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Superimposition intraoral scanner (IOS) þ face scanner (FS) þ cone beam computed tomography (CBCT). (A) CBCT images obtained with CS 9300 (Carestream Dental, Rochester, NY), visualized in the proprietary software of the device, and imported in the Mimics (Materialise, Leuven, Belgium) software, for 3D bone reconstruction. (B) Intraoral digital impression with CS 3600 (Carestream Dental), lateral, frontal, and occlusal views, file format .PLY. (C) Face scans with OBI (Mede SA, Lugano, Switzerland), frontal, and lateral views, file format .OBJ. (D) Superimposition of the intraoral digital impression (.PLY) on the face scan (.OBJ), to obtain the 3D virtual dentate patient, lateral views. The software used for the superimposition is Meshlab (an open source software). (E) 3D bone reconstruction and implant planning (Mimics, Materialise), superimposition of the IOS files on the 3D bone reconstruction, design of the surgical guide (Lynx, Gioia del Colle, Italy). (F) Guided implant surgery with flap elevation and bone regeneration with synthetic porous hydroxylapatite. (G) Intraoral digital impression with CS 3600 (Carestream Dental), occlusal and lateral views, file format .PLY, and prosthetic planning with Exocad (Fraunhofer Institute, Frankfurt, Germany). (H) Finalization of the patient.
Source publication
Purpose:
The aim of this literature review was to provide an update on the current scientific knowledge in the field of 3D virtual patient science and to identify a possible easy, smart, and affordable method to combine different file formats obtained from different digital devices.
Methods:
Electronic searches of the Medline database was perfor...
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This study aimed to review the literature on adult mandibular lingula (ML) locations and related distances determined using cone-beam computed tomography (CBCT). A search was conducted for studies on CBCT using the following databases: PubMed, Web of Science, and Embase. The search results were limited to studies published between 1970 and 2021. Th...
Citations
... PEEK is a biocompatible, nonallergic, rigid, radiolucent, white polymer with low plaque affinity [28] and elastic modulus that is close to human bone [29]. Some recent studies have reported on the use of PEEK as a bar fabrication material 5 Case Reports in Dentistry with promising results [30] that must be further investigated. Another aesthetic material incorporated in many dental applications is zirconia [31], a biocompatible ceramic material with wear resistance and high mechanical properties. ...
Bone resorption following tooth loss might compromise retention, stability, and support of conventional removable prostheses, and for this reason, implant-supported overdentures are suggested as a viable alternative for completely edentulous patients. Bars, telescopic attachments, or stud attachments have been used to provide retention through a different mechanism of action based on specific design characteristics. The purpose of this report is to thoroughly describe the applied protocol for the fabrication of an implant overdenture supported by two bars incorporating stud attachments. A 67-year-old male patient presented to the Postgraduate Clinic of the National and Kapodistrian University in Athens seeking dental rehabilitation. The remaining teeth were characterized with poor prognosis, mainly due to their periodontal status. The proposed treatment plan included the placement of four implants in the maxilla and two implants in the mandible and the fabrication of implant-supported overdentures. The diagnostic stages revealed adequate prosthetic space that would enable the fabrication of a bar substructure for the maxillary overdenture. To combine the benefits of bars and stud attachments, two bars with four attachments were fabricated. Evaluation of the delivered prosthesis revealed adequate retention, support, and stability achieved with minimal palatal coverage. Patient’s reported satisfaction and quality of life were increased. Recall appointments at one, six, and twelve months did not reveal any adverse effects or patient’s complaints. According to the present case report, different types of attachments may be used after careful study of each case. More studies are needed to report on different aspects of the chosen treatment plan.
... Digital advancements have revolutionized the practice of implant dentistry by introducing multimodal imaging methods such as Cone Beam Computed Tomography (CBCT) and intra-oral scan (IOS), along with advanced presurgical planning tools and Computer-Aided Design and Manufacturing (CAD-CAM) software [1][2][3][4][5][6]. Additionally, these tools contribute to the creation of surgical guides, facilitating the seamless transfer of planned rehabilitation strategy to the surgical site [7,8]. ...
... Additionally, these tools contribute to the creation of surgical guides, facilitating the seamless transfer of planned rehabilitation strategy to the surgical site [7,8]. These innovations aid in case selection, guide clinical decision-making, and streamline surgical procedures associated with implant placement [4,5,9]. ...
Objectives
To assess quality, clinical acceptance, time-efficiency, and consistency of a novel artificial intelligence (AI)-driven tool for automated presurgical implant planning for single tooth replacement, compared to a human intelligence (HI)-based approach.
Materials and methods
To validate a novel AI-driven implant placement tool, a dataset of 10 time-matching cone beam computed tomography (CBCT) scans and intra-oral scans (IOS) previously acquired for single mandibular molar/premolar implant placement was included. An AI pre-trained model for implant planning was compared to human expert-based planning, followed by the export, evaluation and comparison of two generic implants—AI-generated and human-generated—for each case. The quality of both approaches was assessed by 12 calibrated dentists through blinded observations using a visual analogue scale (VAS), while clinical acceptance was evaluated through an AI versus HI battle (Turing test). Subsequently, time efficiency and consistency were evaluated and compared between both planning methods.
Results
Overall, 360 observations were gathered, with 240 dedicated to VAS, of which 95 % (AI) and 96 % (HI) required no major, clinically relevant corrections. In the AI versus HI Turing test (120 observations), 4 cases had matching judgments for AI and HI, with AI favoured in 3 and HI in 3. Additionally, AI completed planning more than twice as fast as HI, taking only 198 ± 33 s compared to 435 ± 92 s (p < 0.05). Furthermore, AI demonstrated higher consistency with zero-degree median surface deviation (MSD) compared to HI (MSD=0.3 ± 0.17 mm).
Conclusion
AI demonstrated expert-quality and clinically acceptable single-implant planning, proving to be more time-efficient and consistent than the HI-based approach.
Clinical significance
Presurgical implant planning often requires multidisciplinary collaboration between highly experienced specialists, which can be complex, cumbersome and time-consuming. However, AI-driven implant planning has the potential to allow clinically acceptable planning, significantly more time-efficient and consistent than the human expert.
... Digital data acquisition technologies, namely FS, IOSs, photogrammetry, CBCT, and jaw tracking systems, allow the recording of patient's anatomy. 39 The integration of these patient's digital data enable the visualization of the 3D virtual patient or digital replica of the patient. 39 The 3D virtual patient is used to perform a facially driven diagnostic waxing, implant planning, designing, and fabricating an implant prosthesis. ...
... 39 The integration of these patient's digital data enable the visualization of the 3D virtual patient or digital replica of the patient. 39 The 3D virtual patient is used to perform a facially driven diagnostic waxing, implant planning, designing, and fabricating an implant prosthesis. ...
... FS allow the recording of the static 3D facial representation of the patient at different positions, such as rest, smile, shush, and Duchene. 39,40 The integration of facial references into the planning and designing procedures of implant prostheses is critical for ensuring the esthetic integration of the implant rehabilitation. 40 The most remarkable AI-based feature that is available in some facial scanner's programs is the automatic alignment of facial and intraoral scans. ...
Objectives
To provide an overview of the current artificial intelligence (AI) based applications for assisting digital data acquisition and implant planning procedures.
Overview
A review of the main AI‐based applications integrated into digital data acquisitions technologies (facial scanners (FS), intraoral scanners (IOSs), cone beam computed tomography (CBCT) devices, and jaw trackers) and computer‐aided static implant planning programs are provided.
Conclusions
The main AI‐based application integrated in some FS's programs involves the automatic alignment of facial and intraoral scans for virtual patient integration. The AI‐based applications integrated into IOSs programs include scan cleaning, assist scanning, and automatic alignment between the implant scan body with its corresponding CAD object while scanning. The more frequently AI‐based applications integrated into the programs of CBCT units involve positioning assistant, noise and artifacts reduction, structures identification and segmentation, airway analysis, and alignment of facial, intraoral, and CBCT scans. Some computer‐aided static implant planning programs include patient's digital files, identification, labeling, and segmentation of anatomical structures, mandibular nerve tracing, automatic implant placement, and surgical implant guide design.
... Face scanners have exponentially increased in dentistry, and studies have demonstrated the many benefits of incorporating a face scanner into the clinical workflows [1][2][3][4][5][6]. The face scanners, combined with other devices and acquisitions, can virtualize a 3D replica of the patient, which serves as an important tool for diagnosis and treatment planning, monitoring outcomes or treatment predictability, as well as in education and inter-professional communication [7][8][9][10][11][12][13][14]. The accuracy and reliability of 3D images from different face scanners have been extensively evaluated, and the deviations in measurements were found to fall within the clinically acceptable ranges and may be considered reliable. ...
Objective: This study evaluated the reliability of a face scanner in measuring the vertical dimension of occlusion (VDO).
Methods: Fully dentate volunteers (n=20; mean-age=30.0±10.7 years) were recruited. Clinical facial measurements were obtained using a digital caliper and a face scanner (Class 1 LASER, Obiscanner, Fifthingenium, Italy). The scans were imported into a mesh-processing software, and the distances were measured digitally. Measurements were obtained for each participant with the jaws positioned in maximal intercuspation (MI) and with increased vertical distances of 2, 4, and 6 mm. Vertical and horizontal measures were obtained using facial anatomical landmarks: Glabella (GL), Pronasale (PrN), Subnasale (SbN), inferior border of the right and left Alare, Labiale superius (Ls), right and left Cheilion (Ch), Soft Pogonion (SPg), right and left Tragus of the ear (Tr), for all selected vertical positions. Data analysis included intra-class correlation coefficient (ICC), pairwise comparison tests, Bland-Altman plots, and Passing-Bablok regression.
Results: 120 VDO measurements (clinical=60, digital=60) were recorded by two independent evaluators. Mean differences between digital and clinical measurements ranged from 0.054±0.14mm to 0.203±0.13mm. All parameters were strongly correlated (r>0.93; p<0.001). ICC estimates revealed excellent reliability, and the measuring procedure yields the same results on repeated trials irrespective of the raters and measurement methods. Bland-Altman plots revealed a difference between digital and clinical measurements of 1.7% for the vertical measurements. Regression analysis revealed no significant proportional difference between the two methods, so both can be used interchangeably.
Conclusions: The findings of this study demonstrate that VDO can be measured accurately from face scans using 3D mesh-processing software and that even small changes in the VDO could be detected using the digital methods.
Clinical Significance: Findings provide evidence about the reliability of a digital method for jaw relation registrations and may be applied towards incorporating this method into clinical workflows for CAD-CAM dentures.
Keywords: Vertical dimension of occlusion, Jaw relations, 3D Face scan, Digital complete dentures, Removable prosthodontics, Geriatric Dentistry.
... CBCT, a 3D radiographic imaging technique, delivers detailed volumetric data of hard tissues, such as the alveolar bone and the teeth, and has also been used to assess periodontal dimensions, such as the supracrestal tissue attachment [2,[17][18][19]. The integration of data from clinical photographs, IOS, facial scans, and CBCT enables the creation of a virtual patienta comprehensive 3D digital model that accurately mirrors the patient's oral anatomy [20,21]. This approach not only enhances diagnostics, but also the predictability of clinical outcomes in prosthodontics, oral surgery, and periodontal care [15,22]. ...
... Furthermore, this digital simulation facilitates clearer communication with patients by demonstrating potential outcomes, thus aligning expectations, and increasing patient engagement [21,22]. Despite the advantages of creating a virtual patient for dental treatment planning, the integration and alignment of 3D imaging, such as CBCT and IOS, present significant challenges, such as the presence of artifacts from 3D reconstructions and impaired accuracy during image superimposition [20][21][22]. The complexity in superimposing virtual files arises from the differing formats, resolutions, and perspectives provided by each imaging modality [20][21][22]. ...
... Despite the advantages of creating a virtual patient for dental treatment planning, the integration and alignment of 3D imaging, such as CBCT and IOS, present significant challenges, such as the presence of artifacts from 3D reconstructions and impaired accuracy during image superimposition [20][21][22]. The complexity in superimposing virtual files arises from the differing formats, resolutions, and perspectives provided by each imaging modality [20][21][22]. To address the challenges related to the integration and alignment of files of 3D images such as CBCT and IOS, several algorithms of artificial intelligence (AI) have been developed. ...
The advancement of digital image acquisition technologies in dentistry has facilitated the creation of virtual patients through the integration of two-and three-dimensional (2D and 3D) images within digital platforms. These images, sourced from technologies such as Cone Beam Computed Tomography (CBCT), intraoral scanners (IOS), and 3D facial scanners, can be aligned and merged to comprehensively assess the bone structure, gingival and soft tissues, and the dentition. Additionally, 2D clinical photographs are incorporated into the digital project, enhancing aesthetic analysis and planning. Artificial intelligence (AI) algorithms can also be used to enhance and facilitate 3D image alignment. However, detailed information on digital workflows to work with virtual patients for dental and maxillofacial treatment planning is lacking in the literature. The purpose of this article is to describe a technique to create a virtual patient to assess the relationship between the patient's soft and hard tissues with the optional use of AI to enhance the quality of 3D-reconstructed models from CBCT. Within the limitations of this study, the technique described herein is suggested to be useful for prosthetically-driven treatment planning of surgical procedures such as crown lengthening, bone grafts and dental implant placement.
... 11 By superimposing maxillary casts, positional records, and facial scanning, a virtual patient is developed, aiding in the planning, design, and manufacture of complete dentures. 12,13 The applicability of facial scanning associated with intraoral or extraoral scanning for virtual complete denture planning considering the patient's anatomic references has been evaluated and has demonstrated satisfactory functional and esthetic results for definitive complete dentures. 14 After the digital planning and design of complete dentures, the files are processed in a suitable software program, and the patient's definitive or trial complete dentures obtained through milling or 3D printing. ...
... Additionally, the inclusion of bone data acquired with a CBCT device to this data pool set can lead to the formation of the virtual patient. 67 Virtual articulators are software tools incorporated into CAD suites 66 ( Figure 8). There are currently two types of virtual articulators available: the completely adjustable and the mathematically simulated-average value articulator. ...
Aim:
This paper provides a comprehensive review of the established concepts and newer developments related to computer-assisted implant rehabilitation.
Methods:
Two independent researchers searched the English literature published to 31st December 2023 in the PubMed/Medline database for primary and secondary research and related publications on computer-assisted implant planning, computer-assisted implant placement and computer-assisted implant restoration.
Results:
A total of 58,923 papers were identified, 198 relevant papers were read in full text and 110 studies were finally included. Computer-assisted implant rehabilitation was found to result in more precise implant positioning than freehand placement. Advantages include reduced trauma and surgery time; disadvantages include reduced primary implant stability and higher cost.
Conclusion:
Computer-assisted surgery is particularly indicated in cases of critical anatomy, but may encounter limitations in terms of cost, restricted mouth opening, visibility and adjustment of the surgical guides and the need for prior familiarisation with the procedure. Nonetheless, this surgical technique reduces the post-implant placement complication rate.
... Greater predictability, fewer and shorter treatment sessions, less patient discomfort, and elimination of plaster models are advantages of digital workflow with computer-aided designing and computer-aided manufacturing (CAD-CAM) over the conventional workflow [45,46]. The ability to combine and superimpose three-dimensional (3D) meshes from various images to generate a virtual patient model is another essential component of digital workflow [47]. This ability improves virtual treatment planning and patient communication. ...
Background
The advent of digital impressions using computer-aided design and manufacturing technology (CAD/CAM) has simplified and improved the fabrication of implant prostheses in dentistry. The conventional impression has several drawbacks, including tray selection, material type, impression technique, impression disinfection, and cast model storage. The inaccuracies caused by distortion and contraction of impression material can be minimized with digital impressions. This study aimed to compare digital dental impressions of 10 working casts made using the Pindex laser removable die system to fabricate parallel drill channels vs 10 working casts made using the Di-Lok plastic tray removable die system.
Material/Methods
An implant master die with 2 dental implant analogs was fabricated. Ten working casts using the Pindex laser removable die system with parallel drill channels and 10 working casts using the Di-Lok plastic tray removable die system were fabricated. The working casts were scanned using an extra-oral laboratory scanner and the implant master model was scanned with an intra-oral scanner.
Results
The properties of the casts made using the 2 systems were evaluated and analyzed with ANOVA and post hoc Tukey test. The mean horizontal linear distances between A1B1 (P<0.021), A2B2 (P<0.018), C1D1 (P<0.026), C2D2 (P<0.03), B1C1 (P<0.01), and mean vertical distances between B1A2 (P<0.015), C1D2 (P<0.001), B1B2 (P<0.028), and C1C2 (P<0.001) were significantly different between the Pindex system and Di-Lok tray system as compared to intra-oral scans.
Conclusions
Complete digital workflow with intra-oral scans were more than the partial digital workflow with extra-oral scans for the Pindex system and Di-Lok tray systems.
... The electronic search was conducted in five databases (PubMed, Embase, Web of Science, Cochrane, and Scopus libraries) until November 2023, each implementing a search strategy tailored to its platform, as seen in Table 1. Furthermore, a manual search in gray literature databases, 6 customized Google search engines, targeted websites, and reference/citation lists of included studies was conducted to ensure the comprehensive inclusion of all relevant studies. All titles and abstracts were reviewed during the screening process to include studies that investigated AI-based tools employed in digital dental implant planning with a focus on 3D imaging modalities. ...
... Although the anatomy of teeth crowns can be easily obtained by means of intraoral scanners, in order to generate a 3D model of a virtual patient, the anatomy of the maxillary and mandibular bone rely completely on the quality of the CBCT image and accuracy of the bone segmentation performed either manually, semi-automatically or totally computer assisted [15,16]. Accurate segmentation of maxillary and mandibular bone and their defects may assist occasional monitoring of periodontal disease and also provide important information to the management of these defects prior to implant placement. ...
Objectives
To evaluate the correlation of measures of periodontal defects in 3D models segmented by an AI-driven tool with the actual defects in dry skulls and mandibles and to verify the influence of arch, presence of metal artifact (dental fillings/metal posts), type of defect and dental implant artifact on the measures.
Material and Methods
45 periodontal defects were measured with a digital caliper and periodontal probe in three human dried skulls and five mandibles. These skulls and mandibles were scanned with a Cone-Beam Computed Tomography (CBCT) device and their digital files followed automated segmentation by an AI-driven tool (Patient Creator, Relu BV, Leuven, Belgium). The same periodontal defects were measured on the digital model generated by the AI-tool. Correlations of the measuring methods were assessed by means of Intraclass Correlation Coefficient and the influence of arch, presence of artifact and type of defects on the differences were assessed by Student’s t-test.
Results
The intraclass correlations ranged from moderate to excellent values. None of the studied factors (arch, dental fillings/metal posts and type of defect) played a role on the differences between actual and digital defects (P > 0.05). Three-wall defects presented significant influence of dental implant artifact on the measures of height (P = 0.002).
Conclusions
3D models generated by the AI-driven tool presented periodontal defects with linear measures ranging from moderate to excellent correlations with the actual measures.
