A controversy with respect to occlusion.

There are very little controversies on occlusion in healthy individuals, where centric relation is regarded as the criterion for assessing the present occlusion and also for establishing a new occlusal relationship between the upper and the lower jaws. On the other hand, the occlusal position in patients with deformed condyles still remains to be clarified. In this review, the effectiveness and limits of centric relation in these patients are discussed. In addition, the muscle induced occlusal positions, such as the muscular position and the terminal positions of habitual closing movements, are suggested as a substitution for centric relation. Finally, the importance of a stable intercuspal position, where the habitual closing movements terminate without any premature tooth contact, is emphasized.

Application of photogrammetry for analysis of occlusal contacts.

INTRODUCTION: The conventional 2D-analysis methods for occlusal contacts provided limited information on tooth morphology. This present study aims to detect 3D positional information of occlusal contacts from 2D-photos via photogrammetry. We propose an image processing solution for analysis of occlusal contacts and facets via the black silicone method and a photogrammetric technique. MATERIALS AND METHODS: The occlusal facets were reconstructed from a 2D-photograph data-set of inter-occlusal records into a 3D image via photogrammetry. The configuration of the occlusal surface was reproduced with polygons. In addition, the textures of the occlusal contacts were mapped to each polygon. DIFFERENCE FROM CONVENTIONAL METHODS: Constructing occlusal facets with 3D polygons from 2D-photos with photogrammetry was a defining characteristic of this image processing technique. It allowed us to better observe findings of the black silicone method. Compared with conventional 3D analysis using a 3D scanner, our 3D models did not reproduce the detail of the anatomical configuration. However, by merging the findings of the inter-occlusal record, the deformation of mandible and the displacement of periodontal ligaments under occlusal force were reflected in our model. EFFECT OR PERFORMANCE: Through the use of polygons in the conversion of 2D images to 3D images, we were able to define the relation between the location and direction of the occlusal contacts and facets, which was difficult to detect via conventional methods. CONCLUSION: Through our method of making a 3D polygon model, the findings of inter-occlusal records which reflected the jaw/teeth behavior under occlusal force could be observed 3-dimensionally.

The influence of zirconia coping designs on the fracture load of all-ceramic molar crowns.

This study investigated the influence of zirconia coping designs on the fracture load of all-ceramic crown. Four kinds of zirconia copings were designed (a: Conventional zirconia coping with flat occlusal surface: thickness of the each coping is 0.6 mm evenly, and at the cervical margin area, the coping is adjusted sharply so as to fit preparation margin, b: Conventional zirconia coping with shoulder collar of 1 mm: thickness of the each coping is 0.6 mm evenly, and there is a collar of 0.6 mm from the margin, c: Zirconia coping with following original cuspal configuration (concave): two inclined cusp planes, and at the cervical margin area, the coping is adjusted sharply so as to fit preparation margin, and d: Zirconia coping with supporting configuration on the occlusal area: supporting configuration against the occlusal force, and at the cervical margin area, the coping is adjusted sharply so as to fit preparation margin) and porcelain was fired. Vertical and lateral load were conducted until fracture. Coping design affected the fracture load; conventional uniform thickness coping design showed the lowest load (a), whereas cuspal configuration to perform even thickness of porcelain showed the highest fracture load both load directions (c).

Design for functional occlusal surface of CAD/CAM crown using VR articulator.

In this present study, we introduce an approach that utilizes the VR articulator to mimic lateral excursions and design a functional occlusal surface. We then take the resultant occlusal surface from this approach and compare it with a conventional method. As a result, we developed a novel CAD/CAM system which can render a functional occlusal surface, via a VR articulator. The marginal fit and occlusion in our CAD/CAM crown was sufficient to apply to the clinic.

Influence of metal artifacts on the creation of individual 3D cranio-mandibular models.

In our clinic, the four-dimensional analysis of mandibular movement has mainly been used to diagnose jaw function disorders. In present, we are considering its application for patients with occlusal issues. Consequently, an improvement in system accuracy is required. However, metal artifacts cause distortions in the 3D-cranio-mandibular model construction process, which leads to accuracy concerns. The purpose of this present study was to grasp the accuracy differences caused by the oral metal restorations in reconstructed 3D-cranio-mandibular models from CT data, and scanned dentition models. The accuracy of the reconstruction was confirmed from comparing the occlusal contacts in VR space and real space. The VR contact areas in the dry skulls without and moderate restoration showed a close similarity to real occlusal contacts. However, the VR contact areas in the dry skull with numerous restorations was not similar to the real contacts. From these results, it is considered that metal artifacts decrease the accuracy of model reconstruction.

Virtual reality image applications for treatment planning in prosthodontic dentistry.

For successful occlusal reconstruction, the prosthodontists must take several points into consideration, such as those involving issues with functional and morphological findings and aesthetics. They then must unify this information into a coherent treatment plan. In this present study we focused on prosthodontic treatment and investigated how treatment planning and simulation could be applied to two cases. The personal occlusion condition can be reproduced on the virtual articulator in VR space. In addition, various simulations can be performed that involve prosthetesis design.

Clinical marginal and internal gaps of zirconia all-ceramic crowns.

PURPOSE: Marginal and internal gaps of NobelProcera crown zirconia were clinically evaluated using silicone materials. MATERIALS AND METHODS: Ninety-one crowns were examined before final cementation, and white and black silicone materials were used to record the marginal and internal fit. The silicone materials were sectioned bucco-lingually and mesio-distally, and the thickness of the silicone layers was measured using a microscope. Sixteen reference points were measured on each specimen, and mean marginal and internal gaps were obtained. Mean marginal gaps among anterior, premolar, and molar tooth groups, in addition to mean gaps at the reference points within the groups, were compared using two-way ANOVA and Games-Howell analysis. RESULTS: The marginal mean values were the smallest among all tooth groups, and the largest were at the rounded shoulders. There were no significant differences in the mean marginal gaps among the three tooth groups, while there were significant differences in the mean marginal and internal gaps of each tooth group. CONCLUSIONS: The mean marginal gap of the NobelProcera crown zirconia was 44.2 µm, which is within clinically accepted standards.

Clinical evaluation of posterior all-ceramic FPDs (Cercon): a prospective clinical pilot study.

PURPOSE: This study prospectively evaluated the clinical performance of posterior zirconium-oxide-based all-ceramic fixed partial dentures (FPDs). METHODS: Forty-two abutments of 21 Cercon FPDs were fitted in 20 patients at the Tsurumi University Dental Hospital from August 2005 to August 2006. The performance of these FPDs was evaluated using the California Dental Association (CDA) quality assessment system at baseline and at all follow-up examinations. RESULTS: All FPDs were examined after a mean observation period of 28.1 (+/-3.4) months. During the observation period, no fracturing of FPDs was seen. All of the FPDs examined were rated as satisfactory with regard to all factors at the follow-up examinations based on the CDA quality assessment criteria. CONCLUSION: Within the limitations of this short-term clinical study, no core framework fractures were seen. According to the CDA criteria, 100% of the FPDs were rated as satisfactory during this observation period.

Investigation of trends and characteristics in patients with obstructive sleep apnea.

BACKGROUND: Oral appliance (OA) therapy for obstructive sleep apnea (OSA) has only been part of Japan's National Health care coverage plan since 2004. Subsequently, not enough time has passed to establish the medical trends and characteristics of OSA patients in Japanese Dental Hospitals. AIM: The aim of this study was to investigate the medical trends and the characteristics in patients with OSA who visited our clinic, and to compare our findings with previous studies. SETTING AND DESIGN: Epidemiological survey (retrospective study). MATERIALS AND METHODS: Two hundred and one patients were recruited at the Internal Medicine Division in the Tsurumi University Dental Hospital from February 2006 to December 2008, consecutively. Patients received a medical interview, and a detailed sleep analysis that included a polysomnography (PSG) to verify the exact nature of their condition. The efficacy of OA was assessed in 49 patients who wore an OA and underwent PSG. RESULTS: Of all subjects, 141 patients visited the Prosthodontic Division to receive OA therapy, 38 patients were treated or received a follow up examination in the Internal Medicine Division. The dropout rate was 10.4% in the all subjects, 17.0% in patients who visited the Prosthodontic Division. The male-to-female ratio was 3.3:1, 3.0:1 in patients who visited the Prosthodontic Division. In addition, females had a lower rate of OAS severity than males. In our patients, the major complication was hypertension and cardiac disease. The success rate of OA was 75.5%. CONCLUSION: This approach allowed us to reveal some of the trends and characteristics in our patients.

Characteristics of mandibular movements in patients with square mandible.

OBJECTIVE: The aim was to report the kinetics of masticatory muscles using a 4-dimensional muscle model and kinetically investigate the etiology of square mandible (SQM) in vivo. STUDY DESIGN: To ascertain the mandibular movements in patients with SQM, we compared a group of 11 SQM patients with painless limited mouth opening to a matched group of 11 healthy volunteers who acted as control subjects. Mandibular movements were recorded using a 6-degrees-of-freedom jaw-tracking device, with the incisal and kinematic condylar as analytic points. RESULTS: For the control group, mean tracking distance for the incisal point was 50.1 +/- 6.8 mm, whereas for the SQM group mean tracking distance was 27.1 +/- 2.8 mm. With lateral excursions, the control group's mean tracking distance of the incisal point was 9.9 +/- 2.01 mm, and the SQM group's was 8.1 +/- 1.64 mm. CONCLUSION: Despite a sufficient lateral excursion, motion of the mandible was limited by some factors at opening and suggests that the mode of lateral movements in SQM patients may differ slightly from those in healthy individuals.

Microtensile bond strength of porcelain laminate veneers bonded to fluorosed teeth.

PURPOSE: The aim of this study was to evaluate the microtensile bond strengths (MTBSs) of porcelain laminate veneers bonded to normal and fluorosed teeth. MATERIALS AND METHOD: Forty human incisors, including 20 normal and 20 moderately fluorosed teeth [Thylstrup Fejerskov Index (TFI) = 4 to 6], were collected. The labial surfaces of the teeth were ground up to 1 mm and polished with #600 silicon carbide abrasive paper. The surfaces were bonded to 1-mm-thick ceramic slices (5 x 5 mm(2)) previously made (VitaVM7) using one of two ceramic cement systems (RelyX or Clapearl) following the manufacturers' instructions. A resin composite was added on top of the ceramic slices and built up to 5-mm thickness to serve as grips. The specimens were stored in water (37 degrees C) for 24 hours, and beams of adhesive interface with a surface area of approximately 1.25 mm(2) were obtained. Then the beams were subjected to MTBS tests at a crosshead speed of 1.0 mm/min. The data were analyzed with two-way ANOVA. RESULTS: The results of the MTBS test (MPa) were 20.55 +/- 5.83 (RelyX/fluorosed), 20.16 +/- 4.61 (RelyX/normal), 18.74 +/- 2.88 (Clapearl/fluorosed), and 21.06 +/- 4.99 (Clapearl/normal). There were no significant differences in the MTBSs among the four groups (p > 0.05). CONCLUSIONS: The MTBSs of ceramic cement systems used were not influenced by the moderately fluorosed teeth.

Influence of cyclic loading on fiber post and composite resin core.

From a selection of four kinds of post and core systems, including a fiber post and composite resin core, the purpose of this study was to determine the most effective system for the restoration of endodontically treated teeth with 0 mm of coronal tooth structure. For experimental abutment teeth, typical human maxillary central incisor teeth were modeled using bovine mandibular incisor teeth. By means of a static loading test, the four restoration systems were evaluated and compared in terms of failure load and failure mode. Further, by means of a cyclic loading test, these systems were assessed in terms of durability. For fiber post and composite resin core, it excelled from the standpoints of failure load and failure mode, and fared favorably too in durability after cyclic loading test. For composite resin post-and-core, it also showed excellent results for both failure load and failure mode in static loading test, but durability significantly decreased with cyclic loading. Taken together, the fiber post and composite resin core was found to be most effective from the standpoints of failure load, failure mode, and durability.

Evaluation of the simulation robot for mandibular movements with the patient-specific 3-dimensional plaster model and mandibular movement data: clinical application of the physical simulation robot.

We developed a multi-phase simulation system for patients with jaw deformity and dysfunction as a collaborate study between our departments. The intended application of the physical simulation robot was to evaluate its function based on well it quantitatively measured the movement of the individual patient. This physical simulation robot consists of a 6-degree-of-freedom robotic manipulator and a plaster model of patient-specific bone geometry. Each plaster model was mounted on the serial-articulated robotic manipulator. To establish the accuracy of the robot movement, the programmed movement of the robotic arm was validated using an optical tracking device. The results of the physical simulation robot corresponded with the data from the 4D analysis system. We could construct interactive relations between the 4D analysis system that was presented by virtual reality and the simulation robot which was constructed from physical simulation.

CT image applications for pre-surgical assessment and surgical pre-planning in Pediatric Dentistry.

In this study we focused on dental anomalies peculiar to children and investigated how 3D-surgical planning and simulation could be applied to each case. This study included 3 patients (2 female and 1 male, 8 to 12 years). The CT imaging was performed via a SOMATOM Plus4. From the resulting data, an image of the tooth and bone was rendered using image analysis software Amira 3.1 which was then used to reconstruct three-dimensional images. The reconstructed 3D images were imported to 3D modeling software, which provided the basis for the surgical simulations. From these results, we were able to gain important insights that helped shape the planning of the surgical operation. Furthermore we consider that these findings would be useful for the patient when taking them through the process of obtaining informed consent.

Dental fiberscope with navigation system for endodontic treatments.

We developed a dental fiberscope with a navigation system. The aim of this study is to direct the position of the tip of the endoscope fiber in the root canal via our navigation system. The distinguishing characteristic of our system is that it could be particularly practical in narrow spaces, such as those involving endodontic treatment typical of root canals. We were subsequently able to precisely indicate the relation of the position between the device and the teeth on the 3D model on the monitor. We inspected our navigation system using both the phantom model and the reconstructed 3D model. From this we could comprehend the relation of the position between the teeth and the device, and aim precisely at the lesion. If we are able to realize the correct position of the endoscope, we can safely and accurately deliver laser irradiation to the lesion. Consequently, the application of the endoscopic navigation system could increase the success rate for root canal treatments with recalcitrant lesions.

Effect of framework shape on the fracture strength of implant-supported all-ceramic fixed partial dentures in the molar region.

PURPOSE: The aim of the present study was to clarify the effects of the shape of the zirconium framework of implant-supported, all-ceramic fixed partial dentures (FPDs) on the fracture strength and fracture mode. MATERIALS AND METHODS: This study consisted of mechanical strength testing and 3D finite element analysis (FEA). The three framework shapes used in this study were: (1) conventional shape (control); (2) convex shape: 1.0-mm curve in the direction of the occlusal surface; and (3) concave shape: 1.0-mm curve in the direction of the gingival surface. Five frameworks were made for each condition (total: 15). A load (N) was applied until the FPD fractured. For FEA, a 3D model consisting of cortical bone, cancellous bone, implant bodies, and superstructure was constructed. RESULTS: The results of the mechanical strength test showed that fracture load was 916.0 +/- 150.1 N for the conventional shape, 1690.5 +/- 205.3 N for the convex shape, and 1515.5 +/- 137.0 N for the concave shape. The mean final fracture load for the FPDs with frameworks was the highest for the convex shape; however, a critical crack in the veneer porcelain (736.5 +/- 145.2 N) was confirmed during loading for the convex shape. Stress distribution maps for all conditions showed that tensile stress was generated at the veneer porcelain on the gingival side of the mesial and distal connectors of the pontic; however, there were differences in the maximum value and stress distribution within the framework. CONCLUSION: The shape of the framework, particularly the shape of the pontic-connector interface, affects the stress distribution, fracture strength, and fracture mode of all-ceramic FPDs, and stress concentration inside a framework may induce cracking of layering porcelain.

[Application of a jaw motion tracking device that measures six degrees of freedom using optoelectronic].

PURPOSE: A jaw motion tracking device that measures six degrees of freedom has recently been developed. Understanding jaw motion is useful, but previous measurement methods were impractical for use in dental clinics. The overall aim of this study was to demonstrate the simple operation, low cost, and high precision of a recently developed jaw tracking device. In addition, this study explored its potential clinical applications. METHODS: In this study, we compared two jaw motion tracking devices: a digital system type of device and an optical type of device. First we established a baseline occlusal plane from which to measure jaw motion in the same subject with both devices. The jaw motion signals were sampled at a frequency of 100 Hz. The subjects were three healthy women (mean age +/- SD = 26.3 +/- 1.2 years) who were recruited from among the crown-and-bridge faculty of Tsurumi University of Dentistry. The jaw motions measured were open-close movement, sagittal border movement, and frontal border movement. In addition, the kinematic axis point was calculated from the sagittal border movement. Data from the digital system type of device and data from the optical device were compared. The data were selected to measure rotation and translocation, i.e. jaw position about protrusion, both laterotrusion and maximal opening of the mouth. RESULTS: The root mean square (RMS) error of position measurement was 0.163 mm with MM-JI-E and 0.178 mm with the optical type of device. The RMS error of jaw motion measurement with the optical type of device was maximum at 0.8mm and minimum at 0.1mm. This was similar to that with digital system type of jaw motion tracking device. CONCLUSION: This study showed the possibility of developing clinical applications for this jaw motion device.

Analysis of masticatory muscle condition using the 4-dimensional muscle model for a patient with square mandible.

The present study was conducted to ascertain characteristics of mandibular movements in patients with SQM, observe the kinetics of masticatory muscles using a four-dimensional (4D) muscle model, and kinetically investigate the etiology of Square Mandible (SQM). As results, 1, In the maximum opening position, location of the condyle was beyond the articular tubercle for volunteer, but within the mandibular fossa for SQM patient. 2, While the temporal muscle of volunteer was markedly expanded, that of SQM patient was not. 3, In both volunteer and SQM during left lateral excursion, the right mandibular condyle moved to a position slightly before the lowest point of the articular tubercle. The 4D muscle model showed that the cause of limited mouth opening in SQM patient was insufficient expansion of the temporal muscle, and not dysfunction of the opening muscles. Insufficient expansion of the temporal muscle stresses the masseter muscle and leads to hypertrophy of the masseter muscle and hyperplasia of the mandibular angle, resulting in the unique facial configuration.

Effect of restoration method on fracture resistance of endodontically treated maxillary premolars.

PURPOSE: The aim of the present study was to compare the fracture resistance of endodontically treated maxillary premolars with mesio-occlusodistal (MOD) cavities restored using various restorative materials and luting agents. MATERIALS AND METHODS: Eighty extracted human maxillary premolars satisfying certain predetermined criteria were subjected to seven different restoration methods (10 premolars per method). After endodontic treatment, an MOD cavity was prepared in each specimen, and restoration was carried out by one of the following methods: group 1 = control (intact premolars); groups 2 and 3 = restoration using a photo-cure resin composite with and without bonding, respectively; groups 4 and 5 = restoration using a cast-metal inlay with zinc phosphate and adhesive resin cements, respectively; groups 6 and 7 = restoration using a cast-metal onlay with zinc phosphate and adhesive resin cements, respectively; and group 8 = restoration using a hybrid resin onlay. A fracture test was conducted to determine the fracture resistance and fracture mode of each specimen. RESULTS: Fracture resistance was greatest for teeth restored using a cast-metal onlay cemented with adhesive resin cement, but those fractures that did occur were generally unrestorable. Fracture resistance of teeth restored using a cast-metal inlay was also high. Fracture resistance for teeth restored using a resin composite was significantly lower, but the majority of these fractures were restorable. CONCLUSION: Endodontically treated maxillary premolars with MOD cavities could be successfully restored by cast onlay and inlay restorations luted with adhesive resin cement, but their failure mode was often unfavorable.

[Verification of precision by 4-dimensional analysis of mandibular movement].

PURPOSE: The 4-dimensional human body model that combines reconstructed 3-dimensional image data (CT and MRI) and exercise data of the human body is widely applied in the medical field. We have applied this technique to assess mandibular movement, particularly in dentistry, and developed a 4-dimensional system of analyzing mandibular movement. The aim of this study was to determine the accuracy of this analysis system. METHODS: A dry skull mandible was fixed at several mandibular positions and the skull-mandible relationship was measured at each position by two procedures: CT scanning was performed and a 3-dimensional image was reconstructed from image data that were regarded as true values; then, optical measurement markers attached to the dental arch were measured 3-dimensionally and calculated as positional measurement values. The measurement values were compared with the corresponding true values to identify measurement errors of the analysis system. RESULTS: The root-mean-square (RMS) errors of the 4-dimensional analysis system of mandibular movement were, on average, 0.41 mm and 0.43 degrees. CONCLUSIONS: These findings suggest that our 4-dimensional analysis system has sufficient measurement accuracy for mandibular movements.