Fabrication technique for a custom implant emergence profile on 3D printed casts

Soft tissue management around dental implant in esthetic zone - the current concepts and novel techniques

It has been said, 'Bone sets the tone, but tissue is the issue.' In the field of implantology, while significant breakthroughs have been achieved in hard tissue regeneration, clinicians find it more challenging to handle soft tissue complications around dental implants. Successfully managing soft tissue around dental implants requires clinicians to have comprehensive knowledge of proper implant placement, prosthetic design and tissue management, and a high level of surgical skills for soft tissue augmentation and grafting. Autogenous gingival grafts can be utilized in various clinical situations, providing surgeons with great potential and freedom to enhance the quality and quantity of peri-implant soft tissue. Emerging trends, such as digital tools for treatment planning, minimally invasive surgical approaches, and innovative biomaterials, can also contribute to a more pleasing outcome. By elucidating these multifaceted considerations, this review will serve as a valuable resource for clinicians aiming to achieve functional and aesthetic excellence in implant-based oral rehabilitation.

Comparison of the residual cement on custom computer-aided design and computer-aided manufacturing titanium and zirconia abutments: A preliminary cohort study

STATEMENT OF PROBLEM

Clinical studies comparing the occurrence and quality of residual cement between custom zirconia and custom titanium abutments with subgingival margins are scarce.

PURPOSE

The purpose of this clinical study was to assess the difference in the amount of residual cement between custom zirconia and titanium abutments with a 1-mm subgingival margin.

MATERIAL AND METHODS

Eighty participants were randomized to receive either a custom zirconia abutment with a bonded titanium insert or a custom titanium abutment with a 1-mm subgingival margin on a posterior bone-level implant. Monolithic lithium disilicate crowns with a screw-access hole were cemented to abutments randomly with either a resin-modified glass ionomer cement or a resin cement. After cementation, the crown-abutment assemblies were removed and photographed from the mesial, buccal, distal, and lingual of the specimen to record the residual cement. The length along the abutment margin of each aspect of the assembly was measured. The surface area of the residual cement (SA) and the surface area of the residual cement per unit length of margin (SA_P) were calculated. Results for the groups were compared with the Fisher exact test, the Friedman test, and the Mann-Whitney U test (α=.05).

RESULTS

The median (lower quartile, upper quartile) of SA and SA_P for the custom zirconia abutment with a bonded titanium insert was 1.9 (0.5, 3.9) mm² and 0.086 (0.032, 0.02) mm², respectively, and for the custom titanium abutment, the values were 2.9 (1.3, 5.1) mm² and 0.138 (0.062, 0.239) mm², respectively. No significant difference was found between the custom zirconia abutments with bonded titanium inserts and titanium abutments for SA (P=.075) and SA_P (P=.083) with the Mann-Whitney U test. No significant difference was found in residual cement between the 4 aspects of the abutment (SA: P=.852; SA_P: P=.954) with the Friedman test and between the 2 types of cement (SA: P=.447; SA_P: P=.878) with the Mann-Whitney U test.

CONCLUSIONS

A similar amount of subgingival residual cement was recorded around the abutment-crown assembly, regardless of the abutment material or cement type used.

Selective Laser Melting and Electron Beam Melting of Ti6Al4V for Orthopedic Applications: A Comparative Study on the Applied Building Direction

The 3D printing process offers several advantages to the medical industry by producing complex and bespoke devices that accurately reproduce customized patient geometries. Despite the recent developments that strongly enhanced the dominance of additive manufacturing (AM) techniques over conventional methods, processes need to be continually optimized and controlled to obtain implants that can fulfill all the requirements of the surgical procedure and the anatomical district of interest. The best outcomes of an implant derive from optimal compromise and balance between a good interaction with the surrounding tissue through cell attachment and reduced inflammatory response mainly caused by a weak interface with the native tissue or bacteria colonization of the implant surface. For these reasons, the chemical, morphological, and mechanical properties of a device need to be designed in order to assure the best performances considering the in vivo environment components. In particular, complex 3D geometries can be produced with high dimensional accuracy but inadequate surface properties due to the layer manufacturing process that always entails the use of post-processing techniques to improve the surface quality, increasing the lead times of the whole process despite the reduction of the supply chain. The goal of this work was to provide a comparison between Ti6Al4V samples fabricated by selective laser melting (SLM) and electron beam melting (EBM) with different building directions in relation to the building plate. The results highlighted the influence of the process technique on osteoblast attachment and mineralization compared with the building orientation that showed a limited effect in promoting a proper osseointegration over a long-term period.

Lithium Disilicate Crown, Zirconia Hybrid Abutment and Platform Switching to Improve the Esthetics in Anterior Region: A Case Report

The hybrid abutment emerged as an alternative to maintain a stable and favorable volume of peri-implant tissue; it is composed of a mesostructure in ceramic and a metallic connection, which can be machined according to the peri-implant emergence profile. This case report presented the clinical steps for a dental implant with immediate provisional restoration, followed by the installation of implant-supported all-ceramic crowns with zirconia abutment and platform switching. A 40-year-old male patient was rehabilitated with an implant-supported ceramic crown in the region of element 11 and a ceramic veneer was cemented on the upper right central incisor. To do so, an atraumatic extraction of the upper left central incisor was performed followed by implant placement and immediate loading. In this case, a zirconia hybrid abutment was used with a metallic link in the cervical region with a concave platform switching base. This association of clinical steps enabled improving the aesthetics in the anterior dental region.