CAD/CAM bilateral ear prostheses construction for Treacher Collins syndrome patients using laser scanning and rapid prototyping

Ear defects in patients affected by Treacher Collins syndrome necessitate the replacement of the existing anatomic residuals of the ears with custom-made prostheses. This paper describes a multidisciplinary protocol involving both medicine and computer-aided design/computer-aided manufacturing for manufacturing ear prostheses. Using innovative prototyping technologies together with conventional silicone processing procedures, a step-by-step procedure is presented. The complete workflow includes laser scanning of the defective regions of a patient's face, the use of 3D anatomic models from an ear digital library and rapid prototyping of both substructures for bar anchoring and moulds for silicone processing.     

计算机辅助设计与制作（CAD—CAM）在口腔科的应用

CAD—CAM在口腔临床上的应用,尤其在口腔修复科全瓷冠、套筒冠的修复以及口腔种植领域的应用,提高了修复体的制作效率和质量。该文就CAD—CAM在口腔修复中的应用新进展作一综述。     

Design of a custom angled abutment for dental implants using computer-aided design and nonlinear finite element analysis

Computer-aided design/computer-aided manufacturing (CAD/CAM) custom abutments have been attracting more and more attention due to their advantages of accuracy fit and esthetic emergence profile. However, the CAD key technology for custom abutments has been seldom studied as well as their biomechanical behavior. This paper explored a novel method to design a CAD/CAM custom angled abutment, evaluated the biomechanical performance of the whole system and compared the difference between the custom and the conventional abutment through 3D nonlinear finite element analysis (FEA). Firstly, the digital data of the dental casts at the healing abutment level was acquired by optical scanner. Thus the position of the healing abutment and the implant can be determined by CAD technology. The custom angled abutment was then designed according to the need of restoration and esthetics with CAD software. The described system can eliminate wax and cast, create an esthetic anatomical emergence profile and provide a satisfactory angle correction. Simulation results indicate that there was no distinct difference in the stress distribution and magnitude of implant-bone interface and screw using the custom or the conventional angled abutment.     

New Design for Rapid Prototyping of Digital Master Casts for Multiple Dental Implant Restorations

Aim

This study proposes the replacement of all the physical devices used in the manufacturing of conventional prostheses through the use of digital tools, such as 3D scanners, CAD design software, 3D implants files, rapid prototyping machines or reverse engineering software, in order to develop laboratory work models from which to finish coatings for dental prostheses. Different types of dental prosthetic structures are used, which were adjusted by a non-rotatory threaded fixing system.

Method

From a digital process, the relative positions of dental implants, soft tissue and adjacent teeth of edentulous or partially edentulous patients has been captured, and a maser working model which accurately replicates data relating to the patients oral cavity has been through treatment of three-dimensional digital data.

Results

Compared with the conventional master cast, the results show a significant cost savings in attachments, as well as an increase in the quality of reproduction and accuracy of the master cast, with the consequent reduction in the number of patient consultation visits. The combination of software and hardware three-dimensional tools allows the optimization of the planning of dental implant-supported rehabilitations protocol, improving the predictability of clinical treatments and the production cost savings of master casts for restorations upon implants.     

CAD/CAM treatment for the elderly--a case report

doi: 10.1111/j.1741‐2358.2011.00521.x CAD/CAM treatment for the elderly – a case report Background: When elderly develop signs and symptoms of Alzheimer’s disease they lose their independence and neglect dental hygiene. Dentists are increasingly confronted by seniors who are in need but who have limited access to dental care. Caretakers and family are also often confronted with behaviour problems besides the dental problems. Objective: To report the importance of shorter and lower impact treatment for seniors when caretakers and family are confronted with a behavioural problem in addition to the dental problem. Materials and methods: In this case report, the oral management of a patient with Alzheimer’s disease was described using chairside computer‐aided design/computer‐aided manufacturing (CAD/CAM) technology while constructing a bonded bridge. Discussion: The case report emphasises the importance of interaction with the patient and added a treatment method for patients with limited cognitive skills who become easily agitated or aggressive. Conclusion: The fabrication of a full ceramic bonded bridge utilising the Cerec 3D chairside CAD/CAM technology in an Alzheimer patient has been shown to be a feasible, precise, aesthetic and durable solution. It added a technique for intervening with patients with limited tolerance for dental procedures, which improves the quality of life of both patient and family.     

CAD–CAM prosthetically guided bone regeneration using preformed titanium mesh for the reconstruction of atrophic maxillary arches

The protocol presented here is intended to minimise the intervention in bone reconstruction surgery when severe atrophy or deformity is present in the maxillary arches. A patient underwent augmentation of an atrophic maxillary arch using titanium mesh and particulate autogenous plus bovine demineralised bone. After computed tomography data elaboration, computer-aided design and computer-aided machining were used to plan the augmentation of bone volume to improve the implant position needed to support the final dental prosthesis. The augmented maxilla was rapidly prototyped in plastic, and the titanium mesh was tested on this model before the surgical intervention. Then, the preformed titanium mesh was implanted in the maxillary arch with bone grafting. The bone was augmented relative to the position of the implants for the definitive fixed implant-supported rehabilitation. The protocol presented here is a viable, reproducible way to determine the correct bone augmentation for the final implant-supported prosthetic rehabilitation.     

数字式一体化口腔临床工程系统的研制

运用数字总线技术实现多模块化控制,对CT或X光片、口腔数字化扫描仪、印模扫描图像等进行三维重建、立体构图,开发系列规划软件,为口腔医生提供优化治疗、修复方案。同时,计算机可联接微型CAD／CAM自动进行义齿、贴面快速加工,以及种植导板等产品的设计、加工;联接手术导航仪进行牙种植手术导航;联接PACS、HIS等系统,实现数字化图像传输以及远程医疗功能。在诊所内一体化完成诊断、治疗、制作、修复、整形、美容等系列复杂、精细工作。     

Multi-scale analysis of the effect of nano-filler particle diameter on the physical properties of CAD/CAM composite resin blocks

The objective of this study was to assess the effect of silica nano-filler particle diameters in a computer-aided design/manufacturing (CAD/CAM) composite resin (CR) block on physical properties at the multi-scale in silico. CAD/CAM CR blocks were modeled, consisting of silica nano-filler particles (20, 40, 60, 80, and 100 nm) and matrix (Bis-GMA/TEGDMA), with filler volume contents of 55.161%. Calculation of Young’s moduli and Poisson’s ratios for the block at macro-scale were analyzed by homogenization. Macro-scale CAD/CAM CR blocks (3 × 3 × 3 mm) were modeled and compressive strengths were defined when the fracture loads exceeded 6075 N. MPS values of the nano-scale models were compared by localization analysis. As the filler size decreased, Young’s moduli and compressive strength increased, while Poisson’s ratios and MPS decreased. All parameters were significantly correlated with the diameters of the filler particles (Pearson’s correlation test, r = ?0.949, 0.943, ?0.951, 0.976, p < 0.05). The in silico multi-scale model established in this study demonstrates that the Young’s moduli, Poisson’s ratios, and compressive strengths of CAD/CAM CR blocks can be enhanced by loading silica nanofiller particles of smaller diameter. CAD/CAM CR blocks by using smaller silica nano-filler particles have a potential to increase fracture resistance.     

Unnoticed swallowing of a unilateral removable partial denture

doi: 10.1111/j.1741‐2358.2011.00621.x Unnoticed swallowing of a unilateral removable partial denture Objective: This paper presents a case report about an unnoticed swallowing of a partial denture impacted in the esophagus in a 74‐year old man without serious complications. Background data: Dental prostheses (removable/fixed dental prostheses or fragments of dentures) appear to constitute a significant proportion of swallowed of impacted foreign bodies in the orolaryngopharynx. Conclusion: This case emphazises that is advisable to contraindicate this type of unilateral removable partial denture to replace teeth as temporary or definitive dental prosthesis.     

Functional rehabilitation of the atrophic mandible and maxilla with fibula flaps and implant-supported prosthesis

Historically, nonvascularized bone grafts have been the standard treatment for severe mandibular and maxillary atrophy, followed by immediate or delayed implant placement. Extreme atrophy is an unfavorable biological and mechanical location for nonvascularized autologous bone transplants. The authors present the results of a multidisciplinary treatment protocol for rehabilitation of extreme mandibular and maxillary atrophy by use of the vascularized fibular flap. This protocol includes bone augmentation, implant surgery, soft-tissue management, and prosthetic restoration. Since 1993, 18 patients with a mean age of 47.5 years presented with extreme mandibular and/or maxillary atrophy and underwent alveolar crest augmentation with vascularized fibular flaps. Bone healing was achieved in 17 of the 18 patients. Seventy-three osteointegrated implants were inserted in 12 of 17 fibular flaps. Altogether, 62 implants were loaded and 11 dental prostheses were made. Average follow-up of the loaded implants was 41 months. The success rate of loaded implants was 100 percent. The authors strongly recommend the use of the fibular bone flap when dealing with extreme atrophy of the mandible and maxilla and suggest the protocol outlined in this review.     

氧化铝玻璃复合体强度及断裂韧性的研究

全瓷修复材料抗拉强度,脆性大且制作困难,限制了它在牙科临床上应用,随着ＣＡＤ／ＣＡＭ技术和Ｉｈ－Ｃｅｒａｍ技术的完美结合,使得牙科陶瓷强度和断裂韧性很大的提高,给临床全瓷修复体的制作提供了新的途径,本研究采用α型高纯度,超细氧化铝粉末,经等静压处理,在在１３５０℃下烧结成一定强度的多孔氧化铝坯体。最后在多孔氧化铝坯体的表面采用镧硅硼玻璃进行渗透,制作具有一定强度和半透明的氧化铝玻璃复合体。结果表明     

Genetic design automation: engineering fantasy or scientific renewal?

The aim of synthetic biology is to make genetic systems more amenable to engineering, which has naturally led to the development of computer-aided design (CAD) tools. Experimentalists still primarily rely on project-specific ad hoc workflows instead of domain-specific tools, which suggests that CAD tools are lagging behind the front line of the field. Here, we discuss the scientific hurdles that have limited the productivity gains anticipated from existing tools. We argue that the real value of efforts to develop CAD tools is the formalization of genetic design rules that determine the complex relationships between genotype and phenotype.     

Structure,mechanism, and enantioselectivity shifting of lipase LipK107 with a simple way

Because of the complex mechanisms of enzymatic reactions, no precise and simple method of understanding and controlling the chiral selectivity of enzymes has been developed. However, structure-based rational design is a powerful approach to engineering enzymes with desired catalytic activities. In this work, a simple, structure-based, large-scale in silico design and virtual screening strategy was developed and successfully applied to enzyme engineering. We first performed protein crystallization and X-ray diffraction to determine the structure of lipase LipK107, which is a novel family I.1 lipase displaying activity for both R and S isomers in chiral resolution reactions. The catalytic mechanism of family I.1, which includes LipK107, was ascertained first through comparisons of the sequences and structures of lipases from other families. The binding states of LipK107, including the energy and the conformation of complexes with the R and S enantiomers, have been evaluated by careful biocomputation to figure out the reason for the higher S selectivity. Based on this study, a simple strategy for manipulating the chiral selectivity by modulating a crucial distance in the enzyme–substrate complex and judging virtual mutations in silico is recommended. Then, a novel electrostatic interaction analysis protocol was used to design LipK107 mutants to validate our strategy. Both positive and negative mutations determined using this theoretical protocol have been implemented in wet experiments and were proved to produce the desired enantioselectivity, showing a 176% increase or 50% decrease in enantioselectivity as desired. Because of its accuracy and versatility, the strategy is promising for practical applications.     

A Systems Approach to Sustainable Technical Product Design

Many existing methods for sustainable technical product design focus on environmental efficiency while lacking a framework for a holistic, sustainable design approach that includes combined social, technical, economic, and environmental aspects in the whole product life cycle, and that provides guidance on a technical product development level. This research proposes a framework for sustainable technical product design in the case of skis. We developed a ski under the Grown brand, benchmarked according to social, environmental, economic, and technical targets, following an initial sustainability assessment, and delivered the first environmental life cycle assessment (ELCA) and the first social life cycle assessment (SLCA) of skis. The framework applies a virtual development process as a combination of ELCA to calculate the environmental footprint as carbon equivalents of all materials and processes and a technical computer‐aided design (CAD) and computer‐aided engineering (CAE) simulation and virtual optimization using parameter studies for the nearly prototype‐free development of the benchmarked skis. The feedback loops between life cycle assessment (LCA) and virtual simulation led to the elimination of highly energy intensive materials, to the pioneering use of basalt fibers in skis, to the optimization of the use of natural materials using protective coatings from natural resins, and to the optimization of the production process. From an environmental perspective, a minimum 32% reduction in carbon equivalent emissions of materials in relation to other comparably performing skis has been achieved, as well as a pioneering step forward toward transparent communication of the environmental performance by the individual, comparable, and first published ski carbon footprint per volume unit.     

Computer-aided design of biological circuits using TinkerCell

Synthetic biology is an engineering discipline that builds on modeling practices from systems biology and wet-lab techniques from genetic engineering. As synthetic biology advances, efficient procedures will be developed that will allow a synthetic biologist to design, analyze, and build biological networks. In this idealized pipeline, computer-aided design (CAD) is a necessary component. The role of a CAD application would be to allow efficient transition from a general design to a final product. TinkerCell is a design tool for serving this purpose in synthetic biology. In TinkerCell, users build biological networks using biological parts and modules. The network can be analyzed using one of several functions provided by TinkerCell or custom programs from third-party sources. Since best practices for modeling and constructing synthetic biology networks have not yet been established, TinkerCell is designed as a flexible and extensible application that can adjust itself to changes in the field.     

Influence of custom-made implant designs on the biomechanical performance for the case of immediate post-extraction placement in the maxillary esthetic zone: a finite element analysis

Due to the increasing adoption of immediate implantation strategies and the rapid development of the computer aided design/computer aided manufacturing technology, a therapeutic concept based on patient-specific implant dentistry has recently been reintroduced by many researchers. However, little information is available on the designs of custom-made dental implant systems, especially their biomechanical behavior. The influence of the custom-made implant designs on the biomechanical performance for both an immediate and a delayed loading protocol in the maxillary esthetic zone was evaluated by means of the finite element (FE) method. FE models of three dental implants were considered: a state of the art cylindrical implant and two custom-made implants designed by reverse engineering technology, namely a root-analogue implant and a root-analogue threaded implant. The von Mises stress distributions and micro-motions around the bone-implant interfaces were calculated using ANSYS software. In a comparison of the three implant designs for both loading protocols, a favorable biomechanical performance was observed for the use of root-analogue threaded implant which approximated the geometry of natural anterior tooth and maintained the original long-axis. The results indicated that bone-implant interfacial micro-motion was reduced and a favorable stress distribution after osseointegration was achieved.     

Viability of Bioprinted Cellular Constructs Using a Three Dispenser Cartesian Printer

Tissue engineering has centralized its focus on the construction of replacements for non-functional or damaged tissue. The utilization of three-dimensional bioprinting in tissue engineering has generated new methods for the printing of cells and matrix to fabricate biomimetic tissue constructs. The solid freeform fabrication (SFF) method developed for three-dimensional bioprinting uses an additive manufacturing approach by depositing droplets of cells and hydrogels in a layer-by-layer fashion. Bioprinting fabrication is dependent on the specific placement of biological materials into three-dimensional architectures, and the printed constructs should closely mimic the complex organization of cells and extracellular matrices in native tissue. This paper highlights the use of the Palmetto Printer, a Cartesian bioprinter, as well as the process of producing spatially organized, viable constructs while simultaneously allowing control of environmental factors. This methodology utilizes computer-aided design and computer-aided manufacturing to produce these specific and complex geometries. Finally, this approach allows for the reproducible production of fabricated constructs optimized by controllable printing parameters.     

Quantitative measurement of speech sound distortions with the aid of minimum variance spectral estimation method for dentistry use

In this paper, we search an adequate quantitative method based on minimum variance spectral analysis in order to reflect the dependence of the speech quality on the correct positioning of the dental prostheses. We also search some quantitative parameters, which reflect the correct position of dental prostheses in a sensitive manner.     

Finite element analysis of implant-supported prosthesis with pontic and cantilever in the posterior maxilla

The aim of this study was to evaluate the influence of pontic and cantilever designs (mesial and distal) on 3-unit implant-retained prosthesis at maxillary posterior region verifying stress and strain distributions on bone tissue (cortical and trabecular bones) and stress distribution in abutments, implants and fixation screws, under axial and oblique loadings, by 3D finite element analysis. Each model was composed of a bone block presenting right first premolar to the first molar, with three or two external hexagon implants (4.0 × 10 mm), supporting a 3-unit splinted dental fixed dental prosthesis with the variations: M1 – three implants supporting splinted crowns; M2 – two implants supporting prosthesis with central pontic; M3 – two implants supporting prosthesis with mesial cantilever; M4 – two implants supporting prosthesis with distal cantilever. The applied forces were 400 N axial and 200 N oblique. The von Mises criteria was used to evaluate abutments, implants and fixation screws and maximum principal stress and microstrain criteria were used to evaluate the bone tissue. The decrease of the number of implants caused an unfavorable biomechanical behavior for all structures (M2, M3, M4). For two implant-supported prostheses, the use of the central pontic (M2) showed stress and strain distributions more favorable in the analyzed structures. The use of cantilever showed unfavorable biomechanical behavior (M3 and M4), mainly for distal cantilever (M4). The use of three implants presented lower values of stress and strain on the analyzed structures. Among two implant-supported prostheses, prostheses with cantilever showed unfavorable biomechanical behavior in the analyzed structures, especially for distal cantilever.     

Dental implications of bisphophonate-related osteonecrosis

doi: 10.1111/j.1741‐2358.2012.00622.x
Dental implications of bisphophonate‐related osteonecrosis Objectives: The aim is to explore the current theories about clinical , pathological and dental management of bisphosphonate related osteonecrosis of the jaws. Also discussed are the actions of bisphosphonates, pathogenesis related to the susceptibility of jaws, the predisposing risk factors for the development of bisphosphonate‐related osteonecrosis of the jaws (BRONJ) and diagnostic criteria based on the literature review. Discussion: Osteoporosis is a disease that generally affects the mineral status of both cortical and trabecular bone in post menopausal women. Bisphosphonates are a group of drugs that preserve and increase bone mass. Bisphosphonate drugs are classified according to use and method of delivery. The bisphosphonates used for the treatment of osteoporosis are taken orally. Little is known about the side effects and dangers of the long‐term use of therapeutic doses of Bisphosphonates. A recent complication reported is osteonecrosis of jaws. The use of IV bisphosphonates for multiple myeloma and metastatic bone diseases suggests that dosage, length of treatment, and route of administration, as well as cofactors such as use of glucocorticoids and immunosuppressive agents, and dental surgery, could all be related to the incidence of BRONJ. This review provides an update on current knowledge about clinical, pathological and management aspects of BRONJ. Conclusions: Little evidence exists to direct the prosthodontic management of patients with a history of bisphosphonate use. Patients with active osteonecrosis related to bisphosphonate use have reduced tissue tolerance to function with removable prostheses and decreased potential for osseointegration of dental implants. Decisions should be based on clinical judgment tempered by the presenting conditions, medical profile, and patient needs. A better understanding would help in a dental setting to prevent any complication and help to improve the prognosis for those being treated for osteoradionecrosis.Until further evidence emerges regarding management of patients with active bisphosphonate‐ related osteonecrosis, conservative prosthodontic treatment is reasonable and prudent.