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Rella E, De Angelis P, Papetti L, Damis G, Gasparini G, D'Addona A, Manicone PF. Comparison of Aesthetic, Mechanical Outcome, and Bone Loss in Angulated Screw Channels (ASCs) and Cement-Retained Implant-Supported Prosthesis: A Case-Control Study. Dent J (Basel) 2024; 12:233. [PMID: 39195077 DOI: 10.3390/dj12080233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 07/09/2024] [Accepted: 07/12/2024] [Indexed: 08/29/2024] Open
Abstract
Angulated-screw channels (ASCs) allow the clinician to employ screw-retained restorations in almost all cases, as the access hole can be moved away from the vestibular portion of the crown, where it would jeopardize the final esthetic result. The objective of this study was to compare screw-retained restorations employing ASCs with restorations cemented on angled abutments. In this study, 30 subjects, equally divided into two groups: group 1 (cemented restorations on angulated abutments) and group 2 (screw-retained restorations adopting ASCs), were treated and retrospectively compared after 2 years using the pink esthetic score (PES) and the white esthetic score (WES). All restorations were in use at the last follow-up, with a survival rate of 100%. Three mechanical complications were observed (2 chippings and 1 crown came loose), with a success rate of 93% in group 1 and 87% in group 2 (p > 0.05). No statistically significant differences were reported regarding the esthetic outcome; the marginal bone loss (MBL) showed better results for the screw-retained restorations, both at the distal aspect (group 1 = 0.98 mm ± 0.16; group 2 = 0.45 mm ± 0.06; p = 0.006) and at the mesial aspect (group 1 = 1.04 ± 0.27; group 2 = 0.45 ± 0.005; p < 0.001). From an esthetical perspective, screw-retained restorations with ASCs and cemented restorations on angulated abutments are both effective means of restoring implants; both have excellent esthetic outcomes, but screw-retained restorations have reduced bone loss when compared to cemented ones but are more prone to mechanical complications. Still, our results must be cautiously observed given the reduced dimension of our sample. Larger studies are needed to confirm our findings.
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Affiliation(s)
- Edoardo Rella
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, IRCSS "A. Gemelli" Foundation, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Paolo De Angelis
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, IRCSS "A. Gemelli" Foundation, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Laura Papetti
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, IRCSS "A. Gemelli" Foundation, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giovanni Damis
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, IRCSS "A. Gemelli" Foundation, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Giulio Gasparini
- Maxillo-Facial Surgery Unit, IRCSS "A. Gemelli" Foundation, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Antonio D'Addona
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, IRCSS "A. Gemelli" Foundation, Catholic University of the Sacred Heart, 00168 Rome, Italy
| | - Paolo Francesco Manicone
- Division of Oral Surgery and Implantology, Department of Head and Neck, Oral Surgery, and Implantology Unit, Institute of Clinical Dentistry, IRCSS "A. Gemelli" Foundation, Catholic University of the Sacred Heart, 00168 Rome, Italy
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Abu Al-Faraj TM, Alsubhi BM, Almarhoon AN, Almarshoud AA, Alqattan MS, Alqahtani SH, Al Osaimi AA, Saad Alshammari L, Almakrami AI, Alwadai YS. Comparison of Peri-Implant Soft Tissue Around Zirconia and Titanium Abutments in the Aesthetic Zone: A Narrative Review. Cureus 2024; 16:e65782. [PMID: 39211689 PMCID: PMC11361734 DOI: 10.7759/cureus.65782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2024] [Indexed: 09/04/2024] Open
Abstract
This narrative review compares the peri-implant soft tissue responses around zirconia and titanium abutments in the aesthetic zone, emphasizing their mechanical, biological, and aesthetic properties. Titanium abutments, known for their excellent mechanical strength and fatigue resistance, have traditionally been the standard in dental restorations but face challenges in aesthetic integration due to their metallic appearance and potential for higher inflammatory responses. Zirconia abutments, emerging as a promising alternative, offer superior aesthetic outcomes, reduced plaque accumulation, and lower inflammatory responses, making them ideal for use in visible areas with thin soft tissue biotypes. However, zirconia's mechanical properties, such as lower fracture resistance, necessitate careful clinical application. The review also highlights rare instances of titanium allergies, underscoring the importance of individualized treatment planning and regular monitoring to ensure the longevity and success of implant restorations.
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Neckel N, Pohl J, Preissner S, Wagendorf O, Sachse C, Vach K, Heiland M, Nahles S. Cross-sectional analysis comparing prefabricated titanium to individualized hybrid zirconia abutments for cemented zirconia based fixed dental prostheses: a critical concept assessment. Int J Implant Dent 2024; 10:13. [PMID: 38498247 PMCID: PMC10948712 DOI: 10.1186/s40729-024-00529-y] [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: 10/19/2023] [Accepted: 03/05/2024] [Indexed: 03/20/2024] Open
Abstract
PURPOSE Despite the differences in material properties and shapes among the different types of prefabricated titanium (pTiA) and individualized hybrid zirconia abutments (ihZiA), the biological and clinical relevance of materials and construction features remains vague. Yet, individualized ihZiA are increasingly implemented into daily routine aiming to satisfy rising expectations. The objective was to compare these two types of abutments in fixed dental prostheses (FDP). METHODS This cross-sectional study examined 462 implants in 102 patients comparing pTiA (52 patients) to ihZiA (50 patients) for FDP. These different treatment regimens were evaluated in terms of peri-implant health, radiographic bone loss, and oral-health related quality of life (OH-QoL) with special consideration of abutment type and superstructure design. RESULTS ihZiA showed significantly different design features than prefabricated pTiA, but the annual bone loss in both groups did not. Visible titanium in the esthetic zone negatively impacted OHIP 14 scores. The combination of an emergence angle (EA) of < 30° and a concave emergence profile (EP) as well as gingiva thickness (p = 0.002) at the time of the prosthetic restoration significantly improved the annual peri-implant bone loss, independently of the abutment type. CONCLUSION ihZiA showed comparable results to pTiA. To optimize the long-term outcome, not just material alone but generating adequate soft tissue thickness, minimizing the EA, and applying a concave EP seem to be the most relevant factors. To improve OH-QoL, particular attention must be paid to the esthetic zone.
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Affiliation(s)
- Norbert Neckel
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
| | - Josephine Pohl
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Saskia Preissner
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Oliver Wagendorf
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Claudia Sachse
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Kirstin Vach
- Faculty of Medicine and Medical Center, Institute of Medical Biometry and Medical Statistics, University of Freiburg, Freiburg, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Susanne Nahles
- Department of Oral and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Sadid-Zadeh R, Lin K, Li R, Nagy K. Fracture strength of screw-retained zirconia crowns assembled on zirconia and titanium implants. J Prosthodont 2024; 33:273-280. [PMID: 36973859 DOI: 10.1111/jopr.13683] [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: 12/12/2022] [Revised: 03/04/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023] Open
Abstract
PURPOSE This in vitro study evaluated the fracture strength of screw-retained zirconia crowns connected to zirconia (Zr) and titanium (Ti) implants after undergoing a simulation of 5 years of clinical use. MATERIALS AND METHODS Forty-eight screw-retained zirconia crowns were fabricated and assembled on four implant systems, with 12 in each group: (1) Zr implant (pure ceramic; Straumann AG) (PZr); (2) Zr implant (NobelPearl; Nobel Biocare) (NPZr); (3) Ti-Zr implant (Bone Level Roxolid; Straumann AG) (RSTiZr); (4) Ti implant (Conical Connection PMC; Nobel Biocare) (NRTi). Crowns were luted to their associated abutments using resin cement and then torqued to their assigned implants at the recommended torque value. Specimens were subjected to dynamic loading for 1,200,000 loading cycles. Fracture strength, measured in Newtons (N), was tested under static compression load using a universal testing machine at an angle of 30°. One-way ANOVA and Tukey's multiple comparisons post hoc test were used to compare the mean fracture values between the groups at a significance level of 0.05. RESULTS The average fracture strengths for the RSTiZr and NRTi groups were 1207 ± 202 and 1073 ± 217 N, respectively, which was significantly (p < 0.0001) higher than the PZr and NPZr groups (712 ± 76 and 571.6 ± 167 N, respectively). However, no significant difference was found between the fracture strength value of RSTiZr and NRTi (p = 0.260) or PZr and NPZr (p = 0.256) groups. CONCLUSIONS Zirconia crowns connected to Zr implants have the potential to withstand the average physiological occlusal forces which occur in the anterior and premolar regions.
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Affiliation(s)
- Ramtin Sadid-Zadeh
- Department of Restorative Dentistry, University at Buffalo School of Dental Medicine, Buffalo, New York, USA
| | - Kevin Lin
- Department of Restorative Dentistry, University at Buffalo School of Dental Medicine, Buffalo, New York, USA
| | - Rui Li
- Department of Restorative Dentistry, University at Buffalo School of Dental Medicine, Buffalo, New York, USA
| | - Katalin Nagy
- Head of Oral Surgery, Faculty of Dentistry, University of Szeged, Szeged, Hungary
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Zhang M, Ho DKL, Pelekos G, Fok MR. Clinical performance of implant-supported single hybrid abutment crown restoration: A systematic review and meta-analysis. J Prosthodont Res 2024; 68:63-77. [PMID: 37316260 DOI: 10.2186/jpr.jpr_d_22_00279] [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: 06/16/2023]
Abstract
PURPOSE To investigate survival rates and technical and biological complications of one-piece screw-retained hybrid abutments in implant-supported single crowns (SCs). STUDY SELECTION An electronic search was performed on five databases for clinical studies involving implant-supported single hybrid abutment crowns constructed using titanium-base (Ti base) abutments, with at least 12 months of follow-up. The RoB 2, Robins-I, and JBI tools were used to assess the risk of bias for the different study types. Success, survival, and complication rates were calculated, and a meta-analysis was performed to obtain a pooled estimate. Peri-implant health parameters were extracted and analyzed. RESULTS 22 records (20 studies) were included in this analysis. Direct comparisons between screw-retained hybrid abutment SCs and cemented SCs showed no significant differences in the 1-year survival and success rates. For SCs using a hybrid abutment crown design, their 1-year survival rate was 100% (95% CI: 100%-100%, I2 = 0.0%, P = 0.984), and a success rate of 99% (95% CI: 97%-100%, I2 = 50.3%, P = 0.023) was calculated. No confounding variables significantly affected the estimates. The individual technical complication rate was low at 1-year follow-up. The estimated incidence of all types of complications in hybrid abutment SCs is less than 1%. CONCLUSIONS Within the limitations of this study, implant-supported SCs using a hybrid abutment crown design showed favorable short-term clinical outcomes. Additional well-designed clinical trials with at least a 5-year observation period are required to confirm their long-term clinical performance.
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Affiliation(s)
- Mengze Zhang
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Dominic King Lun Ho
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - George Pelekos
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
| | - Melissa Rachel Fok
- Division of Periodontology and Implant Dentistry, Faculty of Dentistry, The University of Hong Kong, Hong Kong SAR, China
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Viski IS, Lee JD, Scialabba R, Lee SJ. Retrieval of cement-retained zirconia implant-supported crowns with an Er,Cr:YSGG laser. J Prosthet Dent 2024:S0022-3913(23)00830-2. [PMID: 38184397 DOI: 10.1016/j.prosdent.2023.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 12/14/2023] [Accepted: 12/15/2023] [Indexed: 01/08/2024]
Abstract
STATEMENT OF PROBLEM Cement-retained implant-supported crowns can be challenging to retrieve from the abutment once technical or biological issues arise. Removal traditionally requires sectioning the crown with rotary instruments, which causes irreversible damage to the crown and potential damage to the periodontal apparatus stabilizing the implant. PURPOSE The purpose of this in vitro study was to evaluate an erbium, chromium-doped yttrium, scandium, gallium, and garnet (Er,Cr:YSGG) laser as a minimally invasive alternative for the retrieval of zirconia implant-supported crowns from titanium abutments. Time, temperature, and structural changes to the crown after retrieval were assessed. Appropriate laser parameters were established for this method of crown retrieval. MATERIAL AND METHODS Twenty zirconia crowns were milled for a maxillary left second premolar based on a CAD-CAM implant analog cast. Ten of these crowns were cemented with a noneugenol zinc oxide dental cement (group Temp) (n=10). The remaining 10 were cemented with a self-adhesive universal resin cement (group Resin) (n=10). Er,Cr:YSGG laser irradiation was performed with the Waterlase iPlus for 1-minute cycles. An attempt was made to remove the crown with a mechanical instrument after each cycle. A type K thermocouple continuously recorded temperature at the level of the abutment. For statistical comparison of decementation time and temperature, the Mann-Whitney test was used (α=.05). Scanning electron microscopy of the nonirradiated and the irradiated crowns was used for analysis of structural and dimensional changes. RESULTS A significant difference (P<.001) was found in the time ±standard deviation required to retrieve the crowns between group Temp (02:40 ±00:18 minutes:seconds) and group Resin (05:26 ±00:36 minutes:seconds). A significant difference (P<.001) was found in the mean ±standard deviation temperature recorded between group Temp (24.0 ±1.19 °C) and group Resin (25.7 ±0.66 °C). No structural changes to crowns were observed after irradiation. CONCLUSIONS Retrieval of cement-retained zirconia implant-supported crowns with an Er,Cr:YSGG laser is safe and efficient. Crowns luted with zinc oxide dental cement were retrieved significantly faster while maintaining a significantly lower average temperature than those luted with resin cement. Laser irradiation for decementation did not cause structural changes to zirconia implant-supported crowns.
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Affiliation(s)
- Ionut Sebastian Viski
- Graduate student, Advanced Graduate Prosthodontics, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass
| | - Jason D Lee
- Assistant professor, Advanced Graduate Prosthodontics, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass
| | - Rebecca Scialabba
- Graduate Dental student, Harvard School of Dental Medicine, Boston, Mass
| | - Sang J Lee
- Associate Professor, Advanced Graduate Prosthodontics, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass.
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Schubert O, Goob J, Schweiger J, Güth JF, Edelhoff D, Graf T. Clinical performance of monolithic lithium disilicate hybrid abutment crowns over at least 3.5 years. J Prosthodont 2024; 33:34-40. [PMID: 37243453 DOI: 10.1111/jopr.13719] [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: 01/03/2023] [Accepted: 05/19/2023] [Indexed: 05/28/2023] Open
Abstract
PURPOSE Hybrid abutment crowns (HACs) made from monolithic ceramics represent an efficient option for single restorations on implants. However, long-term data are scarce. The purpose of this clinical trial was to evaluate the survival and complication rates of CAD-CAM fabricated HACs over a time period of at least 3.5 years. MATERIALS AND METHODS Twenty-five patients with a total of 40 HACs made of monolithic lithium disilicate ceramic bonded to a titanium base CAD-CAM abutment were retrospectively evaluated. All implants and screw-retained restorations were placed and manufactured in the same department of a university hospital. Only crowns that had been in service for more than 3.5 years were included in the study. HACs were evaluated regarding technical and biological complications. Functional Implant Prosthodontic Scores (FIPS) were obtained. RESULTS The mean observation time was 5.9 ± 1.4 years. Implant survival was 100%, and HAC survival was 97.5%. Over the observation period, one crown fracture was observed, necessitating refabricating of the restoration. Three minor biological complications were found. The overall mean FIPS score was 8.69 ± 1.12 points. CONCLUSIONS Within the limitations of this study, monolithic screw-retained HACs milled from lithium disilicate ceramics and bonded to titanium bases appeared to be a reliable treatment option over more than 3.5 years due to their low biological and technical complication rates.
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Affiliation(s)
- Oliver Schubert
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Janosch Goob
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Josef Schweiger
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Jan-Frederik Güth
- Department of Prosthodontics, Center for Dentistry and Oral Medicine (Carolinum), Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
| | - Daniel Edelhoff
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Graf
- Department of Prosthodontics, Center for Dentistry and Oral Medicine (Carolinum), Goethe-University Frankfurt am Main, Frankfurt am Main, Germany
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Wittneben JG, Abou-Ayash S, Gashi A, Buser D, Belser U, Brägger U, Sailer I, Gavric J. Implant-supported single all-ceramic crowns made from prefabricated (stock) or individualized CAD/CAM zirconia abutments: A 5 year randomized clinical trial. J ESTHET RESTOR DENT 2024; 36:164-173. [PMID: 38173277 DOI: 10.1111/jerd.13188] [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: 10/08/2023] [Revised: 12/04/2023] [Accepted: 12/05/2023] [Indexed: 01/05/2024]
Abstract
AIM The aim of this randomized, prospective, and clinical multicenter study was to compare the overall clinical performance of two restorative options over a 5-year period: individualized CAD/CAM abutments veneered with a hand-layered ceramic, and prefabricated zirconium dioxide abutments veneered with press ceramic and inserted into a single edentulous gap in the anterior maxilla. MATERIALS AND METHODS Forty subjects were recruited from two universities: 20 from the University of XX and 20 from the University of XY. Each subject received an implant to restore a single edentulous gap in the maxillary anterior region (14-24 FDI). 20 patients were randomized into each Group. Group A received a one-piece single crown produced from a prefabricated zirconia abutment with pressed ceramic and Group B received an individualized CAD/CAM zirconia abutment with a hand-layered technique. After 5 years, the aesthetic and radiographic parameters were assessed. RESULTS Group A had four dropouts and one failure, resulting in a 95% survival rate and 95% success rate. Group B had two dropouts and two failures which resulted in a 90% survival rate and 90% success rate. No crestal bone level changes were observed, with a mean DIB of 0.06 mm in Group A and 0.09 mm in Group B. No statistically significant differences were present at baseline, 6 months, 1 year, 3 years, or 5 years for DIB values between time points and groups. Pink aesthetic score/white aesthetic score, Peri-Implant and Crown Index, and Implant Crown Aesthetic Index values were stable over time at all five points for both groups. CONCLUSION Both implant-supported restorative options represent a valuable treatment option for the restoration of implant crowns in the anterior maxilla. CLINICAL SIGNIFICANCE In general, the use of ceramic abutments in the anterior zone represents a valuable treatment procedure with both standardized and CAD/CAM individualized abutments and following the recommendations from the respective manufacturer(s).
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Affiliation(s)
- Julia-Gabriela Wittneben
- Private Practice, Zürich, Switzerland
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Samir Abou-Ayash
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | | | - Daniel Buser
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Urs Belser
- Department of Reconstructive Dentistry, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Urs Brägger
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Irena Sailer
- Department of Reconstructive Dentistry, School of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Jelena Gavric
- Department of Reconstructive Dentistry, School of Dental Medicine, University of Geneva, Geneva, Switzerland
- Private Practice, Geneva, Switzerland
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Zandinejad A, Khurana S, Liang Y, Liu X. Comparative evaluation of gingival fibroblast growth on 3D-printed and milled zirconia: An in vitro study. J Prosthodont 2024; 33:54-60. [PMID: 36693242 DOI: 10.1111/jopr.13650] [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: 08/20/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The purpose of this study was to analyze the fibroblast growth and proliferation on 3D-printed zirconia in presence and absence of porosities. MATERIAL AND METHODS A total of 40 bars (8 × 4 × 3) were included in this study. Thirty 3D-printed and 10 milled zirconia samples were prepared. The 3D-printed samples had different porosities, 0% (PZ0), 20% (PZ20), and 40% (PZ40) with 10 specimens in each group. Milled zirconia samples were used as the control (MZ). Rat gingival fibroblasts were cultured for 48 h, and the proliferation of fibroblasts on each sample in each group (n = 10) was determined by MTT assays. The differences among the four groups were compared by one-way ANOVA. To test the significance of the observed differences between two groups, an unpaired Student's t-test was applied. The significance level was set at p < 0.05. Qualitative analysis for the cell culture was performed using scanning electron microscopy. RESULTS One-way ANOVA showed that the numbers of the fibroblasts among the four groups had a statistical difference. Post hoc Bonferroni test revealed that there was no significant difference between PZ0 and MZ; however, all other groups and among groups were significantly different. CONCLUSIONS Fibroblasts had a better affinity toward the MZ and PZ0 in a short period of cell culture time.
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Affiliation(s)
- Amirali Zandinejad
- Implant Dentistry Associations of Arlington, Arlington, Texas, USA
- Department of Comprehensive Dentistry, College of Dentistry, Texas A&M University, Dallas, Texas, USA
| | - Saumya Khurana
- Department of Biomedical Science, College of Dentistry, Texas A&M University, Dallas, Texas, USA
| | - Yongxi Liang
- Department of Biomedical Science, College of Dentistry, Texas A&M University, Dallas, Texas, USA
| | - Xiaohua Liu
- Department of Biomedical Science, College of Dentistry, Texas A&M University, Dallas, Texas, USA
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Lv X, Pu Y, Zhang X, Jiang X, Zhang X, Shi J, Lai H. One-piece versus two-piece zirconia abutment supported single implant crown in the esthetic region: 3-Year results from a split-mouth randomized controlled clinical trial. Clin Oral Implants Res 2023; 34:1330-1341. [PMID: 37655630 DOI: 10.1111/clr.14173] [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: 04/06/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES To compare the clinical, radiographic, and immunological outcomes between one-piece versus two-piece zirconia abutments supported single implant crowns in the esthetic region. MATERIALS AND METHODS The study followed a split-mouth, double-blind, and randomized controlled clinical design for a duration of 3 years. Twenty-two eligible patients with 44 implants were randomly assigned to two groups: Group 1 (one-piece zirconia abutment with zirconia base, n = 22) and Group 2 (two-piece zirconia abutment with titanium base, n = 22). The primary outcome was the technical complication rate. Additionally, survival rates, cytokines concentrations in peri-implant crevicular fluid (PICF), peri-implant conditions, marginal bone loss, and pink/white esthetics score (PES/WES) were assessed as secondary outcomes. RESULTS Twelve of 22 patients attended the 1-year follow-up (due to the COVID pandemic), and 19 patients attended the 3-year examination. Two abutments in Group 1 were fractured after 10 and 12 months in function. Additionally, one screw loosening occurred in Group 1 at 1-year follow-up. The 3-year technical complication rate was significantly higher in Group 1 than that in Group 2 (15.79% vs. 0%, p < .001). The 3-year implant survival rate was 100% in both groups. The concentration of IFN-γ in PICF was significantly upregulated in Group 2 (p = .018). Furthermore, the IL-6 concentration was positively correlated with BOP% (p = .020). CONCLUSIONS Two-piece zirconia abutments exhibited superior technical performance compared to one-piece designs during a 3-year follow-up in the anterior region. However, further long-term research is necessary to verify the immunological stability of two-piece zirconia abutments.
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Affiliation(s)
- Xiaolei Lv
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yiping Pu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillo-facial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaomeng Zhang
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xue Jiang
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Zhang
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Junyu Shi
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hongchang Lai
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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11
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Staehlke S, Brief J, Senz V, Eickner T, Nebe JB. Optimized Gingiva Cell Behavior on Dental Zirconia as a Result of Atmospheric Argon Plasma Activation. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4203. [PMID: 37374388 DOI: 10.3390/ma16124203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023]
Abstract
Several physico-chemical modifications have been developed to improve cell contact with prosthetic oral implant surfaces. The activation with non-thermal plasmas was one option. Previous studies found that gingiva fibroblasts on laser-microstructured ceramics were hindered in their migration into cavities. However, after argon (Ar) plasma activation, the cells concentrated in and around the niches. The change in surface properties of zirconia and, subsequently, the effect on cell behavior is unclear. In this study, polished zirconia discs were activated by atmospheric pressure Ar plasma using the kINPen®09 jet for 1 min. Surfaces were characterized by scanning electron microscopy, X-ray photoelectron spectroscopy (XPS), and water contact angle. In vitro studies with human gingival fibroblasts (HGF-1) focused on spreading, actin cytoskeleton organization, and calcium ion signaling within 24 h. After Ar plasma activation, surfaces were more hydrophilic. XPS revealed decreased carbon and increased oxygen, zirconia, and yttrium content after Ar plasma. The Ar plasma activation boosted the spreading (2 h), and HGF-1 cells formed strong actin filaments with pronounced lamellipodia. Interestingly, the cells' calcium ion signaling was also promoted. Therefore, argon plasma activation of zirconia seems to be a valuable tool to bioactivate the surface for optimal surface occupation by cells and active cell signaling.
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Affiliation(s)
- Susanne Staehlke
- Institute for Cell Biology, Rostock University Medical Center, 18057 Rostock, Germany
| | - Jakob Brief
- VITA Zahnfabrik H. Rauter GmbH & Co. KG, 79713 Bad Säckingen, Germany
| | - Volkmar Senz
- Institute for Biomedical Engineering, Rostock University Medical Center, 18119 Rostock, Germany
| | - Thomas Eickner
- Institute for Biomedical Engineering, Rostock University Medical Center, 18119 Rostock, Germany
| | - J Barbara Nebe
- Institute for Cell Biology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Science and Technology of Life, Light and Matter, University of Rostock, 18059 Rostock, Germany
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12
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Bae EB, Cho WT, Park DH, Hwang SH, Lee SH, Yun MJ, Jeong CM, Huh JB. Comparison of fit and trueness of zirconia crowns fabricated by different combinations of open CAD-CAM systems. J Adv Prosthodont 2023; 15:155-170. [PMID: 37441720 PMCID: PMC10333096 DOI: 10.4047/jap.2023.15.3.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/26/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE This study aims to clinically compare the fitness and trueness of zirconia crowns fabricated by different combinations of open CAD-CAM systems. MATERIALS AND METHODS Total of 40 patients were enrolled in this study, and 9 different zirconia crowns were prepared per patient. Each crown was made through the cross-application of 3 different design software (EZIS VR, 3Shape Dental System, Exocad) with 3 different processing devices (Aegis HM, Trione Z, Motion 2). The marginal gap, absolute marginal discrepancy, internal gap(axial, line angle, occlusal) by a silicone replica technique were measured to compare the fit of the crown. The scanned inner and outer surfaces of the crowns were compared to CAD data using 3D metrology software to evaluate trueness. RESULTS There were significant differences in the marginal gap, absolute marginal discrepancy, axial and line angle internal gap among the groups (P < .05) in the comparison of fit. There was no statistically significant difference among the groups in terms of occlusal internal gap. The trueness ranged from 36.19 to 43.78 µm but there was no statistically significant difference within the groups (P > .05). CONCLUSION All 9 groups showed clinically acceptable level of marginal gaps ranging from 74.26 to 112.20 µm in terms of fit comparison. In the comparison of trueness, no significant difference within each group was spotted. Within the limitation of this study, open CAD-CAM systems used in this study can be assembled properly to fabricate zirconia crown.
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Affiliation(s)
- Eun-Bin Bae
- Department of Prosthodontics, Dental Research Institute, Dental and Life Sciences Institute, Education and Research Team for Life Science on Dentistry, School of Dentistry, Pusan National University, Yangsan, Republic of Korea
- The Shapiro Family Laboratory of Viral Oncology and Aging Research & Section of Restorative Dentistry, UCLA School of Dentistry, Los Angeles, CA, USA
| | - Won-Tak Cho
- Department of Prosthodontics, Dental Research Institute, Dental and Life Sciences Institute, Education and Research Team for Life Science on Dentistry, School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - Do-Hyun Park
- Department of Prosthodontics, Dental Research Institute, Dental and Life Sciences Institute, Education and Research Team for Life Science on Dentistry, School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - Su-Hyun Hwang
- Department of Prosthodontics, Dental Research Institute, Dental and Life Sciences Institute, Education and Research Team for Life Science on Dentistry, School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - So-Hyoun Lee
- Department of Prosthodontics, Dental Research Institute, Dental and Life Sciences Institute, Education and Research Team for Life Science on Dentistry, School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - Mi-Jung Yun
- Department of Prosthodontics, Dental Research Institute, Dental and Life Sciences Institute, Education and Research Team for Life Science on Dentistry, School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - Chang-Mo Jeong
- Department of Prosthodontics, Dental Research Institute, Dental and Life Sciences Institute, Education and Research Team for Life Science on Dentistry, School of Dentistry, Pusan National University, Yangsan, Republic of Korea
| | - Jung-Bo Huh
- Department of Prosthodontics, Dental Research Institute, Dental and Life Sciences Institute, Education and Research Team for Life Science on Dentistry, School of Dentistry, Pusan National University, Yangsan, Republic of Korea
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13
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Çeken A, Kılınç H, Turgut S. Effect of abutment types and resin cements on the esthetics of implant-supported restorations. J Adv Prosthodont 2023; 15:114-125. [PMID: 37441718 PMCID: PMC10333101 DOI: 10.4047/jap.2023.15.3.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/31/2023] [Accepted: 06/20/2023] [Indexed: 07/15/2023] Open
Abstract
PURPOSE The aim of the study was to evaluate the optical properties of new generation (3Y-TZP) monolithic zirconia (MZ) with different abutment types and resin cement shades. MATERIALS AND METHODS A1/LT MZ specimens were prepared (10 × 12 × 1 mm, N = 30) and divided into 3 groups according to cement shades as transparent (Tr), yellow (Y) and opaque (O). Abutment specimens were obtained from 4 different materials including zirconia (Group Z), hybrid (Group H), titanium (Group T) and anodized yellow titanium (Group AT). MZ and abutment specimens were then cemented. L*, a*, and b* parameters were obtained from MZ, MZ + abutment, and MZ + abutment + cement. ΔE001* (between MZ and MZ + abutment), ΔE002* (between MZ and MZ + abutment + cement) and ΔE003* (between MZ + abutment and MZ + abutment + cement) values were calculated. Statistical analyses included 2-way ANOVA, Bonferroni, and Paired Sample t-Tests (P < .05). RESULTS Abutment types and resin cements had significant effect on L*, a*, b*, ΔE001*, ΔE002*, and ΔE003* values (P < .001). Without cementation, whereas zirconia abutment resulted in the least discoloration (ΔE001* = 0.68), titanium abutment caused the most discoloration (ΔE001* = 4.99). The least ΔE002* = 0.68 value was seen using zirconia abutment after cementation with yellow shaded cement. Opaque shaded cement caused the most color change (ΔE003* = 5.24). Cement application increased the L* values in all groups. CONCLUSION The least color change with/without cement was observed in crown configurations created with zirconia abutments. Zirconia and hybrid abutments produced significantly lower ΔE002* and ΔE003* values in combination with yellow shaded cement. The usage of opaque shaded cement in titanium/anodized titanium groups may enable the clinically unacceptable ΔE00* value to reach the acceptable level.
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Affiliation(s)
- Asena Çeken
- Çerkezköy Oral and Dental Health Care Center, Tekirdağ Provincial Health Directorate, Tekirdağ, Türkiye
| | - Hamiyet Kılınç
- Department of Prosthodontics, Faculty of Dentistry, On Dokuz Mayıs University, Samsun, Türkiye
| | - Sedanur Turgut
- Department of Prosthodontics, Faculty of Dentistry, Karadeniz Technical University, Trabzon, Türkiye
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14
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Tonin BSH, Fu J, He Y, Ye N, Chew HP, Fok A. The effect of abutment material stiffness on the mechanical behavior of dental implant assemblies: A 3D finite element study. J Mech Behav Biomed Mater 2023; 142:105847. [PMID: 37127010 DOI: 10.1016/j.jmbbm.2023.105847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE This study aimed to evaluate the stress distribution and microgap formation in implant assemblies with conical abutments made of different materials under an oblique load. MATERIALS AND METHODS The mechanical behavior of an implant assembly with a titanium abutment was analyzed and compared with that of an assembly with a Y-TZP abutment using finite element analysis (FEA). A torque of 20 Ncm was first applied to the abutment screw, followed by oblique loads of 10 N-280 N applied to the prosthesis placed on the implant. The maximum stress in the abutment screw, the microgap formation process, and the critical load for bridging the internal implant space were evaluated. RESULTS No significant difference in stress distribution between the two cases was observed, with the stresses being mainly concentrated at the top half of the screw (the predicted maximum von Mises stress was approximately 1200 MPa at 280 N). The area in contact at the implant-to-abutment interface decreased with increasing load for both abutments, with the critical load for bridging the internal implant space being roughly 140 N. The maximum gap size being was approximately 470 μm with either abutment. CONCLUSION There was no significant difference in the stress distribution or microgap formed between implant assemblies with titanium and Y-TZP abutments having an internal conical connection.
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Affiliation(s)
- Bruna S H Tonin
- Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Jing Fu
- Department of Prosthodontics, The Affiliated Hospital of Qingdao University, School of Stomatology of Qingdao University, China
| | - Yiting He
- Department of Prosthodontics, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Ning Ye
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Hooi Pin Chew
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Alex Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.
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15
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Takano R, Honda J, Kobayashi T, Kubochi K, Takata H, Komine F. Fracture strength of implant-supported hybrid abutment crowns in premolar region fabricated using different restorative CAD/CAM materials. Dent Mater J 2023; 42:187-192. [PMID: 36476684 DOI: 10.4012/dmj.2022-165] [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: 12/12/2022]
Abstract
The present study investigated the fracture strength of hybrid abutment crowns (HACs) in the premolar region that were fabricated with different restorative computer-aided design/computer-aided manufacturing (CAD/CAM) materials. The abutment-implant structures were randomly assigned into four groups (n=11 per group): bi-layered zirconia restorations (BL), translucent zirconia (4Y-PSZ) restorations (TZ), lithium disilicate ceramic restorations (LD), and dispersed nanoparticle-filled composite resin restorations (CM). All restorations were adhesively bonded to the titanium abutments. After the restoration-abutment complex was tightened onto the implant, the fracture strength was measured. The TZ (2.06 kN) and LD (1.87 kN) groups had significantly higher median fracture strengths than the BL (1.12 kN) and CM (1.10 kN) groups. In terms of fracture resistance, the 4Y-PSZ and lithium disilicate ceramic monolithic restorations would be superior to bi-layered 3Y-TZP and composite resin monolithic restorations for HACs in the premolar region.
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Affiliation(s)
- Ryoki Takano
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
| | - Junichi Honda
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
| | - Tatsuro Kobayashi
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
| | - Kei Kubochi
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
| | - Hiroki Takata
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
| | - Futoshi Komine
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
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16
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Mendes TA, Vilhena L, Portugal J, Caramês J, Ramalho AL, Lopes LP. Wear of Titanium Implant Platforms with Different Abutment Connections and Abutment Materials: A Pilot Study. J Funct Biomater 2023; 14:jfb14040178. [PMID: 37103268 PMCID: PMC10146395 DOI: 10.3390/jfb14040178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/28/2023] Open
Abstract
The most commonly used material in dental implants and their abutments is titanium. Zirconia is a more aesthetic alternative to titanium abutments; however, it is much harder. There are concerns that zirconia could damage the surface of the implant over time, especially in less stable connections. The aim was to evaluate the wear of implants with different platforms connected to titanium and zirconia abutments. A total of six implants were evaluated, two of each connection type: external hexagon, tri-channel, and conical connections (n = 2). Half of the implants were connected to zirconia abutments, and the other half to titanium abutments (n = 3). The implants were then cyclically loaded. The implant platforms were evaluated by digital superimposing micro CT files and calculating the area of the loss surface (wear). In all the implants, a statistically significant loss of the surface area (p = 0.028) was observed when comparing the area before and after cyclic loading. The average lost surface area was 0.38 mm2 with titanium abutments and 0.41 mm2 with zirconia abutments. The average lost surface area was 0.41 mm2 with the external hexagon, 0.38 mm2 with the tri-channel, and 0.40 mm2 with the conical connection. In conclusion, the cyclic loads induced implant wear. However, neither the type of abutment (p = 0.700) nor the connection (p = 0.718) influenced the amount of surface area lost.
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Affiliation(s)
- Teresa A Mendes
- Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisbon, Portugal
| | - Luis Vilhena
- Department of Mechanical Engineering, Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), University of Coimbra, 3004-516 Coimbra, Portugal
| | - Jaime Portugal
- Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisbon, Portugal
| | - João Caramês
- Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisbon, Portugal
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys), 1600-277 Lisbon, Portugal
| | - Amilcar L Ramalho
- Department of Mechanical Engineering, Centre for Mechanical Engineering, Materials and Processes (CEMMPRE), University of Coimbra, 3004-516 Coimbra, Portugal
| | - Luis P Lopes
- Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277 Lisbon, Portugal
- Laboratório de Instrumentação, Engenharia Biomédica e Física da Radiação (LIBPhys), 1600-277 Lisbon, Portugal
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17
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Zhai Z, Nakano T, Chen Y, Watanabe S, Matsuoka T, Ishigaki S. Implant deformation and implant-abutment fracture resistance after standardized artificial aging: An in vitro study. Clin Implant Dent Relat Res 2023; 25:107-117. [PMID: 36415012 DOI: 10.1111/cid.13157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Zirconia abutments have been widely adopted in clinical implant practice. The unique mechanical properties of zirconia may significantly affect the long-term prognosis of implant treatments. The purpose of this study was to investigate the influence of abutment material on implant deformation and fracture resistance of internal conical connection implant-abutment complexes of two diameters after standardized artificial aging. MATERIALS AND METHODS Thirty original abutments (one-piece titanium, one-piece zirconia, zirconia with alloy base) with two diameters (regular, narrow) were connected to internal conical connection implants and subjected to a standardized artificial aging process consisting of thermal cycling and mechanical cyclic loading. Microcomputed tomography (μCT) scans of implant bodies were performed before and after aging. 3-dimensional images of implant bodies were generated from the μCT scans and aligned for before and after aging to calculate the volumetric deformation amount. Finally, fracture resistance was measured using a mechanical static loading test for the surviving aged and 30 brand-new specimens. RESULTS All specimens survived artificial aging. No significant difference in implant deformation was found in the regular groups (p = 0.095). In narrow groups, the one-piece zirconia group showed significantly less deformation (p < 0.0001). For fracture resistance, no significant decrease was observed after aging in any group (p > 0.05). One-piece zirconia abutments showed significantly lower strength than the other two materials for both diameters (p < 0.0001). CONCLUSIONS In the regular diameter system, abutment material had no significant influence on the tested mechanical property degradation after simulated long-term oral use. The mechanical performance of narrow diameter one-piece zirconia abutments differed from the other two materials. For optimal performance, one-piece zirconia abutments should be adopted only in anterior regions.
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Affiliation(s)
- Zhihao Zhai
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Tamaki Nakano
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Yuming Chen
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Shota Watanabe
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Takashi Matsuoka
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Shoichi Ishigaki
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
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18
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Saponaro PC, Karasan D, Donmez MB, Johnston WM, Yilmaz B. Prosthetic complications with monolithic or micro-veneered implant-supported zirconia single-unit, multiple-unit, and complete-arch prostheses on titanium base abutments: A single center retrospective study with mean follow-up period of 72.35 months. Clin Implant Dent Relat Res 2023; 25:99-106. [PMID: 36321480 DOI: 10.1111/cid.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/13/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The influence of prosthetic design on prosthetic complications when monolithic or micro-veneered zirconia prostheses are supported with titanium base (ti-base) abutments is not well-known. PURPOSE The purpose of this single center, retrospective study was to assess the prevalence of prosthetic complications with monolithic or micro-veneered single-unit, multi-unit, and complete-arch zirconia prostheses supported with ti-base abutments (implant level or multi-unit abutment level). MATERIAL AND METHODS This study retrospectively evaluated the electronic health record (EHR) of participants who received either monolithic or micro-veneered implant-supported single-unit, multi-unit, and/or complete-arch prostheses supported by ti-base or zirconia-ti-base hybrid abutments delivered between the years 2010 and 2021. Data were analyzed by using logistic regression and Exact Mantel-Haenszel chi-square test (α = 0.05) to assess the clinical performance of prostheses and complications including crown decementation, feldspathic porcelain chipping, prosthesis fracture, zirconia-ti-base hybrid abutment decementation, abutment screw loosening, screw fracture, abutment fracture, implant loss, and prosthesis remake. RESULTS The study included 94 participants (50 female, 44 male) with a mean age of 59.5 years (range: 24-101 years of age). The retrospective EHR evaluation yielded 82 single-unit, 51 multi-unit, and 20 complete-arch prostheses on 325 implants. Among 153 prostheses delivered, 108 were micro-veneered (47 single-unit, 41 multi-unit, and 20 complete-arch prostheses) and 45 were monolithic. The average duration was 72.35 months (6.02 years) with a follow-up period of 5-132 months. From the time of insertion to the time of EHR review, of 153 prostheses, 78.43% did not exhibit any prosthetic complication. However, 33 prostheses (21.57%) from 29 participants (30.85%) had at least one prosthetic complication. Only four patients (4.25%) experienced two or more prosthetic complications. Prosthetic design affected the probability of having a complication (p = 0.005); complete-arch prostheses had higher probability (p ≤ 0.028). Single-unit prostheses had lower probability of complication than multi-unit prostheses (p = 0.005). The most commonly observed complication was fracture of veneering material (5.88%) followed by prosthetic screw loosening (4.57%) and decementation between the zirconia and the ti-base abutment (2.61%). Micro-veneered complete-arch prostheses had higher probability of having chipping than that of not having (p < 0.001), and other micro-veneered prosthetic designs had similar probability of chipping with that of complete-arch prostheses (p ≥ 0.082). Frequency of chipping was affected by veneering (p < 0.001). Monolithic prostheses had lower probability of chipping than micro-veneered prostheses, regardless of the prosthetic design (p < 0.001). CONCLUSIONS The frequency of prosthetic complications varied depending on prosthetic design. Complete-arch prostheses had the highest probability of complications while the single-unit prostheses had the lowest. Micro-veneered prostheses had higher probability for chipping than monolithic prostheses. Probability of chipping was similar for micro-veneered single-unit, multi-unit, and complete-arch zirconia prostheses.
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Affiliation(s)
- Paola C Saponaro
- Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Mustafa Borga Donmez
- Department of Prosthodontics, Faculty of Dentistry, Istinye University, Istanbul, Turkey.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - William Michael Johnston
- Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA
| | - Burak Yilmaz
- Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
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19
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Zhai Z, Nakano T, Chen Y, Watanabe S, Matsuoka T, Ishigaki S. Abutment removal torque and implant conical surface morphological changes after standardized artificial aging: An in vitro study. J Prosthet Dent 2022:S0022-3913(22)00738-7. [PMID: 36528391 DOI: 10.1016/j.prosdent.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
STATEMENT OF PROBLEM Zirconia abutments have become popular as they provide favorable esthetic outcomes. However, studies investigating how abutment material affects abutment screw torque performance and implant conical surface morphological changes in internal conical connection systems are scarce. PURPOSE The purpose of this in vitro study was to investigate the influence of abutment material on abutment removal torque and implant conical surface morphological changes in internal conical connection implant-abutment assemblies of 2 diameters after simulated long-term oral use. MATERIAL AND METHODS Thirty abutments of 3 materials (1-piece titanium, 1-piece zirconia, zirconia with alloy base) and 2 diameters (regular, narrow) made by the original manufacturer were connected to internal conical connection implants and subjected to a standardized artificial aging process consisting of thermal cycling and mechanical cyclic loading with parameters corresponding to anterior and posterior mastication scenarios simulating long-term oral use. An abutment removal torque test was done before and after aging. Morphological changes in the implant conical contact surface were observed with a scanning electron microscope (SEM). Initial and after-aging torque loss values were calculated and analyzed separately with 1-way ANOVA and Tukey HSD post hoc tests (α=.05). RESULTS All specimens survived artificial aging. For initial and after-aging torque loss, the 1-piece zirconia groups showed significantly greater values (P<.001) for both diameters. In the SEM observation, the 1-piece zirconia groups showed distinct widespread surface damage while the other groups exhibited only minor damages. CONCLUSIONS Regardless of diameter, 1-piece zirconia abutments tend to induce more abutment removal torque loss and implant conical surface morphological changes than those with metal connections, both initially and after simulated long-term oral use. Zirconia abutments with an alloy base performed similarly to 1-piece titanium abutments.
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Affiliation(s)
- Zhihao Zhai
- Clinical Fellow, Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Tamaki Nakano
- Assistant Professor, Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan.
| | - Yuming Chen
- PhD student, Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Shota Watanabe
- Clinical Fellow, Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Takashi Matsuoka
- Clinical Fellow, Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Shoichi Ishigaki
- Associate Professor, Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
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de Matos JDM, Lopes GDRS, Queiroz DA, Pereira ALJ, Sinhoreti MAC, Ramos NDC, Lino V, de Oliveira FR, Borges ALS, Bottino MA. Influence of the Peek Abutments on Mechanical Behavior of the Internal Connections Single Implant. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8133. [PMID: 36431619 PMCID: PMC9696524 DOI: 10.3390/ma15228133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 06/16/2023]
Abstract
The present study aimed to evaluate the biomechanical behavior of PEEK abutments with different heights on single titanium implants. To investigate the implant surface, different tests (scanning electron microscopy, energy-dispersive X-ray, and X-ray diffraction) were adopted. Herein, 20 implants received the 4.5 × 4.0 mm PEEK short abutment (SA) and 20 received the 4.5 × 5.5 mm PEEK long abutment (LA). The abutments were installed using dual-cure resin cement. To determine the fatigue test, two specimens from each group were submitted to the single load fracture test. For this, the samples were submitted to a compressive load of (0.5 mm/min; 30°) in a universal testing machine. For the fatigue test, the samples received 2,000,000 cycles (2 Hz; 30°). The number of cycles and the load test was analyzed by the reliability software SPSS statistics using Kaplan-Meier and Mantel-Cox tests (log-rank) (p < 0.05). The maximum load showed no statistically significant differences (p = 0.189) for the SA group (64.1 kgf) and the LA group (56.5 kgf). The study groups were statistically different regarding the number of cycles (p = 0.022) and fracture strength (p = 0.001). PEEK abutments can be indicated with caution for implant-supported rehabilitation and may be suitable as temporary rehabilitation.
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Affiliation(s)
- Jefferson David Melo de Matos
- Department of Restorative Dental Sciences, Center for Dental Biomaterials, University of Florida (UF Health), Gainesville, FL 32601, USA
- Department of Biomaterials, Dental Materials, and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos 12228-900, SP, Brazil
| | - Guilherme da Rocha Scalzer Lopes
- Department of Biomaterials, Dental Materials, and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos 12228-900, SP, Brazil
| | - Daher Antonio Queiroz
- Department of Restorative Dentistry & Prosthodontics, School of Dentistry, The University of Texas Health Science Center at Houston (UTHealth), Houston, TX 77054, USA
| | - André Luiz Jesus Pereira
- Plasmas and Processes Laboratory, Physics Departament, Aeronautics Technological Institute (ITA), 50 Marechal Eduardo Gomes Square, São José dos Campos 12228-900, SP, Brazil
| | - Mário Alexandre Coelho Sinhoreti
- Department of Restorative Dentistry, Dental Materials Division, Piracicaba Dental School (FOP-UNICAMP), Piracicaba 13416-000, SP, Brazil
| | - Nathália de Carvalho Ramos
- Department of Biomaterials, Dental Materials, and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos 12228-900, SP, Brazil
- Department of Dentistry, Universidade São Francisco (USF), Bragança Paulista 12916-900, SP, Brazil
- Department of Dentistry, Postgraduate Program in Dentistry, University of Taubaté (UNITAU), Taubaté 12080-000, SP, Brazil
| | - Vinicius Lino
- Department of Biomaterials, Dental Materials, and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos 12228-900, SP, Brazil
| | - Flavio Rosa de Oliveira
- Department of Biomaterials, Dental Materials, and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos 12228-900, SP, Brazil
| | - Alexandre Luiz Souto Borges
- Department of Biomaterials, Dental Materials, and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos 12228-900, SP, Brazil
| | - Marco Antonio Bottino
- Department of Biomaterials, Dental Materials, and Prosthodontics, São Paulo State University (Unesp), Institute of Science and Technology, São José dos Campos 12228-900, SP, Brazil
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21
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Clinical Outcomes of Dental Implants with Two Different Internal Connection Configurations—A RCT. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4040046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: The aim of the present study was to highlight clinical and radiographical differences among implants sharing the same macro-geometry but with two different prosthodontic connections. Methods: Patients requiring at least 2 implants in the posterior area of the jaw were randomly divided into two groups (Conical (CS) and Internal Hexagonal (IH) connection). At implant surgery (T0), insertion torque, implant stability quotient (ISQ values recorded by resonance frequency analysis, RFA), and soft tissue thickness (STH) were assessed. A 1-abutment/1-time protocol was applied, and the prosthesis was realized following a fully digital workflow. At the 36-month follow-up periapical x-rays were taken. In order to statistically analyse differences among the two groups and the different variables, paired T-test was used. Linear regression analysis was conducted to analyze how marginal bone loss (MBL) was affected by other independent variables. A neural network created to predict the success (good or not good) of the implant itself was implemented. Results: 30 out of 33 patients (14 males, 16 females, mean age: 68.94 ± 13.01 years) (32 CS and 32 IH) were analyzed. No implants failed. Marginal bone loss at the 3-year time-point was 0.33 ± 0.34 mm and 0.43 ± 0.37 mm respectively for CS and IH with a significant difference between the two groups (p = 0.004). The presence of keratinized gingiva (p = 0.034) significantly influenced MBL. Conclusions: Both the implant connections investigated presented optimal clinical outcomes with minimal marginal bone loss; however, CS implants and implants with the presence of a greater width of keratinized tissue presented significantly lower MBL.
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22
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Halim FC, Pesce P, De Angelis N, Benedicenti S, Menini M. Comparison of the Clinical Outcomes of Titanium and Zirconia Implant Abutments: A Systematic Review of Systematic Reviews. J Clin Med 2022; 11:jcm11175052. [PMID: 36078982 PMCID: PMC9456707 DOI: 10.3390/jcm11175052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 08/25/2022] [Accepted: 08/26/2022] [Indexed: 01/07/2023] Open
Abstract
Background: Dental implants are widely used and in order to answer to esthetic demands, zirconia has been introduced as an abutment material as an alternative to titanium. Several studies have been published on this topic, but the results have been often inconsistent. The objective of the present study is to systematically analyze the existing literature comparing clinical outcomes of titanium and zirconia implant abutments. The study was designed as a systematic review of systematic reviews. Methods: This systematic review is in accordance with the Transparent Reporting of Systematic Reviews and Meta-analyses. A MEDLINE/PubMed, Cochrane Database of Systematic Reviews and SCOPUS literature search was performed up to and including June 2021. Data were extracted independently by two reviewers and tAMSTAR2 was used to assess the quality of the systematic reviews. Results: The electronic search identified 1146 papers, and 175 duplicates were removed. After manual screening, 954 studies were excluded and the final analysis was conducted on 11 papers. Both mechanical and esthetic outcomes and biological complications were analyzed. Conclusions: It can be concluded that titanium abutments have a better mechanical resistance than zirconia ones. Plaque accumulation is reported to be slightly higher on titanium but without any significant inflammatory process. The esthetic outcomes seem to be more related to the thickness (>3 mm) of the soft tissues than to the abutment material.
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Affiliation(s)
| | - Paolo Pesce
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
| | - Nicola De Angelis
- Division of Restorative Dentistry and Endodontics, Department of Surgical Sciences (DISC), University of Genoa, 16126 Genoa, Italy
- Dental Department, University Tunku Abdul Raman, Sungai Buloh 47000, Malaysia
- Dental Department, University Trisakti, Jakarta 11440, Indonesia
- Correspondence:
| | - Stefano Benedicenti
- Division of Restorative Dentistry and Endodontics, Department of Surgical Sciences (DISC), University of Genoa, 16126 Genoa, Italy
| | - Maria Menini
- Division of Prosthodontics and Implant Prosthodontics, Department of Surgical Sciences (DISC), University of Genoa, 16132 Genoa, Italy
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23
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Gallo S, Pascadopoli M, Pellegrini M, Pulicari F, Manfredini M, Zampetti P, Spadari F, Maiorana C, Scribante A. CAD/CAM Abutments versus Stock Abutments: An Update Review. PROSTHESIS 2022; 4:468-479. [DOI: 10.3390/prosthesis4030038] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
With the evolution of CAD/CAM technology, custom titanium and/or zirconia abutments are increasingly being used, leading to several comparisons in the literature, both mechanical and aesthetic, to evaluate performance differences between these two types of abutments. Therefore, the aim of this comprehensive review is to present the most recent data on the latest comparisons between CAD/CAM and stock abutment applications. The PICO model was used to perform this review, through a literature search of the PubMed (MEDLINE) and Scopus electronic databases. CAD/CAM abutments allow individualization of abutment parameters with respect to soft tissue, allow increased fracture toughness, predict the failure mode, show no change in the fracture toughness over time, reduce the prosthetic steps, and reduce the functional implant prosthesis score and pain perceived by patients in the early stages. The advantages associated with the use of stock abutments mainly concern the risk of corrosion, time spent, cost, and fit, evaluated in vitro, in the implant–abutment connection. Equal conditions are present regarding the mechanical characteristics during dynamic cycles, screw loss, radiographic fit, and degree of micromotion. Further randomized controlled clinical trials should be conducted to evaluate the advantages reported to date, following in vitro studies about titanium and/or zirconia stock abutments.
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Molinero-Mourelle P, Roccuzzo A, Yilmaz B, Lam WYH, Pow EHN, Del Río Highsmith J, Gómez-Polo M. Microleakage assessment of CAD-CAM Cobalt-Chrome and Zirconia abutments on a conical connection dental implant: A comparative in vitro study. Clin Oral Implants Res 2022; 33:945-952. [PMID: 35818785 PMCID: PMC9544167 DOI: 10.1111/clr.13973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 06/19/2022] [Accepted: 06/22/2022] [Indexed: 11/28/2022]
Abstract
Objective To assess the marginal and bacterial microleakage in zirconia and CAD‐CAM or cast Co‐Cr implant abutments. Methods Sixty‐four conical connection implants with their respective abutments were divided into four groups (Co‐Cr (milled, laser‐sintered, and cast) and Zirconia (milled)). All specimens were subjected to a chewing simulation and thermocycling. After aging process, specimens were submerged in a 0.2% methylene blue solution with Porphyromonas gingivalis (P.g) for 48 h. The marginal microleakage was measured using a 40× optical microscopy at the internal part of the implant, and when positive microleakage was observed, a DNA isolation with a polymerase chain reaction (PCR) test was used. The microbiological assessment was based on colony forming units (CFUs). Results Thirty (47%) implant‐abutments presented microleakage and the PCR was performed on those specimens (1 Zirconia, 1 Co‐Cr milled, 14 Co‐Cr laser‐sintered and 14 cast). Seven specimens (1 Co‐Cr laser‐sintered and six cast) presented values below the PCR detection limit (< 100 CFUs). The lowest CFUs count occurred in the Co‐Cr milled group (5.17E+02 CFUs/ml) followed by zirconia (7.70E+03 CFUs/ml). The Co‐Cr cast (9.39E+03 CFUs/ml) and laser‐sintered (2.4E+05 CFUs/ml) groups had higher bacterial count. The CFU count comparison performed between Co‐Cr cast and laser‐sintered resulted in a statistically significant differences in favor of Co‐CrCL (p < .05). Conclusions The abutment material and fabrication technique affected the implant‐abutment microleakage. Although the CAD‐CAM abutments presented favorable results, all tested groups presented microleakage.
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Affiliation(s)
- Pedro Molinero-Mourelle
- Department of Conservative Dentistry and Orofacial Prosthetics. Faculty of Dentistry, Complutense University of Madrid.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Oral and Maxillofacial Surgery, Copenhagen University Hospital (Rigshospitalet), Copenhagen, Denmark
| | - Burak Yilmaz
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Switzerland.,Department of Preventive, and Pediatric Dentistry, School of Dental Medicine, University of Bern, Switzerland
| | - Walter Yu Hang Lam
- Prosthodontics, Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, PR China
| | - Edmond H N Pow
- Prosthodontics, Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Hong Kong Special Administrative Region, PR China
| | - Jaime Del Río Highsmith
- Department of Conservative Dentistry and Orofacial Prosthetics. Faculty of Dentistry, Complutense University of Madrid
| | - Miguel Gómez-Polo
- Department of Conservative Dentistry and Orofacial Prosthetics. Faculty of Dentistry, Complutense University of Madrid
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Chopra D, Jayasree A, Guo T, Gulati K, Ivanovski S. Advancing dental implants: Bioactive and therapeutic modifications of zirconia. Bioact Mater 2022; 13:161-178. [PMID: 35224299 PMCID: PMC8843948 DOI: 10.1016/j.bioactmat.2021.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/22/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022] Open
Abstract
Zirconium-based implants have gained popularity in the dental implant field owing to their corrosion resistance and biocompatibility, attributed to the formation of a native zirconia (ZrO2) film. However, enhanced bioactivity and local therapy from such implants are desirable to enable the earlier establishment and improved long-term maintenance of implant integration, especially in compromised patient conditions. As a result, surface modification of zirconium-based implants have been performed using various physical, chemical and biological techniques at the macro-, micro-, and nano-scales. In this extensive review, we discuss and detail the development of Zr implants covering the spectrum from past and present advancements to future perspectives, arriving at the next generation of highly bioactive and therapeutic nano-engineered Zr-based implants. The review provides in-depth knowledge of the bioactive/therapeutic value of surface modification of Zr implants in dental implant applications focusing on clinical translation.
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Affiliation(s)
| | | | | | - Karan Gulati
- Corresponding authors. School of Dentistry, University of Queensland, 288 Herston Road, Herston QLD, 4006, Australia.
| | - Sašo Ivanovski
- Corresponding authors. School of Dentistry, University of Queensland, 288 Herston Road, Herston QLD, 4006, Australia.
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26
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Enkling N, Marder M, Bayer S, Götz W, Stoilov M, Kraus D. Soft tissue response to different abutment materials: A controlled and randomized human study using an experimental model. Clin Oral Implants Res 2022; 33:667-679. [PMID: 35467040 DOI: 10.1111/clr.13932] [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: 04/29/2021] [Revised: 02/01/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Aim of this study was to compare the soft-tissue response to implant abutments made of titanium, zirconia, zirconia veneered with feldspar ceramics and PEEK by various clinical, histological, microbiological and molecular biological markers in an experimental model. MATERIALS AND METHODS 40 experimental one-piece healing abutments of four different materials were mounted on bone-level implants in 20 volunteering patients (split-mouth design). After a three months period of open healing, clinical parameters at the abutments were assessed and adjacent mucosa was sampled for inflammatory cytokine mRNA-concentrations and histological analysis by a novel method. In addition, PISF-samples were obtained for the analysis of periodonto-pathogenic bacteria counts and active MMP-8 levels. Marginal bone level change was measured by intra oral radiographs. RESULTS Abutments of the different materials did not exhibit significant differences regarding clinical parameters, pathogenic bacteria counts or pro-inflammatory cytokine concentrations. Likewise, no significant differences were detected regarding soft tissue morphology or bone level change. Compared to titanium abutments, significantly less mononuclear inflammatory cells were detected in the mucosa at abutments made of zirconia veneered with feldspar ceramics. CONCLUSIONS All examined abutment materials exhibited a similar soft tissue response compared to titanium and histological data did not reveal early signs of elevated inflammation caused by PEEK- and feldspar-veneered zirconia abutments. Due to the short observation period and the small sample size, a final conclusion on the long term suitability of those abutment materials cannot be drawn. However, based on the presented data, we consider further studies on that subject as appropriate.
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Affiliation(s)
- Norbert Enkling
- Department of Prosthodontics, Preclinical Education and Material Sciences, University of Bonn.,Department of Reconstructive Dentistry and Gerodontology, University of Bern
| | - Michael Marder
- Department of Prosthodontics, Preclinical Education and Material Sciences, University of Bonn
| | - Stefan Bayer
- Department of Prosthodontics, Preclinical Education and Material Sciences, University of Bonn
| | - Werner Götz
- Department of Orthodontics, University of Bonn
| | - Milan Stoilov
- Department of Prosthodontics, Preclinical Education and Material Sciences, University of Bonn
| | - Dominik Kraus
- Department of Prosthodontics, Preclinical Education and Material Sciences, University of Bonn
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Vazouras K, Gholami H, Margvelashvili-Malament M, Kim YJ, Finkelman M, Weber HP. An esthetic evaluation of different abutment materials in the anterior Maxilla: A randomized controlled clinical trial using a crossover design. J Prosthodont 2022; 31:673-680. [PMID: 35405771 DOI: 10.1111/jopr.13520] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 03/31/2022] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To assess the effect of implant abutment material and soft tissue thickness on the peri-implant soft tissue color using spectrophotometry and to evaluate gingival esthetics and patient satisfaction with three different abutments. MATERIALS AND METHODS Twenty-five patients with a missing maxillary tooth in the esthetic area received an endosseous implant using a two-stage protocol. Grey titanium, pink anodized titanium, and hybrid zirconia custom abutments were fabricated for each participant and inserted for one week with a cross-over design in a randomized manner. Color measurements were made using a spectrophotometer comparing midfacial peri-implant soft tissue and marginal gingiva of the contralateral tooth. CIE Lab color scale was employed following the formula: ΔE = [(∆L)2 +(∆a)2 +(∆b)2 ] ½ . PES scores were recorded, and patient satisfaction questionnaires were completed at each abutment change visit and at 1-year follow-up. Statistical analysis was performed using Friedman's test and the Wilcoxon signed-rank test with Bonferroni correction as well as the Mann-Whitney U test (α = 0.05). RESULTS Abutment material type significantly affected the ΔΕ values of the peri-implant mucosa when compared to the contralateral teeth. At baseline, the highest ΔΕ means ± standard deviation (SD) values were obtained with grey titanium (11.25 ±2.98), followed by pink anodized titanium (9.90 ±2.51), and zirconia abutments (6.46 ±1.43). Differences were statistically significant irrespective of soft tissue thickness. The highest PES values were obtained with zirconia abutments (10.88 ±0.88), followed by pink anodized titanium (10.12 ±1.13) and the lowest with grey titanium (9.68 ±1.41). PES differences were significant only for the thin soft tissue group. Regarding patient satisfaction, VAS scores for the pink anodized and zirconia hybrid abutment groups were higher than the grey titanium group for each question. CONCLUSION The color difference between soft tissues around teeth and implants was significant in all groups regardless of tissue thickness. The hybrid zirconia abutments resulted in the least color difference, followed by pink anodized and grey titanium. Significantly different PES values were recorded only for the thin tissue group. There was no significant difference in patient satisfaction between zirconia and pink anodized abutments at the 1-year follow up. Pink anodized abutments represent a good esthetic alternative to zirconia hybrid abutments especially in mechanically challenging situations. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Konstantinos Vazouras
- Assistant Professor and Program Director of Post-graduate Prosthodontics, Department of Prosthodontics, Tufts School of Dental Medicine, Boston, MA
| | - Hadi Gholami
- Assistant Professor and Program Director of Post-graduate Prosthodontics, Department of Prosthodontics, Tufts School of Dental Medicine, Boston, MA
| | - Mariam Margvelashvili-Malament
- Assistant Professor and Program Director of Post-graduate Prosthodontics, Department of Prosthodontics, Tufts School of Dental Medicine, Boston, MA
| | - Yong Jeong Kim
- Associate Professor, Department of Prosthodontics, Tufts School of Dental Medicine, Boston, MA
| | - Matthew Finkelman
- Associate Professor, Department of Public Health and Community Service, Tufts School of Dental Medicine, Boston, MA
| | - Hans-Peter Weber
- Professor Emeritus, Department of Prosthodontics, Tufts School of Dental Medicine, Boston, MA
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Hjerppe J, Jung RE, Hämmerle CH, Özcan M, Mühlemann S. Mechanical stability of fully personalized, abutment-free zirconia implant crowns on a novel implant-crown interface. J Dent 2022; 121:104121. [PMID: 35395344 DOI: 10.1016/j.jdent.2022.104121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/24/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To test the failure load and failure mode of a novel implant-crown interface specifically designed for the fabrication of fully personalized, abutment-free monolithic zirconia CAD-CAM crowns compared to conventional implant-abutment interfaces involving prefabricated or centrally manufactured abutments for zirconia CAD-CAM crowns. METHODS Implants (N=48) were divided into groups (n=12) according to different implant-abutment interface designs: (1) internal implant connection with personalized, abutment-free CAD-CAM crowns (Abut-Free-Zr), (2) internal conical connection with customized, centrally manufactured zirconia CAD-CAM abutments (Cen-Abut-Zr), (3) prefabricated titanium base abutments from manufacturer 1 (Ti-Base-1), (4) additional prefabricated titanium base abutments from manufacturer 2 (Ti-Base-2). All specimens were restored with a screw-retained monolithic zirconia CAD-CAM molar crown and subjected to thermomechanical aging (1.200.000 cycles, 49 N, 1.67 Hz, 30° angulation, thermocycling 5-50°C). Static load until failure was applied in a universal testing machine. Failure modes were analyzed descriptively under digital microscope. Mean failure load values were statistically analyzed at a significance level of p<0.05. RESULTS All specimens survived thermomechanical aging. The mean failure loads varied between 1332 N (Abut-Free-Zr) and 1601 N (Ti-Base-2), difference being significant between these groups (p<0.05). No differences between the other groups were seen. The predominant failure mode per group was crown fracture above implant connection (Abut-Free-Zr, 75%), abutment fracture below implant neck (Cen-Abut-Zr, 83%), crown fracture leaving an intact abutment (Ti-Base-1/Ti-Base-2 100%). CONCLUSIONS Implant-crown interface with fully personalized, abutment-free monolithic CAD-CAM zirconia crowns exhibited similar failure loads as conventional implant-abutment interfaces (except group Ti-Base-2) involving CAD-CAM crowns with prefabricated or centrally manufactured abutment. CLINICAL SIGNIFICANCE The new implant connection simplifies the digital workflow for all-ceramic implant reconstructions. The specific design of the implant-crown interface allows the fabrication of fully personalized, abutment-free zirconia implant crowns both in-house and in-laboratory without the need of a prefabricated abutment or central manufacturing.
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Affiliation(s)
- Jenni Hjerppe
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland.
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Christoph Hf Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Mutlu Özcan
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
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29
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da Cruz MB, Marques JF, Silva N, Madeira S, Carvalho Ó, Silva FS, Caramês J, Mata A. Human Gingival Fibroblast and Osteoblast Behavior on Groove-Milled Zirconia Implant Surfaces. MATERIALS 2022; 15:ma15072481. [PMID: 35407819 PMCID: PMC9000173 DOI: 10.3390/ma15072481] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/23/2022] [Accepted: 03/24/2022] [Indexed: 12/25/2022]
Abstract
Two type of cells representing periodontal hard tissues (osteoblasts) and soft tissues (fibroblasts) were evaluated in response to microgroove-milled zirconia surfaces. A total of 90 zirconia discs were randomly assigned to four width-standardized milling microgroove-textured groups and a control group without grooves (UT). The sandblast and acid-etch protocol were applied to all samples. Both cell lines were cultured on zirconia discs from 1 day up to 14 days. Cell morphology and adhesion were evaluated after 1 day of culturing. Cell viability and proliferation of the cells were measured. Alkaline phosphatase activity, collagen I, osteopontin, interleukin 1β and interleukin 8 secretions were assessed at predefined times. The results obtained were presented in the form of bar graphs as means and standard deviations. Multi comparisons between groups were evaluated using two-away ANOVA or Mann−Whitney tests, and a p-value < 0.05 was established. Group comparisons with regard to cell viability, proliferation and secretion of collagen I, interleukin-1β and interleukin 8 revealed no statistically significant differences. The alkaline phosphatase activity and osteopontin secretion were significantly higher in the group with a large groove compared to the small one and the control group. Nevertheless, the viability of gingival and bone cells did not appear to be affected by the milled microgroove texture compared to the conventional sandblasted and acid-etched texture, but they seem to influence osteoblasts’ cellular differentiation.
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Affiliation(s)
- Mariana Brito da Cruz
- Universidade de Lisboa, Faculdade de Medicina Dentária, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), LIBPhys-FTC UID/FIS/04559/2013, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; (J.F.M.); (J.C.); (A.M.)
- Correspondence: ; Tel.: +351-911-042-881
| | - Joana Faria Marques
- Universidade de Lisboa, Faculdade de Medicina Dentária, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), LIBPhys-FTC UID/FIS/04559/2013, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; (J.F.M.); (J.C.); (A.M.)
| | - Neusa Silva
- Universidade de Lisboa, Faculdade de Medicina Dentária, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal;
| | - Sara Madeira
- Center for Microelectromechanical Systems (CMEMS), Department of Mechanical Engineering, University of Minho, 4800-058 Guimarães, Portugal; (S.M.); (Ó.C.); (F.S.S.)
| | - Óscar Carvalho
- Center for Microelectromechanical Systems (CMEMS), Department of Mechanical Engineering, University of Minho, 4800-058 Guimarães, Portugal; (S.M.); (Ó.C.); (F.S.S.)
| | - Filipe Samuel Silva
- Center for Microelectromechanical Systems (CMEMS), Department of Mechanical Engineering, University of Minho, 4800-058 Guimarães, Portugal; (S.M.); (Ó.C.); (F.S.S.)
| | - João Caramês
- Universidade de Lisboa, Faculdade de Medicina Dentária, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), LIBPhys-FTC UID/FIS/04559/2013, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; (J.F.M.); (J.C.); (A.M.)
- Universidade de Lisboa, Faculdade de Medicina Dentária, Bone Physiology Research Group, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal
| | - António Mata
- Universidade de Lisboa, Faculdade de Medicina Dentária, Unidade de Investigação em Ciências Orais e Biomédicas (UICOB), LIBPhys-FTC UID/FIS/04559/2013, Rua Professora Teresa Ambrósio, 1600-277 Lisboa, Portugal; (J.F.M.); (J.C.); (A.M.)
- Universidade de Lisboa, Faculdade de Medicina Dentária, Cochrane Portugal, Instituto de Saúde Baseada na Evidência (ISBE), Avenida Professor Egas Moniz, 1649-028 Lisboa, Portugal
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Lang R, Hiller KA, Kienböck L, Friedl K, Friedl KH. Influence of autoclave sterilization on bond strength between zirconia frameworks and Ti-base abutments using different resin cements. J Prosthet Dent 2022; 127:617.e1-617.e6. [DOI: 10.1016/j.prosdent.2022.01.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 01/21/2023]
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Woo M, Anunmana C, Eiampongpaiboon T. Influence of zirconia/glass veneer thickness and implant abutment material on the final shade of implant restorations. J Indian Prosthodont Soc 2022; 22:272-278. [PMID: 36511058 PMCID: PMC9416959 DOI: 10.4103/jips.jips_179_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Aim The aim of this study was to investigate the combined effect of ceramic material, ceramic thickness, and implant abutment background to the final color of restorations. Settings and Design This was a comparative in vitro study. Materials and Methods Three different types of monolithic and porcelain-veneered zirconia disc-shaped specimens (Prettau Anterior, VITA YZ ST, and VITA YZ HT) were prepared in A3 shade with two different thicknesses (1 mm and 1.5 mm) (n = 10). Each zirconia material was made of 4-mm thickness as a control specimen of each monolithic zirconia type, and 4-mm thick veneering ceramic (VITA VM9 Base Dentine) was made as a control for veneered zirconia groups. Three simulated implant abutments were fabricated from titanium, white-shaded and yellow-shaded zirconia. The zirconia specimens were placed on different abutment backgrounds, and the color difference (ΔE) between experimental and control specimens was measured. Statistical Analysis Used The three-way ANOVA and the Scheffé test were used for data analysis (α = 0.05). Results The mean ΔE values between two thicknesses were significantly different in every background for all zirconia materials. The ΔE values of zirconia specimens on yellow zirconia were lower than those of other abutments. The clinically acceptable ΔE value (ΔE <3) was found in some monolithic zirconia specimens on white-shaded and yellow-shaded abutments, while the ΔE value is approximately 3 or less in all 1.5-mm thick porcelain-veneered zirconia groups. Conclusions Different zirconia materials on implant abutments affected the final color of restorations. To achieve satisfactory color, the minimum thickness of zirconia restorations should be at least 1.5 mm on yellow zirconia abutment.
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Affiliation(s)
- Manita Woo
- Dental Implant Center, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Chuchai Anunmana
- Department of Prosthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Trinuch Eiampongpaiboon
- Department of Prosthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand,Address for correspondence: Dr. Trinuch Eiampongpaiboon, Department of Prosthodontics, Faculty of Dentistry, Mahidol University, 6 Yothi Road, Ratchathewi, Bangkok 10400, Thailand. E-mail:
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Crestal bone loss and implant failure of prefabricated versus customized abutments: a 10-year retrospective radiological study. Clin Oral Investig 2021; 26:2879-2886. [PMID: 34767097 DOI: 10.1007/s00784-021-04269-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES There is no information today about the impact of abutment type on the crestal bone stability. This retrospective study was aimed to evaluate the crestal bone levels (CBL) and failures of implants with prefabricated and customized abutments after the long term. MATERIALS AND METHODS The mesial and distal CBL around dental implants with prefabricated and custom abutments were recorded. Measures were completed at 5- and 10-year endpoints. RESULTS Sixty-three patients with 249 implants were included. One hundred twenty-seven implants (51%) were restored with prefabricated and 122 implants (49%) with customized abutments. All the patients received fixed restorations. The results showed that the CBL was higher in patients with custom abutments than the CBL of patients with prefabricated abutments. The mean bone loss around implants with prefabricated abutments was 0.29 mm mesial/0.45 mm distal after 10 years. Meanwhile, the mean bone loss at implants with custom abutments was 1.19 mm mesial/1.27 mm distal (p < 0.05) after 10 years. None of the implants with prefabricated abutments failed up to 10-year follow-up, whereas 4.1% of implants with customized abutments failed. CONCLUSION Implants with prefabricated abutments present less crestal bone loss compared to customized abutments. CLINICAL RELEVANCE The selection of abutment type is associated with the crestal bone stability or marginal bone loss.
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Guzman‐Perez G, Jurado CA, Rincon‐Reyna CA, Alresayes S, Torrealba Y, Alshabib A, Fu C, Tsujimoto A. Esthetic outcome for implant therapy of a maxillary lateral incisor using prefabricated titanium and customized zirconia abutments: 4-year clinical reports. Clin Case Rep 2021; 9:e04983. [PMID: 34721855 PMCID: PMC8530022 DOI: 10.1002/ccr3.4983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/29/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
The reported clinical scenarios presented two patients, one managed with a prefabricated abutment and the other with a customized abutment, and both patients were pleased with the outcome. However, from a professional viewpoint, the esthetic outcome using the custom zirconia abutment was superior to that using the prefabricated titanium abutment.
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Affiliation(s)
| | - Carlos Alberto Jurado
- ProsthodontistTexas Tech University Health Sciences Center El Paso Woody L. Hunt School of Dental MedicineEl PasoTexasUSA
| | | | - Saad Alresayes
- Prosthetic Dental Sciences DepartmentKing Saud University College of DentistryRiyadhSaudi Arabia
| | - Ysidora Torrealba
- Department of Restorative DentistryUniversity of Alberta Faculty of Medicine and DentistryEdmontonCanada
| | - Abdulrahman Alshabib
- Department of Restorative DentistryKing Saud University College of DentistryRiyadhSaudi Arabia
| | - Chin‐Chuan Fu
- Department of Restorative SciencesUniversity of Alabama at Birmingham School of DentistryBirminghamAlabamaUSA
| | - Akimasa Tsujimoto
- Department of Operative DentistryUniversity of Iowa School of DentistryIowa CityIowaUSA
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Totou D, Naka O, Mehta SB, Banerji S. Esthetic, mechanical, and biological outcomes of various implant abutments for single-tooth replacement in the anterior region: a systematic review of the literature. Int J Implant Dent 2021; 7:85. [PMID: 34494174 PMCID: PMC8423965 DOI: 10.1186/s40729-021-00370-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background The choice of the appropriate implant abutment is a critical step for a successful outcome. Titanium abutments have demonstrated high survival rates, due to their excellent biocompatibility and high mechanical strength, although they often result in a grayish discoloration of the peri-implant mucosa. This esthetic concern culminated in the introduction of ceramic abutments. The aim of this review was to assess the esthetic, mechanical, and biological outcomes as well as the survival of the different types of abutments used for single-implant restorations in the anterior area. Material and methods An electronic search was conducted in Medline, Embase, and Cochrane Central databases using the appropriate Mesh terms and predetermined eligibility criteria. The quality of the studies was assessed using the ROB 2 tool. The last search was conducted on 18th of March 2020. Results From the 2074 records initially identified, 23 randomized controlled trials (32 publications) were included for qualitative analysis. Data were classified based on study information, specific characteristics of the intervention and comparator, and information related to the outcome measures. Seven studies exhibited an overall low risk of bias, while twelve studies raised some concerns. Conclusions The rate of abutment failure was low and was associated with the ceramic abutments, especially those with internal connection. Limited correlation was noted between soft tissue thickness and color difference. Titanium abutments caused significantly more discoloration to the soft tissues than ceramic abutments, while hueing (gold or pink) slightly improved their color performance. Zirconia allowed a better color match than titanium or gold abutments, still discolored slightly the soft tissues. The submucosally modified zirconia abutments exhibited encouraging results. No significant difference was reported between materials or different types of retention on recession, papillary fill, and biological outcomes.
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Affiliation(s)
- Dimitra Totou
- Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, UK
| | - Olga Naka
- Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, UK. .,School of Dentistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Shamir B Mehta
- Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, UK
| | - Subir Banerji
- Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, UK
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Dini C, Borges GA, Costa RC, Magno MB, Maia LC, Barão VAR. Peri-implant and esthetic outcomes of cemented and screw-retained crowns using zirconia abutments in single implant-supported restorations-A systematic review and meta-analysis. Clin Oral Implants Res 2021; 32:1143-1158. [PMID: 34352144 DOI: 10.1111/clr.13824] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the peri-implant tissue changes and esthetic outcomes of cemented and screw-retained crowns of single-tooth implants in the esthetic zone using zirconia abutments. MATERIAL AND METHODS An electronic search was performed on nine databases. The risk-of-bias was assessed by the revised Cochrane risk-of-bias tool for randomized (RoB 2) and non-randomized (ROBINS-I) clinical trials. Marginal bone level change, soft tissue thickness, bleeding on probing, probing depth, survival rates of implants and crowns, complications, plaque and papilla indexes, and pink esthetic score data were extracted and analyzed. The certainty of evidence was accessed through the GRADE approach. RESULTS Nine records were included and 7 were used in the meta-analyses. Screw-retained crowns presented greater marginal bone level change (MD -0.04 [-0.08, -0.00] p = 0.04, I2 = 0%) compared to cemented crowns up to 1-year. At 3 and 4 years no significant differences (p > 0.05) were observed. Soft tissue thickness did not differ between groups (p > 0.05). The bleeding on probing was higher in cemented group than in screw-retained crowns at 1-year (MD 0.17 [0.08, 0.27] p = 0.0005, I2 = 0%), at medium-term periods (3 and 4 years) no statistically significant differences (p > 0.05) were observed for this outcome. Probing depth, survival rates of implants and crowns, complications, and plaque index, as well as esthetic analysis using the papilla index and pink esthetic score did not differ statistically (p > 0.05) between both retention systems at short and medium-term periods. CONCLUSION The connection system considering zirconia abutments presented no influence on peri-implant parameters and esthetics evaluation for medium-term periods (3 and 4 years).
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Affiliation(s)
- Caroline Dini
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP, Piracicaba, Brazil
| | - Guilherme Almeida Borges
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP, Piracicaba, Brazil
| | - Raphael Cavalcante Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP, Piracicaba, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rua Rodolpho Paulo Rocco - Cidade Universitária, Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rua Rodolpho Paulo Rocco - Cidade Universitária, Rio de Janeiro, Brazil
| | - Valentim Adelino Ricardo Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP, Piracicaba, Brazil
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Kihara H, Sugawara S, Yokota J, Takafuji K, Fukazawa S, Tamada A, Hatakeyama W, Kondo H. Applications of three-dimensional printers in prosthetic dentistry. J Oral Sci 2021; 63:212-216. [PMID: 34078769 DOI: 10.2334/josnusd.21-0072] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
This narrative review aims to provide an overview of recent studies and case reports on three-dimensional (3D) printing, and to verify the applicability of 3D printers in the field of dental prostheses. This review was performed by conducting a search of PubMed. The clinical application of fabricating a prosthesis made with cobalt-chromium is considered possible depending on the material and hardware of the 3D printer. However, it is currently difficult to assess the clinical use of 3D-printed zirconia crowns. Further research is required, such as verification of materials used, margin morphology, and hardware. Clinically acceptable results have been reported for patterns using 3D printers. Interim restorations made using a 3D printer have been reported with good results that are considered clinically usable. Dentures made with 3D printers need further verification in terms of strength and deformation. Custom trays made with 3D printers are clinically useful, however, issues remain with design time and effort. Although several studies have reported the usefulness of 3D printers, further verification is required since 3D printers are still considered new technology.
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Affiliation(s)
- Hidemichi Kihara
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Shiho Sugawara
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Jun Yokota
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Kyoko Takafuji
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Shota Fukazawa
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Ayaka Tamada
- Department of Dysphagia Rehabilitation, Nagasaki University Hospital
| | - Wataru Hatakeyama
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
| | - Hisatomo Kondo
- Department of Prosthodontics and Oral Implantology, School of Dentistry, Iwate Medical University
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Kunrath MF, Gupta S, Lorusso F, Scarano A, Noumbissi S. Oral Tissue Interactions and Cellular Response to Zirconia Implant-Prosthetic Components: A Critical Review. MATERIALS 2021; 14:ma14112825. [PMID: 34070589 PMCID: PMC8198172 DOI: 10.3390/ma14112825] [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: 03/24/2021] [Revised: 05/15/2021] [Accepted: 05/18/2021] [Indexed: 12/20/2022]
Abstract
Background: Dental components manufactured with zirconia (ZrO2) represent a significant percentage of the implant prosthetic market in dentistry. However, during the last few years, we have observed robust clinical and pre-clinical scientific investigations on zirconia both as a prosthetic and an implantable material. At the same time, we have witnessed consistent technical and manufacturing updates with regards to the applications of zirconia which appear to gradually clarify points which until recently were not well understood. Methods: This critical review evaluated the “state of the art” in relation to applications of this biomaterial in dental components and its interactions with oral tissues. Results: The physico-chemical and structural properties as well as the current surface treatment methodologies for ZrO2 were explored. A critical investigation of the cellular response to this biomaterial was completed and the clinical implications discussed. Finally, surface treatments of ZrO2 demonstrate that excellent osseointegration is possible and provide encouraging prospects for rapid bone adhesion. Furthermore, sophisticated surface treatment techniques and technologies are providing impressive oral soft tissue cell responses thus leading to superior biological seal. Conclusions: Dental devices manufactured from ZrO2 are structurally and chemically stable with biocompatibility levels allowing for safe and long-term function in the oral environment.
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Affiliation(s)
- Marcel F. Kunrath
- Dentistry Department, School of Health and Life Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), P.O. Box 6681, Porto Alegre 90619-900, RS, Brazil;
- Materials and Nanoscience Laboratory, Pontifical Catholic University of Rio Grande do Sul (PUCRS), P.O. Box 6681, Porto Alegre 90619-900, RS, Brazil
| | - Saurabh Gupta
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20901, USA; (S.G.); (S.N.)
- Master Dental Science, Universitat Jaume I, 12071 Castellón de la Plana, Spain
| | - Felice Lorusso
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via dei Vestini, 31-66100 Chieti, CH, Italy;
| | - Antonio Scarano
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20901, USA; (S.G.); (S.N.)
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via dei Vestini, 31-66100 Chieti, CH, Italy;
- Correspondence: ; Tel.: +08713554084
| | - Sammy Noumbissi
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20901, USA; (S.G.); (S.N.)
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, Via dei Vestini, 31-66100 Chieti, CH, Italy;
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Molinero-Mourelle P, Cascos-Sanchez R, Yilmaz B, Lam WYH, Pow EHN, Del Río Highsmith J, Gómez-Polo M. Effect of Fabrication Technique on the Microgap of CAD/CAM Cobalt-Chrome and Zirconia Abutments on a Conical Connection Implant: An In Vitro Study. MATERIALS 2021; 14:ma14092348. [PMID: 33946477 PMCID: PMC8125438 DOI: 10.3390/ma14092348] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/20/2021] [Accepted: 04/27/2021] [Indexed: 01/03/2023]
Abstract
The aim of this in vitro study was to investigate the microgaps at the implant-abutment interface when zirconia (Zr) and CAD/CAM or cast Co-Cr abutments were used. METHODS Sixty-four conical connection implants and their abutments were divided into four groups (Co-Cr (milled, laser-sintered and castable) and Zirconia (milled)). After chewing simulation (300,000 cycles, under 200 N loads at 2 Hz at a 30° angle) and thermocycling (10,000 cycles, 5 to 50 °C, dwelling time 55 s), the implant-abutment microgap was measured 14 times at each of the four anatomical aspects on each specimen by using a scanning electron microscope (SEM). Kruskal-Wallis and pair-wise comparison were used to analyze the data (α = 0.05). RESULTS The SEM analysis revealed smaller microgaps with Co-Cr milled abutments (0.69-8.39 μm) followed by Zr abutments (0.12-6.57 μm), Co-Cr sintered (7.31-25.7 μm) and cast Co-Cr (1.68-85.97 μm). Statistically significant differences were found between milled and cast Co-Cr, milled and laser-sintered Co-Cr, and between Zr and cast and laser-sintered Co-Cr (p < 0.05). CONCLUSIONS The material and the abutment fabrication technique affected the implant-abutment microgap magnitude. The Zr and the milled Co-Cr presented smaller microgaps. Although the CAD/CAM abutments presented the most favorable values, all tested groups had microgaps within a range of 10 to 150 μm.
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Affiliation(s)
- Pedro Molinero-Mourelle
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (R.C.-S.); (J.D.R.H.); (M.G.-P.)
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3007 Bern, Switzerland;
- Correspondence: ; Tel.: +34-913941922
| | - Rocio Cascos-Sanchez
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (R.C.-S.); (J.D.R.H.); (M.G.-P.)
| | - Burak Yilmaz
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3007 Bern, Switzerland;
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, 3007 Bern, Switzerland
| | - Walter Yu Hang Lam
- Prosthodontics, Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Sai Ying Pun, Hong Kong, China; (W.Y.H.L.); (E.H.N.P.)
| | - Edmond Ho Nang Pow
- Prosthodontics, Restorative Dental Sciences, Faculty of Dentistry, The University of Hong Kong, Sai Ying Pun, Hong Kong, China; (W.Y.H.L.); (E.H.N.P.)
| | - Jaime Del Río Highsmith
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (R.C.-S.); (J.D.R.H.); (M.G.-P.)
| | - Miguel Gómez-Polo
- Department of Conservative Dentistry and Orofacial Prosthodontics, Faculty of Dentistry, Complutense University of Madrid, 28040 Madrid, Spain; (R.C.-S.); (J.D.R.H.); (M.G.-P.)
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Padilla-Avalos CA, Marroquín-Soto C. [Prosthetic intermediaries in oral implantology: Literature review]. REVISTA CIENTÍFICA ODONTOLÓGICA 2021; 9:e064. [PMID: 38465276 PMCID: PMC10919799 DOI: 10.21142/2523-2754-0902-2021-064] [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: 05/01/2021] [Accepted: 06/03/2021] [Indexed: 03/12/2024] Open
Abstract
Prosthetic intermediaries in oral implantology are attachments that allow connection between the implant and the prosthesis itself. Although this rehabilitation has a high success rate; the selection of the prosthetic abutment represents is important in implant treatment. Currently, there is a great variety of intermediate abutments, corresponding to various techniques and materials. Prosthetic intermediaries can be classified according to the type of connection, their retention to the prosthesis, their axial relationship with the implant body, the manufacturing material and type of manufacture, or whether rehabilitation is single or multiple. This scenario can lead to doubts as to the selection of the ideal implant attachment in each case in order to achieve satisfactory rehabilitation, as well as functional and aesthetic requirements and the preservation of biological principles. Indeed, oral implantology has revolutionized dentistry and will continue to expand the range of possibilities; therefore, it is important to classify the prosthetic options available. The present literature review aims to demonstrate the different alternatives and options available for the intermediate abutments most used in implant prostheses.
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Affiliation(s)
- César-Augusto Padilla-Avalos
- Facultad de Odontología, Universidad de San Martín de Porres. Lima, Perú. , Universidad de San Martín de Porres Facultad de Odontología Universidad de San Martín de Porres Lima Peru
| | - Consuelo Marroquín-Soto
- Facultad de Odontología, Universidad de San Martín de Porres. Lima, Perú. , Universidad de San Martín de Porres Facultad de Odontología Universidad de San Martín de Porres Lima Peru
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Orchestrating soft tissue integration at the transmucosal region of titanium implants. Acta Biomater 2021; 124:33-49. [PMID: 33444803 DOI: 10.1016/j.actbio.2021.01.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 01/03/2021] [Accepted: 01/05/2021] [Indexed: 12/20/2022]
Abstract
Osseointegration at the bone-implant interface and soft tissue integration (STI) at the trans-mucosal region are crucial for the long-term success of dental implants, especially in compromised patient conditions. The STI quality of conventional smooth and bio-inert titanium-based implants is inferior to that of natural tissue (i.e. teeth), and hence various surface modifications have been suggested. This review article compares and contrasts the various modification strategies (physical, chemical and biological) utilized to enhance STI of Ti implants. It also details the STI challenges associated with conventional Ti-based implants, current surface modification strategies and cutting-edge nano-engineering solutions. The topographical, biological and therapeutic advances achievable via electrochemically anodized Ti implants with TiO2 nanotubes/nanopores are highlighted. Finally, the status and future directions of such nano-engineered implants is discussed, with emphasis on bridging the gap between research and clinical translation.
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Challenging replacement of a maxillary canine with an implant-supported restoration: A surgical and prosthetic approach. J Prosthet Dent 2021; 128:228-232. [PMID: 33640088 DOI: 10.1016/j.prosdent.2020.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 11/23/2022]
Abstract
This clinical report describes the replacement of a traumatized maxillary canine that was extracted after unsuccessful orthodontic extrusion with an implant-supported restoration. Guided bone regeneration surgery was performed, followed by a second surgery with implant placement plus simultaneous bone and tissue regeneration. Esthetics and function were achieved with the placement of a veneered zirconia implant-supported restoration.
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Cárdenas R, Sánchez D, Euán R, Flores AM. Effect of fatigue loading and failure mode of different ceramic implant abutments. J Prosthet Dent 2021; 127:875-881. [PMID: 33483141 DOI: 10.1016/j.prosdent.2020.09.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
STATEMENT OF PROBLEM Currently many options are available for restoring a dental implant, although the ideal implant abutment for withstanding the occlusal load and the restorative material for fulfilling the esthetic need remains unclear. Zirconia (Zir) abutments offer good esthetics, but concerns still remain regarding their fracture strength, complex fabrication, and higher cost as compared with those of titanium (Ti) base abutments offering lower cost, acceptable esthetics, and a straightforward procedure. PURPOSE The purpose of this in vitro study was to evaluate the fracture strength and failure mode of single-tooth Zir and Ti base implant abutments with fatigue loading. MATERIAL AND METHODS Forty restorations were included using 4 different types of abutment-restorations. Zir abutments with lithium disilicate crowns (ZirLd); titanium base abutments with custom Zir abutments and lithium disilicate crowns (TiZirLd); titanium base abutments with monolithic lithium disilicate abutment-crowns (TiLd); titanium base abutments with monolithic polymer-infiltrated ceramic abutment-crowns (TiEn). Specimens were subjected to a progressive cyclic loading by using a custom-made mastication simulator at a frequency of 1.4 Hz starting with a load of 88 N followed by stages of 170, 210, 250, and 290 N for a maximum of 20 000 cycles each or until fracture occurred. The number of cycles, maximum load, and failure modes were recorded. Statistical analysis was done by using the Mann-Whitney U test (α=.05). RESULTS Group TiEn showed a lower resistance to fatigue, with a mean ±standard deviation of 5054 ±123.3 cycles subjected to a mean force of 170 N. Groups ZirLd and TiLd resisted higher forces without fracture 13452.6 ±7094.3 cycles, and load of 178 ±16.9 N, followed by the TiLd group with a mean ±standard deviation of 25798.6 ±5498.7 cycles, and load of 202 ±16.9 N, while the TiZirLd group showed a mean of 48235.4 cycles subjected to a mean force of 258 N. The failure mode observed in the TiEn occurred only in the ceramic, whereas in the ZirLd and TiLd group, it was above the shoulder level of the Ti base abutment. Even though the TiZirLd group was able to withstand higher loads and a higher number of cycles, the failures were catastrophic and presented fractures of the titanium-base abutment and prosthetic screw. CONCLUSIONS The TiZirLd, ZirLd, and TiLd abutment-restorations have the potential to withstand the average physiological occlusal forces that occur in the anterior region. The group with the higher fatigue resistance was TiZirLd, although care should be taken with patients presenting parafunctional habits since the failure mode can be catastrophic. Also, polymer-infiltrated ceramic is not suitable for a Ti base abutment when subjected to oblique loading.
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Affiliation(s)
- Rubén Cárdenas
- Adjunct Professor, Department of Prosthodontics, Autonomous University of Nuevo León, Monterrey, Nuevo León, Mexico; Professor, Department of Restorative Dentistry, Autonomous University of Yucatán, Mérida, Yucatán, México
| | - Diana Sánchez
- Professor, Department of Prosthodontics, Autonomous University of Nuevo León, Monterrey, Nuevo León, Mexico
| | - Raúl Euán
- Chairman, Department of Prosthodontics, Autonomous University of Nuevo León, Monterrey, Nuevo León, Mexico.
| | - Arturo M Flores
- Professor, Department of Prosthodontics, Autonomous University of Nuevo León, Monterrey, Nuevo León, Mexico
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Giner S, Bartolomé JF, Gomez-Cogolludo P, Castellote C, Pradíes G. Fatigue fracture resistance of titanium and chairside CAD-CAM zirconia implant abutments supporting zirconia crowns: An in vitro comparative and finite element analysis study. J Prosthet Dent 2020; 125:503.e1-503.e9. [PMID: 33243472 DOI: 10.1016/j.prosdent.2020.09.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 09/15/2020] [Accepted: 09/16/2020] [Indexed: 11/25/2022]
Abstract
STATEMENT OF PROBLEM Zirconia abutments with a titanium base are promising candidates to substitute for titanium abutments based on clinical studies reporting good short-term survival rates. However, information on the long-term performance of zirconia abutments supporting ceramic crowns is scarce. PURPOSE This in vitro comparative and finite element analysis study compared the fatigue life performance of ceramic computer-aided design and computer-aided manufacturing (CAD-CAM) monolithic restorations and zirconia abutments fabricated with a chairside workflow connected to a titanium interface versus titanium abutments. MATERIAL AND METHODS Twenty-two internal connection implants were divided into 2 groups, one with a zirconia abutment and monolithic ceramic zirconia crown (ZZ) and the other with a titanium abutment and zirconia crown (TiZ). They were subjected to a fatigue test to determine the fatigue limit and fatigue performance of each group as per International Organization for Standardization (ISO) 14801. Microstructural analysis of the fracture surfaces was conducted by using a scanning electron microscope (SEM). Simulations of the in vitro study were also conducted by means of finite element analysis (FEA) to assess the stress distribution over the different parts of the restoration. RESULTS The fatigue limit was 250 N for the TiZ group and 325 N for the ZZ group. In both groups, the screw was the part most susceptible to fatigue and was where the failure initiated. In the zirconia abutment models, the stress on the screw was reduced. CONCLUSIONS Chairside CAD-CAM zirconia abutments with a titanium base supporting zirconia crowns had higher fatigue fracture resistance compared with that of titanium abutments.
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Affiliation(s)
- Sergio Giner
- Researcher, Department of Buccofacial Prosthesis, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
| | - José F Bartolomé
- Researcher, Instituto de Ciencia de Materiales de Madrid (ICMM), Consejo Superior de Investigaciones Científicas (CSIC), Madrid, Spain.
| | - Pablo Gomez-Cogolludo
- Associate Professor, Department of Buccofacial Prostheses, Faculty of Odontology, Complutense University of Madrid, Madrid, Spain
| | - Carlos Castellote
- Professor, Department of Industrial and Aerospace Engineering, Faculty of Engineering, University Europea of Madrid, Madrid, Spain
| | - Guillermo Pradíes
- Professor and Head, Department of Buccofacial Prosthesis, Faculty of Odontology, University Complutense of Madrid, Madrid, Spain
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Silva GC. A straightforward technique to obtain a subgingival nonglazed polished zirconia area in monolithic implant-supported prostheses. J Prosthet Dent 2020; 127:368-370. [PMID: 33248677 DOI: 10.1016/j.prosdent.2020.07.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/22/2020] [Accepted: 07/22/2020] [Indexed: 10/22/2022]
Affiliation(s)
- Guilherme C Silva
- Adjunct Professor, Department of Restorative Dentistry, School of Dentistry, Federal University of Minas Gerais, (UFMG), Belo Horizonte, Brazil.
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DuVall NB, DeReis SP, Vandewalle KS. Fracture strength of various titanium-based, CAD-CAM and PFM implant crowns. J ESTHET RESTOR DENT 2020; 33:522-530. [PMID: 33174333 DOI: 10.1111/jerd.12672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVE CAD-CAM has dramatically advanced dental restorative procedures to include implant-supported crowns. The purpose of this study was to compare the fracture resistance following mechanical loading and thermocycling of various screw-retained and cement-retained ceramic and polymethylmethacrylate material combinations using the TiBase abutment compared to PFM implant-supported crowns. OVERVIEW Twelve implant restorations were fabricated for each of eight groups. Three groups were screw-retained and five groups were cement-retained implant restorations. The ceramic and polymethylmethacrylate restorations were fabricated on the TiBase abutment while the PFM restorations were fabricated on an UCLA abutment. Data were analyzed with a one way Analysis of Variance and Tukey's post-hoc test to evaluate the effect of abutment and crown type on fracture load (alpha = 0.05). A significant difference was found in the maximum fracture load between groups (P < 0.001). CONCLUSIONS The screw-retained implant restorations demonstrated higher fracture loads than their cement-retained counterparts. The TiBase abutment compared favorably to the UCLA abutment. CLINICAL SIGNIFICANCE The TiBase abutment is a titanium insert which combines the esthetics of a ceramic abutment with the mechanical properties of a titanium abutment and should be considered a viable clinical alternative to the conventional implant-supported PFM crown based on theses in vitro results and in context of in vivo studies. The lithium disilicate hybrid abutment/crown implant-supported restoration utilizing the TiBase abutment may be an ideal clinical choice due to simplicity, single appointment CAD-CAM, and esthetics.
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Affiliation(s)
- Nicholas B DuVall
- Program Director, AEGD Residency, 96th Dental Squadron, Eglin AFB, Florida, USA.,US Air Force Postgraduate Dental College, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA
| | - Stephen P DeReis
- Certified Dental Technician, 81st Dental Squadron, Keesler AFB, Mississippi, USA
| | - Kraig S Vandewalle
- US Air Force Postgraduate Dental College, Uniformed Services University of the Health Sciences, Bethesda, Maryland, USA.,Director of Dental Research, AEGD Residency, 59th Dental Training Squadron, Joint Base San Antonio-Lackland, Texas, USA
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Retention and Clinical Performance of Zirconia Crowns: A Comprehensive Review. Int J Dent 2020; 2020:8846534. [PMID: 33123199 PMCID: PMC7584951 DOI: 10.1155/2020/8846534] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 09/24/2020] [Accepted: 10/04/2020] [Indexed: 11/30/2022] Open
Abstract
Zirconia has been used for rehabilitation of edentulous spaces approximately for a decade, and there have been several reports regarding the clinical performance and retention of zirconia crowns. Outstanding mechanical properties, biocompatibility, and excellent aesthetics make zirconia-based crowns as a popular crown among the current all-ceramic crowns in restorative dentistry. However, restoration with a zirconia crown is a challenging treatment. The goal of this study was to assess the current literature to summarize the studies reporting the effective risk factors on retention of zirconia crowns to provide clinicians with a useful point of view in the decision-making process for use of these restorations. Literature based-search was performed to find related articles until August 2020 using EMBASE, Google Scholar, and MEDLINE. Search terms used were “zirconia restorations properties,” “zirconia crowns clinical performance,” “zirconia crown survival,” “biological complications,” and “zirconia crown retention.” Results were limited to papers available in English. The references of all related literature were also searched for further citations. Overall, although clinical long-term and follow-up studies are a vital requirement to conclude that zirconia has great reliability, it seems that zirconia crown restorations are both well tolerated and sufficiently resistant.
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Annual review of selected scientific literature: A report of the Committee on Scientific Investigation of the American Academy of Restorative Dentistry. J Prosthet Dent 2020; 124:274-349. [PMID: 32811666 DOI: 10.1016/j.prosdent.2020.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 06/23/2020] [Accepted: 06/24/2020] [Indexed: 01/20/2023]
Abstract
This comprehensive review of the 2019 restorative dental literature is offered to inform busy dentists regarding remarkable publications and noteworthy progress made in the profession. Developed by the Scientific Investigation Committee of the American Academy of Restorative Dentistry, each author brings discipline-specific expertise to 1 of 8 sections of the report: (1) prosthodontics; (2) periodontics, alveolar bone, and peri-implant tissues; (3) implant dentistry; (4) dental materials and therapeutics; (5) occlusion and temporomandibular disorders; (6) sleep-related breathing disorders; (7) oral medicine and oral and maxillofacial surgery; and (8) dental caries and cariology. The report targets important information likely to influence day-to-day dental treatment decisions. Each review is not intended to stand alone but to update interested readers so that they may visit source material when greater detail is desired. As the profession moves toward evidence-based clinical decision-making, an incredible volume of potentially valuable dental literature continues to increase. It is the intention of this review and its authors to provide assistance in negotiating the extensive dental literature published in 2019. It is our hope that readers find this work useful in the clinical management of dental patients.
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State of the Art on Biomaterials for Soft Tissue Augmentation in the Oral Cavity. Part II: Synthetic Polymers-Based Biomaterials. Polymers (Basel) 2020; 12:polym12081845. [PMID: 32824577 PMCID: PMC7465038 DOI: 10.3390/polym12081845] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 08/13/2020] [Accepted: 08/15/2020] [Indexed: 01/10/2023] Open
Abstract
Most of the polymers used as biomaterials for scaffolds are naturally occurring, synthetic biodegradable, and synthetic non-biodegradable polymers. Since synthetic polymers can be adapted for obtaining singular desired characteristics by applying various fabrication techniques, their use has increased in the biomedical field, in dentistry in particular. The manufacturing methods of these new structures include many processes, such as electrospinning, 3D printing, or the use of computer-aided design/computer-aided manufacturing (CAD/CAM). Synthetic polymers show several drawbacks that can limit their use in clinical applications, such as the lack of cellular recognition, biodegradability, and biocompatibility. Moreover, concerning biodegradable polymers, the time for matrix resorption is not predictable, and non-resorbable matrices are preferred for soft tissue augmentation in the oral cavity. This review aimed to determine a new biomaterial to offset the present shortcomings in the oral environment. Researchers have recently proposed a novel non-resorbable composite membrane manufactured via electrospinning that has allowed obtaining remarkable in vivo outcomes concerning angiogenesis and immunomodulation throughout the polarization of macrophages. A prototype of the protocol for in vitro and in vivo experimentation with hydrogels is explained in order to encourage innovation into the development of promising biomaterials for soft tissue augmentation in the near future.
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Affiliation(s)
- Takao HANAWA
- Institute of Biomaterials and Bioengineering, Tokyo Medical and Dental University
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Has zirconia made a material difference in implant prosthodontics? A review. Dent Mater 2020; 36:1-8. [DOI: 10.1016/j.dental.2019.08.100] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 08/19/2019] [Indexed: 12/17/2022]
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