The Conometric Concept: Definitive Fixed Lithium Disilicate Restorations Supported by Conical Abutments

PURPOSE

The use of the conical coupling connection to support definitive restorations was evaluated in cases involving full acrylic resin or hybrid acrylic resin-composite prostheses. The aim of this study was to evaluate the performance of definitive fixed partial prostheses made with lithium disilicate and supported by coupling connection abutments and healed implants.

MATERIALS AND METHODS

The prostheses were placed in the posterior regions of partially edentulous patients; 65 patients received fixed lithium disilicate restorations splinted with conical coupling connections to two implants. Implants were placed into healed sites and fresh extraction sockets. The prostheses were placed after healing periods of 3 months: restorations were followed yearly for 3 years. At each follow-up visit, peri-implant bone levels and pocket depths were recorded. Esthetic, functional, and biologic United States Public Health Services (USPHS) parameters modified by the FDI World Dental Federation study design were assessed at the last follow-up appointments.

RESULTS

Two prostheses (3.07%) fractured: one was related to framework design error; one was caused by a car accident. Three patients reported small chips: these restorations were immediately polished. No significant difference involving peri-implant bone and probing levels between the experimental times were found. None of the prostheses became loose.

CONCLUSIONS

The results of this research indicated that abutment-prostheses coupling connections were successful within the timeframe of this study.

Strain gauge analysis of implant-supported, screw-retained metal frameworks: Comparison between different manufacturing technologies

Over the past decades, the technological development in the medical field, coupled with the ongoing scientific research, has led to the development and improvement of dental prostheses supported by screw-retained metal frameworks. A key point in the manufacture of the framework is the achievement of a passive fit, intended as the capability of an implant-supported reconstruction to transmit minimum strain to implant components as well as to the surrounding bone, when subject to any load. The fitting of four different kinds of screw-retained metal frameworks was tested in this article. They differ both in materials and manufacturing process: two frameworks are made by casting, one framework is made by computer-aided design and computer-aided manufacturing and one framework is made by electric resistance spot welding (WeldONE, DENTSPLY Implants Manufacturing GmbH, Mannheim, Germany). The passivity of the frameworks was evaluated on the entire system, composed of a resin master cast, the implant analogues embedded in the cast and the frameworks. Strains were recorded by means of an electrical strain gauge connected to a control unit for strain gauge measurements. The experimental tests were carried out in the laboratories of the Department of INdustrial engineering at the University of Bologna. The results of the test campaigns, which compared three samples for each technological process, showed that no significant differences exist between the four framework types. In particular, the frameworks made by the resistance welding approach led to a mechanical response that is well comparable to that of the other tested frameworks.

Marginal bone loss around implants with platform-switched Morse-cone connection: a radiographic cross-sectional study

OBJECTIVES

The aims of the present cross-sectional study are to evaluate the bone remodeling around Morse-cone implants placed subcrestally 1 year after loading and the prevalence of bone loss >0.5 mm after at least 3 years of loading.

MATERIAL AND METHODS

Subjects who underwent a radiographic check in 2013 with implants that had been in function for at least 3 years were considered for inclusion. The study population comprised of 145 subjects with a total of 523 implants. At the moment of insertion, all the implants were placed subcrestally from 1 to 3 mm as clinically measured. Radiographs taken at baseline, that is 1 year after loading (T0), and at the follow-up visit in 2013 (T1) were examined. The distance between the rim of the implant and the marginal bone level at mesial and distal aspects of each implant was determined and the mean bone loss calculated.

RESULTS

In the total sample, the mean bone loss occurred between baseline and 2013 examination was 0.42 ± 0.77 mm; at T1 424 implants presented the marginal bone level at the implant rim (78) or above it (346). On the other hand, 99 implants presented the rim above the bone crest. Fifty-one implants that at T1 presented the rim above the bone crest, and that between T0 and T1 had lost at least 0.5 mm, were considered losers: 10 implants lost up to 0.5 mm, 11 lost from 0.6 to 1 mm, 16 lost from 1.1 to 2 mm, and 14 lost more than 2 mm of bone. On a subject basis, 34 subjects (group A) with a total of 200 implant sites presented loser implants, while 111 subjects (group B) with 323 implants displayed non-loser implants.

CONCLUSIONS

Within the limits of a cross-sectional study, the results show that Morse-cone implants placed subcrestally in the vast majority of cases (89.9%) are able to maintain the bone crest at level of the rim or above it 1 year after loading. The incidence of loser sites (bone loss >0.5 mm) after at least 3 years of follow-up is 9.7% at implant level and 23.5% at patient level.

Microstructural characterization and hardness properties of electric resistance welding titanium joints for dental applications

The electric resistance welding procedure is used to join a titanium bar with specific implant abutments in order to produce a framework directly in the oral cavity of the patient. This investigation studied the effects of the welding process on microstructure and hardness properties of commercially pure (CP2 and CP4) Ti components. Different welding powers and cooling procedures were applied to bars and abutments, normally used to produce the framework, in order to simulate the clinical intraoral welding procedure. The analyses highlighted that the joining process did not induce appreciable changes in the geometry of the abutments. However, because of unavoidable microstructural modifications in the welded zones, the hardness decreased to values lower than those of the unwelded CP2 and CP4 Ti grades, irrespective of the welding environments and parameters.

Adult stem cells properties in terms of commitment, aging and biological safety of grit-blasted and Acid-etched ti dental implants surfaces

Titanium (Ti) is one of the most widely used biomaterials for manufacturing dental implants. The implant surface properties strongly influence osseointegration. The aim of the present study was to in vitro investigate the characteristics of Ti dental implants in terms of mutagenicity, hemocompatibility, biocompatibility, osteoinductivity and biological safety. The Ames test was used to test the mutagenicity of the Ti dental implants, and the hemolysis assay for evaluating their hemocompatibility. Human adipose - derived stem cells (ADSCs) were then seeded onto these implants in order to evaluate their cytotoxicity. Gene expression analyzing with real-time PCR was carried out to investigate the osteoinductivity of the biomaterials. Finally, the genetic stability of the cells cultured onto dental implants was determined by karyotyping. Our results demonstrated that Ti dental implants are not mutagenic, do not cause hemolysis, and are biocompatible. The MTT assay revealed that ADSCs, seeded on Ti dental implants, proliferate up to 30 days in culture. Moreover, ADSCs loaded on Ti dental implants show a substantial expression of some osteoblast specific markers, such as COL1A1, OPN, ALPL, and RUNX2, as well as chromosomal stability after 30 days of culture in a medium without osteogenic factors. In conclusion, the grit-blasted and acid-etched treatment seems to favor the adhesion and proliferation of ADSCs and improve the osteoinductivity of Ti dental implant surfaces.

Eight-Year Results of Site Retention of Anorganic Bovine Bone and Anorganic Bovine Matrix

The long-term fate of some biomaterials is still unknown, and the reports present in the literature are not conclusive as to whether these biomaterials are resorbed over time or not. Different reports can be found with regard to the resorption behavior of anorganic bovine bone (ABB). The aim of the present study was to provide a comparative histological and histomorphometrical evaluation, in the same patient, of 2 specimens retrieved from a sinus augmented with ABB and with anorganic bovine matrix added to a cell-binding peptide (PepGen P-15), respectively, after a healing period of 6 months and after 8 years of implant loading, to evaluate the resorption of both biomaterials. A unilateral sinus augmentation procedure with ABB (50%) and with PepGen P-15 (50%) was performed in a 54-year-old male patient. Two titanium dental implants with a sandblasted and acid-etched surface were inserted after 6 months. During this procedure, 2 tissue cores were retrieved from the sinus with a trephine, before implant insertion. After an additional 6 months, a fixed prosthetic restoration was fabricated. One of these implants, after a loading period of 8 years, fractured in the coronal portion and was removed. Both specimens, one retrieved after a 6-month healing period and the other after an 8-year loading period, were treated to obtain thin ground sections. In the 6-month specimen, the histomorphometry showed that the percentage of newly formed bone was 27.2% ± 3.6%, marrow spaces 35.6% ± 2.3%, residual ABB particles 25.1% ± 1.2%, and residual PepGen P-15 particles 12.1% ± 2.2%. In the 8-year specimen, the histomorphometry showed that the percentage of newly formed bone was 51.4% ± 4.8%, marrow spaces 40% ± 7.1%, residual ABB particles 6.2% ± 0.7%, and residual PepGen P-15 particles 2.4% ± 0.5%. Both biomaterials underwent significant resorption over the course of this study.

Osteocyte density in the peri-implant bone of implants retrieved after different time periods (4 weeks to 27 years)

Bone tissue is characterized by a constant turnover in response to mechanical stimuli, and osteocytes play an essential role in bone mechanical adaptation. However, little to no information has been published regarding osteocyte density as a function of implantation time in vivo. The aim of this retrospective histological study was to evaluate the osteocyte density of the peri-implant bone in implants retrieved because of different reasons in a time period from 4 weeks to 27 years. A total of 18 samples were included in the present study. Specimens were divided into 3 groups depending on the loading history of the implants: loading between 4 weeks and 7 months (group 1); loading between 1 and 5 years (group 2); loading between 14 and 27 years (group 3). All the samples were histologically evaluated and osteocyte density was obtained using the ratio of the number of osteocytes to the bone-area (mm(2) ). The osteocyte density values significantly increased in the Group 2 (1-5 years) compared with Group 1 (4 weeks-7 months), and significantly decreased in the Group 3 (14-27 years) compared to Group 2. No significant differences were detected between Group 1 and Group 3. The decrease in osteocyte density observed in samples that were in vivo for long periods of time under loading is possibly because of the fact that once the bone structure is well aligned and biomechanically competent, a lower number of osteocytes are necessary to keep the tissue homeostasis under loading.

Blood vessels are concentrated within the implant surface concavities: a histologic study in rabbit tibia

Angiogenesis plays a key role in bone formation and maintenance. Bone formation has been reported to initiate in the concavities rather than the convexities in a hydroxyapatite substratum and the implant threads of dental implants. The aim of the present study was to evaluate the number of the blood vessels inside the concavities and around the convexities of the threads of implants in a rabbit tibia model. A total of 32 thread-shaped implants blasted with apatitic calcium phosphate (TCP/HA blend) (Resorbable Blast Texturing, RBT) (Maestro, BioHorizons(®), Birmingham, AL, USA) were inserted in 8 rabbits. Each rabbit received 4 implants, 2 in the right and 2 in left tibia. Implants were retrieved after 1, 2, 4, and 8 weeks and treated to obtain thin ground sections. Statistically significant differences were found in the number of vessels that had formed in the concavities rather than the convexities of the implants after 1 (p = 0.000), and 2 weeks (p = 0.000), whilst no significant differences after 4 (p = 0.546) and 8 weeks (p = 0.275) were detected. The present results supported the hypothesis that blood vessel formation was stimulated by the presence of the concavities, which may provide a suitable environment in which mechanical forces, concentrations and gradients of chemotactic molecules and blood clot retention may all drive vascular and bone cell migration.

Fibrin clot extension on zirconia surface for dental implants: a quantitative in vitro study

PURPOSE

The surface chemical and physical properties of materials used for implants have a major influence on blood clot organization. This study aims to evaluate the blood clot extension (bce) on zirconia and titanium. bce was measured in association to surface roughness (Ra) and static contact angle (θ).

MATERIALS AND METHODS

Forty disk-shaped samples of sandblasted yttria tetragonal zirconia polycrystal (sb-YTZP), machined titanium (m-Ti), and sandblasted, high-temperature, acid-etched titanium (p-Ti) were used in the present study. About 0.2 mL of human blood, immediately dropped onto the specimen's surface and left in contact for 5 minutes at room temperature, was used to measure the bce. Specimens were observed under confocal scanning laser and scanning electron microscopes.

RESULTS

The bce (mean × 10(7)  ± standard deviation [SD] × 10(6)  μm(2) ) was 2.97 ± 6.68 for m-Ti, 5.64 ± 6.83 for p-Ti, and 3.61 ± 7.67 for sb-YTZP. p-Ti samples showed a significantly higher bce. Ra (mean ± SD [μm]) was 0.56 ± 0.7 for m-Ti, 3.78 ± 0.8 for p-Ti, and 2.68 ± 0.6 for sb-YTZP. The difference was not significant between sb-YTZP and p-Ti. θ (mean ± SD) was 55.6 ± 5.6 for m-Ti, 48.7 ± 2.8 for sb-YTZP, and 38.0 ± 2.2 for p-Ti. The difference was not significant between m-Ti and sb-YTZP.

CONCLUSIONS

The sb-YTZP demonstrated a significantly lesser amount of bce compared with p-Ti specimens, notwithstanding that any significant difference was present between Ra and θ.

Immediate rehabilitation of the edentulous mandible using Ankylos SynCone telescopic copings and intraoral welding: a pilot study

The aim of this prospective study was to assess the suitability of immediate rehabilitation of the edentulous mandible using SynCone copings and the intraoral welding technique. Patients with an edentulous mandible were fitted with a removable restoration supported by an intraorally welded titanium bar. Copings were connected to their respective SynCone 5-degree abutments and then welded to a titanium bar using an intraoral welding unit. This framework was used to support the definitive restoration, which was delivered on the day of implant placement. Restoration success and survival, implant success, and biologic or technical complications were assessed immediately after surgery and at 6 and 12 months. Twenty-two patients were consecutively treated with 88 immediately loaded implants. No acrylic resin fractures or radiographically detectable alterations of the welded frameworks were present in the 22 restorations delivered. One implant (1.1%) failed 1 month after surgery; all remaining implants (98.9%) were clinically stable at the 12-month follow-up. Within its limitations, this pilot study demonstrated that it is possible to successfully rehabilitate the edentulous mandible on the day of surgery with a definitive restoration supported by an intraorally welded titanium framework and SynCone 5-degree abutments.

Immediate loading of zygomatic implants using the intraoral welding technique: a 12-month case series

The aim of this prospective study was to evaluate the concept of intraoral welding as a suitable technique for fabricating a fixed restoration for the edentulous maxilla the day of surgery using standard and zygomatic implants. Ten consecutive patients (four men, six women; mean age, 62.3 ± 11.6 years) were involved in this study, each of whom had an edentulous atrophic maxilla and received two standard and two zygomatic implants. All implants were loaded immediately with a fixed prosthesis supported by an intraorally welded titanium framework. Definitive abutments were connected to the implants, and a titanium bar was welded to them using an intraoral welding unit. This framework was used to support the definitive prosthesis, which was fitted the day of implant placement. Patients were checked for swelling, pain, and framework stability at 1, 3, 6, and 12 months. A total of 20 immediately loaded standard and 20 zygomatic implants were used. The cases included in this study achieved a 100% prosthetic success rate at the 12-month follow-up. No fracture or radiographically detectable alteration of the welded frameworks was noticed. It is possible to successfully rehabilitate the edentulous atrophic maxilla with a permanently fixed prosthesis supported by an intraorally welded titanium framework attached to standard and zygomatic implants the day of surgery.

Histologic and histomorphometric evaluation of an implant retrieved 8 years after insertion in a sinus augmented with anorganic bovine bone and anorganic bovine matrix associated with a cell-binding peptide: a case report

Few histologic and histomorphometric reports are present in the literature regarding the peri-implant bone response around implants inserted in sinuses grafted with different biomaterials. Anorganic bovine bone (ABB) and anorganic bovine matrix with the addition of an active cell-binding peptide (PepGen P-15) are xenogenic materials that have been reported to present biocompatibility and osteoconductivity. A monolateral sinus augmentation procedure with ABB (50%) and PepGen P-15 (50%) was performed in a 54-year-old man. Two titanium implants with a sandblasted and acid-etched surface were inserted after 6 months. After an additional 6 months, a fixed prosthetic restoration was fabricated. One implant fractured in the coronal portion after an 8-year loading period and was removed using a 5-mm trephine bur. Few particles of both grafting materials were present in the peri-implant bone. No graft material particles were found in contact with the implant surface, and bone was always interposed between the graft materials and surface. No inflammatory cell infiltrate, multinucleated giant cells, or foreign body reaction cells were found. The tissues around the implant were composed of 51.4% ± 4.8% bone, 6.2% ± 0.7% ABB particles, 2.4% ± 0.5% PepGen P-15, and 40.0% ± 7.1% marrow spaces. The bone-implant contact percentage was 78.4% ± 4.1%. A sinus augmentation procedure using ABB and PepGen P-15 produced bone formation with subsequent implant osseointegration, which was still present after 8 years of implant loading.

Effect of titanium surface topographies on human bone marrow stem cells differentiation in vitro

Coating characteristics of dental implants such as composition and topography regulate cell response during implant healing. The aim of this study was to assess how surface topography can affect osteogenic differentiation of mesenchymal stem cells (MSCs) by analyzing the expression levels of bone-related genes and MSCs marker. Thirty disk-shaped, commercially pure Grade 2 titanium samples (10 × 2 mm) with 3 different surface topographies (DENTSPLY-Friadent GmbH, Mannheim, Germany) were used in the present study: 10 Ti machined disks (control), 10 Ti sandblasted and acid-etched disks (DPS(®)) and 10 sandblasted and acid-etched disks at high temperature (Plus(®)). Samples were processed for real-time reverse transcription-polymerase chain reaction (RT-PCR) analysis. By comparing machined and Plus(®) disks, quantitative real-time RT-PCR showed a significant reduction of the bone-related genes osteocalcin (BGLAP) and osteoblast transcriptional factor (RUNX2). The comparison between DPS(®) and Plus(®) disks showed a slight induction of all the genes examined (RUNX2, ALPL, COL1A1, COL3A1, ENG, FOSL1, SPP1, and SP7); only the expression of BGLAP remained stable. The present study, demonstrated that implant surface topography affects osteoblast gene expression. Indeed, Plus(®) surface produces an effect on MSCs in the late differentiation stages.

Peri-implant collagen fibers around human cone Morse connection implants under polarized light: a report of three cases

Most of the histologic studies found in the literature on the peri-implant soft tissues have been done in animals and usually have been confined to mandibular implants fitted with healing or standard abutments. Few studies have investigated human peri-implant soft tissues. Moreover, the structure and dimensions of the peri-implant soft tissues in immediately loaded implants have not been investigated in depth. Human histologic data are valuable to validate animal models. This histologic and histomorphometric study evaluated the peri-implant soft tissues around three immediately loaded implants in humans. The implants were retrieved using a trephine and treated to obtain thin, ground sections. The sulcular epithelium was composed of approximately four to five layers of parakeratinized epithelial cells and had a length of approximately 1.2 to 1.3 mm. The junctional epithelium was composed of approximately three to four layers of epithelial cells and had a length of approximately 1.0 to 1.5 mm. Connective tissue attachment had a width of between 400 and 800 μm. Peri-implant collagen fibers, in the form of bundles (1- to 5-μm thick), began at the crestal bone and were oriented perpendicular to the abutment surface until 200 μm from the surface, where they became parallel running in several directions. Collagen fibers appeared to form a three-dimensional network around the abutment. No acute or chronic inflammatory cell infiltrate was present. Collagen fibers oriented in a perpendicular manner and in direct contact with the abutment surface were not observed in any of the specimens. This differentiated network of fibers may have clinical relevance as a mechanical protection of the underlying bone. These human histologic data are extremely valuable to validate and confirm those obtained from studies performed on animal models. Moreover, immediate loading of the implants did not compromise soft tissue integration.

Bone regeneration with algae-derived hydroxyapatite: a pilot histologic and histomorphometric study in rabbit tibia defects

PURPOSE

Algipore is a biologic hydroxyapatite derived from calcifying maritime algae. The present study evaluated this material histologically and histomorphometrically after implantation in rabbit tibia defects for 4 weeks.

MATERIALS AND METHODS

Six New Zealand rabbits were used in this study. In each rabbit tibia, two 7-mm defects were prepared. Control defects were left empty, and test defects were filled with Algipore. Twenty-four specimens (12 test and 12 control) were retrieved and processed for histology.

RESULTS

In control sites, newly formed trabecular bone with large marrow spaces was plentiful in the most peripheral areas of the defects but sparse elsewhere. In contrast, in test sites, a large quantity of newly formed bone around the biomaterial particles was detected in the central medullary portion of the defect. In addition, in several areas, the biomaterial particles were bridged by newly formed bone. The percentage of contact between newly formed bone and biomaterial particles was 71.2% ± 9.8%. Inside the central portion of the biomaterial particles, it was possible to see newly formed bone (about 35.3% ± 4.8% in each particle). In test sites, newly formed bone represented 31.1% ± 1.9% of the material, with residual biomaterial particles occupying 33.4% ± 2.8% and marrow spaces another 34.7% ± 4.3%. In the control sites, the values were 30.2% ± 2.2% for newly formed bone and 68.7% ± 4.1% for marrow spaces. A statistically significant difference was found in the percentage of marrow space between the two groups, but no significant difference was observed in the percentage of newly formed bone.

CONCLUSIONS

The present rabbit study confirmed the high osteoconductivity and resorbability of this biomaterial.

Sinus augmentation with phycogene hydroxyapatite: histological and histomorphometrical results after 6 months in humans. A case series

BACKGROUND

Phycogene hydroxyapatite is a biological hydroxyapatite derived from calcifying maritime algae, and is prepared by hydrothermal conversion by pyrolitical segmentation of the calcium carbonate of native algae into fluorhydroxyapatite. The aim of the present study was a histological and histomorphometrical evaluation, in humans, of specimens retrieved from sinuses augmented with phycogene hydroxyapatite, after a healing period of 6 months.

CASE SERIES

Ten healthy patients with noncontributory past medical history (four women and six men, all nonsmokers, mean age 59 years, range 54-65 years) were included in this study. All patients were candidates for augmentation in the posterior maxilla in order to receive fixed restorations. The maxillary sinuses were filled with phycogene hydroxyapatite (Algipore®, Dentsply Friadent, Mannheim, Germany). Twenty-three implants (XiVE®, Dentsply Friadent, Mannheim, Germany) were placed in the augmented sinuses after a healing period of about 6 months. The bone cores were retrieved and were processed for histology. Most particles of phycogene hydroxyapatite were surrounded by a mineralized tissue, and the biomaterial particles had served as an osteoconductive scaffold. Most particles were bridged by newly formed bone characterized by the presence of large osteocytic lacunae, also around the phycogene hydroxyapatite particles, which appeared to be partially resorbed and substituted by new bone. No inflammatory cells or foreign body reaction cells were present around the biomaterial. No gaps were present at the bone-particle interface, and the bone was always in close contact with the particles. Histomorphometry showed that the percentage of newly formed bone was 35.2 ± 3.6%, marrow spaces 35.6 ± 2.3%, and residual grafted material 37.1 ± 3.8%.

DISCUSSION

In conclusion, the present results support the literature findings that phycogene hydroxyapatite can be used, successfully, for sinus augmentation procedures.