Current challenges for 3D printing complete dentures: experiences from a multi-centre clinical trial.

Aims To develop an optimal clinical and laboratory protocol for the fabrication of 3D printing dentures.Design A prospective feasibility study across three UK dental schools.Material and methods Each patient received one conventional and one 3D-printed denture. Both dentures were constructed using the same impression, jaw registration and wax trial denture. Variables investigated included methods of digitisation of the impression and optional use of a 3D-printed baseplate for jaw registration.Results Clinicians strongly preferred 3D-printed baseplates. Patients felt that conventional and printed dentures were similar in retention and stability. More patients favoured conventional dentures over 3D-printed dentures in terms of comfort.Discussion It is feasible to combine conventional clinical work with digital techniques to produce 3D-printed dentures. 3D-printed baseplates offer a cost-effective alternative to conventional bases at the jaw registration stage. Challenges were faced in tooth positioning and managing occlusion, particularly where roots required adjustment.Conclusion 3D printing is suitable for producing baseplates for jaw registration blocks and wax trial insertions. It is feasible to produce 3D-printed dentures using conventional clinical techniques for impressions, jaw registration and wax trial insertion. The workflow used in this study for 3D-printed dentures is not superior to conventional dentures. Further work is required.

Integrated Experimental-Theoretical Approach To Determine Reliable Molecular Reaction Mechanisms on Transition-Metal Oxide Surfaces.

By combining experimental and theoretical approaches, we investigate the quantitative relationship between molecular desorption temperature and binding energy on d and f metal oxide surfaces. We demonstrate how temperature-programmed desorption can be used to quantitatively correlate the theoretical surface chemistry of metal oxides (via on-site Hubbard U correction) to gas surface interactions for catalytic reactions. For this purpose, both CO and NO oxidation mechanisms are studied in a step-by-step reaction process for perovskite and mullite-type oxides, respectively. Additionally, we show solutions for over-binding issues found in COx, NOx, SOx, and other covalently bonded molecules that must be considered during surface reaction modeling. This work shows the high reliability of using TPD and density functional theory in conjunction to create accurate surface chemistry information for a variety of correlated metal oxide materials.

Stable and Active Oxidation Catalysis by Cooperative Lattice Oxygen Redox on SmMn2O5 Mullite Surface.

The correlation between lattice oxygen (O) binding energy and O oxidation activity imposes a fundamental limit in developing oxide catalysts, simultaneously meeting the stringent thermal stability and catalytic activity standards for complete oxidation reactions under harsh conditions. Typically, strong O binding indicates a stable surface structure, but low O oxidation activity, and vice versa. Using nitric oxide (NO) catalytic oxidation as a model reaction, we demonstrate that this conflicting correlation can be avoided by cooperative lattice oxygen redox on SmMn2O5 mullite oxides, leading to stable and active oxide surface structures. The strongly bound neighboring lattice oxygen pair cooperates in NO oxidation to form bridging nitrate (NO3-) intermediates, which can facilely transform into monodentate NO3- by a concerted rotation with simultaneous O2 adsorption onto the resulting oxygen vacancy. Subsequently, monodentate NO3- species decompose to NO2 to restore one of the lattice oxygen atoms that act as a reversible redox center, and the vacancy can easily activate O2 to replenish the consumed one. This discovery not only provides insights into the cooperative reaction mechanism but also aids the design of oxidation catalysts with the strong O binding region, offering strong activation of O2, high O activity, and high thermal stability in harsh conditions.

Deformation and retentive force following in vitro cyclic fatigue of cobalt-chrome and aryl ketone polymer (AKP) clasps.

OBJECTIVE: To compare the retention force of individual clasps made from cobalt chromium (CoCr) or new aryl ketone polymer (AKP) material, Ultaire™ AKP, following prolonged fatigue testing along ideal and non-ideal paths of removal and to assess 3D deformation of the active and passive clasp tips. METHODS: CoCr and AKP clasps were manufactured in their standard, respective processes, digitally scanned prior to testing, then cycled 15,000 times over an e.max analogue crown in artificial saliva. Retentive load was measured in situ, as a function of cycles. Clasps were rescanned to assess deformation and along with their antagonists subjected to SEM to assess localised wear. RESULTS: Distortion of the CoCr clasps was consistently larger than Ultaire™ AKP clasps, irrespective of removal path. CoCr clasps had significantly higher retentive forces than AKP clasps, for both removal paths. Ultaire™ AKP clasps showed a lower but relatively constant retentive force. The non-ideal path of removal affected retentive forces for both clasp materials. SEM showed localised removal of glaze for e.max crowns used with CoCr clasps. SIGNIFICANCE: Ultaire™ AKP clasps showed significantly less permanent deformation and lower retentive force than CoCr clasps. Unlike CoCr, the Ultaire™ AKP clasps did not work harden, nor had as large a reduction in retentive force and accompanying permanent deformation; the retentive force for the Ultaire™ AKP clasps was consistent over 15,000 cycles of fatigue mimicking prolonged clinical use. The AKP material was more robust; showing minimal deformation even in non-ideal paths of removal, as many patients would routinely use.

Dentures for Randomised Controlled Trials.

Making complete dentures for dental research is difficult. The difficulty is not in the construction of dentures, but making sure the clinician is blind to the randomizations, and avoiding confounding variables. For research purposes it is essential that two sets of dentures are similar in every way, apart from the area to be investigated. A previous article showed how to duplicate a lower denture when it was articulated against a single upper denture. This paper describes the additional duplication of upper dentures. These additional problems presented the clinical and technical teams at the Leeds Dental Institute some challenges.

IMPROVDENT: improving dentures for patient benefit. A crossover randomised clinical trial comparing impression materials for complete dentures.

BACKGROUND: According to the UK Adult Dental Health Survey (2009) 15% of adults aged 65-74, 30% aged 75-84 and 47% aged >85 years are edentulous and require complete dentures. Patients' quality of life and nutrition status are affected by poor dentures. The quality of the dental impression is the most important issue for improving the fit and comfort of new dentures. There is paucity of RCT evidence for which impression material is best for complete dentures construction. This study aims to compare two impression materials for effectiveness and cost effectiveness. METHODS/DESIGN: IMPROVDENT is a double-blind crossover trial comparing the use of alginate and silicone, two commonly used denture impression materials, in terms of patient preference and cost-effectiveness. Eighty five edentulous patients will be recruited and provided with two sets of dentures, similar in all aspects except for the impression material used (alginate or silicone). Patients will try both sets of dentures for a two-week period, unadjusted, to become accustomed to the feel of the new dentures (habituation period). Patients will then wear each set of dentures for a period of 8 weeks (in random order) during which time the dentures will be adjusted for optimum comfort. Finally, patients will be given both sets of dentures for a further two weeks to wear whichever denture they prefer (confirmation period).Patients will be asked about quality of life and to rate dentures on function and comfort at the end of each trial period and asked which set they prefer at the end of the habituation period (unadjusted denture preference) and confirmation period (adjusted denture preference). A health economic evaluation will estimate incremental cost-effectiveness ratios of producing dentures from the two materials. A qualitative study will investigate the impact of dentures on behaviour and quality of life. FUNDING: IMPROVDENT is funded by NIHR RfPB (PB-PG-0408-16300). DISCUSSION: This trial aims to provide evidence on the costs and quality of dentures cast from two different commonly used impression materials; the intention is to significantly impact on the quality of denture production within NHS dentistry. TRIAL REGISTRATION: ISRCTN Register: ISRCTN01528038 UKCRN Portfolio ID: 8305.