Digital Workflow Research Articles

Digital-assisted multidisciplinary treatment for complex occlusal rehabilitation: an 18-month follow-up case report

BackgroundThis case report highlights the importance of standardized and fully digital sequential treatment in complex occlusal rehabilitation cases. To fully resolve the patient’s dental needs, such cases often require multidisciplinary interventions including periodontal therapy, endodontic treatment, anterior esthetics, implant restoration, and prosthetic rehabilitation. A fully digital workflow (including facial scanners, intraoral scanners, jaw motion tracking systems, virtual articulators, and computer-aided design software) streamlined the complex treatment, enhancing workflow simplicity, efficiency, visibility, and precision.Case presentationThe patient presented with decreased chewing efficiency of the upper and lower prostheses, along with unsatisfactory esthetic appearance of the anterior teeth. After physical examination and radiological assessment, this complex occlusal rehabilitation case required periodontal therapy, anterior esthetic enhancement, implant restoration, and fixed prosthetic rehabilitation. Therefore, a fully digital workflow was adopted. Full-crown prostheses were placed on teeth 13, 23, and 34; a fixed bridge encompassed positions 32 to 42, and single implant crowns were placed on teeth 35 and 36. Implant-supported fixed bridges were constructed for teeth 12 to 22 and 44 to 46, anchored by implants at teeth 12, 22, 44, and 46. All definitive prostheses were fabricated from zirconia ceramics, chosen for their durability and esthetic characteristics. Finally, restorations with satisfactory esthetic and functional characteristics were seated, preserving the tooth and its supporting structures. During treatment and follow-up, the T-scan occlusal analysis system was utilized to continuously monitor and guide the adjustment of occlusal distribution across the patient’s dental arches. After 18 months, the patient remains satisfied with the definitive restorations.ConclusionsThis report is intended to help dentists understand and implement standardized and fully digital workflows during the management of complex occlusal rehabilitation cases; it may also facilitate harmonious integration of esthetic and functional characteristics.

Complex rehabilitation of erosive tooth wear with digital workflows

Complex rehabilitation of erosive tooth wear with digital workflows

TMD management with full digital workflow: a beneficial clinical protocol

TMD management with full digital workflow: a beneficial clinical protocol

An innovative impression reference technique to simplify the digital workflow in immediately loaded zygomatic implants

An innovative impression reference technique to simplify the digital workflow in immediately loaded zygomatic implants

Digital workflow for full arch rehab and surgical guide for implant placement

Digital workflow for full arch rehab and surgical guide for implant placement

Digital Workflow for Full Arch Veneers

Digital Workflow for Full Arch Veneers

Convolutional neural network for automated tooth segmentation on intraoral scans

BackgroundTooth segmentation on intraoral scanned (IOS) data is a prerequisite for clinical applications in digital workflows. Current state-of-the-art methods lack the robustness to handle variability in dental conditions. This study aims to propose and evaluate the performance of a convolutional neural network (CNN) model for automatic tooth segmentation on IOS images.MethodsA dataset of 761 IOS images (380 upper jaws, 381 lower jaws) was acquired using an intraoral scanner. The inclusion criteria included a full set of permanent teeth, teeth with orthodontic brackets, and partially edentulous dentition. A multi-step 3D U-Net pipeline was designed for automated tooth segmentation on IOS images. The model’s performance was assessed in terms of time and accuracy. Additionally, the model was deployed on an online cloud-based platform, where a separate subsample of 18 IOS images was used to test the clinical applicability of the model by comparing three modes of segmentation: automated artificial intelligence-driven (A-AI), refined (R-AI), and semi-automatic (SA) segmentation.ResultsThe average time for automated segmentation was 31.7 ± 8.1 s per jaw. The CNN model achieved an Intersection over Union (IoU) score of 91%, with the full set of teeth achieving the highest performance and the partially edentulous group scoring the lowest. In terms of clinical applicability, SA took an average of 860.4 s per case, whereas R-AI showed a 2.6-fold decrease in time (328.5 s). Furthermore, R-AI offered higher performance and reliability compared to SA, regardless of the dentition group.ConclusionsThe 3D U-Net pipeline was accurate, efficient, and consistent for automatic tooth segmentation on IOS images. The online cloud-based platform could serve as a viable alternative for IOS segmentation.

Implant-Prosthetic Rehabilitation of the Agenesis of Maxillary Lateral Incisors: A 2-Year Prospective Clinical Study with Full Digital Workflow

Implant-Prosthetic Rehabilitation of the Agenesis of Maxillary Lateral Incisors: A 2-Year Prospective Clinical Study with Full Digital Workflow

Clinical evaluation of a one-piece polyetheretherketone removable partial denture fabricated using a novel digital workflow: A self-controlled clinical trial.

To explore the clinical application of one-piece polyetheretherketone (PEEK) removable partial dentures (RPDs) fabricated using a novel digital workflow and to evaluate their weights and fits in vivo and patient satisfaction. Fifteen cases with posterior partially edentulous situations were selected, and each patient received two types of RPDs, including a novel digital workflow (test group) and a conventional workflow (control group). For the test group, one-piece RPDs were designed through three-dimensional (3D) methods by scanning stone casts and fabricated by milling PEEK discs. Each RPD was weighed. The gaps between the oral tissue and RPDs in each group were duplicated using a polyvinylsiloxane (PVS) replica and measured by 3D analysis. A visual analog scale (VAS) was used to evaluate the patient's satisfaction. Paired t-tests were used to compare the differences in the weight, the gaps of each RPD, and VAS values between the two groups. One-way analysis of variance tests was used to compare the differences in the gap among different components in each group. The RPD in the test group weighed less than that in the control group (p<0.01). No statistically significant differences in the gaps of denture bases and rests (p>0.05) were found between the two groups, but the gaps of major connectors in the test group were significantly smaller than in the control group (p<0.05). The VAS scores for comfortableness and masticatory efficiency were not significantly different between the two groups (p>0.05) but the scores for the aesthetic appearance of the clasps in the test group were significantly higher than that in the control group (p<0.05). One-piece PEEK RPDs manufactured using a novel digital workflow weighed less than conventional RPDs and exhibited a clinically acceptable internal fit. Although the aesthetic appearance of the PEEK clasps was superior to the control, there is still room for improvement.

The Paradoxes of Digital Tools in Hospitals: Qualitative Interview Study.

Digital tools are progressively reshaping the daily work of health care professionals (HCPs) in hospitals. While this transformation holds substantial promise, it leads to frustrating experiences, raising concerns about negative impacts on clinicians' well-being. The goal of this study was to comprehensively explore the lived experiences of HCPs navigating digital tools throughout their daily routines. Qualitative in-depth interviews with 52 HCPs representing 24 medical specialties across 14 hospitals in Switzerland were performed. Inductive thematic analysis revealed 4 main themes: digital tool use, workflow and processes, HCPs' experience of care delivery, and digital transformation and management of change. Within these themes, 6 intriguing paradoxes emerged, and we hypothesized that these paradoxes might partly explain the persistence of the challenges facing hospital digitalization: the promise of efficiency and the reality of inefficiency, the shift from face to face to interface, juggling frustration and dedication, the illusion of information access and trust, the complexity and intersection of workflows and care paths, and the opportunities and challenges of shadow IT. Our study highlights the central importance of acknowledging and considering the experiences of HCPs to support the transformation of health care technology and to avoid or mitigate any potential negative experiences that might arise from digitalization. The viewpoints of HCPs add relevant insights into long-standing informatics problems in health care and may suggest new strategies to follow when tackling future challenges.

Analyzing the accuracy of a cross-mounting technique utilizing digitized interocclusal records.

To compare the accuracy of a partially digital cross-mounting workflow of direct scans of interocclusal records to a conventional workflow by analyzing the deviations of sequentially cross-mounted casts. A set of reference casts, comprising maxillary and mandibular full-arch prepared casts and interim prostheses, was articulated, mounted, and scanned to generate four reference casts for cross-mounting. In the conventional approach, 15 sets of these four casts were printed. Polyvinylsiloxane (PVS) records were made using the reference casts and utilized for sequential cross-mounting. In the partially digital group, the same PVS interocclusal records were scanned and used for digital cross-mounting via design software. The mean deviations of both groups from the reference cast were analyzed using a 3D inspection software program. Statistical tests, including paired t-test and analysis of variance (ANOVA), were conducted to compare the average discrepancies between the two groups and to evaluate discrepancies in the anterior and posterior regions (α=0.05). The range of discrepancies was similar in both the conventional and partially digital groups. The final set of related casts had a mean deviation of 201.58±136.98mm in the conventional workflow and 248.69±164.71mm in the partially digital workflow. No statistically significant difference was found between conventional and partially digital groups (p=0.091). Error propagation was examined by comparing discrepancies at each step within the cross-mounting process. In the conventional group, no significant difference was found (p=0.148), but a significant difference was found among groups in the partially digital group at each step of sequential mounting (p<0.001). A significant difference was observed between anterior and posterior deviations in the partially digital group (p<0.001), but not in the conventional group (p=0.143). The study reveals that there is no statistically significant difference between conventional and partially digital cross-mounting workflows. However, within the partially digital group, a significant difference in deviation emerges across cross-mounting steps, with increased deviation in the anterior region.

Digital twin-driven energy consumption management of integrated heat pipe cooling system for a data center

The energy consumption management (ECM) for the integrated heat pipe cooling (IHPC) systems has become a significant cost-cutting strategy, given the growing demand for the decreased cooling and maintenance costs in data centers. However, the traditional ECM strategies lack an integration with the real-time information and the automatic feedback control, causing the risks of system operation difficult to diagnose and the potential for energy saving hard to exploit. In this respect, a digital twin approach was proposed to efficiently and automatically implement the ECM strategy for an IHPC system. First, a digital twin architecture was established to enable seamless integration and real-time interaction between the physical system and the digital twin. Secondly, the digital twin models of monitoring, simulation, energy evaluation and optimization were developed to drive the corresponding services. Finally, the approach was verified on an IHPC system operating in a real-life data center. It is found that the approach can automatically detect and justify the abnormal states of the IHPC system. Moreover, the approach can reduce the power consumption by 23.63% while meeting the production requirements. The mean relative errors of the supply air temperature and the cooling capacity between the digital twin simulated and the on-site records are 1.43% and 1.46%, respectively. In summary, the proposed approach provides a digital twin workflow that can significantly improve the efficiency of the ECM strategy deployed on an IHPC system.

Enhanced carbon dioxide drainage observed in digital rock under intermediate wetting conditions

Carbon dioxide (CO2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$_2$$\\end{document}) trapping in capillary networks of reservoir rocks is a pathway to long-term geological storage. At pore scale, CO2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$_2$$\\end{document} drainage displacement depends on injection pressure, temperature, and the rock’s interaction with the surrounding fluids. Modeling this interaction requires adequate representations of both capillary volume and surface. For the lack of scalable representations, however, the prediction of a rock’s CO2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$_2$$\\end{document} storage potential has been challenging. Here, we report how to represent a rock’s pore space by statistically sampled capillary networks (ssCN) that preserve morphological rock characteristics. We have used the ssCN method to simulate CO2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$_2$$\\end{document} drainage within a representative sandstone sample at reservoir pressures and temperatures, exploring intermediate- and CO2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$_2$$\\end{document}-wet conditions. This wetting regime is often neglected, despite evidence of plausibility. By raising pressure and temperature we observe increasing CO2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$_2$$\\end{document} penetration within the capillary network. For contact angles approaching 90∘\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$^\\circ$$\\end{document}, the CO2\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$_2$$\\end{document} saturation exhibits a pronounced maximum reaching 80%\\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$\\%$$\\end{document} of the accessible pore volume. This is about twice as high as the saturation values reported previously. For enabling validation of our results and a broader application of our methodology, we have made available the rock tomography data, the digital rock computational workflows, and the ssCN models used in this study.

Impact of Cut-out-rescan and Data Exchange by Over-scanning Techniques on Marginal Fit of CAD/CAM Lithium Disilicate Crowns.

Evaluate the impact of adjustment procedures - cut-out-rescan (COR) and data exchange by over-scanning (DEOS) techniques - through CAD/CAM software on the marginal fit outcome of ceramic crowns. Twenty-eight de-identified teeth were adapted in a mandibular typodont set. Tooth #19 was prepared for a lithium disilicate crown and seven groups, G0 to G6 (n=10), were created based on the rescanned areas (mesial and/or buccal) on the typodont using an intraoral scanner through COR or DEOS techniques. A digital workflow was used to design and mill 70 crowns according to the groups. Each crown was temporarily cemented on tooth #19 and scanned with micro-computed tomography to measure the marginal fit. The data were analyzed statistically by the Kruskal-Wallis test followed by the Mann-Whitney test to compare the groups pairwise as a post-hoc (α=0.05). Statistically significant differences were found for vertical misfit (μm) between the groups for Marginal Gap Buccal (MGB) and Marginal Gap Mesial (MGM) (p=0.003 and p=0.029, respectively). No significant difference was found for Finish Line Buccal (FLB) and Finish Line Mesial (FLM) (p=0.062 and p=0.092, respectively). G3 (COR buccal and mesial) had the highest MGB (57.75 μm), statistically different from all other groups. G4 (DEOS buccal) (41.60 μm) was different from G6 (DEOS buccal and mesial) (44.21 μm) (p=0.023). For MGM, G0 (control) (53.96 μm) was different from G5 (DEOS mesial) (45.76 μm) and G6 (DEOS buccal and mesial) (48.56 vm) (p=0.013 and p=0.041, respectively) and G2 (COR mesial) (58.43 μm) was different from G5 (DEOS mesial) (45.76 μm) (p=0.016). Despite a statistically significant difference in certain groups for both techniques, COR and DEOS techniques are viable options for image editing during acquisition. Lithium disilicate crowns can be produced with satisfactory marginal gap values utilizing a chairside CAD/CAM system.

Full Digital Workflow for Aesthetic Rehabilitation of the Upper Teeth: A Case Report

The present case report presents a digital workflow for designing an aesthetic rehabilitation of the upper anterior teeth in an adult male. The patient suffered from a gummy smile resulting from an unfavorable ratio between upper lip length and gingiva/tooth display. In addition, the tooth shapes, color, and position were not accepted by the patient. The treatment planning included gingivectomy based on a digitally designed PMMA guide performed using a soft tissue SOGA laser (Shenzhen Soga Technology Co., Ltd., Shenzhen, China). The preparation was guided by the plastic guides for preparation control created digitally in Exocad software (Rijeka 3.1. Darmstadt, Germany) and printed in three-dimensional plastic. Next, both arches and maximum intercuspation were scanned. The milled lithium disilicate veneers were manufactured using CAD-computer-aided manufacturing (CAM) equipment. The restorations were cemented using a translucent light-cure resin cement (RelyX Universal, 3M ESPE, St. Paul, MN, USA). Next, occlusion adjustment and polishing were executed. Based on the present case report, it can be assumed that the application of digital techniques allows us to achieve an aesthetic and functional result with reduced work time and errors. Emphasizing the clinical impact, these methods enhance patient satisfaction and treatment accuracy in intricate aesthetic rehabilitations.

Fabrication of an Immediate Complete Denture with Digital Workflow: A Case Report

Fabrication of an Immediate Complete Denture with Digital Workflow: A Case Report

Efficient Digital Workflow to Replace a Missing Denture Tooth for Complete Denture Repair.

Debonded denture teeth is a common complication on a fixed or removable dental prosthesis when denture teeth are fabricated separately from the denture base and bonded together. Missing denture teeth can alter a person's appearance, speech, or ability to eat. Traditionally, denture teeth repair can be a challenge for clinicians or dental laboratory technicians to find the identical tooth mould to meet esthetic and functional demands. This case report describes a digital workflow to scan, design, and mill a well-fitting and esthetic denture tooth to expedite treatment, improve patient satisfaction, and increase troop readiness when traditional methods may not be feasible.

Implementation of anterior segment ophthalmic telemedicine.

The growing push to integrate telemedicine into ophthalmic practices requires physicians to have a thorough understanding of ophthalmic telemedicine's applications, limitations, and recent advances in order to provide well tolerated and appropriate clinical care. This review aims to provide an overview of recent advancements in the use of ophthalmic telemedicine for anterior segment eye examinations. Virtual care for anterior segment evaluation relies on appropriate technology, novel workflows, and appropriate clinical case selection. Recent advances, particularly in the wake of the COVID-19 pandemic, have highlighted the utility of home-based assessments for visual acuity, external evaluation, tonometry, and refraction. Additionally, innovative workflows incorporating office-based testing into virtual care, termed 'hybrid telemedicine', enable high-quality ophthalmic testing to inform clinical decision-making. Novel digital tools and workflows enable high-quality anterior segment evaluation and management for select ophthalmic concerns. This review highlights the clinical tools and workflows necessary to enable anterior segment telehealth.

A digital CAD/CAM configurator for the production of orthodontic appliances – Going new ways

Functional therapy in growing patients is a highly relevant area in orthodontics. With the increasing integration of computer-aided design and manufacturing technology (CAD/CAM) in orthodontics, we are witnessing significant advancements in the design of orthodontic appliances. Modern 3D printing technologies allow for the creation of complex, customized equipment in a cost-effective and time-efficient manner, using robust and durable resins. Additionally, the creative input of dental CAD design programs has led to the development of new designs.The aim of this report is to present a novel digital orthodontic prescription that aligns with the concept of a “full digital workflow”. This prescription utilizes a digital virtual configurator, enabling effective communication between the clinician, the technician and the patient.Using this prescription system, clinicians can easily configurate an orthodontic appliance before sending it to a dental technician for individualisation. 3D printing of the final design can then be performed directly within the dental office or by the technician. This approach allows the clinician to explore different orthodontic equipment options and modules, without the requirement for a demanding and sophisticated design process and without any knowledge of CAD. The availability of the present configurator might represent a fundamental advancement in the field of the CAD/CAM production of removable appliance linked to economic and ecological benefits.

Tooth autotransplantation with adjunctive application of enamel matrix derivatives using a digital workflow: A prospective case series

ObjectivesDigital protocols and bioactive materials may reduce complications and improve tooth autotransplantation (ATT) success and survival rates. This prospective study assesses the performance of a fully digital autotransplantation protocol of close-apex molars with the adjunctive application of Enamel Matrix Derivatives (EMD). MethodsTwelve adult patients with 13 hopeless molar teeth were replaced with autotransplantation of closed apex third molars. Outcomes, including success and survival rates, clinical, endodontic, radiographic, patient-reported outcome measures (PROMs), and digital image assessments, were conducted over a two-year follow-up period. ResultsSurvival and success rates were 100% and 91.2%, respectively, with no progressive inflammatory or replacement root resorption (ankylosis) except for one tooth presenting radiographic furcation involvement. A significant probing depth reduction of 2.4 ± 2.58 mm and CAL gains of 2.8 ± 3.03 mm were observed in transplanted teeth compared to the hopeless receptor teeth. Radiographic bone levels remained stable throughout the study period (-0.37 ± 0.66 mm), and digital image assessments showed minimal alveolar ridge width changes (-0.32 to -0.7 mm) and gingival margin changes (-0.95 to -1.27 mm) from baseline to last visit. PROMs indicated very high patient satisfaction. ConclusionThe use of a digital ATT protocol with adjunctive use of EMD in closed-apex third molars demonstrated promising short-term high success and survival rates. Additionally, this type of therapy adequately preserves the dimensions of the alveolar ridge in the receptor site. Clinical significanceThis is the first prospective clinical study examining the effect of a digital tooth autotransplantation protocol combined with the application of EMD. It demonstrates that this approach is an effective treatment for replacing hopeless teeth and also validates the digital assessment of ATT alveolar ridge preservation at the recipient site.