Optimizing mandibular implant-overdentures based on 3D printing technologies and attachment systems
Notice bibliographique
Résumé
Background: Since 2002, the use of two-implant mandibular overdentures (IOD) has been advocated as the minimum standard of care for treating mandibular edentulism. Despite favorable patient-reported outcomes and satisfactory clinical performance, the existing IODs designed for mandibular edentulism come with inherent limitations. The primary disadvantages of these dental prostheses include the loss of attachment retention due to wear over time, necessitating regular maintenance appointments. Another significant hurdle for IODs lies in their time-consuming and expensive fabrication process. Although conventional denture-making techniques have been well-established for over a century, recent developments have brought computer-aided design and manufacturing (CAD/CAM) options to the forefront for dental professionals.Objectives: The overall objective of this thesis has been to tackle the IODs’ limitations, specifically the loss of retention in attachment systems and the lengthy and costly fabrication processes, by exploring methods for the optimization of this type of dental prostheses.Methods: To address this objective, a combination of research methodologies was used. First, an in vitro study (manuscript I) was carried out to explore the retentive properties and structural integrity of two attachment systems (Novaloc and Locator attachments) for two-implant overdentures subjected to mechanical cycling representing masticatory forces for up to 12 months of use. Then, a scoping review (manuscript II), as well as a meta-analysis (manuscript III) were conducted to map the current literature regarding the CAD/CAM removable dental prosthesis. Through the fourth manuscript, a series of in vitro tests was performed to optimize the mechanical and surface properties of the 3D-printed denture base material through varying printing orientations and post-processing strategies before moving forward to the clinical trial phase. Lastly, in manuscript V, a protocol for the first cross-over mixed-methods randomized controlled trial (RCT) comparing CAD/CAM IODs with the conventional ones was developed.Results: The findings from the in vitro attachment study show that the Novaloc attachment system preserved retentive forces longevity relative to the Locator system, despite lower overall retentive force. The review and meta-analysis suggested that CAD/CAM dentures are comparable to conventional dentures regarding patient- and clinician-centered outcomes, yet they offer lower fabrication costs. In our set of experimental tests on 3D-printed denture base material, we found that both printing orientation and post-processing technique affect the mechanical and surface properties of these materials. Finally, we prepared a protocol for a cross-over mixed-methods RCT in comparing CAD/CAM IODs with the conventional ones, which has been approved by the Ethical Review Board at McGill University. The study is currently ongoing and began recruitment in January 2024.Conclusions: Our scoping review and meta-analysis indicated the need to conduct more well-designed high-quality RCTs regarding the CAD/CAM dentures, particularly IODs. Through our series of in vitro tests, we found an ideal scenario for the attachment system and processing parameter for 3D-printed denture base material to use in the clinical setting. Our results, if confirmed in our RCT, will have significant effect on clinical practice, by improving the tested procedure and showcasing an opportunity for greater access to oral health care for the edentulous population
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,004 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,001 | 0,002 |
| Bibliométrie | 0,003 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,002 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».