Saponaro Paola C, Yilmaz Burak, Heshmati Reza H, McGlumphy Edwin A
Clinical Assistant Professor, Division of Restorative Science and Prosthodontics, The Ohio State University College of Dentistry, Columbus, Ohio.
Associate Professor, Division of Restorative Science and Prosthodontics, The Ohio State University College of Dentistry, Columbus, Ohio.
J Prosthet Dent. 2016 Sep;116(3):431-5. doi: 10.1016/j.prosdent.2016.03.017. Epub 2016 May 7.
Computer-aided design and computer-aided manufacture (CAD-CAM)-fabricated complete dentures (CD) seek to address the disadvantages associated with conventional CD fabrication. However, few if any randomized clinical trials, cross-sectional, and/or retrospective analyses are available for the clinical performance of CAD-CAM-fabricated CDs.
The purpose of this retrospective study was to evaluate clinician experience with digital CD fabrication attempted in a 2-visit protocol. The actual number of appointments required for insertion and the number of postinsertion adjustment visits, and whether the incidence of treatment complications was related to operator experience were recorded and evaluated.
Patients who had received CAD-CAM-fabricated CDs were identified from a retrospective chart review. The number of appointments needed to insert digital CDs in attempting the 2-visit fabrication protocol marketed by the company, the number of postinsertion adjustments, and the reported complications were counted. There was no control group for comparative purposes used in this study. Whether the experience level of the operator influenced the frequency of a complication, the number of appointments needed to insert the definitive prostheses, and the number of postinsertion visits was determined by using an analysis of variance assessed at the 95% confidence level (α=.05). The frequency of a complication at each of the levels of operator experience was analyzed using the Exact Mantel-Haenszel chi-square test.
Of the 48 rehabilitated participants, 24 participants were treated at the predoctoral level and 24 were treated at the graduate prosthodontics resident level. A total of 31 participants satisfied the true 2-visit fabrication protocol, and the remaining 17 participants required additional clinical visits because of complications on the day of insertion. The CD prostheses of 5 participants from the sample population required remaking using the conventional method. The mean number of postinsertion adjustment visits was 2.08. Of the 90 arches completed, 22 prostheses could not be inserted at the second appointment.
The mean number of appointments needed to insert the prostheses in both groups was 2.39 visits--not 2 as claimed by the company. The most common types of complications observed were lack of denture retention, inaccurate occlusal vertical dimension, and incorrect centric relation.
计算机辅助设计与计算机辅助制造（CAD-CAM）制作的全口义齿旨在解决传统全口义齿制作相关的缺点。然而，关于CAD-CAM制作的全口义齿的临床性能，几乎没有随机临床试验、横断面研究和/或回顾性分析。
本回顾性研究的目的是评估临床医生采用两次就诊方案进行数字化全口义齿制作的经验。记录并评估义齿戴入所需的实际就诊次数、戴入后调整就诊次数，以及治疗并发症的发生率是否与操作者经验有关。
通过回顾性病历审查确定接受CAD-CAM制作的全口义齿的患者。统计按照公司销售的两次就诊制作方案尝试戴入数字化全口义齿所需的就诊次数、戴入后调整次数以及报告的并发症。本研究未设用于比较的对照组。使用95%置信水平（α=0.05）评估的方差分析确定操作者的经验水平是否影响并发症的发生频率、戴入最终修复体所需的就诊次数以及戴入后就诊次数。使用精确曼特尔-亨塞尔卡方检验分析每个操作者经验水平下并发症的发生频率。
在48例接受修复的参与者中，24例在博士前水平接受治疗，24例在口腔修复学研究生住院医师水平接受治疗。共有31例参与者符合真正的两次就诊制作方案，其余17例参与者因戴入当天出现并发症而需要额外的临床就诊。样本人群中有5例参与者的全口义齿修复体需要采用传统方法重新制作。戴入后调整就诊的平均次数为2.08次。在完成的90个牙弓中，有22个修复体在第二次就诊时无法戴入。
两组戴入修复体所需的平均就诊次数为2.39次，并非如公司所宣称的2次。观察到的最常见并发症类型为义齿固位不足、咬合垂直距离不准确和正中关系不正确。
