patients' number was 437 and visits' number 960 during 2007-2009. Referrals to the primary care facial pain unit came from primary care dentists (80%), respective primary care pain unit GPs (6%), oral hygienists (3%) and ordinary GPs (2%). Four percentage of the patients' referrals came from secondary and tertiary care clinics of various types and 5% from private sector dentists and specialists. The average number of telephone consultations per year increased from 51 to 300 between study periods. During the follow-up period, the main reason for seeking care from our unit was temporomandibular disorders. Education in self-care, oral appliance therapy and physiotherapy were mostly used as management for these pain problems. The facial pain management unit in primary health care could be a useful model to serve increasing numbers of chronic facial pain patients.