Validité, fiabilité et reproductibilité des modèles digitaux obtenus avec iTero (Align Technology) et Unitek TMP Digital (3M) en comparaison avec les modèles de plâtre

Objectif: L'objectif primaire de cette étude était d'évaluer la validité, la fiabilité et la reproductibilité des mesures dentaires obtenues sur les modèles digitaux iTero (Align Technology, San Jose, Californie) et Unitek TMP Digital (3M, Monrovia, Californie) en comparaison avec celles obtenues sur les modèles de plâtre (gold standard). L'objectif secondaire était de comparer les deux différents matériaux à empreinte (l'alginate et le polyvinylsiloxane-PVS) afin de déterminer si le choix du matériau affectait la précision des mesures. Méthodes: Le premier volet de l'étude impliquait les modèles digitaux Unitek et iTero, obtenus à partir de 25 paires de modèles de plâtre choisis de façon randomisée et provenant de la pratique privée d'un des co-auteurs. Des empreintes d'alginate et de PVS ont été prises sur les modèles de plâtre et numérisées par le scanner Unitek. Les modèles ont ensuite été numérisés avec le scanner iTero. Le deuxième volet de l'étude cherchait à comparer les modèles digitaux iTero (numérisation intra-orale) avec les modèles de plâtre (empreintes d'alginate et de PVS) obtenus à partir de 25 patients de la clinique d'orthodontie de l'Université de Montréal ayant besoin d'un traitement orthodontique. Dans les deux volets de l'étude, deux auteurs ont pris les mesures suivantes sur les différents modèles: largeur mésio-distale de chaque dent de la première molaire à l'autre première molaire, le périmètre d'arcade, les distances intermolaire et intercanine, le surplomb vertical et le surplomb horizontal. Les ratios et excès Bolton 6 et 12, l'espace requis et les différentiels d'espace au maxillaire et à la mandibule, ont été calculés. Résultats: La fiabilité (ICC) entre les modèles digitaux (Unitek et iTero) et les modèles de plâtre était bonne à excellente pour toutes les mesures [ICC=0,762–0,998], et la fiabilité entre les deux matériaux à empreinte était excellente [ICC=0,947–0,996]. Dans les deux volets de l'étude, les mesures faites sur les modèles iTero étaient généralement plus grandes que celles faites sur les modèles de plâtre. Les plus grandes différences moyennes pour la comparaison iTero-plâtre étaient trouvées au niveau de l'espace disponible au maxillaire et à la mandibule (systématiquement plus grande pour cette variable), soit 2,24 mm et 2,02 mm respectivement dans le premier volet, et 1,17 mm et 1,39 mm respectivement dans le deuxième volet. Les différences étaient considérées cliniquement non significatives pour toutes les variables. La reproductibilité intra-examinateur était bonne à excellente pour les modèles de plâtre et les modèles digitaux, à l'exception du différentiel d'espace à la mandibule pour les modèles Unitek [ICC=0,690-0,692]. La reproductibilité inter-examinateur était bonne à excellente pour les modèles de plâtre et les modèles digitaux dans les deux volets de l'étude, mais acceptable à modérée pour les modèles Unitek au niveau des analyses Bolton 6 et 12, et des différentiels d'espace au maxillaire et à la mandibule [ICC=0,362-0,548]. Conclusions: La précision et la fiabilité des mesures dentaires faites sur les modèles digitaux Unitek et iTero étaient cliniquement acceptables et reproductibles en comparaison avec les celles faites sur les modèles de plâtre. Le choix de matériel à empreinte entre l'alginate et le PVS n'affectait pas la précision des mesures. Cette étude semble démontrer que les modèles digitaux Unitek et iTero, utilisés avec leur logiciel respectif, sont une alternative fiable et reproductible aux modèles de plâtre pour le diagnostic et l’analyse des modèles orthodontiques.

Design and development of a haptic dental training system - hapTEL

This paper presents a novel design of a virtual dental training system (hapTEL) using haptic technology. The system allows dental students to learn and practice procedures such as dental drilling, caries removal and cavity preparation for tooth restoration. This paper focuses on the hardware design, development and evaluation aspects in relation to the dental training and educational requirements. Detailed discussions on how the system offers dental students a natural operational position are documented. An innovative design of measuring and connecting the dental tools to the haptic device is also shown. Evaluation of the impact on teaching and learning is discussed.

Evaluation of mechanical properties of dental feldsphatic porcelains for metal and zirconia core

Studies has been reported a significant incidence of chipping of the feldspathic porcelain veneer in zirconia-based restorations. The purpose of this study was to compare the three-point flexural strength (MPa), Weibull parameters, Vickers hardness (VHN) and Vickers indentation fracture toughness (MPa/mm(1/2)) in feldspatic porcelains for metal and for zirconia frameworks. Bar specimens were made with the porcelains e.MaxCeram (EM) and VitaVM9 (V9) for zirconia core, and Duceragold (DG) and VitaVMK95 (VK) for metal core (n = 15). Kruskal-Wallis and Dun test were used for statistical analysis. There was no significant difference (p=0.31) among the porcelains in the flexural strength (Median = 73.2; 74.6; 74.5; 74.4). Weibull calculation presented highest reliability for VK (10.8) followed by em (7.1), V9 (5.7) and DG (5.6). Vickers hardness test showed that em (536.3), V9 (579.9) and VK (522.1) had no difference and DG (489.6) had the lowest value (p<.001). The highest fracture toughness was to VK (1.77), DG (1.58) had an intermediate value while V9 (1.33) and em (1.18) had the lowest values (p<.001). Despite of the suitable flexural strength, reliability and high hardness, the porcelains used to zirconia-based fixed dental prostheses showed lower fracture toughness values.

A study of the microstructural characteristics of dental amalgams

Metallographic studies by scanning electron microscopy and energy dispersive spectroscopy carried out for two types of dental amalgam showing a porous multiphase material. Surface analysis shows that the structure of the Dispersalloy amalgam consists of gamma-Ag3Sn, gamma(1)-Ag2Hg3, eta'-Cu6Sn5, epsilon-Cu3Sn and eutectic Ag-Cu phases. while Velvalloy amalgam consists mainly of gamma, gamma(1) and gamma(2)-Sn7-8Hg phases. The latter phase presents an uniform distribution often associated with voids.

Influence of the power level of an ultra-sonic system on dental cavity preparation

The aim of this study was to evaluate the shape of dental cavities made with the CVDentus® system using different ultrasound power levels. One standard cavity was made on the buccal aspect of 15 bovine incisors with a CVDentus® cylindrical bur (82142). The sample was divided into three groups: G1 - ultrasound with power II; G2 - ultrasound with power III; and G3 - ultrasound with power IV. A standardizing device was used to obtain standardized preparations and ultrasound was applied during one minute in each dental preparation. The cavities were sectioned in the middle, allowing observation of the cavity's profile with a magnifying glass, and width and depth measurement using the Leica Qwin program. The Kruskal-Wallis (p < 0.05) and Dunn statistical analyses demonstrated differences between the dental cavity shapes when powers III and IV were used. However, the cavities that were made with power III presented dimensions similar to those of the bur used for preparation. We concluded that the power recommended by the manufacturer (III) is the most adequate for use with the CVDentus® system.

Assessment of a new infrared laser transillumination technology (808nm) for the detection of occlusal caries-an in vitro study

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Microstructural, physical, and fluid dynamic assessment of spinel-based and phosphate-bonded investments for dental applications

This work reports the experimental evaluation of physical and gas permeation parameters of four spinel-based investments developed with or without inclusion of sacrificial fillers. Data were compared with those of three commercial formulations. Airflow tests were conducted from 27 to 546°C, and permeability coefficients were fitted from Forchheimer's equation. Skeletal densities found for spinel- (ρs = 3635 ± 165 kg/m3) and phosphate-bonded (ρs = 2686 ± 11 kg/m3) samples were in agreement with the literature. The developed investments were more porous and less permeable than commercial brands, and the differences were ascribed to the different pore morphologies and hydraulic pore sizes of ceramic matrices. The inclusion of both fibers and microbeads resulted in increases of total porosity (42.6–56.6%) and of Darcian permeability coefficient k1 (0.76 × 10−14–7.03 × 10−14 m2). Air permeation was hindered by increasing flow temperatures, and the effect was related to the influence of gas viscosity on ΔP, in accordance with Darcy's law. Casting quality with molten titanium (CP Ti) was directly proportional to the permeability level of the spinel-based investments. However, the high reactivity of the silica-based investment RP and the formation of α-case during casting hindered the benefits of the highest permeability level of this commercial brand.

An esthetics rehabilitation with computer-aided design/ computer-aided manufacturing technology

This paper describes a case of a rehabilitation involving Computer Aided Design/Computer Aided Manufacturing (CAD-CAM) system in implant supported and dental supported prostheses using zirconia as framework. The CAD-CAM technology has developed considerably over last few years, becoming a reality in dental practice. Among the widely used systems are the systems based on zirconia which demonstrate important physical and mechanical properties of high strength, adequate fracture toughness, biocompatibility and esthetics, and are indicated for unitary prosthetic restorations and posterior and anterior framework. All the modeling was performed by using CAD-CAM system and prostheses were cemented using resin cement best suited for each situation. The rehabilitation of the maxillary arch using zirconia framework demonstrated satisfactory esthetic and functional results after a 12-month control and revealed no biological and technical complications. This article shows the important of use technology CAD/CAM in the manufacture of dental prosthesis and implant-supported.

Synchrotron X-ray diffraction characterization of healthy and fluorotic human dental enamel

With the introduction of fluoride as the main anticaries agent used in preventive dentistry, and perhaps an increase in fluoride in our food chain, dental fluorosis has become an increasing world-wide problem. Visible signs of fluorosis begin to become obvious on the enamel surface as opacities, implying some porosity in the tissue. The mechanisms that conduct the formation of fluorotic enamel are unknown, but should involve modifications in the basic physical-chemistry reactions of demineralization and remineralisation of the enamel of the teeth, which is the same reaction of formation of the enamel's hydroxyapatite (HAp) in the maturation phase. The increase of the amount of fluoride inside of the apatite will result in gradual increase of the lattice parameters. The aim of this work is to characterize the healthy and fluorotic enamel in human tooth using Synchrotron X-ray diffraction. All the scattering profile measurements were carried out at the X-ray diffraction beamline (XRD1) at the Brazilian Synchrotron Light Laboratory-LNLS, Campinas, Brazil. X-ray diffraction experiments were performed both in powder samples and polished surfaces. The powder samples were analyzed to obtain the characterization of a typical healthy enamel pattern. The polished surfaces were analyzed in specific areas that have been identified as fluorotic ones. X-ray diffraction data were obtained for all samples and these data were compared with the control samples and also with the literature data. (c) 2012 Elsevier Ltd. All rights reserved.

Dental Pulp Vascular Permeability Changes Induced by Dental Bleaching

Aiming to compare the effect of different light sources for dental bleaching on vascular permeability of dental pulps, forty-eight incisors were used. The bleaching agent (35% hydrogen peroxide) was activated by halogen light; LED (Light Emitting Diode) or LED, followed by laser phototherapy (LPT) (lambda = 780 nm; 3 J/cm(2)). After the bleaching procedures, the animals received an intra-arterial dye injection and one hour later were sacrificed. The teeth were diaphanized and photographed. The amount of blue stain content of each dental pulp was quantified using a computer imaging program. The data was statistically compared (p <= 0.05). The results showed a significant higher (p <= 0.01) dye content in the groups bleached with halogen light, compared with the control, LED and LED plus LPT groups. Thus, tooth bleaching activated by LED or LED plus LPT induces lesser resulted in increased vascular permeability than halogen light.

Dental pulp vascular permeability changes induced by dental bleaching

Aiming to compare the effect of different light sources for dental bleaching on vascular permeability of dental pulps, forty-eight incisors were used. The bleaching agent (35 % hydrogen peroxide) was activated by halogen light; LED (Light Emitting Diode) or LED, followed by laser phototherapy (LPT) (λ = 780 nm; 3 J/cm²). After the bleaching procedures, the animals received an intra-arterial dye injection and one hour later were sacrificed. The teeth were diaphanized and photographed. The amount of blue stain content of each dental pulp was quantified using a computer imaging program. The data was statistically compared (p < 0.05). The results showed a significant higher (p < 0.01) dye content in the groups bleached with halogen light, compared with the control, LED and LED plus LPT groups. Thus, tooth bleaching activated by LED or LED plus LPT induces lesser resulted in increased vascular permeability than halogen light.

Comparison of real-time polymerase chain reaction and DNA-strip technology in microbiological evaluation of periodontitis treatment

The impact of a semiquantitative commercially available test based on DNA-strip technology (microIDent®, Hain Lifescience, Nehren, Germany) on diagnosis and treatment of severe chronic periodontitis of 25 periodontitis patients was evaluated in comparison with a quantitative in-house real-time PCR. Subgingival plaque samples were collected at baseline as well as at 3, 6, and 12 months later. After extracting DNA, Aggregatibacter actinomycetemcomitans, Porphyromonas gingivalis, Tannerella forsythia, Treponema denticola, and several other periodontopathogens were determined by both methods. The results obtained by DNA-strip technology were analyzed semiquantitatively and additionally quantitatively by densitometry. The results for the 4 major periodontopathogenic bacterial species correlated significantly between the 2 methods. Samples detecting a high bacterial load by one method and negative by the other were always found in less than 2% of the total samples. Both technologies showed the impact of treatment on microflora. Especially the semiquantitative DNA-strip technology clearly analyzed the different loads of periodontopathogens after therapy and is useful in microbial diagnostics for patients in dental practices.

Improving the sustainability of an appropriate technology solution; bone char defluoridation filters in Arusha, Tanzania

High concentrations of fluoride naturally occurring in the ground water in the Arusha region of Tanzania cause dental, skeletal and non-skeletal fluorosis in up to 90% of the region’s population [1]. Symptoms of this incurable but completely preventable disease include brittle, discolored teeth, malformed bones and stiff and swollen joints. The consumption of high fluoride water has also been proven to cause headaches and insomnia [2] and adversely affect the development of children’s intelligence [3, 4]. Despite the fact that this array of symptoms may significantly impact a society’s development and the citizens’ ability to perform work and enjoy a reasonable quality of life, little is offered in the Arusha region in the form of solutions for the poor, those hardest hit by the problem. Multiple defluoridation technologies do exist, yet none are successfully reaching the Tanzanian public. This report takes a closer look at the efforts of one local organization, the Defluoridation Technology Project (DTP), to address the region’s fluorosis problem through the production and dissemination of bone char defluoridation filters, an appropriate technology solution that is proven to work. The goal of this research is to improve the sustainability of DTP’s operations and help them reach a wider range of clients so that they may reduce the occurrence of fluorosis more effectively. This was done first through laboratory testing of current products. Results of this testing show a wide range in uptake capacity across batches of bone char emphasizing the need to modify kiln design in order to produce a more consistent and high quality product. The issue of filter dissemination was addressed through the development of a multi-level, customerfunded business model promoting the availability of filters to Tanzanians of all socioeconomic levels. Central to this model is the recommendation to focus on community managed, institutional sized filters in order to make fluoride free water available to lower income clients and to increase Tanzanian involvement at the management level.

A paradigm shift in mechanical biofilm management? Subgingival air polishing: a new way to improve mechanical biofilm management in the dental practice

In the past few years indications for the use of the air polishing technology have been expanded from supragingival use (airflow) to subgingival air polishing (perioflow) by the development of new low-abrasive glycine-based powders and devices with a subgingival nozzle. Several studies on the subgingival use of air polishing have been completed. On 7 June 2012, during the Europerio 7 Congress in Vienna, a consensus conference on mechanical biofilm management took place aiming to review the current evidence from the literature on the clinical relevance of the subgingival use of air polishing and to make practical recommendations for the clinician. Bernita Bush (Bern), Prof Johannes Einwag (Stuttgart), Prof Thomas Flemmig (Seattle), Carmen Lanoway (Munich), Prof Ursula Platzer (Hamburg), Prof Petra Schmage (Hamburg), Brigitte Schoeneich (Zurich), Prof Anton Sculean (Bern), Dr Clemens Walter (Basel), and Prof Jan Wennström (Gothenburg) discussed under the moderation of Klaus-Dieter Bastendorf and Christian Becker (both ADIC Association for Dental Infection Control) the available clinical studies to reach a consensus on available clinical evidence. This paper summarizes the main conclusions of the consensus conference and points to the clinical relevance of the findings for the dental practitioner.

Children's dental services under the Medicaid program.

"OTA-BP-H-78"--P. [4] of cover.