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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (1): 81-87. doi: 10.19723/j.issn.1671-167X.2024.01.013

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Trueness of different digital design methods for incisal guidance of maxillary anterior implant-supported single crowns

Sui LI1,Wenjie MA1,Shimin WANG2,Qian DING1,*(),Yao SUN1,Lei ZHANG1,*()   

  1. 1. Department of Prosthodontics, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
    2. Center of Dental Laboratory, Peking University School and Hospital of Stomatology & National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2023-10-10 Online:2024-02-18 Published:2024-02-06
  • Contact: Qian DING,Lei ZHANG E-mail:dingqian@hsc.pku.edu.cn;drzhanglei@yeah.net
  • Supported by:
    the Clinical Research Foundation of Peking University School and Hospital of Stomatology(PKUSS-2023CRF503);the National Program for Multidisciplinary Cooperative Treatment on Major Diseases(PKUSSNMP-202004)

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Abstract:

Objective: To compare the trueness of incisal guidance of implant-supported single crowns designed by patient-specific motion (PSM) with that designed by average-value virtual articulator (AVA). Methods: The study had recruited 12 participants with complete dentition and stable incisal guidance. An intraoral scanner was used to scan digital casts and record two types of patient-specific motion (data only including protrusive movement, and data including protrusive movement and lateral protrusive movement). The lingual surfaces of the maxillary incisors which guided the protrusive movement was selected and elevated to create a reference cast. A maxillary central incisor of original casts was vir-tually extracted and implanted to generate a working cast. The Dental system software program was used to design implant-supported single crowns with the anatomical coping design method. The incisal guidance was designed by different methods. The incisal guidance in control group was designed by the average-value virtual articulator. The incisal guidance in experiment groups was designed by the patient-specific motion only including protrusive movement (PSM1) and with the patient-specific motion including protrusive movement and lateral protrusive movement (PSM2). The incisal guidance of prosthesis designed by these 3 methods were compared with the original incisal guidance in Geomagic Control 2015 (3DSystem, America). The measurements included: Average of positive values, ratio of positive area and maximum value reflecting supra-occlusion; average of negative values, ratio of negative area and minimum value reflecting over-correction; and root mean square reflecting overall deviation. Results: Statistical data were collected using the median (interquartile range) method. The average of positive values, ratio of positive area and average of negative values of the PSM2 group were smaller than those of the control group [8.0 (18.8) μm vs. 37.5 (47.5) μm; 0 vs. 7.2% (38.1%); -109.0 (63.8) μm vs.-66.5 (64.5) μm], and the ratio of negative area of PSM2 group was larger than those of the control group [52.9% (47.8%) vs. 17.3% (45.3%)], with significant differences (P all < 0.05). The ratio of positive area [0.1% (7.0%)] and average of negative values [-97.0 (61.5) μm] of PSM1 group, were smaller than those of the control group, and the ratio of negative area [40.7% (39.2%)] of the PSM1 group was larger than that of the control group, with significant differences (P < 0.05). The average of positive values [20.0 (42.0) μm] and ratio of positive area of PSM1 group was larger than that of the PSM2 group with significant differences (P < 0.05). Conclusion: To establish the incisor guidance of implant-supported single crowns, compared with the average-value virtual articulator and the patient-specific motion only including protrusive movement, the patient-specific motion including protrusive movement and lateral protrusive movement is more conducive to reducing the protrusive interference of prosthesis and improving the occlusal fit.

Key words: Dental implant, Dental prosthesis design, Computer-aided design, Maxillary anterior teeth, Incisal guidance

CLC Number: 

  • R782.1

Figure 1

Two different patient-specific motion A, patient-specific motion with protrusive movement; B, patient-specific motion with protrusive movement and lateral protrusive movement."

Figure 2

Preprocessing of digital maxillary casts A, the original cast; B, the lingual surfaces of maxillary incisors that guided the protrusive movement was selected; C, the selected surfaces elevated by 300 μm to create a reference cast; D, the copied original cast; E, right maxillary central incisor was virtually extracted and a scan body was inserted to generate a working cast; F, left maxillary central incisor was virtually extracted and a scan body was inserted to generate another working cast."

Figure 3

Design the incisal guidance of implant-supported single crowns in 3 groups AVA, average-value virtual articulator; PSM1, patient-specific motion only including protrusive movement; PSM2, patient-specific motion including protrusive movement and lateral protrusive movement. The red and yellow area in the lingual surface of the designed crowns indicated protrusive inter-ference detected by the virtual articulator or patient-specific motion in the Dental System software program."

Figure 4

Comparison results between the incisal guidance of prosthesis and the original incisal guidance Representative images of the color-coded maps showing the deviations between the incisal guidance designed by different methods (AVA, PSM1, PSM2) and the original incisal guidance. The green-coded areas indicated the deviation within tolerance range (-100 to 50 μm). The red-coded areas (positive deviation out of the tolerance range) indicated supra-occlusion. The blue-coded areas (negative deviation out of the tolerance range) indicated over-correction. Abbreviations as in Figure 3."

Table 1

Deviation analysis results of designed prosthesis with original tooth morphology (n = 24)"

Group Measurements indicating supra-occlusion Measurements indicating over-correction RMS/μm
MAX/μm +AVG/μm +S/% MIN/μm -AVG/μm -S/%
AVA 97.0 (128.8) 37.5 (47.5) 7.2 (38.1) -201.5 (136.8) -66.5 (64.5) 17.3 (45.3) 90.0 (55.5)
PSM1 46.0 (117.3) 20.0 (42.0) 0.1 (7.0) -234.5 (162.0) -97.0 (61.5) 40.7 (39.2) 104.5 (67.0)
PSM2 14.0 (47.5) 8.0 (18.8) 0 (0) -252.5 (105.5) -109.0 (63.8) 52.9 (47.8) 118.5 (62.5)

Table 2

Pairwise comparison of deviation analysis results (Wilcoxon signed rank test)"

Group 1 Group 2 Measurements Z P
PSM2 PSM1 MAX -2.949 0.003
+AVG -2.876 0.004
+S -2.271 0.023
MIN -0.486 0.627
-AVG -1.263 0.207
-S 1.943 0.052
RMS 0.786 0.432
PSM2 AVA MAX -3.467 0.001
+AVG -3.391 0.001
+S -3.173 0.002
MIN -2.000 0.045
-AVG -2.615 0.009
-S 3.200 0.001
RMS 1.986 0.047
PSM1 AVA MAX -1.886 0.059
+AVG -1.506 0.132
+S -1.964 0.050
MIN -1.743 0.081
-AVG -2.429 0.015
-S 2.986 0.003
RMS 2.458 0.014
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