Fabrication Of Restorations Research Articles

A Combination of Internal and External Connection Screw-Retained Implant Restorations in Esthetic Zone Rehabilitation: A Case Report

This case report describes the rehabilitation of the Esthetic-Zone of the maxillary jaw of a 70-year-old female patient by using 4 implants (BEGO Semados® RS/RSX) with the challenging position of her implants due to her age and channel access of the Fixtures and also the Difficulty in supplying desired prosthetic parts due to existing problems. In the beginning, the treatment plan was to reconstruct the mouth using conventional restoration with UCLA abutments, but due to the unavailability of non-hex abutments As well as the failure to achieve the desired Esthetic demands of the patient by using this treatment plan, especially in the anterior implant area of the jaw, it Innovatively was decided to use a combination of cylindrical abutments (BEGO MultiPlus system) and UCLA abutments to Design and fabrication of the Final restoration.

The Effect of Preformed Anatomic Provisional Restorations on Peri-Implant Mucosal Dimensions with Immediate Tooth Replacement Therapy.

Immediate Tooth Replacement Therapy (ITRT) has become popular due to its ability to reduce treatment time and provide immediate esthetic results. However, long-term challenges, such as mid-facial recession and labial bone resorption, have been reported. Anatomic temporary cylinders (ATC), which allow for efficient fabrication of provisional transitional restorations in the esthetic zone, were designed to mimic the natural emergence profile and guide mucosal tissue healing. This study examines the effect of ATCs on the fabrication of provisional restorations compared to conventional non-anatomic temporary cylinders (CTCs) in terms of peri-implant mucosal preservation and stability in patients undergoing ITRT using the dual-zone grafting technique. Parameters evaluated were peri-implant mucosal tissue thickness (PIMTT), Pink Esthetic Score (PES), and radiographic outcomes, including labial plate dimension (LPD). The use of ATCs resulted in a statistically significant increase in PIMTT compared to CTCs, suggesting better preservation of peri-implant mucosal architecture. Additionally, the ATC group exhibited a positive change in LPD, although this difference was not clinically significant. The findings indicate that ATCs may offer advantages in maintaining peri-implant mucosal stability, contributing to the esthetic and functional outcomes of implant-supported restorations. Further long-term studies are needed to validate these preliminary results. The use of anatomic temporary cylinders (ATC) in immediate tooth replacement therapy (ITRT) demonstrated improved peri-implant mucosal tissue thickness, suggesting enhanced maintenance of peri-implant mucosal architecture. This can contribute to healthier and more esthetic outcomes while potentially reducing the risk of complications such as mid-facial recession.

Use of feldspathic ceramics in a digital protocol: A clinical case

When starting to work within a digital protocol, especially with the ability to implement restorations directly at the patient’s chairside, doctors face the challenge of selecting the appropriate material. The correct choice of block can help achieve a highly aesthetic and quality result in a short time. Modern CAD/CAM systems allow for the fabrication of a single restoration at the patient’s chairside in just 10 minutes, as demonstrated in this clinical case.

Evaluating Retention of Onlay Versus Complete Coverage Using E.Max-Restoration

This study compared the retention of different types of indirect restorations (only or full coverage) utilized on endodontically treated molars. Fourteen patients requiring restoration of endodontically treated molars were randomly allocated into two groups (n = 7) according to the type of restoration used. lithium disilicate ceramic crowns were given to the control group. While lithium disilicate ceramic onlays were given to the intervention group. The heat pressing technique was used for the fabrication of both restorations. Following the final cementation with adhesive resin cement, the restoration was assessed at three, six, twelve, and twenty-four months using the modified USPHS criteria. Statistical analysis was performed using the chi-square test. Results: At all intervals, there was no statistically significant difference in retention (P > 0.05) between the two tested groups. Both groups showed comparable results, with full coverage showing somewhat higher retention after 2 years. Regardless of the type of restoration, the emax-press produced high clinical performance in terms of retention. Compared to full coverage, onlay has proven to be a trustworthy substitute.

Achieving new excellence in an augmented reality dental education system

Background/purposeSimEx-Plus (EPED. Inc) was already a mature augmented reality (AR) dental training simulator that allowed students to have a high quality dental education practice. Now the EPCAD software has been further developed into a comprehensive computer-aided design software. It helps relevant professionals learn how to create digital fixed prosthesis in a virtual environment. This study used the newly developed EPCAD software that was integrated within the SimEx-Plus to design dental restorations then digital output milling restorations. We hope that the SimEx-Plus AR dental training simulator can achieve the multi-purpose function in one machine. Materials and methodsA right maxillary central incisor was prepared in the standard dental model. The restorations were designed by EPCAD software integrated with the SimEx-Plus and milled by a 4-axis dental milling machine (N4+, vhf camfacture AG). The internal gap of the restoration was evaluated. ResultsThe internal gaps of the crowns set on the right maxillary central incisor were among 68.27–89.80 μm. The different setting for digital output did not influence the internal gap (P 0.05, One-Way ANOVA). However, the internal gap on the palatal side was larger than that on the labial, mesial, distal, and incisal surfaces (P < 0.05, One-Way ANOVA). ConclusionThe new software EPCAD that was integrated within the SimEx-Plus AR dental training simulator could design restorations, and the designed restorations had good internal gap for clinical use. The professionals can learn tooth preparation and digital restoration fabrication by the SimEx-Plus AR dental training system.

Avenues and Future Prospects of 3D Bioprinting

3D bioprinting has opened numerous avenues in the medical field, particularly advancing biomedical techniques for administration of drugs, fabrication of prostheses, surgical operations and restoration of damaged body parts. In this review we discuss the principles of 3D bioprinting, its applications, advantages over traditional methods, recent advancements and the future prospects of automation within the field.. The review also delves into the creation of more physiologically relevant tissue models for drug screening and toxicity testing. Finally, we also explore more recent advancements showcasing the impact of printing in space, integration of artificial intelligence (AI), and development of 4D bioprinting. Expressing current limitations and challenges, the review underscores the potential of 3D bioprinting in personalized medicine.

Comparative Evaluation of Microhardness and Polymerization Shrinkage in Residual Zirconia Reinforced Provisional Restorations: An In Vitro Study.

Aim The aim of this study is to evaluate and compare the microhardness and polymerization shrinkage of polymethyl methacrylate reinforced with residual zirconia. Materials and methods A total of 360 resin samples were fabricated, with dimensions of 12 mm × 12 mm × 3 mm and 12 mm × 8 mm × 6 mm. Zirconia dust (40% by weight) was added to 180 of these samples. The study included four groups: Group A (autopolymerizing acrylic resin), Group H (heat-polymerizing acrylic resin), Group ZA (autopolymerizing acrylic resin with zirconia dust), and Group ZH (heat-polymerizing acrylic resin with zirconia dust). Each group consisted of 90 samples, with 45 samples used for evaluating microhardness and 45 samples for assessing polymerization shrinkage. Results Group ZH exhibited the highest microhardness at 6.06 ± 0.31 GPa. It also recorded the lowest shrinkage values, measuring 52.11 ± 3.21 mm³. Tukey's honestly significant difference test revealed that microhardness was significantly higher in Group ZA (4.53 ± 0.29 GPa) compared to Group A (3.51 ± 0.25 GPa). However, Group H (5.42 ± 0.26 GPa) demonstrated greater hardness than Group ZA. Regarding shrinkage, the addition of zirconia dust resulted in reduced values, with Group ZA (73.93 ± 3.55 mm³) showing less shrinkage compared to Group A (91.9 ± 6.38 mm³). Similarly, Group ZH (52.11 ± 3.21 mm³) had lower shrinkage than Group H (66.71 ± 5.97 mm³). Group A exhibited the highest shrinkage among all the groups. Conclusion Within the limitations of this study, it can be concluded that there is an increase in hardness and a decrease in shrinkage values of the resin with the addition of zirconia dust in heat and autopolymerizing acrylic resin used for the fabrication of provisional restorations. Zirconia-incorporated heat-activated resin showed superior microhardness and decreased shrinkage values. Although the addition of residual zirconia to autopolymerized samples demonstrated better hardness, it was observed that pure heat-polymerized samples showed greater hardness. Reusing computer-aided design and computer-aided manufacturing powder waste can cut down on economic losses and aid in environmental sustainability.

Color stability of precolored and extrinsically colored monolithic multilayered polychromatic zirconia: Effects of surface finishing and aging.

To explore the impact of zirconia types, coloring methods, and surface finishing on the color stability of monolithic multilayered polychromatic zirconia after artificial aging, including thermocycling and simulated toothbrushing. Eighty square-shaped zirconia samples were divided into 2 types (M3Y-TZP and M6Y-PSZ), further categorized based on coloring methods (precolored and extrinsically colored) and surface finishing techniques (mechanical polishing or glazing). The color stability was assessed using the CIEDE2000 formula. Artificial aging was simulated via thermocycling and toothbrushing. All samples were analyzed with a spectrophotometer to determine the post-aging color changes (ΔE00). The ΔE00 were interpreted and classified using the 50:50% perceptibility threshold (PT) and the 50:50% acceptability threshold (AT). Comparisons between groups for ΔE00 differences were performed using three-way ANOVA, with pairwise comparisons facilitated by Fisher's protected least significant difference test, α = 0.05. The study results indicated significant impacts of zirconia type, coloring method, and surface finishing on color stability. The M6Y groups experienced significantly greater color changes (6.61 ± 1.63) compared to the M3Y groups (3.40 ± 2.24), p < 0.0001. For both types of zirconia, extrinsically colored samples exhibited significantly higher ΔE00 when mechanically polished (p = 0.004). However, surface finishing had no significant effect on ΔE00 in precolored samples of either zirconia material (p = 1.000). The evaluation and categorization of ΔE00 variations indicated that nearly all color changes in the M6Y groups, regardless of being precolored, extrinsically colored, polished, or glazed, were deemed extremely unacceptable (Grade 1). In contrast, the M3Y groups showed more acceptable results, with the majority of color changes classified as moderately unacceptable (Grade 3). The color stability of multilayered polychromatic zirconia is influenced by the type of material, extrinsic coloring, and the chosen surface treatment post-artificial aging. The translucent 6Y-PSZ exhibited lower color stability, especially with only mechanical polishing. For the fabrication of M3Y-TZP and 6Y-PSZ monolithic multilayered polychromatic zirconia restorations, extrinsic coloring should be paired with glazing to maintain color stability. Conversely, in the absence of extrinsic coloring, both glazing and mechanical polishing are effective in preserving color stability.

Brittle-Ductile Threshold in Lithium Disilicate under Sharp Sliding Contact.

Computer-aided design (CAD)/computer-aided manufacturing (CAM) milling and handpiece grinding are critical procedures in the fabrication and adjustment of ceramic dental restorations. However, due to the formation of microfractures, these procedures are detrimental to the strength of ceramics. This study analyzes the damage associated with current brittle-regime grinding and presents a potential remedy in the application of a safer yet still efficient grinding regime known as "ductile-regime grinding." Disc-shaped specimens of a lithium disilicate glass-ceramic material (IPS e.max CAD) were obtained by cutting and crystallizing the lithium metasilicate CAD/CAM blanks (the so-called blue blocks) following the manufacturer's instructions. The discs were then polished to a 1 µm diamond suspension finish. Single-particle micro-scratch tests (n = 10) with a conical diamond indenter were conducted to reproduce basic modes of deformation and fracture. Key parameters such as coefficient of friction and penetration depth were recorded as a function of scratch load. Further, biaxial flexure strength tests (n = 6) were performed after applying various scratch loads to analyze their effects on ceramic strength. Scanning electron microscopy (SEM) and focused ion beam (FIB) were used to characterize surface and subsurface damage. Statistical analysis was performed using one-way analysis of variance and Tukey tests. While the SEM surface analysis of scratch tracks revealed the occurrence of both ductile and brittle removal modes, it failed to accurately determine the threshold load for the brittle-ductile transition. The threshold load for brittle-ductile transition was determined to be 70 mN based on FIB subsurface damage analyses in conjunction with strength degradation studies. Below 70 mN, the specimens exhibited neither strength degradation nor the formation of subsurface cracks. Determination of the brittle-ductile thresholds is significant because it sets a foundation for future research on the feasibility of implementing ductile-regime milling/grinding protocols for fabricating damage-free ceramic dental restorations.

Lithium Silicate-Based Glass Ceramics in Dentistry: A Narrative Review

Considering the rapid evolution of lithium silicate-based glass ceramics (LSCs) in dentistry, this review paper aims to present an updated overview of the recently introduced commercial novel LSCs. The clinical and in vitro English-language literature relating to the microstructure, manufacturing, strengthening, properties, surface treatments and clinical performance of LSC materials was obtained through an electronic search. Findings from relevant articles were extracted and summarised for this manuscript. There is considerable evidence supporting the mechanical and aesthetic competency of LSC variants, namely zirconia-reinforced lithium silicates and lithium–aluminium disilicates. Nonetheless, the literature assessing the biocompatibility and cytotoxicity of novel LSCs is scarce. An exploration of the chemical, mechanical and chemo-mechanical intaglio surface treatments—alternative to hydrofluoric acid etching—revealed promising adhesion performance for acid neutralisation and plasma treatment. The subtractive manufacturing methods of partially crystallised and fully crystallised LSC blocks and the additive manufacturing modalities pertaining to the fabrication of LSC dental restorations are addressed, wherein that challenges that could be encountered upon implementing novel additive manufacturing approaches using LSC print materials are highlighted. Furthermore, the short-term clinical performance of zirconia-reinforced lithium silicates and lithium–aluminium disilicates is demonstrated to be comparable to that of lithium disilicate ceramics and reveals promising potential for their long-term clinical performance.

A Newly Formulated Vinyl Polysiloxane Impression Material with Improved Mechanical Properties.

To evaluate the mechanical properties of a newly formulated vinyl polysiloxane (VPS) impression material. Experimental, Capture (S&C Polymer), Express, Imprint 3 and Imprint 4 (3M ESPE), Start VPS (Danville), Honigum (DMG), Virtual (Ivoclar Vivadent), Elite HD+ (Zhermack) were evaluated for tear strength, tensile strength, and elongation at break. Un-nicked specimens with a 90° angle on one side (type C) for tear strength were prepared and tested according to ASTM-D624. Dumbbell-shaped specimens (type 1) for tensile strength and elongation at break were prepared and tested according to ISO 37. All tests were carried out at 500 mm/min on a Shimadzu (AGS-X-10 KN-table top) tester. A one-way analysis of variance (ANOVA) was used to analyze the data. Experimental material showed significantly higher or higher tear strength and elongation at break compared to other impression materials for both light body (LB) and heavy body (HB). For tensile strength, Experimental is similar to most impression materials; however, significantly lower than Imprint 3 and Start VPS for LB. This parameter for HB is higher or significantly higher than other impression materials except Start VPS. Tear strength and tensile strength were not correlated for LB but have a weak or moderate correlation for HB. Elongation at break is inversely proportional to tensile strength moderately for LB; however, there is no or very weak relation for HB. Experimental VPS impression material demonstrated a significantly higher tear strength and adequate tensile strength with higher elongation compared to other commercially available VPS impression materials. Adequate mechanical properties can provide accurate impressions for successful clinical fabrication of restorations. Experimental VPS impression material is suitable for use in dental impressions for fabrication of restorations.

A data-driven approach for the partial reconstruction of individual human molar teeth using generative deep learning.

Due to the high prevalence of dental caries, fixed dental restorations are regularly required to restore compromised teeth or replace missing teeth while retaining function and aesthetic appearance. The fabrication of dental restorations, however, remains challenging due to the complexity of the human masticatory system as well as the unique morphology of each individual dentition. Adaptation and reworking are frequently required during the insertion of fixed dental prostheses (FDPs), which increase cost and treatment time. This article proposes a data-driven approach for the partial reconstruction of occlusal surfaces based on a data set that comprises 92 3D mesh files of full dental crown restorations. A Generative Adversarial Network (GAN) is considered for the given task in view of its ability to represent extensive data sets in an unsupervised manner with a wide variety of applications. Having demonstrated good capabilities in terms of image quality and training stability, StyleGAN-2 has been chosen as the main network for generating the occlusal surfaces. A 2D projection method is proposed in order to generate 2D representations of the provided 3D tooth data set for integration with the StyleGAN architecture. The reconstruction capabilities of the trained network are demonstrated by means of 4 common inlay types using a Bayesian Image Reconstruction method. This involves pre-processing the data in order to extract the necessary information of the tooth preparations required for the used method as well as the modification of the initial reconstruction loss. The reconstruction process yields satisfactory visual and quantitative results for all preparations with a root mean square error (RMSE) ranging from 0.02 mm to 0.18 mm. When compared against a clinical procedure for CAD inlay fabrication, the group of dentists preferred the GAN-based restorations for 3 of the total 4 inlay geometries. This article shows the effectiveness of the StyleGAN architecture with a downstream optimization process for the reconstruction of 4 different inlay geometries. The independence of the reconstruction process and the initial training of the GAN enables the application of the method for arbitrary inlay geometries without time-consuming retraining of the GAN.

An Update on the Use of Lasers in Prosthodontics.

Lasers are employed in all fields of modern dentistry nowadays, including both surgical and non-surgical dental procedures. Prosthodontics, a branch of dentistry, has also embraced lasers as an invaluable addition to conventional methodologies. This helps improve the standard of care for patients and dentists due to its precise excision, quick healing, and enhanced tissue response after surgeries. In prosthodontics, the most commonly used lasers are carbon dioxide, argon, and yttrium-aluminum-garnet (YAG) lasers. Many reviews have been published in the literature regarding the use of lasers in dentistry; however, reviews on the use of lasers in the field of prosthodontics are limited. This review aims to explain the diverse applications and advancements of lasers in prosthodontics. Furthermore, it will highlight the integration of lasers in diagnostic protocols, treatment modalities, and the fabrication of prosthetic restorations.

3D Printed Materials for Permanent Restorations in Indirect Restorative and Prosthetic Dentistry: A Critical Review of the Literature.

The objective of this study was to review the scientific evidence currently available on 3D printable materials and 3D printing technologies used for the fabrication of permanent restorations, focusing on material properties that are clinically relevant. A literature search was performed on four databases (MEDLINE/PubMed, Scopus, Cochrane Library, Web of Science) for articles published from January 2013 until November 2023, using a combination of free words: (restorative dentistry OR prosthetic dentistry) AND (3D printing OR additive manufacturing OR rapid prototyping) AND materials. Two reviewers screened titles and/or abstracts of 2.468 unique studies. In total, 83 studies were selected for full-text reading, from which 36 were included in the review. The assessed variables were mechanical properties, reporting in most of the cases positive results, dimensional accuracy and fit, reporting conflicting results with a predominance of positive, aesthetic properties, with positive reports but scarcely addressed, and biological properties, almost unexplored in independent studies. Despite numerous studies with positive results in favor, papers with negative outcomes were also retrieved. Aesthetic and biological properties are conversely still mostly unexplored. There remains a lack of conclusive evidence for viable 3D printable restorative and prosthodontic materials for permanent restorations. Research should be strengthened by defining international standards for laboratory testing and, where pre-clinical data are promising, conducting clinical trials.

CAD - CAM in Pediatric Dentistry: A brief insight

On introduction of computer aided technology/computer aided manufacturing in pediatric dentistry, treating children has become effortless, mainly children with special health-care needs. This technology aims at the fabrication of restorations with higher strength and better aesthetics by an effortless, quicker and more precise operational process. This technology has proved to be a boon in various fields in pediatric dentistry. The latest trend of minimally invasive dentistry, relies on selective caries removal and restoring it with material which is highly adhesive and aesthetic. CAD-CAM makes use of an optical impression of the required area and occlusion which is taken using hassle-free intra-oral scanners. Machinable high strength composite/ceramic blocks are used which can be polymerized under pressure and temperature. The CAD-CAM technology has its advantage of needing less chair side time, brisk production of restorations with increased precision, eliminating the need for classic methods of impression, high strength and aesthetic restorations and prostheses. CAD-CAM technology can be used for smile designing in patients with developmental defects like Amylogenesis Imperfect, Molar-Incisor Hypo mineralization, etc., prosthetic rehabilitation in patients’ requiring stainless steel crowns and zirconia crowns, restorative procedures like inlays and onlays, naso-alveolar molding etc. Thus, it opens up a sea of possibilities for providing a high quality of treatment for the child with minimal hassle and maximal benefits to the child. Bangladesh Journal of Medical Science Vol.23 (Special Issue) 2024 p.S38-S42

Use of Ultra-Translucent Monolithic Zirconia as Esthetic Dental Restorative Material: A Narrative Review

It has been observed in recent years that zirconia (Zr) is being increasingly used for a wide range of clinical applications. There are several reasons for this, but the most significant one is its excellent mechanical properties, specifically its transformation toughening properties compared to other dental ceramics and its improved natural appearance when compared to ceramometal restorations. As a result of the advancement of chairside milling and developments in rapid-sintering technology, the fabrication of dental restorations has become more computerized, time-saving, and accurate over the past few decades. However, a main disadvantage of conventional Zr restorations is that they lack the translucency of glass–ceramics, although they are extremely strong. Recently, by increasing the yttrium %, changing the grain size, and reducing the impurities, the ultra-translucent monolithic zirconia “5-mol%-yttria-stabilized tetragonal zirconia polycrystals” has been introduced, with successful attempts to make translucent Zr an aesthetically attractive option for minimally invasive veneer restorations. It is important to note that veneer restorations do not possess the mechanical retentive features of the tooth preparations and rely primarily on bonding to resin cement. This presents a great challenge for the inert Zr since it does not bond chemically with resin cement, unlike glass–ceramic materials that establish chemical adhesion with resin cement, favoring their use for indirect veneer restorations. Taking this into account, this article aims to review the progressive development of ultra-translucent monolithic Zr materials as they are available today and, in the future, represents a concerted drive toward maximum translucency and strength, which renders them a viable treatment option for esthetic veneer restorations.

Materials and Methods for All-Ceramic Dental Restorations Using Computer-Aided Design (CAD) and Computer-Aided Manufacturing (CAM) Technologies-A Brief Review.

The materials used in dentistry for the fabrication of all-ceramic restorations have undergone great and rapid developments over the last two decades. Among the most common ceramic materials in dentistry are those based on zirconium and lithium disilicate. Due to the properties of these materials, they are in great demand in the field of dental restoration production. Thus, dental restorations that will use those materials are commonly machined in CAD/CAM systems, which offer the possibility of manufacturing all-ceramic dental restorations in a very short period of time. This article reviews the modern materials in the field of all-ceramic dental restorations, their manufacturing processes, as well as what determines which ceramic materials are used for the production of CAD/CAM blanks and their production technology.

Accuracy of Dental Restorations Fabricated Using Milling vs 3D-Printed Molds: A Pilot Study.

To compare the accuracy of 12 different dental restorations fabricated with milling or 3D-printed molds and robotically controlled casting. Twelve dental restorations (11 inlays and onlays and 1 crown) were made per restoration type, one per each of the 12 different teeth models (total of 24 restorations). On each tooth preparation, two restorations were manufactured using different CAD/ CAM techniques: (1) milling and (2) robotically controlled casting and 3D-printed molds. In addition, twolayer restorations were manufactured with 3D-printed molds. The marginal and internal gaps were evaluated at 120 points per restoration based on micro-CT 3D imaging. Internal gaps were evaluated using a replica technique with silicone. Median values (interquartile ranges) for marginal gaps, middle internal gaps, and central internal gaps were significantly lower for 3D-printed mold restorations (44.3 [65.4] μm, 95.4 [96.2] μm, and 104.6 [78.1] μm) compared to milled restorations (58.4 [93] μm, 145.9 [85.8] μm, and 138.6 [65.7] μm). Internal gaps in the 3D-printed mold group were 6% to 51% smaller than in the milled group. The accuracy of restorations fabricated with 3D-printed molds may be preferable compared to milled restorations, except in the case of crown restoration. However, additional studies with a larger number of samples and different types of restorations are needed to confirm the results.

Influence of the Manufacturing Trinomial (Technology, Printer, and Material) on the Marginal and Internal Discrepancies of Printed Metal Frameworks for the Fabrication of Tooth-Supported Prostheses: A Systematic Review and Meta-analysis.

The purpose of this systematic review and meta-analysis was to compare the influence of fabrication method (conventional, subtractive, and additive procedures) and manufacturing trinomial (technology, printer, and material combination) on the marginal and internal fit of cobaltchromium (Co-Cr) tooth-supported frameworks. An electronic systematic review was performed in five data bases: MEDLINE/PubMed, Embase, World of Science, Cochrane, and Scopus. Studies that reported the marginal and internal discrepancies of tooth-supported Co-Cr additive manufacturing (AM) frameworks were included. Two authors independently completed the quality assessment of the studies by applying the Joanna Briggs Institute Critical Appraisal Checklist for Quasi-Experimental Studies. A third examiner was consulted to resolve lack of consensus. A total of 31 articles were included and classified based on the evaluation method: manufacturing accuracy, the dual- or triple-scan method, stereomicroscope, optical coordinate measurement machine, microCT, profilometer, and silicone replica. Six subgroups were created: 3D Systems, Bego, Concept Laser, EOS, Kulzer, and Sisma. Due to the heterogeneity and limited data available, only the silicone replica group was considered for meta-analysis. The metaanalysis showed a mean marginal discrepancy of 91.09 μm (I2 = 95%, P < .001) in the conventional group, 77.48 μm (I2 = 99%, P < .001) in the milling group, and 82.92 μm (I2 = 98%, P < .001) in the printing group. Additionally, a mean internal discrepancy of 111.29 μm (I2 = 94%, P < .001) was obtained in the conventional casting group, 121.96 μm (I2 = 100%, P < .001) in the milling group, and 121.25 μm (I2 = 99%, P < .001) in the printing group. Manufacturing method and selective laser melting (SLM) metal manufacturing trinomial did not impact the marginal and internal discrepancies of Co-Cr frameworks for the fabrication of tooth-supported restorations.

Timing implant provisionalization: Decision-making and systematic workflow.

Provisionalization is an important step to achieve esthetic results in implant cases, and many different techniques for provisional restoration fabrication have been described. However, depending on the clinical scenario, the provisionalization strategy will require different approaches and timing. The clinician should modify the provisional restorations efficiently to reduce the number of disconnections from the implant, as repeated disconnections may have biological consequences. This article aims to schematize different scenarios requiring implant provisionalization and propose strategies to help the clinician condition the peri-implant tissues, respecting perio-prosthodontic fundamentals for soft tissue, biological, and esthetic stability. The clinical outcomes of modern implant therapy aim to achieve results that emulate natural dentition. Different scenarios may require adjunct therapy, including hard- and soft-tissue grafting, which complicates treatment. The provisionalization strategy will vary depending on the initial condition of the tissues, the need for reconstructive procedures, and the timing of implant placement. Selecting the right strategy based on the case type is necessary to reduce treatment time and complications associated with inadequate prosthetic handling of the soft tissues. Proper emergence profile conditioning through provisional restorations will allow for biologically sound and esthetically pleasing outcomes in implant restorations.