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Item Accuracy of digital duplication scanning methods for complete dentures(Wiley, 2023) Alehaideb, Abdullah; Lin, Wei-Shao; Levon, John A.; Chu, Tien-Min G.; Yang, Chao-Chieh; Prosthodontics, School of DentistryPurpose To compare the accuracy of four digital scanning methods in duplicating a complete denture. Material and Methods Four scanning methods were used: cone beam computed tomography (CBCT), Straumann desktop scanner (DS), Trios intraoral scanner (TIO), and Virtuo Vivo intraoral scanner (VVIO). Each method was used to duplicate all the surfaces of a printed complete denture. The denture was scanned 10 times in each group. The trueness (in root mean square, RMS) and precision (in standard deviation, SD) were calculated by comparing the combined dentition, denture extension, and intaglio surfaces with the reference file. One-way analysis of variance and F-tests were used to test statistical differences (α = 0.05). Results For the scanning accuracy of the whole denture, CBCT showed the highest RMS (0.249 ± 0.020 mm) and lowest trueness than DS (0.124 ± 0.014 mm p < 0.001), TIO (0.131 ± 0.006 mm p < 0.001), and VVIO (0.227 ± 0.020 mm p = 0.017), while DS and TIO showed smaller RMS than VVIO (p < 0.001). For the trueness of dentition, denture extension, and intaglio surfaces, CBCT also showed the highest mean RMS and lowest trueness among all groups (p < 0.001). DS and TIO had smaller mean RMS and higher trueness among all groups in all surfaces (p < 0.001, except VVIO in intaglio surface, p > 0.05). TIO had significantly lower within-group variability of RMS and highest precision compared to DS (p = 0.013), CBCT (p = 0.001), and VVIO (p < 0.001) in the combined surface. For dentition and denture extension surfaces, TIO showed similar within-group variability of RMS with the DS group (p > 0.05) and lower than CBCT and VVIO (p < 0.001). Conclusion The 7 Series desktop scanner and Trios 4 intraoral scanner can duplicate dentures in higher trueness than CBCT and the Virtuo Vivo intraoral scanner. The Trios 4 intraoral scanner was more precise in the combined surfaces than other scanning methods, while the 7 Series desktop scanner and Trios 4 intraoral scanner were more precise in the denture extension surface.Item Comparison of surface characteristics of denture base resin materials with two surface treatment protocols and simulated brushing(Wiley, 2023) Alouthah, Hesham; Lippert, Frank; Yang, Chao-Chieh; Levon, John A.; Lin, Wei-Shao; Prosthodontics, School of DentistryPurpose To investigate the effects of 4 denture base materials, 2 surface treatment protocols, and simulated brushing (SB) on the surface hardness, surface roughness, surface gloss, and the surface loss of denture base materials. Materials and Methods Four denture base resin material groups (compression-molded, injection-molded, 3D-printed, and milled) with two different surface treatment protocols (polished and glazed) were utilized in this study. A total of 80 samples (n = 10) were evaluated for surface hardness (Vickers) before SB. SB was performed for each sample (custom-built V8 cross brushing machine, 50,000 reciprocal strokes). Surface roughness (Ra) was measured before and after SB with a non-contact optical profilometer. Surface gloss was performed using a glossmeter to determine changes in surface reflectivity of the specimens before and after SB. Surface loss (wear resistance) was measured after SB using optical profilometry. The effects of material, surface treatment, and SB on all surface characteristics were examined with two-way and three-way analysis of variance models (ANOVA) (α = 0.05). Results The polished compression-molded group had significantly higher surface hardness than all other groups. The protective glaze coating significantly increased the surface hardness for all groups (P < 0.001). SB increased the surface roughness of all groups regardless of surface treatments (P < 0.001). The increase in surface roughness after SB was significantly higher with polished surface treatment than with a glazed surface treatment in all groups (P < 0.001). Surface gloss was significantly higher with the glazed surface treatment than with the polished surface treatment for all denture base materials (P < 0.001). After SB, milled denture base material showed the highest, and 3D-printed material showed the second highest surface gloss compared to the other groups (P < 0.001), regardless of surface treatment. In all materials tested, surface glaze significantly decreased surface loss (P < 0.001). With the glaze surface treatment, compression-molded denture base material had significantly less surface loss (more surface gain) than other materials, while with the polished surface treatment, 3D-printed denture base material had the least surface loss when compared with other groups. Conclusions A single layer of nano-filled, light-polymerizing protective glaze coating has displayed potential for enhancing the longevity of denture base materials, as evidenced by increased hardness and wear resistance. Following simulated brushing, the milled denture material exhibited the highest surface gloss and lowest surface roughness among all groups, regardless of the surface treatment protocol. This indicates that milled denture base material possesses favorable surface properties and may serve as a viable alternative to traditional denture base materials.Item Expediting the Rehabilitation of Severely Resorbed Ridges Using a Combination of CAD-CAM and Analog Techniques: A Case Report(MDPI, 2024-02-02) Jurado, Carlos A.; Azpiazu-Flores, Francisco X.; Fu, Chin-Chuan; Rojas-Rueda, Silvia; Guzman-Perez, Gerardo; Floriani, Franciele; Prosthodontics, School of DentistryWith the life expectancy increasing, there is a growing need for prosthetic dental treatments to restore the oral health, function, and quality of life of edentulous patients. Presently, only a few articles are available describing the oral rehabilitation of patients with severely resorbed ridges with milled complete dentures. This clinical case report provides a straightforward protocol consisting of a combination of analog and digital techniques for the rehabilitation of edentulous patients with severely resorbed ridges with milled fixed and removable complete dentures. This technique permits the minimization of the number of appointments, improves patient comfort, allows for the digital archiving of important clinical data, and permits the manufacture of prostheses with improved mechanical properties. These favorable outcomes were achieved by using the patient’s existing PMMA complete denture as a custom tray for a final impression with light-bodied Polyvinylsiloxane. Subsequently, the resulting models were digitized, and a digital complete denture was designed and manufactured in an expedited manner using CAD-CAM techniques. Therefore, this case report highlights the potential of CAD/CAM technology to predictably restabilize oral functions and improve patients’ quality of life.Item Caregivers' Perception about the Relationship between Oral Health and Overall Health in Individuals with Disability in Qatif, Saudi Arabia: A Cross-Sectional Study(Hindawi, 2022-10-03) Alalshaikh, Marwa; Alsheikh, Rasha; Alfaraj, Amal; Al-Khalifa, Khalifa S.; Prosthodontics, School of DentistryBackground: In Saudi Arabia, there are many people with disabilities that do not receive adequate healthcare, especially in the field of dentistry. Objective: This study focused on assessing caregivers' perception of the relationship between oral healthcare and the overall health status of individuals with special healthcare needs (SHCN) in Qatif, Saudi Arabia. Methodology Design. This cross-sectional study was conducted using a questionnaire that was divided into two sections. The first part included demographic information such as the age and gender of both the caregiver and the person with a disability and the type of disability. The second part investigated the systemic health of the individual with a disability and the caregivers' perception of the relationship between the management and treatment of systemic health and oral healthcare in relation to the overall health status. The results of descriptive analyses were summarized using frequency distribution tables. Bivariate analyses (chi-square test) were also performed. Significant differences were considered at a p value of 0.05. Setting. Initiated in school setting. Results: A total of 186 caregivers participated in the study. As much as 83.3% agree that oral health affects overall health, and 48.9% agreed that untreated dental problems could affect cardiac health. Age was the only factor found to be significantly associated with caregiver perception as younger caregivers were more likely to rightly understand the relationship between oral health and general health (p < 0.05). Conclusion: This study has shown the extent to which caregivers of individuals with special care needs to understand the role of oral health in the general health of an individual. Three-quarters of the caregivers agree that dental health affects overall health, and age is a factor that might influence this understanding.Item Barriers to Dental Care in Individuals with Special Healthcare Needs in Qatif, Saudi Arabia: A Caregiver’s Perspective(Dove Press, 2021-01-22) Alfaraj, Amal; Halawany, Hassan S.; Al-Hinai, Muntasar T.; Al-Badr, Abid H.; Alalshaikh, Marwa; Al-Khalifa, Khalifa S.; Prosthodontics, School of DentistryObjective: Access to dental care is a key factor influencing oral health outcomes. Individuals with special healthcare needs are at risk of not having access to dental care services which they need to maintain their oral health. This study assessed the magnitude of this problem and identified barriers responsible for the difficulties in accessing dental care in Qatif, Saudi Arabia, as reported by caregivers of individuals with special healthcare needs. Methods: This cross-sectional study collected data using a self-administered survey questionnaire from caregivers of individuals with special healthcare needs across 11 centers (eight special needs centers and three schools) in Qatif, Eastern Province of Saudi Arabia, between February and April 2019. Results: A total of 186 caregivers participated in the study, 102 (54.8%) of whom reported difficulties in getting access to dental care. The key barriers included lack of time on the part of caregivers (60.8%), unsuitable clinic environment (53.9%), difficulties with transportation (51.9%), medical/health status of the individual with special healthcare needs (51.0%), and geographically distant dental clinics (51.0%). Caregiver demographics (age, gender, and educational level) had no significant influence on the difficulties reported by caregivers in getting access to dental care for individuals with special healthcare needs (p>0.05). Conclusion: A large proportion of caregivers in Qatif, Saudi Arabia, experience difficulties with access to dental care services for individuals with special healthcare needs. The most common barriers are physical accessibility of dental facilities (for individuals with special healthcare needs), affordability, and lack of skills and knowledge of dental care providers.Item The effects of manufacturing technologies on the surface accuracy of CAD-CAM occlusal splints(Wiley, 2023-10) Orgev, Ahmet; Levon, John A.; Chu, Tien-Min G.; Morton, Dean; Lin, Wei-Shao; Prosthodontics, School of DentistryPurpose To investigate the effects of the manufacturing technologies on the surface (cameo and intaglio) accuracy (trueness and precision) of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal splints. Materials and methods The digital design of the master occlusal splint was designed in a CAD software program. Six groups (n = 10) were tested in this study, including Group 1 – Milling (Wax), Group 2 – Heat-polymerizing, Group 3 – Milling (M series), Group 4 – Milling (DWX-51/52D), Group 5 – 3D-printing (Cares P30), and Group 6 – 3D-printing (M2). The study samples were placed in a scanning jig fabricated from putty silicone and Type III dental stone. The study samples were then scanned with a laboratory scanner at the intaglio and cameo surfaces, and the scanned files were exported in standard tessellation language (STL) file format. The master occlusal splint STL file, was used as a reference to compare with all scanned samples at the intaglio and cameo surfaces in a surface matching software program. Root mean square (RMS, measured in mm, absolute value) values were calculated by the software for accuracy comparisons. Group means were used as the representation of trueness, and the standard deviation for each group was calculated as a measure of precision. Color maps were recorded to visualize the areas of deviation between study samples and the master occlusal splint file. The data were normalized and transformed to rank scores, and one-way ANOVA was used to test for the differences between the groups. Pairwise comparisons were made between different groups. Fishers least square differences were used to account for the family-wise error rate. A 5% significance level was used for all the tests. Results The null hypotheses were rejected. The manufacturing technologies significantly affected the trueness of occlusal splints at both intaglio and cameo surfaces (p < 0.001). At the cameo surfaces, Group 1 – Milling (Wax) (0.03 ± 0.02 mm), Group 3 – Milling (M series) (0.04 ± 0.01 mm), and Group 4 – Milling (DWX-51/52D) (0.04 ± 0.01 mm) had the smallest mean RMS values and highest trueness. Group 3 had the smallest standard deviation and highest precision among all groups (p < 0.001, except p = 0.005 when compared with Group 2). Group 5 had the largest standard deviation and lowest precision among all groups (p < 0.001). At the intaglio surfaces, Group 1 – Milling (Wax) (0.06 ± 0.01 mm) had the smallest RMS values and highest trueness among all groups (p < 0.001), and Group 2 – Heat-polymerizing (0.20 ± 0.03 mm) and Group 5 – 3D-printing (Cares P30) (0.15 ± 0.05 mm) had significantly larger mean RMS and standard deviation values than all other groups (p < 0.001), with lowest trueness and precision. In the color maps, Group 2 – Heat-polymerizing and Group 5 – 3D-printing (Cares P30) showed the most discrepancies with yellow and red (positive discrepancies) in most areas, and Group 1 – Milling (Wax) showed the best and most uniform surface matching with the most area in green. Conclusion The manufacturing technologies significantly affected the trueness and precision of occlusal splints at both intaglio and cameo surfaces. The 5-axis milling units and industrial-level CLIP 3D-printer could be considered to achieve surface accuracy of occlusal splints.Item Translucency parameter and color masking ability of CAD-CAM denture base materials against metal substrates(Wiley, 2023-04) Wang, Yun-Ju; Chu, Tien-Min G.; Lin, Wei-Shao; Prosthodontics, School of DentistryPurpose To investigate the translucency parameters of traditional, milled, and 3D-printed denture base materials at 3 different thicknesses and the color masking ability of each material against a metallic background between different thicknesses. Material and methods A traditional heat-polymerizing polymethylmethacrylate (PMMA) (H-Lucitone) material was used as the control group. Two milled pre-polymerized resin blocks (M-Lucitone and IvoBase) and five 3D-printed denture base materials (P-Lucitone, Dentca LP, Dentca OP, Formlabs, and Kulzer) were used as experimental groups. A total of 240 samples, (n = 30, per material) were fabricated to a final specimen dimension of 12×12 mm and in thicknesses of 1.0, 2.0, and 3.0 mm (n = 10 per thickness/material) according to the manufacturers’ recommendations. The color coordinates (L*, a*, b*) in CIELab color space for all specimens placed against a white, black, and metallic background were measured with a spectrophotometer. The translucency parameters (TP00) at each thickness and the color differences between 1 mm and 2 mm (dE00M1-2) and between 2 mm and 3 mm (dE00M2-3) against the metallic background were calculated with the CIEDE2000 color matrix. Comparisons between the groups for differences in TP00 were made using One-way ANOVA separately for each thickness. Comparisons of groups and materials for differences in dE00M1-2 and dE00M2-3 were made using Two-way ANOVA and Fisher's Protected Least Significant Differences (α = 0.05). Results The TP00 decreased with increasing thickness in all 8 material groups. All 3D-printed materials, except P-Lucitone, had higher TP00 than milled pre-polymerized resin materials (M-Lucitone and IvoBase), and traditional heat-polymerizing PMMA (H-Lucitone) material (P<.001) at all thicknesses. In the 1 mm and 2 mm thickness, heat-polymerizing acrylic resin (H-Lucitone) had the lowest TP00, and in the 3 mm thickness, milled acrylic resin (M-Lucitone and IVOBase) had had lowest TP00 (p < 0.001). All material groups had significantly lower values of dE00M2-3 than dE00M1-2 (p < 0.001). The color differences dE00M2-3 were significantly lower in H-Lucitone, M-Lucitone, P-Lucitone, and IvoBase groups than in other materials, while the color difference of dE00M1-2 was significantly lower in H-Lucitone, P-Lucitone and Dentca LP than other materials (p < 0.001). Conclusions The results from this study provide clinicians and dental technicians with information regarding the selection of denture base materials to achieve desired color masking outcomes, according to available prosthetic space. Thicker prostheses significantly improved the color masking abilities of denture acrylic resins against a metallic background. In a thickness of 1 and 2 mm, the heat-polymerizing acrylic resin had a lower translucency parameter and better color masking ability. When the prosthesis thickness reached 3 mm, the milled acrylic resin had a lower translucency parameter and better color masking ability. When compared to the heat-polymerizing resin and milled acrylic resin materials, except for one 3D-printing resin (P-Lucitone), the color masking abilities of the remaining 3D-printing resin materials were low, regardless of prosthesis thickness.Item Non-Psychoactive Cannabinoid Modulation of Nociception and Inflammation Associated with a Rat Model of Pulpitis(MDPI, 2023-05-16) Laks, Elana Y.; Li, Hongbo; Ward, Sara Jane; Prosthodontics, School of DentistryDespite advancements in dental pain management, one of the most common reasons for emergency dental care is orofacial pain. Our study aimed to determine the effects of non-psychoactive Cannabis constituents in the treatment of dental pain and related inflammation. We tested the therapeutic potential of two non-psychoactive Cannabis constituents, cannabidiol (CBD) and β-caryophyllene (β-CP), in a rodent model of orofacial pain associated with pulp exposure. Sham or left mandibular molar pulp exposures were performed on Sprague Dawley rats treated with either vehicle, the phytocannabinoid CBD (5 mg/kg i.p.) or the sesquiterpene β-CP (30 mg/kg i.p.) administered 1 h pre-exposure and on days 1, 3, 7, and 10 post-exposure. Orofacial mechanical allodynia was evaluated at baseline and post-pulp exposure. Trigeminal ganglia were harvested for histological evaluation at day 15. Pulp exposure was associated with significant orofacial sensitivity and neuroinflammation in the ipsilateral orofacial region and trigeminal ganglion. β-CP but not CBD produced a significant reduction in orofacial sensitivity. β-CP also significantly reduced the expression of the inflammatory markers AIF and CCL2, while CBD only decreased AIF expression. These data represent the first preclinical evidence that non-psychoactive cannabinoid-based pharmacotherapy may provide a therapeutic benefit for the treatment of orofacial pain associated with pulp exposure.Item Digital Gothic Arch Tracing Device with Open-Source Software for CAD/CAM Denture Fabrication(Quintessence Publishing, 2022) Orgev, Ahmet; Lin, Wei-Shao; Morton, Dean; Prosthodontics, School of DentistryDigital or CAD/CAM workflows and protocols are being increasingly utilized because of their improved efficiency and reproducibility. For the fabrication of complete dentures, digital workflows can reduce treatment time and clinical visits while enhancing the reliability and reproducibility of the laboratory phase and materials. However, establishing centric relation (CR) and vertical dimension of occlusion (VDO) in a reproducible way is still a challenging step for complete denture fabrication in both analog and digital workflows. This clinical report describes a digital workflow utilizing an individualized gothic arch tracing device (GATD) using open-source software for the fabrication of complete dentures. With this workflow, clinicians can offer customized solutions according to patient rehabilitation, with good reproducibility using gothic arch tracing to be implemented in the digital workflow.Item Marginal Fit, Mechanical Properties, and Esthetic Outcomes of CAD/CAM Interim Fixed Dental Prostheses (FDPs): A Systematic Review(MDPI, 2023-02-28) Al-humood, Hussain; Alfaraj, Amal; Yang, Chao-Chieh; Levon, John; Chu, Tien-Min Gabriel; Lin, Wei-Shao; Prosthodontics, School of DentistryThis systematic review aimed to study the outcomes of CAD-CAM (milled and 3D-printed) interim dental prostheses when compared to conventional ones. The focused question of "In natural teeth, what are the outcomes of CAD-CAM interim FDPs compared to the conventionally-manufactured ones regarding marginal fit, mechanical properties, esthetics, and color stability" was formulated. The systematic search was conducted electronically in the PubMed/MEDLINE, CENTRAL, EMBASE, Web of Science, New York Academy of Medicine Grey Literature Report, and Google Scholar databases by using the MeSH keywords and keywords associated with the focused question and limiting articles to those published between 2000 and 2022. A manual search was conducted in selected dental journals. The results were analyzed qualitatively and are presented in table format. Of the included studies, 18 studies were in vitro and 1 was a randomized clinical trial. Of the eight studies analyzing the mechanical properties, five studies favored the milled interim restorations, one study favored both 3D-printed and milled interim restorations, and two studies reported better mechanical properties in conventional interim restorations. Among four studies evaluating the marginal discrepancies, two studies favored the marginal fit in milled interim restorations, one study reported a better marginal fit in both milled and 3D-printed interim restorations, and one study found conventional interim restorations have a better marginal fit and smaller marginal discrepancy when compared to both milled and 3D-printed restorations. Among five studies that evaluated both the mechanical properties and marginal fit, 1 study favored 3D-printed interim restorations and four studies favored milled interim restorations over the conventional ones. Two studies analyzing the esthetics outcomes demonstrated better results with milled interim restorations compared to conventional and 3D-printed interim restorations in terms of their color stabilities. The risk of bias was low for all the studies reviewed. The high level of heterogeneity within the studies excluded meta-analysis. Most of the studies favored the milled interim restorations over the 3D-printed and conventional restorations. The results suggested that milled interim restorations offer a better marginal fit, higher mechanical properties, and better esthetic outcomes in terms of color stabilities.