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North American dental schools were surveyed to determine the types of clinical experiences and the extent of material use that predoctoral students encounter with restorative procedures that employ all-ceramic materials. The results were based on an overall response rate of 80% from the 64 surveyed schools. The majority (96%) of the 51 schools responding to the survey did offer an opportunity to become experienced with all-ceramic restorations. The selection of bases and liners for all-ceramic restorations included dentin adhesive agents, glass ionomer materials, and calcium hydroxide products, by a ratio of 5:4:1, respectively. The most commonly used impression material types were addition silicone and polyether. One or both of these materials were used by every school. Dicor glass ceramic and alumina core ceramic were the most commonly used materials by the responding schools for veneers, onlays, and crowns. Dicor glass ceramic and CAD/CAM ceramic were most commonly used for inlays. Crowns were made of more different all-ceramic material types than the other restoration classes. Fabrication of all-ceramic restorations was primarily by commercial laboratories and school technicians. Students have hands-on experience in the fabrication of all-ceramic restorations in 6% of the responding schools. Luting agents for all-ceramic restorations include dual-cured resin, in 96% of the responding schools, light-cured resin, 43%, and glass ionomer cement, 33%. Zinc phosphate, chemical-cured composite, and polycarboxylate were used by less than one fourth of the respondents. Only resin-based composite materials were used to lute ceramic veneers. Rubber dam was applied primarily during luting procedures involving all-ceramic inlays and onlays. Crowns and veneers were isolated by this method in less than 30% of the responding schools. Finishing procedures with all-ceramic restorations were accomplished with three or more instruments by 89% of the schools.
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PMID:The teaching of all-ceramic restorations in North American dental schools: materials and techniques employed. 946 57

Veneers were fabricated by CEREC CAD-CAM and the platinum foil techniques for standardized preparations on 10 artificial teeth. Mesial preparation contacts were broken, but distal contacts remained intact. The veneers were cemented in a standardized manner to their teeth. The veneers and their attached cement were embedded in epoxy resin and sectioned twice gingivally-incisally and mesially-distally to produce eight sections. Three-way ANOVA disclosed that the main effects of fabrication method, section location, and measurement point location as well as all interaction terms significantly affected fit (P < 0.05). However, the difference in mean overall fit between the fabrication methods was too small to be of clinical importance. Restoration of the broken approximal contact did not compromise fit. Incisal margins had the greatest marginal openings. Surface measurement point locations were less well adapted than internal locations. Fit maps for CEREC and platinum foil veneers were strikingly similar.
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PMID:Fit of veneers made by CAD-CAM and platinum foil methods. 948 50

A computer-aided designing and manufacturing (CAD/CAM) technique for clinical fabrication of facial prostheses was developed. Laser surface scanning was applied to acquire three-dimensional imaging data of the patient's facial defect. The three-dimensional imaging data was then transferred to a CAD/CAM interactive program for image processing, which then mathematically designed and produced a model for fabrication of the facial prosthesis. This CAD/CAM technique has the potential to simplify the procedure and decrease the laboratory work required compared to that required for the conventional plaster-cast method. This new technique also provides a novel approach to the fabrication of prostheses for the reconstruction of facial defects. Two alternative three-dimensional modeling processes, laser lithographic modeling and numerically controlled milling modeling, were integrated in this study. The possibilities and current limitations of the techniques are also discussed.
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PMID:A CAD/CAM technique for fabricating facial prostheses: a preliminary report. 949 66

The aim of this study was to evaluate the validity and reliability of volume determinations using the commercially available Seattle ShapeMaker CAD/CAM system for production of prosthetic sockets and to compare it with the commercially available CAPOD system. We used three types of reference objects for volumetric determinations: steel tubes, plaster of Paris casts, and residual limb models. Three different sizes were examined for each type of object. Volume measurements with the two CAD/CAM systems were compared with measurements obtained by water filling, water immersion, or mathematical calculation (tubes only). We found an inconsistent systematic error of less than 3.1% for ShapeMaker and no systematic error for CAPOD. Random errors, represented by the coefficient of variation, were below 1.3% for the ShapeMaker and, in most cases, below 0.4% for the CAPOD. Theoretical changes in volume of 2.6% and 0.8% are possible to detect with these CAD/CAM systems. In our opinion, both systems have sufficient precision for routine clinical use in prosthetics and orthotics. However, in our study, the ShapeMaker committed larger random and systematic errors than CAPOD. This means that, according to our study, CAPOD offers the best possibility to determine and detect small changes in residual limb volume as a function of time.
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PMID:Accuracy and precision of volumetric determinations using two commercial CAD systems for prosthetics: a technical note. 950 50

The number of dental computer-aided design/computer-aided manufacture (CAD/CAM) systems commercially available is growing. These systems range in complexity and application, from manual copy milling of inlays to full computer-controlled systems with a complex library of tooth forms enabling the automated production of crowns and bridges. All CAD/CAM systems permit the production of restorations at the chairside and, at least in theory, eliminate potential inaccuracies associated with the traditional, multistage production of indirect restorations. Their use also minimizes cross-infection. However, the capital costs of these systems are great and a high throughput of restorations is required in order to achieve financial viability. Long-term clinical studies are required before a final judgement may be made of the use of these relatively new systems.
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PMID:Dental CAD/CAM: a millstone or a milestone? 960 Dec 23

The aim of this investigation was to evaluate clinically and histologically a new custom-made, root analogue titanium implant placed into extraction sockets in monkeys (Macaca fascicularis). Three adult monkeys were used in this investigation. After raising full thickness flaps on the buccal and lingual side, the upper central and lateral incisors were extracted. Each tooth root was machine copied to 1 titanium analogue using a new CAD/CAM-system. The implants were installed in the respective extraction sockets and the flaps sutured back. After 6 months of healing biopsies were taken and processed according to the cutting-grinding technique. The percentage of mineralized bone-to-implant contact was measured as a fraction of the rough implant surface using computer-assisted analysis. The main clinical problem that occurred during implant placement was the fracture of the buccal alveolar wall. The histometric evaluation showed a mean mineralized bone-to-implant contact of 41.2 +/- 20.6%. In this investigation it could be shown that implants fabricated by laser copying will osseointegrate. The presented data encourage the performance of clinical and experimental trials evaluating the new system utilizing improved second generation CAD/CAM equipment. Such studies are currently underway.
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PMID:Custom-made root analogue titanium implants placed into extraction sockets. An experimental study in monkeys. 961 43

Three-dimensional registration of the facial surface by methods which are currently in use is difficult because of the long measuring times required by point-based imaging systems. Artifacts caused by movement appear, e.g., blinking. Also the production of a facial plaster-cast model for measuring is not an adequate solution. In order to acquire data of the facial surface in a contact-free manner, a system is needed that has short measuring times, is able to record data of complex surfaces and at the same time does no harm to the open eyes. The method described here represents a new development of an industrial high tech CAD/CAM system. Unlike customary point-based imaging systems, the stripe projection method works using entire planes. Structured light is aimed at the surface to be measured, recorded by videocamera and calculated by triangulation; then the different views are combined by computer. The system has an optic sensor that can record approximately 500,000 measuring points within seconds (ca. 1.7s). Test persons' faces and plaster-cast models of them (n = 15) were measured comparatively and serially (n = 5) to test the validity and reliability of the method for maxillofacial procedures. These investigations show that this method is appropriate for recording three-dimensional soft-tissue profiles. First studies on patients before and after dysgnathia operations were undertaken. A prospective long-term study for collecting data on pre- and postoperative dysgnathia patients has been begun. Initially, it will record the changes in facial soft tissue on the basis of skeletal displacement. Later, predictions about the soft-tissue changes subsequent to dysgnathia surgery can be worked out on the basis of stored data matched with three-dimensional bone data.
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PMID:[3-D imaging of the facial surface by topometry using projected white light strips]. 965 39

The design and development of a simulator for endovascular repair of abdominal aortic aneurysm (AAA) is described. The simulator consists of an interchangeable model of a human AAA based on computed tomography data and is produced by means of computer-aided design and manufacture (CAD/CAM) techniques. The model has renal, iliac, and femoral arteries, and is perfused with a temperature controlled blood-analog fluid under simulated physiological flow conditions. "Fluoroscopic imaging" is simulated by a computerized imaging system that uses visible light. A movable video camera relays images in the antero-posterior and lateral planes of the AAA to a monitor. The imaging system allows "arteriography" and "road-mapping" to be performed so as to facilitate accurate deployment of endovascular stent-grafts. The system has been used for teaching and demonstrating endovascular techniques to clinicians, as well as the evaluation of new stent-graft devices. Its successful incorporation into endovascular workshops has demonstrated its role in the training of clinicians in endovascular repair of AAA.
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PMID:Development of a simulator for endovascular repair of abdominal aortic aneurysms. 977 52

Titanium is used in dentistry for implants and frame work because of its sufficient chemical, physical and biological properties. The corrosion behaviour is from high interest to value biocompatibility. A static immersion test was undertaken with a titanium test specimen (30 mm x 10 mm x 1 mm, immersion time = 4 x 1 w, n = 3 for each series). The following parameters were investigated: specimen preparation, grinding, pH-value, different casting systems, comparison with CAD/CAM, influence of: chloride, thiocyanate, fluoride, lactate, citrate, oxalate, acetate. Atomic absorption spectroscopy was used to analyse the solutions weekly. The course of corrosion was investigated photometrically. Titanium reveals ion releases [(0.01-0.1) microg/(cm2 x d)] in the magnitude of gold alloys. There is little influence of grinding and casting systems in comparison with organic acids or pH value. The ion release increases extreme (up to 500 microg/(cm2 x d)) in the presence of fluoride. Low pH values accelerate this effect even more. Clinically, no corrosion effects were observed. Nevertheless it is recommended that it is best to avoid the presence of fluoride or to reduce contact time. In prophylactic fluoridation of teeth, a varnish should be used.
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PMID:In vitro corrosion of titanium. 979 25

Subperiosteal implants are currently fabricated by using the classic two-stage direct bone impression technique or by the use of the one-stage computer tomography/computer-assisted design-computer-assisted manufacture (CT/CAD-CAM) method. This study compares the accuracy of the two techniques by using cadaver maxillae and mandibles as the models for fabrication of casts. Seven cadaver jaw specimens were collected and subjected to direct bone impressions and to CT scans. Those derived from the direct bone impressions were poured in die stone, while the CT scans were sent for fabrication of CAD-CAM-generated casts. On each of the 14 models so produced, a cast grid was fabricated that was designed as a measuring device. The preciseness of fit of each grid was subjected to analyses that presented levels of accuracy. Statistical evaluation of these levels, reduced to numerical indices, revealed that the direct bone techniques resulted in acceptable castings in seven of seven cases, whereas the CAD-CAM method yielded adequate castings in five of seven cases.
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PMID:An in vitro comparison of the computerized tomography/CAD-CAM and direct bone impression techniques for subperiosteal implant model generation. 983 33


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