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Su G, Zhang Y, Jin C, Zhang Q, Lu J, Liu Z, Wang Q, Zhang X, Ma J. 3D printed zirconia used as dental materials: a critical review. J Biol Eng 2023; 17:78. [PMID: 38129905 PMCID: PMC10740276 DOI: 10.1186/s13036-023-00396-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Accepted: 11/27/2023] [Indexed: 12/23/2023] Open
Abstract
In view of its high mechanical performance, outstanding aesthetic qualities, and biological stability, zirconia has been widely used in the fields of dentistry. Due to its potential to produce suitable advanced configurations and structures for a number of medical applications, especially personalized created devices, ceramic additive manufacturing (AM) has been attracting a great deal of attention in recent years. AM zirconia hews out infinite possibilities that are otherwise barely possible with traditional processes thanks to its freedom and efficiency. In the review, AM zirconia's physical and adhesive characteristics, accuracy, biocompatibility, as well as their clinical applications have been reviewed. Here, we highlight the accuracy and biocompatibility of 3D printed zirconia. Also, current obstacles and a forecast of AM zirconia for its development and improvement have been covered. In summary, this review offers a description of the basic characteristics of AM zirconia materials intended for oral medicine. Furthermore, it provides a generally novel and fundamental basis for the utilization of 3D printed zirconia in dentistry.
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Affiliation(s)
- Guanyu Su
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China
| | - Yushi Zhang
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China
| | - Chunyu Jin
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China
| | - Qiyue Zhang
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China
| | - Jiarui Lu
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China
| | - Zengqian Liu
- Shi-Changxu Innovation Center for Advanced Materials, Institute of Metal Research, Chinese Academy of Sciences, Shenyang, 110016, China
- School of Materials Science and Engineering, University of Science and Technology of China, Hefei, 230026, China
| | - Qiang Wang
- Liaoning Provincial Key Laboratory of Oral Diseases, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China
| | - Xue Zhang
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China.
| | - Jia Ma
- Department of Orthodontics, School and Hospital of Stomatology, China Medical University, No. 117 Nanjing North Street, Shenyang, 110001, China.
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Böse MWH, Beuer F, Naumann M, Spies BC, Neumeyer S, Hildebrand D, Bruhnke M. Root-analogue implants compared to forced orthodontic extrusion: a retrospective analysis of clinical, radiological and esthetic outcomes after restoration. Clin Oral Investig 2023; 27:5875-5886. [PMID: 37581766 PMCID: PMC10560152 DOI: 10.1007/s00784-023-05198-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/03/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES To assess clinical, radiological and esthetic outcomes of restorations supported by root-analogue implants (RAIs) or roots of severely damaged teeth after forced orthodontic extrusion (FOE). MATERIALS AND METHODS Clinical data regarding milled one-piece (titanium/zirconia roots and zirconia abutments) RAIs (REPLICATE™ System) and FOE were recorded and retrospectively evaluated for 40 patients by two investigators. Strict inclusion and exclusion criteria were applied. Functional and esthetic outcomes were assessed for n = 20 pre-molars and n = 20 anterior teeth via comparison of radiographic and digital images applying the novel Functional Implant Prosthodontic Score (FIPS). Krippendorff's alpha coefficient was calculated to assess inter-rater reliability. Mann-Whitney-U-Test was used to compare the assessed parameters. Level of significance was set to p < 0.05. RESULTS After a mean observation period of 18.4 ± 5.7 months for restorations supported by RAIs and 43.9 ± 16.4 months for restorations after FOE, mean FIPS scores were 9.2/8.8 ± 1.1/1.2 (RAIs) and 7.4/7.7 ± 1.3/1.5 (FOE), respectively. Krippendorff's alpha coefficients did not reveal unacceptable inter-rater reliabilities regarding the investigators and applicability of FIPS. Significant differences were documented when comparing restorations after FOE or supported by RAIs regarding bone loss (p < 0.01), presence of papillae (p < 0.05) and quality and quantity of mucosa (p < 0.02) in favor of FOE. CONCLUSIONS Within the main limitations of sample size and the retrospective study design, both concepts seem to provide clinically acceptable results. CLINICAL RELEVANCE Bone- and tissue-preserving characteristics regarding the concept of FOE are promising. It could be applicable for socket preservation and subsequent conventional implant placements in an adapted workflow.
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Affiliation(s)
- Mats Wernfried Heinrich Böse
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197, Berlin, Germany.
| | - Florian Beuer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Michael Naumann
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
| | - Benedikt Christopher Spies
- Medical Center - University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, Hugstetter Straße 55, 79106, Freiburg, Germany
| | - Stefan Neumeyer
- Private Dental Practice, Gemeinschaftspraxis Dr. Stefan Neumeyer & Partner, Leminger Str. 10, 93458, Eschlkam, Germany
| | - Detlef Hildebrand
- Private Dental Practice, Dr. Detlef Hildebrand, Westhafenstraße 1, 13353, Berlin, Germany
| | - Maria Bruhnke
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197, Berlin, Germany
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Hassouna M, Al-Zordk W, Aboshilib M, Ghazy M. Clinical and radiographic prospective study of customized one-piece titanium and one-piece fusion-sputtered zirconia implants: five-year mean follow-up. BMC Oral Health 2022; 22:531. [PMID: 36424624 PMCID: PMC9685929 DOI: 10.1186/s12903-022-02600-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 09/26/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND To evaluate the clinical and radiographic assessment of customized fusion-sputtered one-piece zirconia implants. METHODS Twenty-eight patients received either fusion sputtered one-piece zirconia implants (n = 14) or one-piece titanium implants (n = 14). All implants were one-piece designs. After 4 months of immediate loading, all implants were restored with a monolithic zirconia crown. All implants were evaluated at baseline, 6 months, 1 year, 2 years, and 5 years. Implant mobility, plaque index, and gingival index evaluations were performed. The measurements of marginal bone level were calculated radiographically. RESULTS All implants were well maintained through the evaluation period with a 100% survival rate without any clinical complications. Regarding gingival index, there was no statistically significant difference (P = .364) between zirconia (3.3 ± 0.7 mm) and titanium (3.5 ± 0.6 mm) implants, after 5 years. There was no statistically significant difference (P = .470) between zirconia (1.77 ± 0.039 mm) and titanium (1.80 ± 0.28 mm) implants regarding marginal bone loss, after 5 years. CONCLUSIONS One-piece fusion-sputtered zirconia implant represents a reliable treatment modality in replacing a missing tooth in the esthetic zone.
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Affiliation(s)
- Mahy Hassouna
- grid.10251.370000000103426662Fixed Prosthodontics Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Walid Al-Zordk
- grid.10251.370000000103426662Fixed Prosthodontics Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt
| | - Moustafa Aboshilib
- grid.7155.60000 0001 2260 6941Biomaterials Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Ghazy
- grid.10251.370000000103426662Fixed Prosthodontics Department, Faculty of Dentistry, Mansoura University, Mansoura, Egypt ,Faculty of Dentistry, Horus University, New Damietta, Egypt
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Dantas T, Rodrigues F, Araújo J, Vaz P, Silva F. Customized root-analogue dental implants - Procedure and errors associated with image acquisition, treatment, and manufacturing technology in an experimental study on a cadaver dog mandible. J Mech Behav Biomed Mater 2022; 133:105350. [DOI: 10.1016/j.jmbbm.2022.105350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/21/2022] [Accepted: 06/28/2022] [Indexed: 11/30/2022]
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Liu M, Wang Y, Zhang S, Wei Q, Li X. Success Factors of Additive Manufactured Root Analogue Implants. ACS Biomater Sci Eng 2022; 8:360-378. [PMID: 34990114 DOI: 10.1021/acsbiomaterials.1c01079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dental implantation is an effective method for the treatment of loose teeth, but the threaded dental implants used in the clinic cannot match with the tooth extraction socket. A root analogue implant (RAI) has the congruence shape, which reduces the damage to bone and soft tissue. Additive manufacturing (AM) technologies have the advantages of high precision, flexibility, and easy operation, becoming the main manufacturing method of RAI in basic research. The purpose of this systematic review is to summarize AM technologies used for RAI manufacturing as well as the factors affecting successful implantation. First, it introduces the AM technologies according to different operating principles and summarizes the advantages and disadvantages of each method. Then the influences of materials, structure design, surface characteristics, implant site, and positioning are discussed, providing reference for designers and dentists. Finally, it addresses the gap between basic research and clinical application for additive manufactured RAIs and discusses the current challenges and future research directions for this field.
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Affiliation(s)
- Minyan Liu
- Department of Industry Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Yanen Wang
- Department of Industry Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Shan Zhang
- Department of Industry Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Qinghua Wei
- Department of Industry Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
| | - Xinpei Li
- Department of Industry Engineering, School of Mechanical Engineering, Northwestern Polytechnical University, Xi'an 710072, China
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Lin C, Hu H, Zhu J, Rong Q, Tang Z. Influence of different diameter reductions in the labial neck region on the stress distribution around custom-made root-analogue implants. Eur J Oral Sci 2022; 130:e12833. [PMID: 35014088 DOI: 10.1111/eos.12833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 09/28/2021] [Indexed: 01/16/2023]
Abstract
This study was designed to investigate the influence of diameter reductions on the stress distribution around root-analogue implants via 3D finite element analysis. Four root-analogue implant models with different diameter reductions (0, 1, 2, or 3 mm), a traditional threaded implant and congruent bone models were created through reverse engineering. A 100-N force was applied parallel with and in a 45° angle to the implant axis, respectively. The stress concentration in the labial neck area around implants with 1-2 mm diameter reduction was lower than seen with no reduction. When the implant diameter was reduced by 3 mm, there were obvious stress concentrations in both implant and bone (the maximum stress was 206 and 111 MPa, respectively). In other groups, the maximum stress was 65.1 MPa in the bone and 108 MPa in the implant. Additionally, the stress concentration in the bone around the root-analogue implant when the implant diameter was reduced by 0-2 mm (maximum stress of 65.1 MPa) was obviously smaller than that around the traditional implant (maximum stress 130.4 MPa). Reducing the diameter of maxillary central incisor root-analogue implants by up to 2 mm next to the labial cortical bone could help disperse stress.
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Affiliation(s)
- Chunping Lin
- Department of Stomatology, Fujian Provincial Hospital, Fujian, China.,Second Dental Center, Peking University School and Hospital of Stomatology, Beijing, China
| | - Hongcheng Hu
- Second Dental Center, Peking University School and Hospital of Stomatology, Beijing, China
| | - Junxin Zhu
- Second Dental Center, Peking University School and Hospital of Stomatology, Beijing, China
| | - Qiguo Rong
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, China
| | - Zhihui Tang
- Second Dental Center, Peking University School and Hospital of Stomatology, Beijing, China
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Cunha W, Carvalho O, Henriques B, Silva FS, Özcan M, Souza JCM. Surface modification of zirconia dental implants by laser texturing. Lasers Med Sci 2022; 37:77-93. [PMID: 35022871 DOI: 10.1007/s10103-021-03475-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 11/16/2021] [Indexed: 12/19/2022]
Abstract
The aim of this work was to perform an integrative literature review on the influence of laser irradiation on zirconia implants to enhance surface topographic aspects and the biological response for osseointegration. An electronic search was carried out on the PubMed database using the following search terms: "zirconia" AND "laser" AND "surface modification" OR "surface treatment" AND "dental implants" OR "bone" OR "osteoblast" OR "osseointegration." Of the identified articles, 12 studies were selected in this review. Results reported that the laser irradiation was capable of promoting changes on the zirconia surfaces regarding topographic aspects, roughness, and wettability. An increase in roughness was recorded at micro- and nano-scale and it resulted in an enhanced wettability and biological response. Also, adhesion, spreading, proliferation, and differentiation of osteogenic cells were also enhanced after laser irradiation mainly by using a femtosecond laser at 10nJ and 80 MHz. After 3 months of osseointegration, in vivo studies in dogs revealed a similar average percentage of bone-to-implant contact (BIC) on zirconia surfaces (around 47.9 ± 16%) when compared to standard titanium surfaces (61.73 ±16.27%), denoting that there is no significant difference between such different materials. The laser approach revealed several parameters that can be used for zirconia surface modification such as irradiation intensity, time, and frequency. Laser irradiation parameters can be optimized and well-controlled to reach desirable surface morphologic aspects and biological response concerning the osseointegration process.
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Affiliation(s)
- Welson Cunha
- School of Dentistry, University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra PRD, Portugal
| | - Oscar Carvalho
- Center for MicroElectroMechanical Systems (CMEMS-UMINHO), University of Minho, Campus Azurém, 4800-058, Guimarães, Portugal
| | - Bruno Henriques
- Center for MicroElectroMechanical Systems (CMEMS-UMINHO), University of Minho, Campus Azurém, 4800-058, Guimarães, Portugal.,Ceramic and Composite Materials Research Group (CERMAT), Dept. of Mechanical Engineering (EMC), Federal University of Santa Catarina (UFSC), Florianópolis, 88040-900, Brazil
| | - Filipe S Silva
- Center for MicroElectroMechanical Systems (CMEMS-UMINHO), University of Minho, Campus Azurém, 4800-058, Guimarães, Portugal
| | - Mutlu Özcan
- Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center of Dental Medicine, University of Zürich, Zürich, 8032, Switzerland
| | - Júlio C M Souza
- School of Dentistry, University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra PRD, Portugal. .,Center for MicroElectroMechanical Systems (CMEMS-UMINHO), University of Minho, Campus Azurém, 4800-058, Guimarães, Portugal.
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Lin C, Hu H, Zhu J, Wu Y, Rong Q, Tang Z. Influence of sagittal root positions on the stress distribution around custom-made root-analogue implants: a three-dimensional finite element analysis. BMC Oral Health 2021; 21:443. [PMID: 34521397 PMCID: PMC8438997 DOI: 10.1186/s12903-021-01809-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background Stress concentration may cause bone resorption even lead to the failure of implantation. This study was designed to investigate whether a certain sagittal root position could cause stress concentration around maxillary anterior custom-made root-analogue implants via three-dimensional finite element analysis. Methods The von Mises stresses in the bone around implants in different groups were compared by finite element analysis. Six models were constructed and divided into two groups through Geomagic Studio 2012 software. The smooth group included models of unthreaded custom-made implants in Class I, II or III sagittal root positions. The threaded group included models of reverse buttress-threaded implants in the three positions. The von Mises stress distributions and the range of the stresses under vertical and oblique loads of 100 N were analyzed through ANSYS 16.0 software. Results Stress concentrations around the labial lamella area were more prominent in the Class I position than in the Class II and Class III positions under oblique loading. Under vertical loading, the most obvious stress concentration areas were the labial lamella and palatal apical areas in the Class I and Class III positions, respectively. Stress was relatively distributed in the labial and palatal lamellae in the Class II position. The maximum von Mises stresses in the bone around the custom-made root-analogue implants in this study were lower than around traditional implants reported in the literature. The maximum von Mises stresses in this study were all less than 25 MPa in cortical bone and less than 6 MPa in cancellous bone. Additionally, compared to the smooth group, the threaded group showed lower von Mises stress concentration in the bone around the implants. Conclusions The sagittal root position affected the von Mises stress distribution around custom-made root-analogue implants. There was no certain sagittal root position that could cause excessive stress concentration around the custom-made root-analogue implants. Among the three sagittal root positions, the Class II position would be the most appropriate site for custom-made root-analogue implants.
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Affiliation(s)
- Chunping Lin
- Department of Periodontology, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, 100081, China
| | - Hongcheng Hu
- Second Dental Center, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, 100101, China
| | - Junxin Zhu
- Second Dental Center, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, 100101, China
| | - Yuwei Wu
- Second Dental Center, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, 100101, China
| | - Qiguo Rong
- Department of Mechanics and Engineering Science, College of Engineering, Peking University, Beijing, 100871, China.
| | - Zhihui Tang
- Second Dental Center, Peking University School and Hospital of Stomatology, National Engineering Laboratory for Digital and Material Technology of Stomatology, Beijing Key Laboratory of Digital Stomatology, Beijing, 100101, China.
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Fabris D, Moura JPA, Fredel MC, Souza JCM, Silva FS, Henriques B. Biomechanical analyses of one-piece dental implants composed of titanium, zirconia, PEEK, CFR-PEEK, or GFR-PEEK: Stresses, strains, and bone remodeling prediction by the finite element method. J Biomed Mater Res B Appl Biomater 2021; 110:79-88. [PMID: 34173713 DOI: 10.1002/jbm.b.34890] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Revised: 05/22/2021] [Accepted: 06/07/2021] [Indexed: 11/06/2022]
Abstract
This work aimed to assess the biomechanics, using the finite element method (FEM), of traditional titanium Morse taper (MT) dental implants compared to one-piece implants composed of zirconia, polyetheretherketone (PEEK), carbon fiber-reinforced PEEK (CFR-PEEK), or glass fiber-reinforced PEEK (GFR-PEEK). MT and one-piece dental implants were modeled within a mandibular bone section and loaded on an oblique force using FEM. A MT implant system involving a Ti6Al4V abutment and a cp-Ti grade IV implant was compared to one-piece implants composed of cp-Ti grade IV, zirconia (3Y-TZP), PEEK, CFR-PEEK, or GFR-PEEK. Stress on bone and implants was computed and analyzed while bone remodeling prediction was evaluated considering equivalent strain. In comparison to one-piece implants, the traditional MT implant revealed higher stress peak (112 MPa). The maximum stresses on the one-piece implants reached ~80 MPa, regardless their chemical composition. MT implant induced lower bone stimulus, although excessive bone strain was recorded for PEEK implants. Balanced strain levels were noticed for reinforced PEEK implants of which CFR-PEEK one-piece implants showed proper biomechanical behavior. Balanced strain levels might induce bone remodeling at the peri-implant region while maintaining low risks of mechanical failures. However, the strength of the PEEK-based composite materials is still low for long-term clinical performance.
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Affiliation(s)
- Douglas Fabris
- Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Florianópolis, 88040-900, Brazil
| | - José P A Moura
- Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Florianópolis, 88040-900, Brazil.,Center for MicroElectroMechanical Systems (CMEMS-UMinho), University of Minho, Braga, 4800-058, Portugal
| | - Márcio C Fredel
- Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Florianópolis, 88040-900, Brazil
| | - Júlio C M Souza
- Center for MicroElectroMechanical Systems (CMEMS-UMinho), University of Minho, Braga, 4800-058, Portugal.,School of Dental Sciences, University Institute of Health Sciences (IUCS), CESPU, Gandra PRD, 4585-116, Portugal
| | - Filipe S Silva
- Center for MicroElectroMechanical Systems (CMEMS-UMinho), University of Minho, Braga, 4800-058, Portugal
| | - Bruno Henriques
- Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Florianópolis, 88040-900, Brazil.,Center for MicroElectroMechanical Systems (CMEMS-UMinho), University of Minho, Braga, 4800-058, Portugal
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Fabris D, Fredel MC, Souza JCM, Silva FS, Henriques B. Biomechanical behavior of functionally graded S53P4 bioglass-zirconia dental implants: Experimental and finite element analyses. J Mech Behav Biomed Mater 2021; 120:104565. [PMID: 34087536 DOI: 10.1016/j.jmbbm.2021.104565] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this work was to evaluate the biomechanical behavior of one-piece zirconia implants with a functionally graded bioglass (BG) layer as compared to monolithic zirconia and BG-coated implants, using the finite element method (FEM). METHODS Zirconia disks were infiltrated with bioglass S53P4 and then morphologically inspected by scanning electron microscopy (SEM) followed by mechanical analyses on micro-indentation tests for further biomechanical validation using the finite element method (FEM). On modeling, zirconia dental implants anchored into mandibular bone were simulated on occlusal loading as recorded under mastication. Three types of implants were simulated: i) free of BG coating, ii) with 100 μm or 150 μm thick conventional BG coatings; and iii) with graded BG coatings involving 3 different chemical composition distributions. The stress state at both implant and bone were evaluated using the FEM. The mechanically-induced bone remodelling was analyzed through the bone strain results. RESULTS Infiltration of BG into a zirconia structure resulted in a ∼100 μm thick layer with an exponential-like gradation of chemical composition and properties. Regarding the FEM calculations, the BG coating induced up to 30% decrease on stress in the implant body when compared to the monolithic zirconia implant. The gradient of chemical composition also improved the stresses' distribution. The stresses distribution towards the BG-coatings were significantly high and could lead to failure. Stresses on the bone were recorded down to its strength threshold, with insignificant influence of the coating layer. The bone strain values on all models indicates further bone remodelling although BG-coated and BG-graded zirconia implants showed the highest strain magnitude that may enhance the mechanical stimulation for bone maintenance. SIGNIFICANCE Graded BG-zirconia dental implants showed enhanced overall biomechanical behaviour as compared to the BG-coated or monolithic zirconia dental implants. Also, such biomechanical improvements noticed for the BG-graded system should be considered in combination with the well-known osseointegration benefits of bioactive glasses.
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Affiliation(s)
- Douglas Fabris
- Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900, Florianópolis, SC, Brazil
| | - Márcio C Fredel
- Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900, Florianópolis, SC, Brazil
| | - Júlio C M Souza
- Department of Dental Sciences, University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra PRD, Portugal; CMEMS-UMinho, University of Minho, Campus de Azurém, 4800-058, Guimarães, Portugal
| | - Filipe S Silva
- CMEMS-UMinho, University of Minho, Campus de Azurém, 4800-058, Guimarães, Portugal
| | - Bruno Henriques
- Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Campus Trindade, 88040-900, Florianópolis, SC, Brazil; Department of Dental Sciences, University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra PRD, Portugal; School of Dentistry (DODT), Postgraduate Program in Dentistry (PPGO), Federal University of Santa Catarina, Campus Trindade, 88040-900, Florianópolis, SC, Brazil.
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11
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Dantas T, Madeira S, Gasik M, Vaz P, Silva F. Customized Root-Analogue Implants: A Review on Outcomes from Clinical Trials and Case Reports. MATERIALS 2021; 14:ma14092296. [PMID: 33946678 PMCID: PMC8124429 DOI: 10.3390/ma14092296] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 04/22/2021] [Accepted: 04/23/2021] [Indexed: 01/14/2023]
Abstract
(1) It is estimated that 10% of the world’s population will need a dental implant in their lifetime. Despite all the advances in the comprehension of dental implant designs, materials and techniques, traditional implants still have many limitations. Customized root-analogue implants are, therefore, gaining increased interest in dental rehabilitation and are expected to not only preserve more hard and soft tissues but also avoid a second surgery and improve patient overall satisfaction. In this sense, the aim of this review was to collect and analyse the clinical trials and case reports on customized root-analogue implants available in the literature; (2) This review was carried out according to the PRISMA Statement. An electronic database search was performed using five databases: PubMed, Google Scholar, Medline, Science Direct, and Scopus. The following keywords were used for gathering data: custom-made, dental implants, root-analogue, anatomical, customized and tooth-like; (3) 15 articles meeting the inclusion criteria—articles reporting clinical trials, case reports or animal studies and articles with root-analogue implants and articles with totally customized implant geometries—were selected for the qualitative synthesis. The design and manufacturing techniques, implant material and surface treatments were assessed and discussed; (4) The performance of some root-analogue implants with specific features (i.e., macro-retentions) was successful, with no signs of infection, periodontitis nor bleeding during the follow-up periods.
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Affiliation(s)
- Telma Dantas
- CMEMS (Center for Micro Electro Mechanical Systems), University of Minho, 4800-058 Guimarães, Portugal; (S.M.); (F.S.)
- MIT Portugal Program—School of Engineering, University of Minho, 4800-058 Guimarães, Portugal
- Correspondence:
| | - Sara Madeira
- CMEMS (Center for Micro Electro Mechanical Systems), University of Minho, 4800-058 Guimarães, Portugal; (S.M.); (F.S.)
| | - Michael Gasik
- School of Chemical Engineering, Aalto University Foundation, 02150 Espoo, Finland;
| | - Paula Vaz
- Fixed Prosthodontics, Genetics—Faculty of Dental Medicine, University of Porto, 4200-135 Porto, Portugal;
| | - Filipe Silva
- CMEMS (Center for Micro Electro Mechanical Systems), University of Minho, 4800-058 Guimarães, Portugal; (S.M.); (F.S.)
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Liu T, Chen Y, Apicella A, Mu Z, Yu T, Huang Y, Wang C. Effect of Porous Microstructures on the Biomechanical Characteristics of a Root Analogue Implant: An Animal Study and a Finite Element Analysis. ACS Biomater Sci Eng 2020; 6:6356-6367. [PMID: 33449664 DOI: 10.1021/acsbiomaterials.0c01096] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Full ceramic or metal custom-made root analogue implants (RAIs) are made by replicating the natural tooth geometry. However, it may lead to the stress shielding of the surrounding bone, and an RAI is unable to easily achieve primary stability. Therefore, to improve primary stability and reduce stress shielding, RAI porous structures are proposed. The purpose of this study was to evaluate the effect of porous microstructures on the biomechanical characteristics of the custom-made RAI. METHODS Porous and bulk titanium cylinders and porous RAI and conventional implants for in vivo tests were fabricated using a selective laser melting (SLM) technology. The elastic modulus and the compressive strength of porous titanium cylinders were evaluated. These samples were then implanted into rabbit femurs (cylinders) and beagle dog mandibles (RAI and conventional implants). A simplified three-dimensional geometry of the anterior maxilla of a patient was constructed. Then, based on the extracted standard template library (STL) data, five different RAI models were constructed: (A) smooth surface, (B) pit surface, (C) bulb surface, (D) threaded surface, and (E) porous surface. A conventional implant model was also constructed. A static load of 100 N was applied to the crown in the multivectoral direction. RESULTS The results of the in vivo experiment confirmed that the porous structure decreased the elastic modulus of Ti6Al4V. Additionally, the implantation of the porous custom-made RAIs resulted in increased new bone ingrowth and decreased bone resorption compared to conventional implants. Moreover, the 3D finite element analysis suggested that the bone surrounding porous custom-made RAIs was subjected to a more uniform stress distribution, and the strain values of the surrounding bone were more conducive to bone formation. CONCLUSION Based on these findings, a custom-made RAI with a porous surface accelerates bone formation and might reduce the stress-shielding effect.
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Affiliation(s)
- Ting Liu
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 400010, China
| | - Yu Chen
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 400010, China
| | - Antonio Apicella
- Advanced Materials Lab, University of Campania, Naples, Aversa (CE) 81100, Italy
| | - Zhixiang Mu
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 400010, China
| | - Ti Yu
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 400010, China
| | - Yuanding Huang
- College of Stomatology, Chongqing Medical University, Chongqing 401147, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing 400010, China
| | - Chao Wang
- Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing 400010, China.,Beijing Advanced Innovation Center for Biomedical Engineering, Beihang University, Beijing 100083, China
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Clinical Outcomes of Root-Analogue Implants Restored with Single Crowns or Fixed Dental Prostheses: A Retrospective Case Series. J Clin Med 2020; 9:jcm9082346. [PMID: 32717843 PMCID: PMC7465378 DOI: 10.3390/jcm9082346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/08/2023] Open
Abstract
The objective was to investigate clinical and radiological outcomes of rehabilitations with root-analogue implants (RAIs). Patients restored with RAIs, supporting single crowns or fixed dental prostheses, were recruited for follow-up examinations. Besides clinical and esthetical evaluations, X-rays were taken and compared with the records. Patients were asked to evaluate the treatment using Visual Analogue Scales (VAS). For statistical analyses, mixed linear models were used. A total of 107 RAIs were installed in one dental office. Of these, 31 were available for follow-up examinations. For those remaining, survival has been verified via phone. RAIs were loaded after a mean healing time of 6.6 ± 2.5 months. 12.1 ± 6.9 months after loading, a mean marginal bone loss (MBL) of 1.20 ± 0.73 mm was measured. Progression of MBL significantly decreased after loading (p = 0.013). The mean pink and white esthetic score (PES/WES) was 15.35 ± 2.33 at follow-up. A survival rate of 94.4% was calculated after a mean follow-up of 18.9 ± 2.4 months after surgery. Immediate installation of RAIs does not seem to reduce MBL, as known from the literature regarding screw-type implants, and might not be recommended for daily routine. Nevertheless, they deliver esthetically satisfying results.
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Clinical performance of zirconia implants: A meta-review. J Prosthet Dent 2019; 123:419-426. [PMID: 31451193 DOI: 10.1016/j.prosdent.2019.05.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 05/17/2019] [Accepted: 05/17/2019] [Indexed: 12/11/2022]
Abstract
STATEMENT OF PROBLEM The clinical effectiveness of zirconia implants as an alternative to titanium implants is still controversial. PURPOSE The purpose of this analysis was to identify and evaluate systematic reviews reporting on the clinical outcomes of zirconia implants for oral rehabilitation. MATERIAL AND METHODS An electronic search was undertaken on MEDLINE, Embase, and the Cochrane Oral Health Reviews databases up to December 24, 2018, without language restriction. Eligible reviews were screened and assessed. The eligibility criteria were systematic reviews or meta-analyses, implant survival rate, implant success, marginal bone loss, peri-implant soft tissue status, and biologic and functional complications of zirconia implants. Two review authors independently evaluated the quality assessment of the secondary studies by applying the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) tool. RESULTS Nine reviews fulfilled the inclusion criteria and were evaluated. Seven reviews were classified as moderate and 2 as high quality. The overall AMSTAR's quality of these reports was moderate. In the primary studies contained in these reviews, zirconia implant clinical outcomes were found to be similar or inferior to those for titanium implants. The few primary clinical studies contained in these reviews were not homogeneous among each other, presented poor methodology, and only offered promising short-term outcomes due to the lack of long-term follow-ups. CONCLUSIONS Based on this meta-review, in spite of short-term promising results of zirconia implants, evidence with long term is lacking.
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Westover B. Three-Dimensional Custom-Root Replicate Tooth Dental Implants. Oral Maxillofac Surg Clin North Am 2019; 31:489-496. [DOI: 10.1016/j.coms.2019.03.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Historical development of root analogue implants: a review of published papers. Br J Oral Maxillofac Surg 2019; 57:496-504. [PMID: 31085016 DOI: 10.1016/j.bjoms.2019.01.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Accepted: 01/07/2019] [Indexed: 02/04/2023]
Abstract
The timetable for placing a dental implant can be crucial in the reduction of resorption of the socket after an extraction. The association of immediate implantation with an implant that copies the anatomy of the extracted root seems to add benefits in limiting the hard and soft tissue changes that may occur. The purpose of this paper is to provide an overview of the historical development of all types of root analogue implants from their beginning to the present day. To our knowledge the first individualised ones were described in 1969. Later, the use of titanium instead of the polymers that were used to start with offered better bony integration, and showed that the selection of materials was a key factor in their success. Root analogue implants made from zirconia were also described when attempts were being made to improve aesthetics in the anterior regions. The more recent introduction of digital technology such as DICOM has allowed the fabrication of these implants in less time, and the combination with digital diagnostic options such as cone-beam computed tomography facilitated the fabrication of some types of implants before extraction that could be inserted immediately into the alveolar socket with optimal and safe 3-dimensional positioning. Currently digital planning allows the clinician to design the ideal implant and abutment, which reduces the need for tissue grafting in the surgical phase and gingival conditioning in the prosthetic phase.
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