Edentulous Cases Research Articles

3D evaluation of sagittal inclination of the maxillary dentition in relation to facial landmarks: A cohort study.

The determination of the maxillary occlusal plane presents a significant clinical challenge in the treatment of edentulous patients as well as it is critical for complex full-mouth reconstructions in dentate patients, including those with implant-supported rehabilitations. While the use of a Fox plane plate is standard in edentulous cases, its application in dentate patients lacks thorough documentation in existing literature. This clinical study assessed the sagittal position of the maxillary dentition in relation to facial landmarks using a digital three-dimensional analysis and evaluated the suitability and reliability of applying a simulated Fox plane plate, also known as an occlusal plane guide, in dentate patients. Eighty-one subjects were recruited at the Department of Prosthetic Dentistry of Goethe University Frankfurt, Germany, according to specific inclusion criteria. Intraoral and facial scans were obtained and analyzed using GOM Inspect Pro software (GOM, Braunschweig, Germany). The angles between the maxillary occlusal plane and three variations each of Camper's plane and ala-tragus line, relating to superior, middle, and inferior tragus points, were measured. These modified planes were then compared to a plane established by a simulated digital Fox plane plate, which was adapted to the maxillary anterior teeth and the lowest point of the posterior teeth in both quadrants. A total of 81 subjects (58 female and 23 male) with a mean age of 23.9 years were evaluated in this study. No significant angular difference was found between the angles of the maxillary occlusal plane compared with superior Camper's plane, middle Camper's plane, or superior ala-tragus line (p >0.05). The smallest angle occurred between superior Camper's plane and the maxillary occlusal plane on both the right (3.443°) and left (3.535°) sides. The application of a Fox plane plate resulted in two different occlusal planes in 70% of patients, significantly deviating from the digitally determined plane (p <0.05). Superior and middle Camper's planes, along with superior ala-tragus line, can be considered approximately parallel reference planes and are suitable for routine determining of the maxillary occlusal plane in restorative treatments. However, in contrast to digital evaluation methods, the application of a Fox plane plate in dentate patients showed high variability, indicating its low reproducibility due to its ambiguous positioning on the maxillary dentition. Clinical trial registration site: https://drks.de/search/de/trial/DRKS00030166.

A Semi-Supervised Transformer-Based Deep Learning Framework for Automated Tooth Segmentation and Identification on Panoramic Radiographs.

Automated tooth segmentation and identification on dental radiographs are crucial steps in establishing digital dental workflows. While deep learning networks have been developed for these tasks, their performance has been inferior in partially edentulous individuals. This study proposes a novel semi-supervised Transformer-based framework (SemiTNet), specifically designed to improve tooth segmentation and identification performance on panoramic radiographs, particularly in partially edentulous cases, and establish an open-source dataset to serve as a unified benchmark. A total of 16,317 panoramic radiographs (1589 labeled and 14,728 unlabeled images) were collected from various datasets to create a large-scale dataset (TSI15k). The labeled images were divided into training and test sets at a 7:1 ratio, while the unlabeled images were used for semi-supervised learning. The SemiTNet was developed using a semi-supervised learning method with a label-guided teacher-student knowledge distillation strategy, incorporating a Transformer-based architecture. The performance of SemiTNet was evaluated on the test set using the intersection over union (IoU), Dice coefficient, precision, recall, and F1 score, and compared with five state-of-the-art networks. Paired t-tests were performed to compare the evaluation metrics between SemiTNet and the other networks. SemiTNet outperformed other networks, achieving the highest accuracy for tooth segmentation and identification, while requiring minimal model size. SemiTNet's performance was near-perfect for fully dentate individuals (all metrics over 99.69%) and excellent for partially edentulous individuals (all metrics over 93%). In edentulous cases, SemiTNet obtained statistically significantly higher tooth identification performance than all other networks. The proposed SemiTNet outperformed previous high-complexity, state-of-the-art networks, particularly in partially edentulous cases. The established open-source TSI15k dataset could serve as a unified benchmark for future studies.

Estimation of human age using machine learning on panoramic radiographs for Brazilian patients

This paper addresses a relevant problem in Forensic Sciences by integrating radiological techniques with advanced machine learning methodologies to create a non-invasive, efficient, and less examiner-dependent approach to age estimation. Our study includes a new dataset of 12,827 dental panoramic X-ray images representing the Brazilian population, covering an age range from 2.25 to 96.50 years. To analyze these exams, we employed a model adapted from InceptionV4, enhanced with data augmentation techniques. The proposed approach achieved robust and reliable results, with a Test Mean Absolute Error of 3.1 years and an R-squared value of 95.5%. Professional radiologists have validated that our model focuses on critical features for age assessment used in odontology, such as pulp chamber dimensions and stages of permanent teeth calcification. Importantly, the model also relies on anatomical information from the mandible, maxillary sinus, and vertebrae, which enables it to perform well even in edentulous cases. This study demonstrates the significant potential of machine learning to revolutionize age estimation in Forensic Science, offering a more accurate, efficient, and universally applicable solution.

Evaluation of Periodontal Health of The Abutment Teeth in Partial Dentures Made of Injection Molded PEEK Framework Versus Cobalt Chromium Framework in Mandibular Kennedy Class I Free End Saddle Edentulous Cases: A Randomized Clinical Trial

Evaluation of Periodontal Health of The Abutment Teeth in Partial Dentures Made of Injection Molded PEEK Framework Versus Cobalt Chromium Framework in Mandibular Kennedy Class I Free End Saddle Edentulous Cases: A Randomized Clinical Trial

Treatment of partial mandibular edentious patients using a partially removable prostheses with extracoronal attachments

The management of uni- or bi-terminal edentulous cases in patients who cannot undergo implant-prosthetic treatment is complex and challenging, often requiring a multidisciplinary approach. Correct diagnosis, paraclinical investigations (retroalveolar radiographs, CBCT, blood tests), and a well-elaborated treatment protocol are usually necessary to achieve a predictable and successful outcome. The objective of complete rehabilitation of an arch includes identifying the cause, preventing, and conserving the remaining dental structure. This case study presents an interdisciplinary endo-prosthetic management through endodontic retreatment followed by the realization of a removable prosthesis restoration with extracoronal attachments. The prosthetic restoration yielded excellent functional and aesthetic results. Background. Oral rehabilitation of patients who cannot benefit from implant-prosthetic treatment. Case report. Restoration of the mandible using removable prostheses with extracoronal attachments. Conclusions. Removable prosthetic restorations remain a treatment solution in the era of implant prosthetics.

Long-Term Clinical Outcomes of 3D-Printed Subperiosteal Titanium Implants: A 6-Year Follow-Up.

As an alternative to regenerative therapies, numerous authors have recently proposed bringing back subperiosteal implants. The aim of the study was to present our clinical experience with a subperiosteal jaw implant that needs minimal bone preparation and enables the rapid implantation of prosthetic teeth in edentulous, atrophic alveolar bone. The research included 36 complete or partial edentulous patients (61 subperiostal implants) over a period of 6 years. To create the patient-specific subperiostal implants design, DentalCAD 3.0 Galway software (exocad GmbH, Darmstadt, Germany) was used and fabricated with a Mysint 100 (Sisma S.p.A., Piovene Rocchette, Italy) by titanium alloy powder. The results showed that only 9 of the 36 cases were successful at 6-year follow-up, while 27 cases had complications, including exposure of the metal frame (early or delayed), mobility of the device prior to the first 4-6 months, and late mobility due to recurrent infections and progressive structure exposure; 1 case failed for reasons unrelated to the device. This study indicated that the prudent application of fully customized subperiosteal jaw implants is a dependable alternative for the dental rehabilitation of atrophic edentulous cases that necessitate bone grafts for traditional fixed dental implant solutions.

Full Arch Implant-Prosthetic Rehabilitation in Patients with Cardiovascular Diseases: A 7-Year Follow-Up Prospective Single Cohort Study.

Aim: The rising average age increases edentulous cases, demanding more implant-prosthetic rehabilitation, with cardiovascular diseases being significant factors. This study compared healthy patients (CG = Control Group) and those with cardiovascular disease (TG = Test Group) for implant survival, Marginal Bone Loss (MBL), peri-implant tissue level parameters as Periodontal Screening and Recording (PSR), Plaque Index (PI), Bleeding on Probing (BoP) Peri-implant Probing Depth (PPD), and surgical complications. Smoking impact on both groups and medication influence in the TG were secondary outcomes. Patients underwent full-arch implant prosthetic rehabilitation. Methods: Implant survival rate, MBL, and surgical complications were recorded during the monitoring period (7 years), while peri-implant parameters were assessed at the end of the observational time. A total of 26 and 28 CG and TG patients were recruited, respectively. Results: A total of 128 implants were placed in CG, while 142 in the TG. Implant survival and MBL showed no significant differences (p > 0.05). Nevertheless, peri-implant parameters were more unfavorable in TG. The only significant surgical complication was higher bleeding rates in the TG (p < 0.05). Conclusions: Cardiovascular patients showed similar implant survival and MBL but had adverse peri-implant parameters and increased bleeding rates. Higher smoking levels may relate to unfavorable implant outcomes. Further investigation is needed on drug impact with larger samples.

MANAGEMENT OF REMOVABLE DENTURES WITH FEW REMAINING TEETH

Tooth loss is the most common cause of decreased masticatory function. Losing teeth can also affect the oral cavity and general health, affecting a person's overall quality of life. Various things can cause tooth loss. The most common cause of tooth loss is poor oral health, especially caries and periodontal disease. Dentures can be made for patients who have lost all their teeth or have some remaining teeth. Retaining the remaining natural teeth can inhibit the alveolar bone resorption process and maintain bone height, thereby increasing the retention and stability of the denture. A 60-year-old female patient complained that many teeth were missing due to upper and lower jaw extraction, making it uncomfortable when eating and talking. The upper jaw has teeth 11, 21, 22, and 23 remaining, and the lower jaw still has 43 remain. The patient will have a removable denture with teeth 11, 23, and 43 as supporting teeth. The presence of a tooth can prevent alveolar bone resorption, especially if there is an occlusion load directly on the alveolar bone in edentulous cases. Natural teeth as supports can slow alveolar bone resorption and maintain retention and stabilization of dentures.

Palatal vault configuration and its influence on intraoral scan time and accuracy in completely edentulous arches: a prospective clinical study.

The aim of this prospective clinical study was to compare the influence of palatal vault forms on accuracy and speed of intraoral (IO) scans in completely edentulous cases. Based on the palatal vault form, participants were divided into three equal groups (n = 10 each); Class I: moderate; Class II: deep; Class III: flat palatal vault. A reference model was created for each patient using polyvinylsiloxane impression material. The poured models were digitized using an extraoral scanner. The resultant data were imported as a solid CAD file into 3D analysis software (GOM Inspect 2018; Gom GmbH, Braunschweig, Germany) and aligned using the software's coordinate system to determine its X, Y, and Z axes. Five digital impressions (DIs) of maxilla were captured for each patient using an intraoral scanner (TRIOS; 3Shape A/S, Copenhagen, Denmark) and the resultant Standard Tessellation Language (STL) scan files served as test models. Trueness was evaluated by calculating arithmetic mean deviation (AMD) of the vault area between reference and test files while precision was evaluated by calculating AMD between captured scans to measure repeatability of scan acquisition. The scan time taken for each participant was also recorded. There was no significant difference in trueness and precision among the groups (P = .806 and .950, respectively). Average scan time for Class I and III palatal vaults was 1 min 13 seconds and 1 min 37 seconds, respectively, while class II deep palatal vaults showed the highest scan time of 5 mins. Palatal vault form in edentulous cases has an influence on scan time. However, it does not have a substantial impact on the accuracy of the acquired scans.

Rehabilitation of edentulous patient using endosteal and subperiosteal implants: A case report

&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Introduction: Endosteal implants may be insufficient in treating complete edentulism in severe bone loss, such as advanced bone resorption, trauma, infection, intraoral pathologies, and traumatic tooth extractions. With the developing technology, in cases where bone quality and quantity are inadequate, treatment with custom-made subperiosteal implants also emerges as an alternative.&#x0D; Case: This case report examined the procedural steps and the six-month post-operative period while evaluating our edentulous patient who rehabilitated using endosteal and custom-made sub-periosteal implants.&#x0D; Results: No resorption or mobility of the implants was detected in the 6th-month post-operative control of our complete edentulous case, which was rehabilitated using traditionally used intra-bone implants in the maxilla and subperiosteal implants in the mandible.&#x0D; Conclusion: One of the essential advantages of the subperiosteal implant system is that it provides fixed prosthetic treatment, especially in jaws with advanced bone atrophy. Correct case selection and appropriate surgical and prosthetic treatment will increase success.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

Effect of the level of alveolar atrophy on implant placement accuracy in guided surgery for full-arch restorations supported by four implants: an in vitro study

BackgroundA fixed screw-retained full-arch restoration supported by four implants is a popular treatment option for edentulous arches. Optimal alignment of implants is quite challenging in extremely atrophied edentulous cases, and a small amount of deviation is expected during guided surgery. This study aimed to compare implant accuracy among edentulous jaws with various levels of atrophy.MethodsFive separate copies of each Cawood and Howell model (III–V) were produced for the maxilla and mandible. A total of 120 implants (30 models). The implant accuracy was assessed based on angular deviations at the base (angle, 3D offset, distal, vestibular, and apical) and tip (3D offset, distal, vestibular, and apical).ResultsThe atrophy level of the jaws had a statistically significant effect on deviation; implants showed greater deviation from the planned location as the atrophy level increased.ConclusionGiven that implant deviation increased with the degree of atrophy, a greater safety margin from important anatomical structures is recommended when planning implant location for guided surgery in Cawood and Howell V cases.

Digital fabrication of stackable implant surgical guide for immediate loading in completely edentulous full-arch cases: a dental technique.

The designing and fabrication of a stackable surgical guide for implant placement with immediate prosthetic loading of completely edentulous cases is described in this dental technique. To achieve this, the stackable attachment is designed using free-form designing software, which is later joined to the implant placement guide and the dental prosthesis. This technique should provide the patient with a same-day implant and an esthetic restoration accurately placed in the predesigned position of the centric occluding relationship. It also reduces the number of visits and prosthetic complications related to the improper implant position.

EPA Consensus Project Paper: Accuracy of Photogrammetry Devices, Intraoral Scanners, and Conventional Techniques for the Full-Arch Implant Impressions: A Systematic Review.

The objective of this systematic review was to evaluate and compare the accuracy of digital impression techniques and conventional methods for full-arch implant impressions. An electronic literature search in the databases Medline (Pubmed), Web of Science, and Embase was performed to identify in vitro and in vivo publications (between 2016 and 2022) directly comparing digital and conventional abutment-level impression techniques. All selected articles passed through the data extraction procedure according to defined parameters in inclusion and exclusion criteria. Measurements on linear, angular and/or surface deviations were performed in all selected articles. Nine studies met the inclusion criteria and were selected for this systematic review. 3 articles were clinical studies and 6 studies were in vitro. Accuracy difference mean values of the trueness up to 162+/-77μm between digital and conventional techniques were reported in the clinical studies and up to 43μm in laboratory studies. Methodological heterogeneity was observed in both, in vivo and in vitro studies. Intraoral scanning and photogrammetric method showed comparable accuracy for registering implant positions in the full-arch edentulous cases. A tolerable implant prosthesis misfit threshold and objective misfit assessment criteria (for linear and angular deviations) should be verified in clinical studies.

CBCT Analysis of Edentulous Mandibular Symphysis in Iraqi Patients for Treatment with Implant-Supported Overdentures. Cross-Sectional Single-Center Study.

Overdentures supported by dental implants are a useful treatment strategy for patients with edentulous mandibles. The aim of this study was to evaluate certain characteristics of the mandibular symphyseal edentulous cases for dental implant treatment using CBCT; and if it is associated with gender differences. Ninety patients (45 females and 45 males) were included in this investigation. A section along the midline of each CBCT image was chosen for the edentulous symphyseal area. Symphysis height, width, and cortical thickness was measured for each patient. Bone density were calculated at four points A two-sample Student's t-test and Pearson correlation were used for statistical analysis. Males had a considerably greater symphysis height (26.66±6.21 mm) than females (24.07±5.00 mm) (p = 0.02). Similar results were found for bone width; males had greater means than females. In case of cortical bone thickness; males had thicker bone cortex in the buccal region than females (p = 0.01). While the difference in bone density between genders was small. However, a positive relationship was recorded between symphysis height and width. Height and width of the mandibular symphysis were influenced by gender in edentulous patients, with men showing higher measurements. The reduction of symphyseal height decreased concurrently with the width after teeth were lost, while bone density was maintained in both genders with no difference between them. The lingual cortical bone is significantly thicker than the buccal cortex at the lower part of the symphysis.

Accuracy of Conventional and Digital Workflows in Partially Edentulous Cases Restored with FPDs over Implants. A Systematic Review.

To compare conventional and digital workflows in terms of accuracy in partially edentulous cases restored with implant-supported restorations. An electronic search in the databases PubMed, Scopus, Web Of Science, and CENTRAL was conducted to identify relevant publications, comparing digital and conventional workflows in partially edentulous cases restored with implant-supported prostheses. 18 articles were included in the systematic review. Ten of the studies were in-vitro, and eight were clinical. Sample sizes varied considerably from 20 to 100. In three studies, three implants were investigated, whereas, in all other instances, accuracy was evaluated on two implants. Substantial heterogeneity in the methodology of the selected studies is evident, which prevents summarising the accuracy outcomes. Digital impressions showed similar results in terms of accuracy compared to the conventional approach. There is a lack of uniform criteria for the tolerable misfit, which hampers the ability to transfer in-vitro results to clinical situations. A need for a standardised approach in the evaluation of impression and workflow accuracy is warranted to enable the systematisation and analysis of results from different studies.

Tongue training technique for guiding the mandible in establishing horizontal jaw relation in edentulous patients.

Edentulous patients have poor neuromuscular proprioception to guide the mandible to the desirable horizontal relation. Horizontal jaw relation is a complex relationship in which variation may occur in vertical, anteroposterior and mediolateral directions. The aim of this study was to train the tongue and bring the mandible to centric relation in geriatric edentulous cases. Protrude the tongue to the maximum length and retract back to centric relation, move the tongue on the left side beyond the angle of the mouth and bringing back to centric relation, move the tongue on the right and left side beyond the angle of the mouth and bringing back to centric relation, then the tongue should move upwards and touches the marginal tubercle of upper lip and bringing back to centric relation and move the tongue upward and posteriorly to touch the posterior part of the hard palate of the maxilla and swallowing. Edentulous patient can successfully move the mandible in centric relation after training the tongue. The present technique is useful for establishment of horizontal jaw relation in edentulous cases using tongue training exercise in Prosthodontic dentistry.

Altered cast impression technique in the fabrication of metal frame partial dentures with distal extension: A case report

Metal frame denture is a more ideal treatment than the conventional acrylic denture for its narrower, thinner, rigid, and harder material, so that the design can be made ideally. The aim of this case report is to demonstrate the treat-ment of an edentulous case using altered cast technique to improve support for a partial denture with distal exten-tension. A 48-year-old female patient came to the Halima Dg.Sikati Makassar with complaints of chewing difficulty and lacking of confidence due to the loss of all her maxillary teeth and part of her mandibular teeth. The patient had never worn any denture and had no history of systemic disease. The patient wanted to have a denture made to resto-re the appearance and mastication. Then a panoramic x-ray was performed on the patient. Radiological images ap-pear to be missing all teeth in the maxilla, available teeth: 33, 32, 31, 41, 42 and 43, no impacted teeth, no foreign bodies, no inflammation or neoplastic tissue, good bone density, residual the roots of teeth 15 and 28. The pre-pros-thetic treatment plan was carried out by scaling and extracting the remaining roots on teeth 15 and 28. The prostho-thodontic treatment plan was the manufacture of partial metal frame dentures using the altered case molding techni-que. Altered cast is a molding technique used in the saddle free end of removable partial dentures. This impression technique can produce master case with maximum tissue support, within the limits of physiological tolerance and can accurately record the relationship between the tooth and the residual ridge. It is concluded that metal frame par-tial denture with Alter cast impression technique provides better and stable denture.

Navigating the clinical ambiguity of implant placement in two young pubescent patients: an insight from two case reports

The horizon of implant dentistry has been ever-expanding owing to its long-term success in rehabilitating partially or completely edentulous cases. This perennial success and efficiency have encouraged clinicians to use osseo-integrated implants to replace teeth lost in children either due to trauma or congenital absence. Although a myriad of studies and publications suggest the placement of implants only after the attainment of skeletal maturity, as the growth-related changes such as remodelling, displacement, and mesial drift can put the future of implant and restoration in jeopardy, the use of implants in young pubescent or adolescent looks promising due to its evident psychological and social advantages over other contemporary alternatives such as a removable prosthesis or resin-bonded bridge. The first case report highlights a 16-year follow-up of a young girl treated at the age of 10 with an implant-supported prosthesis for the replacement of a missing maxillary left central incisor. The second case report centers around a 19-year-old teenage girl who underwent rehabilitation with a permanent fixed prosthesis, replacing her previous implant-supported temporary prosthesis. The implant was initially placed when she was 10 years old.

A simplified clinical approach towards renovated esthetics using flangless denture: A case report

In edentulous patient, restoring labial fullness is a delicate technique. To achieve our clinical aim, proper communication between the dentist and the laboratory technician is required. In some completely edentulous cases, the prominent enlarged labial flange of a complete denture contributes to poor facial aesthetics. To solve this problem, the complete denture was adjusted and a gum-fit or flangless denture was prescribed. This case reports presents a simple, cost-effective, conservative and non-surgical option for fabricating dentures in a patient with a large maxillary ridge in order to improve the patient's facial aesthetics.

Comparative analysis of weld strength of nickel-chromium and cobalt-chromium base metal alloys when submitted to tungsten inert gas welding.

Long span base metal alloy fixed prosthesis and partial dental prosthesis frameworks most often require welding for better fit and adaptation. The type of metal alloys used and its effect on the weld strength of the prosthesis have to be investigated. The aim of the study is to comparatively analyze the weld strength of nickel-chromium (Ni-Cr) and cobalt-chromium (Co-Cr) base metal alloys when subjected to tungsten inert gas (TIG) welding. 10 nickel- and cobalt-based specimens were obtained by casting of castable resin patterns of dimension 25 mm × 3 mm × 1 mm. Welding of the samples was carried out using the Lampert PuK 2 welding equipment, and a three-point bend test using a universal testing machine was carried out to evaluate the weld strength of the specimens. Statistical analysis was carried out using the SPSS software version 23. Higher weld strength was observed in the Co-Cr alloy (mean = 898 MPa) than in the Ni-Cr alloy (mean = 690 MPa), when submitted to TIG welding (P < 0.05). TIG welding could be a better alternative for joining base metal alloys for long span edentulous cases, and cobalt-based alloys could be better alternatives to nickel-based alloys that usually tend to cause hypersensitivity reactions.