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Strasding M, Marchand L, Merino E, Zarauz C, Pitta J. Material and abutment selection for CAD/CAM implant-supported fixed dental prostheses in partially edentulous patients - A narrative review. Clin Oral Implants Res 2024; 35:984-999. [PMID: 38864592 DOI: 10.1111/clr.14315] [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: 08/31/2023] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
Restorative material selection has become increasingly challenging due to the speed of new developments in the field of dental material science. The present narrative review gives an overview of the current indications for implant abutments and restoration materials for provisional and definitive implant-supported fixed dental prostheses in partially edentulous patients. For single implant restorations, titanium base abutments for crowns are suggested as an alternative to the conventional stock- and customized abutments made out of metal or zirconia. They combine the mechanical stability of a metallic connection with the esthetic potential of ceramics. For multiple-unit restorations, conical titanium bases especially designed for bridges are recommended, to compensate for deviating implant insertion axes and angulations. Even though titanium base abutments with different geometries and heights are available, certain clinical scenarios still benefit from customized titanium abutments. Indications for the definitive material in fixed implant restorations depend on the region of tooth replacement. In the posterior (not esthetically critical) zone, ceramics such as zirconia (3-5-Ymol%) and lithium-disilicate are recommended to be used in a monolithic fashion. In the anterior sector, ceramic restorations may be buccally micro-veneered for an optimal esthetic appearance. Lithium-disilicate is only recommended for single-crowns, while zirconia (3-5-Ymol%) is also recommended for multiple-unit and cantilever restorations. Attention must be given to the specific mechanical properties of different types of zirconia, as some feature reduced mechanical strengths and are therefore not indicated for all regions and restoration span lengths. Metal-ceramics remain an option, especially for cantilever restorations.
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Affiliation(s)
- Malin Strasding
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Marchand
- Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Elizabeth Merino
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Cristina Zarauz
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - João Pitta
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
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Rutkunas V, Kules D, Mischitz I, Huber S, Revilla-León M, Larsson C, Janda M. Misfit simulation on implant-supported prostheses with different combinations of engaging and nonengaging titanium bases: Part 3: A radiographic evaluation. J Prosthet Dent 2024:S0022-3913(24)00044-1. [PMID: 38418304 DOI: 10.1016/j.prosdent.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/13/2024] [Accepted: 01/17/2024] [Indexed: 03/01/2024]
Abstract
STATEMENT OF PROBLEM The fit of implant-supported prostheses plays an important role in their mechanical and biological stability. Clinically, the prosthetic fit is typically assessed radiographically, but this method relies on the operator's subjective evaluation. Whether available digital tools could optimize the evaluation of the prosthetic fit is uncertain. PURPOSE The purpose of this in vitro study was to evaluate the influence of an image processing program on the radiographic detection of discrepancies in the active and passive fit of implant-supported prostheses. Two-implant-supported screw-retained prostheses were analyzed by simulating the vertical and horizontal misfits of 3 different implant abutment configurations. MATERIAL AND METHODS Seven casts were fabricated using 2 internal-connection titanium implants: 1 control; 3 with vertical (V) misfit of 50 µm, 100 µm, 150 µm; and 3 with horizontal (H) misfit of 35 µm, 70 µm, 100 µm. Thirty bar-shaped zirconia frameworks were fabricated and divided into 3 groups (n=10) according to their attachment to 2 engaging (E-E), 2 nonengaging (NE-NE), and engaging and nonengaging (E-NE) titanium bases. Digital parallel periapical radiographs were made of each specimen in the passive and active fit situation on each cast (1-screw test), except for the E-E specimens, which were only seated on the control, H35, and H70 casts because the fit on the remaining casts was poor. The mean gray value (MGV) was measured at the chosen regions of interest on the second implant (side B) using the ImageJ software program. Differences in the MGV measurements between the passive and active conditions were tested using a t test (α=.05) and compared the different misfit levels using analysis of variance (1-way ANOVA), followed by the Tukey HSD test (α=.05). RESULTS The highest values for the differences between passive and active fit were found for the V150 and H100 misfit simulations (P<.05). Statistical differences between the MGVs were found with some exceptions: the smallest simulated misfits (H35 and V50) revealed statistically significant MGV differences from the highest simulated misfits (V150, H100) and from the H70 in the groups where an engaging component was present (P>.05). In the horizontal misfit group of NE-NE abutment configuration, H70 revealed no significant difference from the control group cast (P>.05). CONCLUSIONS Measuring MGV differences between passive and active fit could be a promising alternative for detecting 70- to 150-µm gaps in the implant-abutment connection that result from the misfit. However, the procedure was not adequate for detecting <50 µm gaps, cannot be uniformly applied to all types of implant-abutment connections, and requires 2 exposures to X-radiation.
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Affiliation(s)
- Vygandas Rutkunas
- Professor, Department of Prosthodontics, Institute of Odontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; and Director, Digitorum Research Center, Vilnius, Lithuania
| | - Daniel Kules
- Postgraduate student, Department of Periodontology, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; and Researcher, Digitorum Research Center, Vilnius, Lithuania
| | - Ingrida Mischitz
- Dental Research Assistant, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
| | - Sandra Huber
- Attending, Department of Dental Medicine and Oral Health, Medical University of Graz, Graz, Austria
| | - Marta Revilla-León
- Affiliate Professor, Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Wash.; Faculty and Director, Digital Dentistry, Kois Center, Seattle, Wash.; and Affiliate Professor, Graduate Prosthodontics, Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Mass
| | - Christel Larsson
- Associate Professor, Faculty of Odontology, Malmö University, Malmö, Sweden; and Associate Visiting Professor, Faculty of Dentistry, Department of Prosthetic Dentistry, Riga Stradins University, Riga, Latvia
| | - Martin Janda
- Assistant Professor, Faculty of Odontology, Malmö University, Malmö, Sweden.
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Sakar D, Guncu MB, Arikan H, Muhtarogullari M, Aktas G, Reiss N, Turkyilmaz I. Effect of different implant locations and abutment types on stress and strain distribution under non-axial loading: A 3-dimensional finite element analysis. J Dent Sci 2024; 19:607-613. [PMID: 38303808 PMCID: PMC10829709 DOI: 10.1016/j.jds.2023.11.001] [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: 10/22/2023] [Revised: 11/05/2023] [Indexed: 02/03/2024] Open
Abstract
Background/purpose Dental implants have been a popular treatment for replacing missing teeth. The purpose of this study was to investigate the impact of engaging (hexagonal) and non-engaging (non-hexagonal) abutments in various six-unit fixed prosthesis on the stress distribution and loading located in the implant neck, implant abutment, and surrounding bone. Materials and methods Three implants were digitally designed and inserted parallel to each other in edentulous sites of the maxillary right canine, maxillary right central incisor, and maxillary left canine. Titanium base engaging abutments, non-engaging abutments and connecting screws were designed. Five distinct models of 6-unit fixed dental prosthesis were created, each featuring different combinations of various abutments. Forces (45-degree angle) were applied to the prosthesis, allowing for the analysis of the stress distribution on the implant neck and abutments, and the maximum and minimum principal stress values on the cortical and trabecular bone. Results Von Mises stress values and stress distributions located in the implant neck region due to the applied loading forces were analyzed. The overall stress values were highest while employing the hexagonal abutments. The maxillary left canine with a hexagonal abutment (model 5) reported the highest von mises value (64.71 MPa) while the maxillary right canine with a non-hexagonal abutment (model 4) presented lowest von mises value (56.69 MPa). Conclusion The results suggest that both the various abutment combinations (engaging and non-engaging) on five different models have a similar influence on the distribution of stress within the implant system.
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Affiliation(s)
- Didem Sakar
- Department of Prosthodontics, School of Dentistry, Hacettepe University, Ankara, Turkey
| | - Mustafa Baris Guncu
- Department of Prosthodontics, School of Dentistry, Hacettepe University, Ankara, Turkey
| | - Hale Arikan
- Department of Prosthodontics, Faculty of Dentistry, Baskent University, Ankara, Turkey
| | - Mehmet Muhtarogullari
- Department of Prosthodontics, School of Dentistry, Hacettepe University, Ankara, Turkey
| | - Guliz Aktas
- Department of Prosthodontics, School of Dentistry, Hacettepe University, Ankara, Turkey
| | - Natalia Reiss
- New York University College of Dentistry, New York, NY, USA
| | - Ilser Turkyilmaz
- Department of Prosthodontics, New York University College of Dentistry, New York, NY, USA
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Ramadan RE, Mohamed FS, Abd-Ellah ME. Quantitative and qualitative assessment of the wear pattern of two attachment systems of dissimilar materials for mandibular implant-retained overdentures: an in-vitro study. BMC Oral Health 2023; 23:948. [PMID: 38036982 PMCID: PMC10687975 DOI: 10.1186/s12903-023-03693-6] [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: 07/22/2023] [Accepted: 11/22/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND Attachment material is one of the contributing factors to the degree of wear of the attachment components in mandibular implant-retained overdentures. The purpose of this in vitro study was to compare the wear behavior of 2 different attachment systems of dissimilar materials in mandibular implant-retained overdentures by qualitative and quantitative methods. METHODS Two attachment systems of different materials were utilized (n = 16); Titach (Dental Evolutions Inc, Beverly Hills, CA, USA) with a titanium-to-titanium interface and Locator R-Tx (Zest Anchors Inc, Escondido, CA, USA) with a titanium-to-nylon interface. One thousand cycles of overdenture insertion and removal simulating 1-year clinical use were performed. All matrices were removed from the overdentures and all patrices were unscrewed from the implants for wear assessment quantitively using a stereomicroscope and qualitatively using a scanning electron microscope. Data were analyzed by using an independent sample t test. RESULTS After cyclic loading, stereomicroscopic findings showed that the Titach group had statistically significant higher wear value than the Locator R-Tx group (p < 0.001). Moreover, scanning electron microscopy images showed noticeable abrasion in Titach patrix at the area of highest convexity. However, the Locator R-Tx matrix displayed an apparent tear of rubber inserts. CONCLUSIONS Titach attachment with the titanium-to-titanium interface revealed more wear than Locator R-Tx attachment with the titanium-to-nylon interface. Thus, the type of attachment material influences the degree of wear of the attachment components.
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Affiliation(s)
- Rania E Ramadan
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Champollion Street, Azarita, 002034868066, Alexandria, Egypt
| | - Faten S Mohamed
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Champollion Street, Azarita, 002034868066, Alexandria, Egypt
| | - Mervat E Abd-Ellah
- Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Champollion Street, Azarita, 002034868066, Alexandria, Egypt.
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