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Shah SD, Zheng F, Seghi RR, Lee DJ. Strength of titanium-zirconium alloy implants with a conical connection after implantoplasty. J Prosthet Dent 2024; 132:593-599. [PMID: 36150928 DOI: 10.1016/j.prosdent.2022.08.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
STATEMENT OF PROBLEM Peri-implantitis occurs around dental implants, and implantoplasty has been used to address this ongoing disease; however, the changes to the physical properties of an implant after implantoplasty have not been well documented. PURPOSE The purpose of this in vitro study was to determine the effect of implantoplasty on fracture strength and the load required for plastic deformation after cyclic fatigue on dental implants. MATERIAL AND METHODS Twenty-six titanium/zirconium (TiZr) alloy implants (Roxolid Bone Level Implant; 4.1×10 mm) were embedded with 50% thread exposure and divided into 4 groups based on whether they had implantoplasty treatment by using different diamond rotary instruments and/or cyclic loading at 250 N for 2 million cycles: C0 (control, no cyclic loading), T0 (test, no cyclic loading), CM (control, cyclic loading), and TM (test, cyclic loading). After implantoplasty and/or cyclic loading, all implants underwent a load-to-failure test. The maximum fracture strength (FS) and load required for the onset of plastic deformation (PD) were recorded in Newtons. One-way ANOVA and nonparametric comparisons with control by using the Dunn and Wilcoxon method for joint ranking were used for statistical analysis. RESULTS The mean ±standard deviation FS for C0, CM, T0, and TM was 1465.2 ±86.4 N, 1480.7 ±64.1 N, 1299.3 ±123.8 N, and 1252.1 ±85.7 N, respectively. The mean ±standard deviation load for onset of PD for C0, CM, T0, and TM was 860.2 ±88.1 N, 797.0 ±130.5 N, 776.5 ±181.8 N, and 631.3 ±84.5 N, respectively. The TM group had a significantly lower FS and PD than the C0, CM, and T0 groups (P<.05) CONCLUSIONS: Both fracture strength (FS) and the onset of plastic deformation (PD) were significantly reduced after a TiZr alloy implant received implantoplasty and cyclic loading.
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Affiliation(s)
- Sweety D Shah
- Former Resident, Advanced Prosthodontics Program, Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio; Private practice, Charlotte, NC
| | - Fengyuan Zheng
- Associate Clinical Professor and Director, Advanced Education in Prosthodontics Program, Department of Restorative Sciences, Division of Prosthodontics, University of Minnesota School of Dentistry; Minneapolis, Minn
| | - Robert R Seghi
- Professor Emeritus, Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio
| | - Damian J Lee
- Associate Professor and Director, Advanced Prosthodontics Program, Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio.
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Esplin KC, Tsai YW, Vela K, Diogenes A, Hachem LE, Palaiologou A, Cochran DL, Kotsakis GA. Peri-implantitis induction and resolution around zirconia versus titanium implants. J Periodontol 2024. [PMID: 39003566 DOI: 10.1002/jper.23-0573] [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: 10/09/2023] [Revised: 02/15/2024] [Accepted: 03/18/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND This study compared titanium and zirconia implant ligature-induced peri-implant defect progression and response to regenerative surgical intervention. METHODS Eight tissue-level endosseous implants were placed in 6 mixed-breed foxhounds, with 2 zirconia and 2 titanium alternating in each hemimandible. Cotton ligatures were placed subgingivally for 16 weeks followed by 8 weeks of spontaneous progression. Standardized radiographs were captured every 2 weeks to evaluate the rate of bone loss. Regenerative surgery was performed utilizing water-jet decontamination, enamel matrix derivative, and locally harvested autogenous bone. After 16 weeks of healing, final radiographic bone levels as well as probing depths, recession, and clinical attachment levels were assessed. RESULTS All 48 implants integrated successfully. The final average post-ligature radiographic defects were 2.88 and 3.05 mm for titanium and zirconia implants, respectively. There was no significant difference between materials in the rate of radiographic bone loss (p = 0.09). Following regenerative surgery, the total average amount of radiographic bone gain was 1.41 and 1.20 mm for titanium and zirconia, respectively. The percentage of defect fill was 51.56% and 37.98% (p = 0.03) for titanium and zirconia, respectively. Inter-group differences were minimal for clinical parameters at the time of sacrifice including periodontal pocket depths (p = 0.81), recession (p = 0.98), or clinical attachment levels (p = 0.51). CONCLUSIONS No significant difference was found in the rate of peri-implant defect development between titanium and zirconia implants. Both materials gained significant radiographic bone following regenerative surgery with significantly greater defect percentage fill in titanium implants. The final clinical parameters were similar in both groups.
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Affiliation(s)
- Kaleb C Esplin
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Yi-Wen Tsai
- ITI Scholarship Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Kathryn Vela
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Anibal Diogenes
- Department of Endodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Lea El Hachem
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Archontia Palaiologou
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - David L Cochran
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
| | - Georgios A Kotsakis
- Department of Periodontics, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- ITI Scholarship Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
- Department of Oral Biology, Rutgers School of Dental Medicine, Newark, New Jersey, USA
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Akhtarkhavari M, Rajagopal P, Clovis Da Costa G, Aras M, Chitre V, Naik SG. Prosthodontic Rehabilitation of a Completely Edentulous Patient by Salvaging Ailing Implants Using a Bar Retained Over Denture: A Case Report. Cureus 2024; 16:e63157. [PMID: 39070396 PMCID: PMC11281885 DOI: 10.7759/cureus.63157] [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] [Accepted: 06/25/2024] [Indexed: 07/30/2024] Open
Abstract
Patients who are edentulous experience challenges with their dentures, especially the mandibular ones. The primary concerns of these patients include reduced chewing efficiency, instability, and loss of retention. With the advancement of implants and prosthetic options, these concerns can be addressed by resorting to implant-supported fixed and removable prostheses. The impetuous use of dental implants to solve these issues leads to inadvertent failures in the treatment undertaken. Improper planning of cases leads to prosthesis breakage and implant failures leaving the patient dissatisfied. One such case of rehabilitation of a completely edentulous over-denture patient with ailing implants is described in this clinical report.
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Affiliation(s)
- Muness Akhtarkhavari
- Department of Prosthodontics and Crown and Bridge, Goa Dental College and Hospital, Bambolim, IND
| | - Praveen Rajagopal
- Department of Prosthodontics and Crown and Bridge, Goa Dental College and Hospital, Bambolim, IND
| | - Godwin Clovis Da Costa
- Department of Prosthodontics and Crown and Bridge, Goa Dental College and Hospital, Bambolim, IND
| | - Meena Aras
- Department of Prosthodontics and Crown and Bridge, Goa Dental College and Hospital, Bambolim, IND
| | - Vidya Chitre
- Department of Prosthodontics and Crown and Bridge, Goa Dental College and Hospital, Bambolim, IND
| | - Sadhvi G Naik
- Department of Prosthodontics and Crown and Bridge, Goa Dental College and Hospital, Bambolim, IND
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Chan MH, Kang J. Diagnosis and Treatment of Periimplant Mucositis and Periimplantitis: An Overview and Related Controversial Issues. Dent Clin North Am 2024; 68:167-202. [PMID: 37951632 DOI: 10.1016/j.cden.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
Abstract
Periimplant mucositis and periimplantitis are common complications of dental implant. This article provides a comprehensive overview of the 2017 World Workshop's new definition, clinical and radiographic presentation, pathogenesis, risk factors, and classification of periimplant diseases. Also, the authors discuss various types of instruments, materials, and techniques commonly used for treatment of nonsurgical and surgical periimplantitis. Lastly, the authors include some controversial topics surrounding this subject.
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Affiliation(s)
- Michael H Chan
- Oral & Maxillofacial Surgery, Department of Veterans Affairs, New York Harbor Healthcare System (Brooklyn Campus), 800 Poly Place (Bk-160), Brooklyn, NY 11209, USA; Oral & Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue (Box-187), Brooklyn, NY 11201, USA.
| | - Joseph Kang
- Oral & Maxillofacial Surgery, Department of Oral and Maxillofacial Surgery, The Brooklyn Hospital Center, 121 DeKalb Avenue (Box-187), Brooklyn, NY 11201, USA
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Stavropoulos A, Bertl K, Isidor F, Vult von Steyern P. Implantoplasty and the risk of fracture of narrow implants with advanced bone loss: A laboratory study. Clin Oral Implants Res 2023; 34:1038-1046. [PMID: 37464268 DOI: 10.1111/clr.14132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 06/03/2023] [Accepted: 07/05/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVES To assess the impact of implantoplasty (IP) on maximum implant failure strength of narrow diameter implants of different type/design and material, with simulated advanced bone loss. MATERIALS AND METHODS Narrow, parallel-walled implants (3.3 mm in diameter × 10 mm long) with an internal connection of different type/design [bone level (BL), tissue level (TL)] and material [Titanium grade IV (Ti), Titanium-Zirconium alloy (TiZr)] from one specific manufacturer were used. Half of the implants were subjected to IP in their coronal 5 mm; the remaining were used as controls (seven implants per group). Dynamic loading prior to maximum load strength testing was included. RESULTS During dynamic loading, the fracture rate of BL implants was low and independent of IP, while that of TL implants increased significantly with IP compared with controls (p = .001). Maximum implant failure strength reduction (in %) due to IP, was 1.3%-25.4%; TiZr BL implants were least affected. Implants subjected to IP compared to those without IP as well as TL implants compared to BL implants showed a significantly lower maximum implant failure strength (p < .002); implant material was not significant (p = .845). CONCLUSIONS Based on data from implants of one specific manufacturer, IP has a significant negative impact on the fracture strength of narrow implants suffering from advanced peri-implantitis. TL implants have been more severely affected compared to BL implants and presented an increased risk for failure during normal chewing forces. In addition, this negative impact of IP on TL implants was independent of the implant material (i.e., Ti or TiZr). CLINICAL RELEVANCE Narrow single TL implants with advanced horizontal bone loss (e.g., 5 mm), when subjected to IP, appear to have an increased fracture risk during normal function.
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Affiliation(s)
- Andreas Stavropoulos
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
- Division of Conservative Dentistry and Periodontology, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
- Department of Periodontology, Dental Clinic, Faculty of Medicine, Sigmund Freud University Vienna, Vienna, Austria
| | - Flemming Isidor
- Section for Prosthetic Dentistry, Department of Dentistry and Oral Health, Aarhus University, Aarhus, Denmark
| | - Per Vult von Steyern
- Nordic Institute of Dental Materials, NIOM, Oslo, Norway
- Department of Dental Materials, Faculty of Odontology, University of Malmö, Malmö, Sweden
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Platt A, Liu CC, Gubler A, Naenni N, Thoma D, Schmidlin PR. In vitro evaluation of different protective techniques to reduce titanium particle contamination during implantoplasty. Clin Oral Investig 2023; 27:4205-4213. [PMID: 37140763 PMCID: PMC10415425 DOI: 10.1007/s00784-023-05037-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/21/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Our aim is to study titanium remains in a bone model during standardized implantoplasty under different isolation and protective modalities. MATERIAL AND METHODS Forty implants were placed in artificial spongy bone blocks mimicking a horizontal bone loss and implant neck protrusion of 5 mm. Samples were randomly divided into four groups (n = 10), which were treated as follows: rubber dam (A), a dental adhesive paste (B), bone wax (C), and an unprotected positive control (D). Implantoplasty was performed using carbide and diamond burs under strict water cooling and standardized suction. After removal of the respective isolation materials, the bone blocks were thoroughly rinsed with tap water for 3 min and titanium chips were collected using a filter integrated in the model. The filter paper was removed and dissolved in 37% hydrochloric acid for 2 h at 120 °C and the titanium remnants were quantified using atomic absorption spectrometry. RESULTS None of the test groups were able to completely prevent titanium particle contamination. Rubber dam (691 ± 249 µg) and bone wax (516 ± 157 µg) were found to be significantly more protective than the positive control (2313 ± 747 µg) (p < 0.001) with respect to the amount of titanium particles that remained in the bone model after implantoplasty. The adhesive paste group (1863.5 ± 538 µg) was not significantly different from the positive control (p = 0.19). CONCLUSIONS Despite some limitations of the present study, titanium particles resulting from a standardized implantoplasty can be assumed to be significantly reduced when the tissues/bone were protected with rubber dam and bone wax, or a combination, depending on individual accessibility. CLINICAL RELEVANCE Tissue protective measures to reduce or avoid particle contamination during implantoplasty is possible and should be considered and further clinically assessed to avoid iatrogenic inflammatory reactions.
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Affiliation(s)
- A Platt
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
| | - C C Liu
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
| | - A Gubler
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
| | - N Naenni
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
| | - D Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
| | - P R Schmidlin
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-Implant Diseases, Center of Dental Medicine, University of Zurich, 8032, Zurich, Switzerland.
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Dasgupta D, Banerjee S, Parasrampuria N, Pal D. Efficacy of implantoplasty in management of peri-implantitis: A systematic review. J Indian Prosthodont Soc 2023; 23:210-217. [PMID: 37929359 PMCID: PMC10467313 DOI: 10.4103/jips.jips_102_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 06/21/2023] [Accepted: 06/21/2023] [Indexed: 11/07/2023] Open
Abstract
Aim Peri-implantitis causes progressive loss of the supporting bony structure around the dental implant. Implantoplasty mechanically removes contaminated threads to achieve smoother implant surface thus reducing the bacterial load enabling fibroblastic growth to stimulate the healing effect. This Systematic review is done to appraise the outcome of implantoplasty on surface quality of Implant (roughness), biocompatibility of implants in peri-implantitis cases. Settings and Design The Settings of the studies are major online databases like PubMed, Scopus, and Cochrane online library. The design of the current study is systematic review of published qualitative studies. Materials and Method 37 articles were identified for the present review and systematic electronic literature search was done from August 2022 to January 2023, via PubMed, Scopus, Medline, and The Cochrane Library (Wiley) databases [PRISMA guidelines]. In vitro studies on implantoplasty for peri-implantitis were included for the review. 2 examiners independently selected based on the inclusion criteria and recorded the necessary data. Statistical Analysis Used Risk of bias assessment tool was evaluated with Newcastle Ottawa scale (NOS) and screened based on Selection, Comparability, and Outcome with the following categories: - maximum of 4, 2 and 4 points respectively. The observations were tabulated and analysed. Results Among the 8 selected studies, two studies reported no statistical difference between implantoplasty and control, one study proposed carbide burs were better than diamond burs, another study also suggested multilaminar burs were better than diamond and carbide. The Newcastle Ottawa scale (NOS) score for the quality of the included studies ranged from 6 to 8. Two of the studies had score of 6 points, eight had 7 points and one had 8 points. Conclusion Implantoplasty has been recommended as an efficacious treatment protocol for peri-implantitis that helps to diminish the inflammation and accompanied by a high success rate.
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Affiliation(s)
- Dolanchanpa Dasgupta
- Department of Prosthodontics and Crown and Bridge, Kusum Devi Sunderlal Dugar Jain Dental College and Hospital, Kolkata, India
| | - Saurav Banerjee
- Departnent of Prosthodontics, Burdwan Dental College and Hospital, Bardhaman, India
| | - Nikita Parasrampuria
- Department of Prosthodontics and Crown and Bridge, Kusum Devi Sunderlal Dugar Jain Dental College and Hospital, Kolkata, India
| | - Dipankar Pal
- Department of Dentistry, R G Kar Medical College and Hospital, Kolkata, West Bengal, India
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Sadowsky SJ. Peri-implantitis after 40 years: Evidence, mechanisms, and implications: A mapping review. J Prosthet Dent 2023:S0022-3913(23)00114-2. [PMID: 36935269 DOI: 10.1016/j.prosdent.2023.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 03/19/2023]
Abstract
STATEMENT OF PROBLEM The high prevalence of peri-implantitis (PI) continues to plague patients and the disease is resistant to present treatment regimens. An analysis of the available research is lacking. PURPOSE Given the abundance and diversity of research on the topic of PI, the purpose of this mapping review was to synthesize the literature on the prevention of PI, the histopathology of the disease, the state of present therapeutics, and any emerging treatments. MATERIAL AND METHODS An extensive literature search was undertaken by using the electronic databases of PubMed, Web of Science, and Science Direct. The keyword strings were peri-implantitis, dental implant, risk assessment, histopathology, prosthesis design, and treatment. The filters applied were time interval from 2000 to 2002; language, English. RESULTS A total of 3635 articles were taken from PubMed, 3686 articles from Web of Science, and 2450 articles from Science Direct. After applying the inclusion and exclusion criteria to the titles and abstracts of selected investigations, 214 studies were retrieved. CONCLUSIONS The evidence reflects a concerning incidence of PI, without a predictable treatment protocol. An in-depth patient risk assessment considering risk modification, emphasis on surgical and restorative expertise, and strict recall and maintenance is essential to minimize PI.
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Affiliation(s)
- Steven J Sadowsky
- Professor, Preventive and Restorative Department, University of the Pacific Arthur A. Dugoni School of Dentistry, San Francisco, Calif.
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Zhang F, Monzavi M, Li M, Čokić S, Manesh A, Nowzari H, Vleugels J, Van Meerbeek B. Fracture analysis of one/two-piece clinically failed zirconia dental implants. Dent Mater 2022; 38:1633-1647. [PMID: 36064469 DOI: 10.1016/j.dental.2022.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Analyzing factors that may have led to fracture of zirconia implants by macro/micro-fractography. METHODS Six one-piece and ten two-piece full-ceramic zirconia implants from two manufacturers, Z-Systems and CeraRoot, were retrieved after clinical failure. The time-to-failure ranged from 3 to 49 months. Optical and scanning electron microscopy (SEM) were used to analyze the fracture planes at the macro- and microscopic level. Treatment planning, surgical protocol, fracture-origin location and characteristic fracture features were assessed. RESULTS The fracture of all implants seemed to have been primarily due to overload in bending mode, while the fracture-initiation sites varied for the one- and two-piece implants. The fracture of all one-piece implants originated in the constriction region between two threads in the endosseous implant part. For two-piece implants, the abutment neck, internal abutment-implant connections and inner threads were found to be the main fracture-initiation sites. Surface defects at the root area for one-piece implants and damages at the abutment surface for two-piece implants were connected to the fracture origins. Importantly, the clinical failures of implants were often found to result from combined effects related to patient aspects, treatment planning/protocols, a high bending moment at the weakest link, implant-surface conditions and specific implant designs. SIGNIFICANCE This study provided information to be considered for future optimization of treatment planning and the surgical protocol for zirconia implants. Optimization of the surface conditions and the zirconia-starting powder were also suggested.
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Affiliation(s)
- Fei Zhang
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, B-3001 Leuven, Belgium`; KU Leuven, Department of Oral Health Sciences, BIOMAT - Biomaterials Research Group & UZ Leuven (University Hospitals Leuven), Dentistry, Kapucijnenvoer 7 block a, B-3000 Leuven, Belgium.
| | - Mona Monzavi
- Periodontics and Ceramic Implantology (private Practice), 1401N Tustin Ave Suite #345, Santa Ana, CA 92705, USA
| | - Maoyin Li
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, B-3001 Leuven, Belgium`
| | - Stevan Čokić
- KU Leuven, Department of Oral Health Sciences, BIOMAT - Biomaterials Research Group & UZ Leuven (University Hospitals Leuven), Dentistry, Kapucijnenvoer 7 block a, B-3000 Leuven, Belgium
| | - Al Manesh
- Mission Dental Implant Center (private Practice), 26800 Crown Valley Pkwy Ste 425, Mission Viejo, CA 92691, USA
| | - Hessam Nowzari
- Periodontics and Implant Dentistry (private practice), 120 S Spalding Dr #201, Beverlyhills, CA 90210, USA
| | - Jef Vleugels
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, B-3001 Leuven, Belgium`
| | - Bart Van Meerbeek
- KU Leuven, Department of Oral Health Sciences, BIOMAT - Biomaterials Research Group & UZ Leuven (University Hospitals Leuven), Dentistry, Kapucijnenvoer 7 block a, B-3000 Leuven, Belgium
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