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de Oliveira Limirio JPJ, Gomes JMDL, Santiago-Junior JF, Nagay BE, Pesqueira AA, Assunção WG, Alves-Rezende MCR, Pellizzer EP. Influence of ceramic crown design (translucent monolithic zirconia vs. bilayered) of implant-supported single crowns after mechanical cycling. J ESTHET RESTOR DENT 2024; 36:1326-1336. [PMID: 38665052 DOI: 10.1111/jerd.13237] [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: 11/26/2023] [Revised: 03/20/2024] [Accepted: 04/03/2024] [Indexed: 08/11/2024]
Abstract
OBJECTIVES This study aimed to assess the influence of translucent monolithic versus bilayered crowns and whether the use of a CoCr base abutments affects the fatigue and fracture resistance of screwed implant-supported single crowns with external connections under mechanical cycling. MATERIALS AND METHODS Fifty specimens were divided into groups: (1) metal-ceramic (MC) crown, (2) veneered zirconia crown (Zr), (3) veneered zirconia crown with a CoCr base abutment (ZrB), (4) monolithic translucent zirconia crown (MZr), and (5) monolithic translucent zirconia crown with a CoCr base abutment (MZrB). Specimens underwent mechanical cycling (5 × 106 cycles; 150 N) evaluating fatigue resistance (number of failures) and those that failed were subsequently subjected to fractographic analyses (stereomicroscope and scanning electron microscope) to evaluate failure location and area, and maximum fracture load was also measured. RESULTS The failure-related survival rate (100%) and maximum fracture resistance of the MZrB were significantly higher than those of MC and Zr (50%; p < 0.05). There were no significant differences in the failure rate and fracture resistance when a CoCr base abutment was used or not in the translucent monolithic Zr groups (p > 0.05;MZrB vs. MZr). Failure location, with MC crowns' fractures, noted at the screw area (p = 0.043), while all-ceramic crowns were mostly in the cuspid and to failure area, the Zr group had the largest mean (15.55 ± 9.17 mm2) among the groups, significant difference only when compared with MC (1.62 ± 0.81 mm2) (p = 0.025). CONCLUSIONS Translucent monolithic zirconia crowns exhibited significantly higher fatigue and fracture resistance compared with conventional MC and bilayered crowns. CLINICAL SIGNIFICANCE The appropriate choice of material and manufacturing technique is crucial for predicting the higher clinical performance of single crowns. Enhanced mechanical resistance in terms of fatigue and fracture resistance can be achieved by replacing MC and bilayered restorations with computer-aided design and computer-aided manufacturing monolithic zirconia.
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Affiliation(s)
| | - Jéssica Marcela de Luna Gomes
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | | | - Bruna Egumi Nagay
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, São Paulo, Brazil
| | - Aldiéris Alves Pesqueira
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | - Wirley Gonçalves Assunção
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
| | | | - Eduardo Piza Pellizzer
- Department of Dental Materials and Prosthodontics, Sao Paulo State University (UNESP), School of Dentistry, Araçatuba, São Paulo, Brazil
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Ntovas P, Ladia O, Pachiou A, Fehmer V, Sailer I. In vitro assessment of cementation of CAD/CAM fabricated prostheses over titanium bases. A systematic review. Clin Oral Implants Res 2024. [PMID: 39189297 DOI: 10.1111/clr.14347] [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: 04/01/2024] [Revised: 07/10/2024] [Accepted: 07/30/2024] [Indexed: 08/28/2024]
Abstract
OBJECTIVES The objective of this study is to investigate the outcomes of clinically relevant laboratory studies regarding the cementation of implant-supported restorations over ti-bases. MATERIALS AND METHODS The present study has been conducted according to PRISMA statement. An electronic search was performed, including publications up to March 2024, to identify studies investigating the parameters affecting the cementation between ti-bases and CAD/CAM prostheses. An assessment of the internal validity was performed, using a custom-made risk of bias tool (QUIN). RESULTS From the included studies, 40.1% were reported on luting systems, 25% on ti-base surface treatment, 25% on restoration surface, 21.8% on restoration material, and 18.7% on ti-base height. The majority of the included studies were associated with a medium risk of bias. In the absence of micro-retentive features, air-abrasion of ti-bases with a minimum height of 3.5 mm can be beneficial for restoration's retention. The bonding performance can vary not only between different bonding systems but also for different applications within the same system, based on a restoration's material and surface treatment as well as on ti-base height and surface treatment. CONCLUSIONS The height of the ti-base seems to be the prevailing factor as it constitutes the prerequisite for other modifications of the bonding surfaces to have an advantageous effect. Since the parameters that can affect bonding performance between ti-base and restoration can interact with each other, it is important for the clinician to focus on verified bonding protocols.
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Affiliation(s)
- Panagiotis Ntovas
- Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | | | - Aspasia Pachiou
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Vincent Fehmer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
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Bischof FM, Mathey AA, Stähli A, Salvi GE, Brägger U. Survival and complication rates of tooth- and implant-supported restorations after an observation period up to 36 years. Clin Oral Implants Res 2024. [PMID: 39177417 DOI: 10.1111/clr.14351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/02/2024] [Accepted: 07/29/2024] [Indexed: 08/24/2024]
Abstract
BACKGROUND Tooth- and implant-supported fixed dental prostheses are well-documented and aesthetic treatment alternatives, and after a comprehensive periodontal treatment, a protocol with a good long-term prognosis if the maintenance program is strictly followed. AIM To reexamine a pre-existing patient cohort in order to obtain estimated long-term survival and complication outcomes of fixed dental prostheses. MATERIALS AND METHODS For this study, patients treated with fixed dental prostheses between 1978 and 2002 were reexamined between 2019 and 2020. The restorations were divided in single crowns and fixed dental prostheses supported by teeth (TSC, FPTDP) and implants (ISC, FPIDP). Survival and complication rates were obtained. Kaplan-Meier functions were used to model complication probabilities, and average hazard ratios of different strata were compared using weighted Cox regression. RESULTS The mean observation time of 40 patients and 223 reconstructions was 20.3 (±9.7, 1.2-36.2) years. The estimated survival rates were 84% (CI: 77%-92%) for TSC, 63% (CI: 51%-79%) for FPTDP, 87% (CI: 71%-100%) for ISC, and 64% (CI: 34%-100%) for FPIDP after 25 years. Biological complications included carious lesions (10.6%), periodontitis (7.9%), and peri-implantitis (6.8%). Technical complications included chipping (20.2%) and loss of retention (10.8%). CONCLUSION Biological complications lead to abutment loss in more than two-thirds of cases, regardless of the type of abutment (tooth or implant). Technical complications are less associated with abutment loss than biological complications.
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Affiliation(s)
- Frank M Bischof
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Ayse A Mathey
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Alexandra Stähli
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Giovanni E Salvi
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Urs Brägger
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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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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Huang B, Chen M, Wang J, Zhang X. Advances in zirconia-based dental materials: Properties, classification, applications, and future prospects. J Dent 2024; 147:105111. [PMID: 38866229 DOI: 10.1016/j.jdent.2024.105111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVES Zirconia (ZrO2) ceramics are widely used in dental restorations due to their superior mechanical properties, durability, and ever-improving translucency. This review aims to explore the properties, classification, applications, and recent advancements of zirconia-based dental materials, highlighting their potential to revolutionize dental restoration techniques. STUDY SELECTION, DATA AND SOURCES The most recent literature available in scientific databases (PubMed and Web of Science) reporting advances of zirconia-based materials within the dental field is thoroughly examined and summarized, covering the major keywords "dental zirconia, classification, aesthetic, LTD, applications, manufacturing, surface treatments". CONCLUSIONS An exhaustive overview of the properties, classifications, and applications of dental zirconia was presented, alongside an exploration of future prospects and potential advances. This review highlighted the importance of addressing challenges such as low-temperature degradation resistance and optimizing the balance between mechanical strength and translucency. Also, innovative approaches to improve the performances of zirconia as dental material was discussed. CLINICAL SIGNIFICANCE This review provides a better understanding of zirconia-based dental biomaterials for dentists, helping them to make better choice when choosing a specific material to fabricate the restorations or to place the implant. Moreover, new generations of zirconia are still expected to make progress on key issues such as the long-term applications in dental materials while maintaining both damage resistance and aesthetic appeal, defining the directions for future research.
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Affiliation(s)
- Bo Huang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Mengbing Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jian Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Xin Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
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Albakri A. The mechanical complications and behavior of angulated dental implant abutment systems versus conventional abutments, a narrative review. Saudi Dent J 2024; 36:1072-1077. [PMID: 39176153 PMCID: PMC11337959 DOI: 10.1016/j.sdentj.2024.06.002] [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: 12/16/2023] [Revised: 05/30/2024] [Accepted: 06/02/2024] [Indexed: 08/24/2024] Open
Abstract
Background Angulated screw channel (ASC) abutment allows off-axis dental implants to be used in dental restorations without the need for cementation. As this is a relatively new system, research on its clinical performance is limited. Objectives To summarize the available in-vitro and in-vivo studies on the mechanical and technical issues associated with the ASC system and compare its clinical performance with that of conventional implant-supported abutments. Methods A comprehensive literature search in PubMed, Web of Science, and ScienceDirect databases was performed, focusing on articles about angulated (angled) screw channel (ASC) systems published in English between January 2015 and November 2023. Only in-vitro and in-vivo studies were included. Results After analyzing the recorded articles, 26 studies (11 in vivo and 15 in vitro) were included in the final discussion and review. Conclusion Although the ASC system is still relatively new, and is presently outperformed by conventional abutment systems in terms of technical and mechanical properties, in short- and medium-term in-vivo studies, it was shown reliable for retaining single or multiple-unit implant restorations in both posterior and anterior zones. Still, further long-term clinical research is needed to fully elucidate the risk factors associated with ASC failures.
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Affiliation(s)
- Ahmed Albakri
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh, Saudi Arabia
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Molinero-Mourelle P, Schimmel M, Forrer FA, Hicklin SP, Raabe C, Chappuis V, Fonseca M. Clinical and radiographic performance of late placed and early loaded dental implants with a conditioned hydrophilic surface in posterior mandible sites: A prospective case series with an 8.5- to 9.5-year follow-up. Clin Implant Dent Relat Res 2024; 26:704-713. [PMID: 38711297 DOI: 10.1111/cid.13333] [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: 01/06/2024] [Revised: 04/05/2024] [Accepted: 04/11/2024] [Indexed: 05/08/2024]
Abstract
OBJECTIVE To assess the clinical outcomes by means of implant and prosthetic survival of late placed and early loaded implants with a hydrophilic, moderately rough surface for partially edentulous patients after a follow-up of 8.5 to 9.5 years. MATERIALS AND METHODS A prospective case series study involving 15 patients with single, late placed and early loaded implants in the posterior mandible was performed. Clinical and radiographical parameters, including biological and technical complications and patient satisfaction, were assessed. RESULTS From an initial sample of 15 patients, 12 were included. A total of 16 implants were observed. After a mean follow-up of 9 years and 7 months (SD ± 3.8 months), implant success and survival rate were 100%. The prosthetic survival rate was 100%, and the prosthetic success rate was 93.8% since a major chipping was observed. No biological complications were observed, and the mean modified plaque index was 0.03 (SD ± 0.09) with a mean probing pocket depth of 2.95 mm (SD ± 0.09). A mean marginal bone level (MBL) of 0.04 mm (SD ± 0.88) and a mean VAS of 9.42 (SD ± 0.90) for patient satisfaction were recorded. CONCLUSION Late placed and early loaded implants with a moderately rough endosseal surface are a reliable option for rehabilitating partially edentulous patients. An implant survival rate of 100% and a prosthodontic success rate of 93.8% were observed. Patient satisfaction scores were high and peri-implant hard and soft tissues remained healthy. The study findings should be carefully interpreted because of the small sample.
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Affiliation(s)
- Pedro Molinero-Mourelle
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Martin Schimmel
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | | | - Stefan Paul Hicklin
- Clinic of Preventive Dentistry, Periodontology and Cariology, and Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Clemens Raabe
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Vivianne Chappuis
- Department of Oral Surgery and Stomatology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Manrique Fonseca
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
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Martínez-Grau J, Robles D, Pérez RA, Marimon X, Fernández-Hernández S, Aroso C, Brizuela-Velasco A. Design Factors of Ti-Base Abutments Related to the Biomechanics Behavior of Dental Implant Prostheses: Finite Element Analysis and Validation via In Vitro Load Creeping Tests. MATERIALS (BASEL, SWITZERLAND) 2024; 17:3746. [PMID: 39124410 PMCID: PMC11313398 DOI: 10.3390/ma17153746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/12/2024]
Abstract
This study has been carried out to analyze the influence of the design of three geometric elements (wall thickness, platform width, and chamfer) of Ti-base abutments on the distribution of stresses and strains on the implant, the retention screw, the Ti base, and the bone. This study was carried out using FEA, analyzing eight different Ti-base models based on combinations of the geometric factors under study. The model was adapted to the standard Dynamic Loading Test For Endosseous Dental Implants. A force of 360 N with a direction of 30° was simulated and the maximum load values were calculated for each model, which are related to a result higher than the proportional elastic limit of the implant. The transferred stresses according to von Mises and microdeformations were measured for all the alloplastic elements and the simulated support bone, respectively. These results were validated with a static load test using a creep testing machine. The results show that the design factors involved with the most appropriate stress distribution are the chamfer, a thick wall, and a narrow platform. A greater thickness (0.4 mm) is also related to lower stress values according to von Mises at the level of the retaining screws. In general, the distributions of tension at the implants and microdeformation at the level of the cortical and trabecular bone are similar in all study models. The in vitro study on a Ti-base control model determined that the maximum load before the mechanical failure of the implant is 360 N, in accordance with the results obtained for all the Ti-base designs analyzed in the FEA. The results of this FEA study show that modifications to the Ti-base design influence the biomechanical behavior and, ultimately, the way in which tension is transferred to the entire prosthesis-implant-bone system.
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Affiliation(s)
- Jordi Martínez-Grau
- Bioengineering Institute of Technology (BIT), Universitat Internaciional de Catalunya (UIC), 08195 Sant Cugat del Vallés, Spain; (J.M.-G.); (R.A.P.); (X.M.)
| | - Daniel Robles
- DENS-ia Research Group, Faculty of Health Sciences, Miguel de Cervantes European University, 47012 Valladolid, Spain; (S.F.-H.); (A.B.-V.)
| | - Román A. Pérez
- Bioengineering Institute of Technology (BIT), Universitat Internaciional de Catalunya (UIC), 08195 Sant Cugat del Vallés, Spain; (J.M.-G.); (R.A.P.); (X.M.)
| | - Xavier Marimon
- Bioengineering Institute of Technology (BIT), Universitat Internaciional de Catalunya (UIC), 08195 Sant Cugat del Vallés, Spain; (J.M.-G.); (R.A.P.); (X.M.)
| | - Saray Fernández-Hernández
- DENS-ia Research Group, Faculty of Health Sciences, Miguel de Cervantes European University, 47012 Valladolid, Spain; (S.F.-H.); (A.B.-V.)
| | - Carlos Aroso
- UNIPRO—Oral Pathology and Rehabilitation Research Unit, University Institute of Health Sciences (IUCS), Cooperativa de Ensino Politécnico e Universitario (CESPU), 4585-116 Granda, Portugal;
| | - Aritza Brizuela-Velasco
- DENS-ia Research Group, Faculty of Health Sciences, Miguel de Cervantes European University, 47012 Valladolid, Spain; (S.F.-H.); (A.B.-V.)
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Zaninovich M, Petrucci C, Drago C. Classification system for maxillary fixed dental prostheses. J Prosthodont 2024. [PMID: 39023038 DOI: 10.1111/jopr.13905] [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: 04/12/2024] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE To present an addendum to existing fixed dental prostheses (FDPs) classification system for maxillary prostheses. The new classification identifies the relationships between FP-1 (fixed prostheses) designs and newly developed clinical interdental gingival contours. MATERIALS AND METHODS Clinical and laboratory descriptions of the various types of full-arch fixed prostheses are described with photographic illustrations. Benefits and limitations of the various prosthetic designs are explained. Surgical differences in the amount of alveolectomy are illustrated. One clinical case is demonstrated. RESULTS A new classification system for maxillary implant fixed complete dentures is presented. The new system will serve as an improved communication aid for clinicians, patients, and laboratory technicians. Treatment of patients with edentulous maxillae and/or terminal dentitions and implant fixed complete dentures include several options relative to design and materials. Restorative space can have a major impact on prosthesis design and longevity. Early on in dental implant therapy, prostheses were generally made with cast metal frameworks, denture bases and denture teeth. Prosthetic complications were widely reported. With increased clinical experience and improved materials, computer-aided design and computer-aided manufacturing (CAD-CAM) protocols were developed that allowed stronger prostheses to be constructed in reduced or small restorative volumes. FP-1 ceramic implant-supported fixed prostheses (CISFPs) are designed to replace only the dental hard tissues and to promote preservation and rehabilitation of gingival soft tissues. The physical properties and minimum thickness requirements in full arch prostheses are influenced by several factors including distances between implants and rigid connector sizes. CONCLUSION FP-1 CISFPs may be the closest prostheses the profession can offer edentulous patients that mimic the look, feel, and function of missing dentitions. Aesthetic outcomes of FP-1 CISFPs are variable and depend on a multitude of factors. This article presented a classification system that builds on existing classification by identifying the level of papilla heights achieved with FP-1 CISFPs.
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Affiliation(s)
- Michael Zaninovich
- Aria Dental Specialist Implant Centre, Perth, Western Australia, Australia
| | | | - Carl Drago
- Greenbrook Dental Group, Brookfield, Wisconsin, US
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10
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Pandey N, Karlin S, Bornstein MM, Rohr N. An Approach to Improve Specimen Processing for the Flexural Strength Testing of Zirconia. MATERIALS (BASEL, SWITZERLAND) 2024; 17:3479. [PMID: 39063771 PMCID: PMC11278445 DOI: 10.3390/ma17143479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 07/03/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024]
Abstract
Measuring the flexural strength of restorative materials such as zirconia is crucial for providing proper indications for clinical applications and predicting performance. Great variations in specimen preparation for flexural strength measurements exist among laboratories. The aim was to evaluate how the processing method, surface treatment, and test method of the specimens affect the flexural strength of zirconia. Zirconia specimens (VITA YZ HT) (n = 270) were processed using CAD/CAM or were conventionally milled with three different surface treatments (machined, ground, polished) and were measured with three-point bending (non-chamfered/chamfered) or biaxial flexural strength test. Weibull statistics were conducted. The mean flexural strength values ranged from 612 MPa (conventional, machined, three-point bending non-chamfered) to 1143 MPa (CAD/CAM, polished, biaxial flexural strength). The highest reliability is achieved when specimens are prepared using thoroughly controllable processing with CAD/CAM and subsequently polished. Higher strength values are achieved with the biaxial flexural strength test method because the stress concentration in relation to the effective volume is smaller. Polishing reduces surface microcracks and therefore increases the strength values.
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Affiliation(s)
- Nashib Pandey
- Biomaterials and Technology, Department Research, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
- Department of Periodontics & Oral Implantology, College of Medical Sciences, Bharatpur 44207, Nepal
| | - Sabrina Karlin
- Biomaterials and Technology, Department Research, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
| | - Michael Marc Bornstein
- Department of Oral Health & Medicine, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
| | - Nadja Rohr
- Biomaterials and Technology, Department Research, University Center for Dental Medicine Basel UZB, University of Basel, 4058 Basel, Switzerland
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11
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Chander NG, Reddy DR. Comparing the influence of cuspal angulation, occlusal loading, and connector widths between tooth- and implant-supported zirconia fixed dental prosthesis. Med J Armed Forces India 2024; 80:442-448. [PMID: 39071759 PMCID: PMC11280270 DOI: 10.1016/j.mjafi.2023.10.004] [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: 02/03/2023] [Accepted: 10/09/2023] [Indexed: 07/30/2024] Open
Abstract
Background Few studies have established the relationship between connector widths, cuspal angulation, loading forces, and supporting structures of zirconia fixed dental prosthesis (FDP). The objective of the study was to compare the stress distribution in implant- and tooth-supported zirconia FDP with different connector designs, and cuspal angulations of replaced teeth under diverse angulations of forces. Methods Finite element (FE) analysis was done by simulating a 3-unit implant- and tooth-supported FDP. FE models with varying cuspal angulations 0°, 20°, and 33° and connector designs 2 mm, 2.5 mm, and 3 mm was generated. The simulated models were loaded with 100 N of forces under different axial and non-axial angulations. The graphical and numerical stresses were observed, recorded, and statistically analyzed. Results Higher stress of 245.55 MPa in implant-supported FDP and lower stress value of 28.22 MPa in tooth-supported FDP was observed at 0-cuspal inclination for 3 mm connector width. The data were statistically analyzed with unpaired t test to eliminate the differences. The inter-group, intra-group tests, p and t values for various connector, and tooth angulations of tooth- and implant-supported FDP were statistically insignificant. (p > 0.05). Conclusion There was no statistically significant difference in stress was observed between tooth- and implant-supported FDP for different connector widths, cuspal inclination, and diverse angulation of forces.
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Affiliation(s)
| | - D. Ravindra Reddy
- Resident (Prosthodontics), SRM Dental College, Chennai, Tamilnadu, India
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Lopes ACO, Benalcázar-Jalkh EB, Bergamo ETP, Campos TMB, de Carvalho LF, Tanaka R, Genova LA, Yamaguchi S, Witek L, Coelho PG, Bonfante EA. Development of ZTA (80% Al 2O 3/20% ZrO 2) pre-sintered blocks for milling in CAD/CAM systems. J Mech Behav Biomed Mater 2024; 154:106533. [PMID: 38598918 DOI: 10.1016/j.jmbbm.2024.106533] [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: 02/23/2024] [Revised: 03/29/2024] [Accepted: 03/29/2024] [Indexed: 04/12/2024]
Abstract
The present work aims to develop a production method of pre-sintered zirconia-toughened-alumina (ZTA) composite blocks for machining in a computer-aided design and computer-aided manufacturing (CAD-CAM) system. The ZTA composite comprised of 80% Al2O3 and 20% ZrO2 was synthesized, uniaxially and isostatically pressed to generate machinable CAD-CAM blocks. Fourteen green-body blocks were prepared and pre-sintered at 1000 °C. After cooling and holder gluing, a stereolithography (STL) file was designed and uploaded to manufacture disk-shaped specimens projected to comply with ISO 6872:2015. Seventy specimens were produced through machining of the blocks, samples were sintered at 1600 °C and two-sided polished. Half of the samples were subjected to accelerated autoclave hydrothermal aging (20h at 134 °C and 2.2 bar). Immediate and aged samples were characterized by scanning electron microscopy (SEM) and X-ray diffraction (XRD). Optical and mechanical properties were assessed by reflectance tests and by biaxial flexural strength test, Vickers indentation and fracture toughness, respectively. Samples produced by machining presented high density and smooth surfaces at SEM evaluation with few microstructural defects. XRD evaluation depicted characteristic peaks of alpha alumina and tetragonal zirconia and autoclave aging had no effect on the crystalline spectra of the composite. Optical and mechanical evaluations demonstrated a high masking ability for the composite and a characteristic strength of 464 MPa and Weibull modulus of 17, with no significant alterations after aging. The milled composite exhibited a hardness of 17.61 GPa and fracture toughness of 5.63 MPa m1/2, which remained unaltered after aging. The synthesis of ZTA blocks for CAD-CAM was successful and allowed for the milling of disk-shaped specimens using the grinding method of the CAD-CAM system. ZTA composite properties were unaffected by hydrothermal autoclave aging and present a promising alternative for the manufacture of infrastructures of fixed dental prostheses.
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Affiliation(s)
- Adolfo C O Lopes
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
| | - Ernesto B Benalcázar-Jalkh
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil.
| | - Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil; Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA; Department of Prosthodontics, NYU Dentistry, New York, NY, 10010, USA
| | - Tiago M B Campos
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
| | - Laura F de Carvalho
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
| | - Ricardo Tanaka
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil; Tanaka Lab, São Paulo, SP, Brazil
| | - Luis A Genova
- Nuclear and Energy Research Institute, IPEN, SP, Brazil
| | - Satoshi Yamaguchi
- Department of Dental Biomaterials, Osaka University Graduate School of Dentistry, Suita, Osaka, Japan
| | - Lukasz Witek
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA; Department of Biomedical Engineering, NYU Tandon School of Engineering, New York University, Brooklyn, NY, USA; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA
| | - Paulo G Coelho
- DeWitt Daughtry Family Department of Surgery, Division of Plastic Surgery, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA; Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, Miami, FL, 33136, USA
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
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Kang CM, Hsu WC, Chen MS, Wu HY, Mine Y, Peng TY. Fracture characteristics and translucency of multilayer monolithic zirconia crowns of various thicknesses. J Dent 2024; 145:105023. [PMID: 38670331 DOI: 10.1016/j.jdent.2024.105023] [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: 02/08/2024] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 04/28/2024] Open
Abstract
OBJECTIVES Multilayer monolithic zirconia (M-Zr) crowns can be engineered to achieve gradational translucency and color intensity. However, this modification may compromise the mechanical strength, raising concerns regarding the ability of M-Zr crowns to withstand occlusal stresses. The effects of M-Zr crown thickness on translucency and ability to endure occlusal forces were investigated at different tooth positions (incisors, premolars, and molars). The objective was to determine the minimal thickness of M-Zr crowns used in tooth preparation to meet aesthetic and functional demands. METHODS M-Zr samples (Vita A1) with four thicknesses (0.5, 1.0, 1.5, and 2.0 mm) were prepared and subjected to translucency testing using a digital colorimeter by 3-third and 9-square division methods. Crown-shaped M-Zr samples with three thicknesses (1.0, 1.5, and 2.0 mm) and three tooth positions (incisor, premolar, and molar) were digitally designed, and 2.0 mm metal abutments were fabricated. The samples were bonded to the abutments; their fracture characteristics were evaluated using a universal testing machine, and their fracture surfaces examined using an optical microscope. Statistical analyses included the Shapiro-Wilk test, Pearson correlation, and one-way and two-way ANOVA with a post hoc Tukey HSD test (α = 0.05). RESULTS Color analysis results revealed a significant negative correlation between thickness and translucency (r < -0.96, P < 0.01), with the highest values in the incisal region. Cross-sectional profiles confirmed the uniform thickness and morphology of the digitally designed M-Zr crowns. The results of fracture strength analysis showed position-dependent variability, a strong positive correlation with thickness (r > 0.96, P < 0.01), and fracture strengths consistently exceeding 1200 N across all tooth positions. Fracture patterns indicated that thinner crowns at the incisors and molars were more prone to cracking, whereas those at the premolars demonstrated significantly higher strength (4872.51 N, P < 0.05), only with crack or even no fracture occurring at 2.0 mm. CONCLUSIONS Thickness significantly influenced both the translucency and fracture strength of M-Zr, with the tooth position playing an additional role, albeit to a lesser extent. Although thinner crowns exhibited lower strength at each tooth position, even at a thickness of 1.0 mm, fracture strength exceeding 1200 N was maintained, surpassing the typical occlusal forces. Thus, it can be asserted that M-Zr crowns with a minimum thickness of 1.0 mm can meet both aesthetic and functional requirements.
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Affiliation(s)
- Chien-Ming Kang
- Huayi Dental Laboratory, Taipei, Taiwan; School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wen-Chieh Hsu
- School of Dentistry, College of Oral Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Oral Hygiene, Hsin Sheng Junior College of Medical Care and Management, Taoyuan, Taiwan; Research Center of Precision Biomedical Implants, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - May-Show Chen
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan; Division of Prosthodontics, Department of Dentistry, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsuan-Yu Wu
- School of Dental Technology, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yuichi Mine
- Department of Medical Systems Engineering, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Project Research Center for Integrating Digital Dentistry, Hiroshima University, Hiroshima, Japan
| | - Tzu-Yu Peng
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan.
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Baus-Domínguez M, Oliva-Ferrusola E, Maza-Solano S, Ruiz-de-León G, Serrera-Figallo MÁ, Gutiérrez-Perez JL, Torres-Lagares D, Macías-García L. Biological Response of the Peri-Implant Mucosa to Different Definitive Implant Rehabilitation Materials. Polymers (Basel) 2024; 16:1534. [PMID: 38891480 PMCID: PMC11174483 DOI: 10.3390/polym16111534] [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: 04/28/2024] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND Sealing the peri-implant tissue is a determining factor for long-term implant survival. In the transmucosal region, the cervical fraction of the prosthetic crown is in contact with these tissues, so mucointegration will also be influenced by the biomaterial used for the prosthetic restoration. This study aims to compare the tissue response generated by definitive restorative materials and polymeric materials from a histological point of view. METHODS This study performed an observational prospective cohort study in which biopsies of the peri-implant mucosa were taken after placement of implant-supported prosthetic restorations made of different materials (zirconium oxide, lithium disilicate, and PMMA). RESULTS A statistically significant difference was observed in the increase in the thickness of the non-keratinized epithelium when comparing the definitive materials (zirconium oxide/lithium disilicate) vs. the provisional material (PMMA) and in the number of collagen fibers when comparing zirconium oxide and lithium disilicate. CONCLUSIONS This study found that zirconia is the material that presents the most adequate biological response of peri-implant tissues. It shows a lower intensity of inflammatory cellular content, a total normality in the number of collagen fibers (the arrangement of the fibers is normal in 90% of the cases), and vascular proliferation of connective tissue in 83% of the cases. These parameters make it a material with a predictable response. Similarly, only the following slight statistically significant differences between the definitive and provisional materials are observed, indicating that the biological response generated by the provisional material (PMMA) is not very different from that obtained with the placement of the definitive restoration.
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Affiliation(s)
- María Baus-Domínguez
- Department of Stomatology, Faculty of Dentistry, University of Seville, C/Avicena S/N, 41009 Seville, Spain; (E.O.-F.); (S.M.-S.); (G.R.-d.-L.); (M.-Á.S.-F.); (J.-L.G.-P.); (D.T.-L.)
| | - Elena Oliva-Ferrusola
- Department of Stomatology, Faculty of Dentistry, University of Seville, C/Avicena S/N, 41009 Seville, Spain; (E.O.-F.); (S.M.-S.); (G.R.-d.-L.); (M.-Á.S.-F.); (J.-L.G.-P.); (D.T.-L.)
| | - Serafín Maza-Solano
- Department of Stomatology, Faculty of Dentistry, University of Seville, C/Avicena S/N, 41009 Seville, Spain; (E.O.-F.); (S.M.-S.); (G.R.-d.-L.); (M.-Á.S.-F.); (J.-L.G.-P.); (D.T.-L.)
| | - Gonzalo Ruiz-de-León
- Department of Stomatology, Faculty of Dentistry, University of Seville, C/Avicena S/N, 41009 Seville, Spain; (E.O.-F.); (S.M.-S.); (G.R.-d.-L.); (M.-Á.S.-F.); (J.-L.G.-P.); (D.T.-L.)
| | - María-Ángeles Serrera-Figallo
- Department of Stomatology, Faculty of Dentistry, University of Seville, C/Avicena S/N, 41009 Seville, Spain; (E.O.-F.); (S.M.-S.); (G.R.-d.-L.); (M.-Á.S.-F.); (J.-L.G.-P.); (D.T.-L.)
| | - José-Luis Gutiérrez-Perez
- Department of Stomatology, Faculty of Dentistry, University of Seville, C/Avicena S/N, 41009 Seville, Spain; (E.O.-F.); (S.M.-S.); (G.R.-d.-L.); (M.-Á.S.-F.); (J.-L.G.-P.); (D.T.-L.)
| | - Daniel Torres-Lagares
- Department of Stomatology, Faculty of Dentistry, University of Seville, C/Avicena S/N, 41009 Seville, Spain; (E.O.-F.); (S.M.-S.); (G.R.-d.-L.); (M.-Á.S.-F.); (J.-L.G.-P.); (D.T.-L.)
| | - Laura Macías-García
- Department of Cytology and Normal and Pathological Histology, School of Medicine, University of Seville, Av. Sánchez Pizjuán S/N, 41009 Seville, Spain
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Maceiras L, Liñares A, Nóvoa L, Batalla P, Mareque S, Pérez J, Blanco J. Marginal changes at bone-level implants supporting dental prostheses with or without intermediate standardised abutments after 36 months: Randomised controlled clinical trial. Clin Oral Implants Res 2024. [PMID: 38797975 DOI: 10.1111/clr.14297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2023] [Revised: 03/18/2024] [Accepted: 05/13/2024] [Indexed: 05/29/2024]
Abstract
OBJECTIVE The objective of this study is to evaluate the changes at marginal bone level at implants restored with screw-retained prosthesis connected directly to the implants or with an intermediate abutment, after 3-year follow-up. MATERIAL AND METHODS Thirty-six partially edentulous patients received 72 implants. Each patient received 2 implants and a 2-4-unit screw-retained implant-prosthesis. The test group implants received a screw-retained prosthesis connected directly to the implant shoulder, the control group prosthesis were connected through a 3-mm standardised intermediate abutment. Clinical and radiological data were recorded at baseline and at 6-, 12-, and 36-month follow-up. RESULTS At 36 months, the mean marginal bone loss was 0.13 ± 0.18 mm for the control group and 0.20 ± 0.24 for the test group, with no significant differences between groups (p > .05). Clinical variables (Probing Pocket Depth, Bleeding on Probing and Plaque Index) at 36 months also showed no significant difference between groups. Minor complications frequency was 6.7% in the control group and 5.3% in test group. None of the groups suffered from mayor complications. Patient Reported Outcomes (PROs) showed a General Satisfaction mean score in the control group of 9.40 (SD 0.82) and 9.37 (SD 1.06) in the test group with no significant differences between groups. CONCLUSIONS Bone-level implants restored with screw-retained partial prostheses with or without intermediate abutments showed similar radiographic and clinical outcomes after 3 years.
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Affiliation(s)
- Lucía Maceiras
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Antonio Liñares
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
- Medical-Surgical Odontology (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Lourdes Nóvoa
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Pilar Batalla
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | - Santiago Mareque
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Juan Blanco
- Periodontology Unit, School of Medicine and Dentistry, University of Santiago de Compostela, Santiago de Compostela, Spain
- Medical-Surgical Odontology (OMEQUI) Research Group, Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Angermair J, Iglhaut G, Meyenberg K, Wiest W, Rack A, Zabler S, Fretwurst T, Nelson K, Kernen F. In vitro assessment of internal implant-abutment connections with different cone angles under static loading using synchrotron-based radiation. BMC Oral Health 2024; 24:396. [PMID: 38549137 PMCID: PMC10976688 DOI: 10.1186/s12903-024-04156-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 03/18/2024] [Indexed: 04/01/2024] Open
Abstract
BACKGROUND The stability of implant-abutment connection is crucial to minimize mechanical and biological complications. Therefore, an assessment of the microgap behavior and abutment displacement in different implant-abutment designs was performed. METHODS Four implant systems were tested, three with a conical implant-abutment connection based on friction fit and a cone angle < 12 ° (Medentika, Medentis, NobelActive) and a system with an angulated connection (< 40°) (Semados). In different static loading conditions (30 N - 90º, 100 N - 90º, 200 N - 30º) the microgap and abutment displacement was evaluated using synchrotron-based microtomography and phase-contrast radioscopy with numerical forward simulation of the optical Fresnel propagation yielding an accuracy down to 0.1 μm. RESULTS Microgaps were present in all implant systems prior to loading (0.15-9 μm). Values increased with mounting force and angle up to 40.5 μm at an off axis loading of 100 N in a 90° angle. CONCLUSIONS In contrast to the implant-abutment connection with a large cone angle (45°), the conical connections based on a friction fit (small cone angles with < 12°) demonstrated an abutment displacement which resulted in a deformation of the outer implant wall. The design of the implant-abutment connection seems to be crucial for the force distribution on the implant wall which might influence peri-implant bone stability.
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Affiliation(s)
| | - Gerhard Iglhaut
- Department of Oral and Maxillofacial Surgery, Translational Implantology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | | | - Wolfram Wiest
- Chair of X-ray Microscopy LRM, University Würzburg, 97074, Würzburg, Germany
| | - Alexander Rack
- Experiments Division, ESRF - The European Synchrotron, Grenoble, France
| | - Simon Zabler
- Deggendorf Institute of Technology DIT, Dieter-Görlitz-Platz 2, 94469, Deggendorf, Germany
| | - Tobias Fretwurst
- Department of Oral and Maxillofacial Surgery, Translational Implantology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, Translational Implantology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany
| | - Florian Kernen
- Department of Oral and Maxillofacial Surgery, Translational Implantology, Medical Center, Faculty of Medicine, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany.
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Bakitian F. Flexural Strength of Translucent Zirconia Materials Produced with Different Multilayer Technologies: An In Vitro Study. Int J Dent 2024; 2024:8410101. [PMID: 38571767 PMCID: PMC10990640 DOI: 10.1155/2024/8410101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 03/08/2024] [Accepted: 03/10/2024] [Indexed: 04/05/2024] Open
Abstract
Objective To evaluate the flexural strength of two translucent multilayered zirconia materials produced with different multilayer technologies. Methodology. Eighty bar-shaped zirconia specimens were prepared from two different multilayered zirconia materials (IPS e.max® ZirCAD Prime and KATANA™ Multilayered Zirconia HTML) and divided into eight groups (n = 10) based on the materials used and the individual layers of the disc for each material: Dentin Prime, Transition Prime, Translucent Prime, Multilayered Prime, Dentin HTML, Transition HTML, Translucent HTML, and Multilayered HTML. The bar-shaped zirconia specimens were cut to include all the layers from translucent to dentin In Multilayered Prime and Multilayered HTML groups. All specimens were fully sintered after cutting from multilayered zirconia discs and subjected to three-point flexural strength test using the universal testing machine. Results The specimens made of HTML zirconia material showed significantly (P < 0.001) higher flexural strength than those made of IPS e.max® ZirCAD Prime material, with no significant difference (P > 0.05) compared to the specimens in the Dentin Prime group. The Dentin Prime specimens had the highest flexural strength (743 ± 116 MPa) compared to those in the Translucent Prime (514 ± 120 MPa), Transition Prime (575 ± 102 MPa), and Multilayered Prime (531 ± 132 MPa) groups. The flexural strength of the specimens from the individual layers of HTML zirconia material was not significantly different (P > 0.05) among the Dentin HTML (763 ± 56 MPa), Translucent HTML (791 ± 106 MPa), Transition HTML (816 ± 85 MPa), and Multilayered HTML (793 ± 102 MPa) groups. Conclusion Multilayered zirconia materials produced with different yttria contents by layer have lower flexural strength than those produced with gradient shade technology and the same yttria content for each layer. Therefore, various factors such as the type of prostheses, nesting strategies of prostheses within the zirconia disc, and the desired aesthetical requirements should be considered when selecting the multilayered zirconia materials.
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Affiliation(s)
- Fahad Bakitian
- Department of Restorative Dentistry, Faculty of Dental Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
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18
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Narde J, Ahmed N, Marrapodi MM, Siurkel Y, Ronsivalle V, Cicciù M, Minervini G. Evaluation and assessment of the survival of tooth implant supported prosthesis in tooth and implant supported rehabilitation cases with metal frameworks. BMC Oral Health 2024; 24:379. [PMID: 38519932 PMCID: PMC10960445 DOI: 10.1186/s12903-024-04117-9] [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: 12/25/2023] [Accepted: 03/07/2024] [Indexed: 03/25/2024] Open
Abstract
INTRODUCTION Over the years, implant therapy has been a commonly used treatment option for individuals who are partially or totally edentulous, with a long-term success rate of over 90%. With significant advancements in biomaterials and technology, implant dentistry can now conduct prosthetic rehabilitations in the majority of patients catering to all types of needs. However, in order to meet the demands of a patient base that is always growing, new trends in implantology are emerging in recent years that are focused on minimally invasive surgery and financial sustainability. In certain clinical scenarios, connecting teeth and implants to support fixed partial prosthesis (FPPs) may be a predictable and workable course of treatment. MATERIALS AND METHODS 22 patients were selected for this study who had tooth and implant supported prosthesis placed as a final restoration. Out of these 22 patients; 12 were male and 10 were female patients. Implants were placed following proper protocol and if grafting procedures were required they were carried out. A second stage surgical procedure was carried out and delayed loading protocols were followed. The statistical analysis was done using the IBM SPSS 24.0, Chicago, USA. The survival of the implants and teeth were measured by the Kaplan Meier survival scale. Bone loss was assessed at baseline(upon loading), 12 months and 24 months. RESULTS The implant survival rate was measured at 6 months, 12 months, 18 months and 24 months. At 24 months, one implant showed failure, so the survival rate of the implants were 95.4%. Bone loss of 1 mm was seen around one implant at 12 months. Bone loss of 1 and 2 mm was present around two implants and one implant respectively at 24 months. CONCLUSION From the results of this study, we can conclude that tooth implant supported prosthesis show very good survival when used in rehabilitation cases.
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Affiliation(s)
- Joshua Narde
- Department of Prosthodontics, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospital, Saveetha University, Chennai, India
| | - Nabeel Ahmed
- Department of Prosthodontics, Saveetha Institute of Medical and Technical Sciences, Saveetha Dental College and Hospital, Saveetha University, Chennai, India.
| | - Maria Maddalena Marrapodi
- Department of Woman, Child and General and Specialist Surgery, University of Campania "Luigi Vanvitelli,", Naples, 80138, Italy
| | - Yuliia Siurkel
- International European University School of Medicine, Akademika Hlushkova Ave, 42В, Kyiv, Kyiv, 03187, Ukraine.
| | - Vincenzo Ronsivalle
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, 95123, Italy
| | - Marco Cicciù
- Department of Biomedical and Surgical and Biomedical Sciences, Catania University, Catania, 95123, Italy
| | - Giuseppe Minervini
- Saveetha Dental College and Hospitals, Saveetha Institute of Medical and Technical Sciences (SIMATS), Saveetha University, Chennai, Tamil Nadu, India
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli", Naples, 80121, Italy
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19
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Zhang Y, Luo J, Di P, Chen B, Li J, Yu Z, Lin Y. Screw-retained ceramic-veneered/monolithic zirconia partial implant-supported fixed dental prostheses: A 5 to 10-year retrospective study on survival and complications. J Prosthodont 2024; 33:221-230. [PMID: 37302066 DOI: 10.1111/jopr.13723] [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: 01/08/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To assess the clinical performance of screw-retained, ceramic-veneered, monolithic zirconia partial implant-supported fixed dental prostheses (ISFDP) over 5-10 years and to evaluate implant- and prosthesis-related factors influencing treatment failure and complications. MATERIALS AND METHODS Partially edentulous patients treated with screw-retained all-ceramic ISFDPs with 2-4 prosthetic units with a documented follow-up of ≥5 years after implant loading were included in this retrospective study. The outcomes analyzed included implant/prosthesis failure and biological/technical complications. Possible risk factors were identified using the mixed effects Cox regression analysis. RESULTS A screened sample of 171 participants with 208 prostheses (95% of the restorations were splinted crowns without a pontic) supported by 451 dental implants were enrolled in this study. The mean follow-up duration after prosthesis delivery was 82.4 ±17.2 months. By the end of the follow-up period, 431 (95.57%) of the 451 implants remained functional at the implant level. At the prosthesis level, 185 (88.94%) of the 208 partial ISFDPs remained functional. Biological complications were observed in 67 implants (14.86%), and technical complications were observed in 62 ISFDPs (29.81%). Analysis revealed only emergence profiles (over-contoured) as a significant risk factor for implant failure (P<0.001) and biological complications (P<0.001). Full-coverage ceramic-veneered zirconia prostheses had a significantly greater chance of chipping (P<0.001) compared with buccal-ceramic-veneered or monolithic zirconia prostheses. CONCLUSIONS Screw-retained ceramic-veneered, monolithic partial ISFDPs have a favorable long-term survival rate. Over-contoured emergence profile is a significant risk factor associated with implant failure and biological complications. Buccal-ceramic-veneered and monolithic zirconia partial ISFDPs lower the initial prevalence of chipping compared with a full-coverage veneered design.
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Affiliation(s)
- Yifan Zhang
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Jia Luo
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Ping Di
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Bo Chen
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Jianhui Li
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Ziyang Yu
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
| | - Ye Lin
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, PR China
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Teng WS, Yew HZ, Jamadon NH, Qamaruz Zaman J, Meor Ahmad MI, Muchtar A. Effect of porcelain veneering technique in bilayered zirconia on bond strength and residual stress distribution. J Mech Behav Biomed Mater 2024; 151:106361. [PMID: 38176199 DOI: 10.1016/j.jmbbm.2023.106361] [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: 11/09/2023] [Revised: 12/26/2023] [Accepted: 12/27/2023] [Indexed: 01/06/2024]
Abstract
The use of all porcelain materials in dentistry has significantly increased in recent years. However, chipping has remained a common problem that affects bilayered zirconia restorations. Bonding between porcelain and the underlying zirconia framework is crucial to the success of the restoration. The bond strength may be affected by such factors as residual thermal stress and the veneering technique. This research focuses on investigating the potential and constraints of materials through an examination of the porcelain veneering technique, particularly hand-layering and heat-pressing. Forty-two cylindrical disc samples of zirconia (n = 7/group) were fabricated in the dimensions of 10 × 1.2 mm (diameter [D] × height [H]). The zirconia specimens were milled from IPS e.max® ZirCad [Z] block and Luxen Zr [L] block (n = 21/zirconia). The zirconia cores were layered with IPS e.max® Zirliner and heat-pressed with IPS e.max® ZirPress to produce a final veneer dimension of 5 × 3 mm (D × H). Conventional layering was performed for the rest of the zirconia cores using IPS e.max® Ceram and Shofu Vintage Zr. The final study groups were Luxen-Vintage (LV), Luxen-Ceram (LC), Luxen Zirpress (LP), ZirCad-Vintage (ZV), ZirCad-Ceram (ZC) and ZirCad-Zirpress (ZP). Five samples were subjected to shear bond testing (SBS) with a universal testing machine with a 5 kN load cell and 0.5 mm/min crosshead speed (n = 5/group). A sample underwent nanoindentation, and another was sectioned using Isomet machine to study the bonding interface. One-way ANOVA was used to run the statistical analyses of the SBS test. Statistical differences were found between ZV with LC and LP (p < 0.05). Residual stress is estimated to be higher in the middle of the porcelain compared with that on the surface and the interface. FESEM imaging reveals portions of visible bare zirconia on Luxen zirconia, whilst crack propagation occurred through voids in all hand-layered groups. Heat-pressed veneering showed comparable but not superior results to conventional hand-layered veneering. Heat-pressed veneering produced similar stress distribution profiles compared with hand-layered veneering.
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Affiliation(s)
- Wen Sheng Teng
- Restorative Department, Faculty of Dentistry, National University of Malaysia, Malaysia
| | - Hsu Zenn Yew
- Restorative Department, Faculty of Dentistry, National University of Malaysia, Malaysia.
| | - Nashrah Hani Jamadon
- Department of Mechanical & Manufacturing Engineering, Faculty of Engineering & Built Environment, National University of Malaysia, Malaysia
| | - Jasmina Qamaruz Zaman
- Restorative Department, Faculty of Dentistry, National University of Malaysia, Malaysia
| | - Meor Iqram Meor Ahmad
- Department of Mechanical & Manufacturing Engineering, Faculty of Engineering & Built Environment, National University of Malaysia, Malaysia
| | - Andanastuti Muchtar
- Department of Mechanical & Manufacturing Engineering, Faculty of Engineering & Built Environment, National University of Malaysia, Malaysia
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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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Wang L, Wang K, Sheng Y, Hao Z, Tang W, Dou R. The effect of phase contents on the properties of yttria stabilized zirconia dental materials fabricated by stereolithography-based additive manufacturing. J Mech Behav Biomed Mater 2024; 150:106313. [PMID: 38109815 DOI: 10.1016/j.jmbbm.2023.106313] [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: 09/29/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/20/2023]
Abstract
The aim is to investigate the impact of phase contents on mechanical properties, translucency, and aging stability of additively manufactured yttria partially stabilized zirconia ceramics. For that purpose, we evaluated two PSZ materials. The first type was prepared utilizing commercially available 5 mol% yttria-stabilized zirconia(5Y-PSZ), while the second type, denoted as 3Y+8Y-PSZ ceramics, was fabricated by blending 3 mol% and 8 mol% yttria-stabilized zirconia powders. Compared to 5Y-PSZ (39.90 wt% tetragonal phases and c/a2 = 1.0141), 3Y+8Y-PSZ is characterized by a greater abundance of tetragonal phases (47.68 wt%), which display higher tetragonality (c/a2 = 1.0165) and lower yttrium oxide content (2.25mol%). As a result, the 3Y+8Y-PSZ demonstrates elevated strength (816.52 MPa) and toughness (4.32 MPa m1/2), accompanied by reduced translucency(CR:0.47) and it exhibits greater susceptibility to aging. The phase contents, yttrium oxide content, and lattice parameters in the tetragonal phase play a crucial role in determining the mechanical properties, translucency, and aging stability of PSZ ceramics.
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Affiliation(s)
- Li Wang
- Jiangsu Key Laboratory of Advanced Food Manufacturing Equipment and Technology, School of Mechanical Engineering, Jiangnan University, Wuxi, 214122, Jiangsu, China; Institute of Advanced Technology, Jiangnan University, Wuxi, 214122, Jiangsu, China.
| | - Kang Wang
- Jiangsu Key Laboratory of Advanced Food Manufacturing Equipment and Technology, School of Mechanical Engineering, Jiangnan University, Wuxi, 214122, Jiangsu, China; Institute of Advanced Technology, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Yang Sheng
- Jiangsu Key Laboratory of Advanced Food Manufacturing Equipment and Technology, School of Mechanical Engineering, Jiangnan University, Wuxi, 214122, Jiangsu, China; Institute of Advanced Technology, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Zongdong Hao
- Jiangsu Key Laboratory of Advanced Food Manufacturing Equipment and Technology, School of Mechanical Engineering, Jiangnan University, Wuxi, 214122, Jiangsu, China; Institute of Advanced Technology, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Weizhe Tang
- Jiangsu Key Laboratory of Advanced Food Manufacturing Equipment and Technology, School of Mechanical Engineering, Jiangnan University, Wuxi, 214122, Jiangsu, China; Institute of Advanced Technology, Jiangnan University, Wuxi, 214122, Jiangsu, China
| | - Rui Dou
- Jiangsu Key Laboratory of Advanced Food Manufacturing Equipment and Technology, School of Mechanical Engineering, Jiangnan University, Wuxi, 214122, Jiangsu, China; Institute of Advanced Technology, Jiangnan University, Wuxi, 214122, Jiangsu, China.
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Al Helou H, Kassis J, Zaidani W, Bylasani T. The effect of repeated baking of porcelain on its bonding strength to a Co-Cr alloy 3D-printed by selective laser melting. Saudi Dent J 2024; 36:296-300. [PMID: 38419985 PMCID: PMC10897619 DOI: 10.1016/j.sdentj.2023.11.002] [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: 07/21/2023] [Revised: 10/31/2023] [Accepted: 11/01/2023] [Indexed: 03/02/2024] Open
Abstract
Objectives This study aimed to evaluate the effect of multiple baking cycles of porcelain on its shear bond strength to a cobalt-chromium (Co-Cr) alloy that is three-dimensionally printed using Selective Laser Melting (SLM) technique. Materials and methods The research sample comprised forty-eight discs measuring 5 mm × 3 mm, divided into four groups according to: the manufacturing method (SLM, casting) and the number of porcelain baking cycles (1, 3) as follows: Group A: Co-Cr alloy by SLM with one baking cycle; Group B: Co-Cr alloy by SLM with three baking cycles; Group C: Ni-Cr alloy by casting with one baking cycle; Group D: Ni-Cr alloy by casting with three baking cycles. Then, porcelain was melted on disks, shear testing was performed and the values of the Shear Bond Strength (SBS) in MegaPascals (MPa) were calculated. Results The mean SBS values for each group were (A: 25.69 - B: 19.51 - C: 35.72 - D: 28.67 MPa). Statistical analysis showed that the manufacturing method and the number of porcelain baking cycles had a significant influence on shear bond durability (P > 0.05): the strength of this bond decreased when baking cycles increased. The Co-Cr samples manufactured by SLM also showed a decrease in binding strength compared to the Ni-Cr samples made by casting. Conclusion Repeated baking of porcelain reduces the strength of the porcelain bond with the Co-Cr alloy made by Selective Laser Melting (SLM) technique.
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Affiliation(s)
- Hiba Al Helou
- Head of the Department of Prosthodontics at Arab Private University of Science and Technology (AUST), Hama Homs international road, Tel Qartal Junction, Syria
| | - Joul Kassis
- Researcher at the Department of Oral and Maxillofacial Surgery, Damascus University, Fayez Mansour Highway, Mazzeh, Damascus, Syria
| | - Wael Zaidani
- Dental student at Arab Private University of Science and Technology (AUST), Hama Homs international road, Tel Qartal Junction, Syria
| | - Tareq Bylasani
- Dental student at Arab University of Science and Technology (AUST), Hama Homs international road, Tel Qartal Junction, Syria
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Toia M, Parpaiola A, Stevanello N, Tattan M, Saleh MHA, Ravidà A. Clinical outcomes of implant- versus abutment-level connection in screw-retained fixed dental prostheses: A 5-year randomized controlled trial. Clin Oral Implants Res 2024; 35:230-241. [PMID: 38012845 DOI: 10.1111/clr.14217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/26/2023] [Accepted: 11/14/2023] [Indexed: 11/29/2023]
Abstract
AIM The aim of the study was to evaluate the 5 years clinical outcomes associated with implant-level connection (IL) versus abutment-level connection (AL) for implants with an internal conical connection (ICC) supporting a screw-retained fixed partial denture. MATERIALS AND METHODS Fifty patients with 119 implants were randomly allocated to either the AL or IL group. Radiographic (Marginal bone loss) and clinical outcomes (Bleeding on Probing, probing pocket depth, plaque accumulation, incidence of peri-implantitis and peri-implant mucositis as well as prosthetic complications) were collected and compared at 1, 2, 3, and 5 years. A linear mixed model was used to evaluate the differences between groups. RESULTS Five years after treatment, the MBL change was not significantly different between the groups at any point. The MBL was 0.23 ± 0.64 mm (AL) and 0.23 ± 0.29 mm (IL). The bleeding on Probing was 44% (AL) and 45% (IL) (p = .89). The mean probing depth was 2.91 ± 1.01 mm (AL) and 3.51 ± 0.67 mm (IL). This difference between the groups was statistically significant but clinical insignificant. Presence of plaque was slightly higher (p = .06) in the IL group (34.4%) compared with the AL group (26.3%). The overall technical, biological, and prosthetic complication rates were similar between groups. None of the implants developed peri-implantitis during the entire follow-up period. CONCLUSION The results of this clinical trial indicated that all clinical and radiographical parameters were clinically comparable between the study groups.
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Affiliation(s)
- Marco Toia
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Andrea Parpaiola
- Department Clinic-Surgical Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | | | - Mustafa Tattan
- Department of Periodontics, University of Iowa College of Dentistry, Iowa City, Iowa, USA
| | - Muhammad H A Saleh
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Andrea Ravidà
- Department of Periodontics and Preventive Dentistry, University of Pittsburgh School of Dental Medicine, Pittsburgh, Pennsylvania, USA
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Ayna M, Jepsen S. A Retrospective Evaluation of 5 Years of Clinical Results of Metal-Ceramic vs. Monolithic Zirconia Superstructures in Maxillary All-on-4 TM Concept. J Clin Med 2024; 13:557. [PMID: 38256690 PMCID: PMC10816938 DOI: 10.3390/jcm13020557] [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: 12/06/2023] [Revised: 01/01/2024] [Accepted: 01/09/2024] [Indexed: 01/24/2024] Open
Abstract
The aim of the current study was to present the clinical and radiological outcomes of monolithic zirconia superstructures compared to the metal-ceramic ones in the All-on-4 concept for the prosthetic rehabilitation of the maxillae. A total of 30 patients were subdivided into groups according to their superstructure type (metal-ceramic (n = 15) or monolithic zirconia (n = 15)). All implants were functionally loaded within 24 h after insertion with provisional acrylic superstructures. Prosthetic complications, marginal bone loss, plaque accumulation, probing pocket depth, bleeding on probing, and bite force were documented over a period of 5 years. Marginal bone loss around the implants of the ceramic group remained well over the five years (1.21 ± 0.23 mm). However, marginal bone loss was significantly lower around the implants in the monolithic zirconia group (0.22 ± 0.14 mm) (p < 0.001). Bleeding on probing, plaque accumulation, and probing pocket depth values were correlated with marginal bone loss. Among all evaluated parameters, no differences could be detected in terms of the angulation of the implants. Detachment or chipping was observed in seven cases in the metal-ceramic superstructure group. In all cases, dentures were removed and repaired in the laboratory. In the monolithic zirconia group, chipping was detected after one year in two cases, after two years in four cases, and after five years in one case and could be managed by polishing in situ. Monolithic zirconia superstructures presented superior results regarding the parameters evaluated.
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Affiliation(s)
- Mustafa Ayna
- Department of Periodontology, University Hospital Bonn, University Bonn, 53127 Bonn, Germany;
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Edelhoff D, Schubert O, Stimmelmayr M, Schweiger J. CAD/CAM full-mouth rehabilitation of an elderly patient: One-piece digital complete denture meets multilayered zirconia with gradient technology. J ESTHET RESTOR DENT 2024; 36:174-185. [PMID: 36866726 DOI: 10.1111/jerd.13031] [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: 12/20/2022] [Revised: 02/02/2023] [Accepted: 02/11/2023] [Indexed: 03/04/2023]
Abstract
OBJECTIVE This article highlights a CAD/CAM complete-mouth rehabilitation in an 82-year-old patient by means of a complete maxillary prosthesis and mandibular implant- and tooth-supported fixed restorations made from multilayered zirconia. CLINICAL CONSIDERATIONS Comprehensive complete-mouth rehabilitations in elderly patients with adaptation of the occlusal vertical dimension (OVD) often present particular challenges. This applies especially when exacting functional and esthetic requirements are to be met and the treatment should not cause the patient too much effort, still ensuring the highest level of quality and efficiency and a low intervention rate. CONCLUSION The digital approach used for the present patient allowed for an efficient treatment procedure, facilitated virtual evaluations using a face-scan, and enhanced the predictability of the prosthodontic outcome. The approach enabled some steps required in the conventional protocol to be omitted, resulting in a straightforward clinical treatment with minimal strain on the patient. CLINICAL SIGNIFICANCE Because of the comprehensive recording of extraoral and intraoral data, for example with a facial scanner, it was possible to transfer a digital replica of the patient to the dental laboratory technician. With this protocol, many steps can be performed in the absence of the real patient.
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Affiliation(s)
- Daniel Edelhoff
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Oliver Schubert
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Michael Stimmelmayr
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
| | - Josef Schweiger
- Department of Prosthetic Dentistry, University Hospital, LMU Munich, Munich, Germany
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Nokar K, Atri F, Nokar S. Comparative Evaluation of the Effect of Implant Crown Materials on Implant Components and Bone Stress Distribution: A 3D Finite Element Analysis. Int J Dent 2023; 2023:1896475. [PMID: 38130700 PMCID: PMC10735729 DOI: 10.1155/2023/1896475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Background Choosing implant crown materials for restoration remains challenging in clinical practice. This study assesses the impact of all-ceramic restoration instead of porcelain-fused-to-metal (PFM) restoration on the stress distribution within implant components and the surrounding bone. Methods Four 3D models of a mandibular second premolar were meticulously prepared. The study groups comprised zirconia, lithium disilicate, and zirconia lithium silicate monolithic ceramic crowns cemented onto a zirconia hybrid abutment. A PFM crown cemented onto a cementable abutment was chosen as the control group. A total vertical load of 583 N was applied to the occlusal contact areas. Stress distribution within the crown and implant components was analyzed using von Mises stress analysis. Principal stress analyses were employed to assess stress distribution in the peripheral bone. Results The PFM model exhibited the highest von Mises stress values for both the implant (428.7 MPa) and crown (79.7 MPa) compared to the other models. The all-ceramic models displayed the highest maximum von Mises stress within the abutment, approximately 335 MPa, compared to the PFM model. von Mises stresses of the abutment and implant in the all-ceramic models were 69% higher and 20% lower, respectively, than those in the PFM model. Screw stresses were relatively consistent across all groups. Principal stresses in spongy bone and minimum principal stress in cortical bone were consistent across all models. Conclusions All-ceramic restoration with a hybrid abutment, as opposed to traditional PFM restoration with a cementable abutment, does not adversely affect the implant and abutment screw and reduces crown stresses. Stresses within hybrid abutments were notably higher than those within cementable abutments. Spongy bone stresses remained unaffected by the type of crown or abutment.
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Affiliation(s)
- Kimia Nokar
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Atri
- Department of Prosthodontics, School of Dentistry, Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saied Nokar
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
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Benalcázar-Jalkh EB, Bergamo ETP, Campos TMB, Coelho PG, Sailer I, Yamaguchi S, Alves LMM, Witek L, Tebcherani SM, Bonfante EA. A Narrative Review on Polycrystalline Ceramics for Dental Applications and Proposed Update of a Classification System. MATERIALS (BASEL, SWITZERLAND) 2023; 16:7541. [PMID: 38138684 PMCID: PMC10744432 DOI: 10.3390/ma16247541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Revised: 11/07/2023] [Accepted: 11/25/2023] [Indexed: 12/24/2023]
Abstract
Dental zirconias have been broadly utilized in dentistry due to their high mechanical properties and biocompatibility. Although initially introduced in dentistry as an infrastructure material, the high rate of technical complications related to veneered porcelain has led to significant efforts to improve the optical properties of dental zirconias, allowing for its monolithic indication. Modifications in the composition, processing methods/parameters, and the increase in the yttrium content and cubic phase have been presented as viable options to improve zirconias' translucency. However, concerns regarding the hydrothermal stability of partially stabilized zirconia and the trade-off observed between optical and mechanical properties resulting from the increased cubic content remain issues of concern. While the significant developments in polycrystalline ceramics have led to a wide diversity of zirconia materials with different compositions, properties, and clinical indications, the implementation of strong, esthetic, and sufficiently stable materials for long-span fixed dental prostheses has not been completely achieved. Alternatives, including advanced polycrystalline composites, functionally graded structures, and nanosized zirconia, have been proposed as promising pathways to obtain high-strength, hydrothermally stable biomaterials. Considering the evolution of zirconia ceramics in dentistry, this manuscript aims to present a critical perspective as well as an update to previous classifications of dental restorative ceramics, focusing on polycrystalline ceramics, their properties, indications, and performance.
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Affiliation(s)
- Ernesto B. Benalcázar-Jalkh
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, SP, Brazil
| | - Edmara T. P. Bergamo
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, SP, Brazil
- Biomaterials Division, NYU Dentistry, New York, NY 10010, USA
- Department of Prosthodontics, NYU Dentistry, New York, NY 10010, USA
| | - Tiago M. B. Campos
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, SP, Brazil
| | - Paulo G. Coelho
- DeWitt Daughtry Family Department of Surgery, Division of Plastic Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
- Department of Biochemistry and Molecular Biology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, 1211 Geneva, Switzerland
| | - Satoshi Yamaguchi
- Department of Dental Biomaterials, Osaka University Graduate School of Dentistry, Suita 565-0871, Osaka, Japan;
| | - Larissa M. M. Alves
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, SP, Brazil
| | - Lukasz Witek
- Biomaterials Division, NYU Dentistry, New York, NY 10010, USA
- Department of Biomedical Engineering, NYU Tandon School of Engineering, New York University, Brooklyn, NY 11201, USA
- Hansjörg Wyss Department of Plastic Surgery, NYU Grossman School of Medicine, New York, NY 10017, USA
| | - Sérgio M. Tebcherani
- Department of Production Engineering, Federal University of Technology—Paraná, Av. Monteiro Lobato Km 04, Ponta Grossa 84016-210, PR, Brazil;
| | - Estevam A. Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Bauru 17012-901, SP, Brazil
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Piza MMT, Bergamo ETP, Campos TMB, Carvalho LF, Goulart CA, Gutierres E, Lopes ACO, Benalcazar Jalkh EB, Bonfante EA. Alumina-toughened zirconia nanocomposite: Aging effect on microstructural, optical, and mechanical properties. Dent Mater 2023; 39:1022-1031. [PMID: 37775460 DOI: 10.1016/j.dental.2023.09.005] [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: 03/13/2023] [Revised: 09/05/2023] [Accepted: 09/15/2023] [Indexed: 10/01/2023]
Abstract
OBJECTIVES To process an alumina-toughened zirconia (ATZ) nanocomposite and to characterize its crystalline phases, microstructure, residual stress, mechanical and optical properties before and after two different artificial aging methodologies. METHODS Disc-shaped specimens were obtained through uniaxial pressing of a commercial ATZ powder comprised of 80%ZrO2 / 20%Al2O3, with a particle size of 50 nm and 150 nm, respectively. Sintering was performed at 1500ºC for 2 h. Groups were established according to the aging protocol as immediate (ATZ-I) and aged either in autoclave (ATZ-A) or hydrothermal reactor (ATZ-R) at 134 ºC for 20 h at 2.2 bar. Crystalline phases and microstructure were assessed by X-ray diffraction (XRD) and scanning electron microscopy (SEM), respectively. Residual stress was evaluated by Raman spectroscopy. Contrast Ratio (CR) and Translucency Parameter (TP) were calculated to characterize optical properties. Mechanical properties were analyzed through Vickers microhardness, fracture toughness, and biaxial flexural strength test. RESULTS XRD spectra of both aging protocols revealed the presence of monoclinic zirconia (20-31%), where higher phase transformation was observed after aging in hydrothermal reactor. Optical properties evaluation demonstrated high opacity (CR: 0.99) and masking ability (TP: 0.26), with no significant differences after aging. Raman spectroscopy evidenced the presence of residual compressive stresses in the aged groups, being significantly higher for ATZ-R (-215.2 MPa). As-sintered specimens revealed hardness of ∼12.3 GPa and fracture toughness of ∼1.9 MPa.m1/2. Characteristic strength was 740 MPa for ATZ-I, 804 MPa for ATZ-A, and 879 MPa for ATZ-R, with significant differences between groups. Weibull modulus ranged from 16.5 to 18.8. All groups demonstrated high reliability up to 500 MPa stress missions (99-100%), with no significant differences after aging. SIGNIFICANCE The experimental ATZ nanocomposite presented high opacity and a high Weibull modulus. While aging created internal compressive stress responsible for an increase in characteristic strength, the nanocomposite was susceptible to hydrothermal degradation. Further studies are required to evaluate its degradation kinetics at low temperatures.
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Affiliation(s)
- Mariana M T Piza
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil.
| | - Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Tiago M B Campos
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil; Department of Physics, Technological Institute of Aeronautics, São José dos Campos, SP, Brazil
| | - Laura F Carvalho
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Celso A Goulart
- São Paulo State University, School of Sciences and Engineering, Tupã, SP, Brazil
| | - Eliezer Gutierres
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Adolfo C O Lopes
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Ernesto B Benalcazar Jalkh
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
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Pera F, Pesce P, Menini M, Fanelli F, Kim BC, Zhurakivska K, Mayer Y, Isola G, Cianciotta G, Crupi A, Ambrogio G, Scotti N, Carossa M. Immediate loading full-arch rehabilitation using transmucosal tissue-level implants with different variables associated: a one-year observational study. Minerva Dent Oral Sci 2023; 72:230-238. [PMID: 37194244 DOI: 10.23736/s2724-6329.23.04782-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
BACKGROUND The aim of the present observational study was to investigate the application of transmucosal tissue-level implants in immediate loading full-arch rehabilitation with different variables associated. METHODS Patients needing a full-arch implant rehabilitation were recruited and rehabilitated with four transmucosal tissue level implants. Data related to implants' diameters and lengths, jaw distributions, and presence of angulated abutments were collected. The following outcomes were evaluated: survival rate, marginal bone loss (MBL), Plaque Index (PI), bleeding on probing (BoP), probing depth (PD). Descriptive statistical analysis was reported and univariate linear regression models were built to assess a significant correlation between MBL and the different implant related factors. RESULTS Twenty patients were rehabilitated for a total implant number of 80; 11 rehabilitations were performed on the maxilla, while 9 were performed on the mandible; 48 implants presented a 3.8 mm diameter and 32 implants presented a 4.25 mm diameter. Implants length varied between 10 to 15 mm; 40 tilted implants were connected to angulated abutment, while 40 straight implants were connected directly to the prostheses (no abutments). At the one year follow-up visit no implants failed resulting in an implant survival rate of 100%. The overall MBL was 1.19±0.30 mm. No statistically significant difference (P>0.05) was highlighted among any of the subgroups analyzed. CONCLUSIONS Despite different variables associated, tissue level implants seem to represent a valid option when applied in immediate loading full-arch rehabilitation. Further research and longer observational periods are encouraged to confirm the result.
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Affiliation(s)
- Francesco Pera
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Paolo Pesce
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Maria Menini
- Department of Surgical Sciences (DISC), University of Genoa, Genoa, Italy
| | - Francesco Fanelli
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Byung-Chan Kim
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Khrystyna Zhurakivska
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Yaniv Mayer
- School of Graduate Dentistry, Health Care Campus Rambam, Haifa, Israel
| | - Gaetano Isola
- School of Dentistry, Department of General Surgery and Surgical-Medical Specialties, University of Catania, Catania, Italy
| | - Giulia Cianciotta
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Armando Crupi
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Giulia Ambrogio
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Nicola Scotti
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Massimo Carossa
- C.I.R. Dental School, Department of Surgical Sciences, University of Turin, Turin, Italy -
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Laleman I, Lambert F, Gahlert M, Bacevic M, Woelfler H, Roehling S. The effect of different abutment materials on peri-implant tissues-A systematic review and meta-analysis. Clin Oral Implants Res 2023; 34 Suppl 26:125-142. [PMID: 37750527 DOI: 10.1111/clr.14159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/24/2023] [Accepted: 07/26/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES In patients with dental implants, what is the effect of transmucosal components made of materials other than titanium (alloys) compared to titanium (alloys) on the surrounding peri-implant tissues after at least 1 year? MATERIALS AND METHODS This systematic review included eligible randomized controlled trials identified through an electronic search (Medline, Embase and Web of Science) comparing alternative abutment materials versus titanium (alloy) abutments with a minimum follow-up of 1 year and including at least 10 patients/group. Primary outcomes were peri-implant marginal bone level (MBL) and probing depth (PD), these were evaluated based on meta-analyses. Abutment survival, biological and technical complications and aesthetic outcomes were the secondary outcomes. The risk of bias was assessed with the RoB2-tool. This review is registered in PROSPERO with the number (CRD42022376487). RESULTS From 5129 titles, 580 abstracts were selected, and 111 full-text articles were screened. Finally, 12 articles could be included. Concerning the primary outcomes (MBL and PD), no differences could be seen between titanium abutment and zirconia or alumina abutments, not after 1 year (MBL: zirconia: MD = -0.24, 95% CI: -0.65 to 0.16, alumina: MD = -0.06, 95% CI: -0.29 to 0.17) (PD: zirconia: MD = -0.06, 95% CI: -0.41 to 0.30, alumina: MD = -0.29, 95% CI: -0.96 to 0.38), nor after 5 years. Additionally, no differences were found concerning the biological complications and aesthetic outcomes. The most important technical finding was abutment fracture in the ceramic group and chipping of the veneering material. CONCLUSIONS Biologically, titanium and zirconia abutments seem to function equally up to 5 years after placement.
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Affiliation(s)
- I Laleman
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
- Dental Biomaterials Research Unit (d-BRU), Faculty of Medicine, University of Liège, Liège, Belgium
| | - F Lambert
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
- Dental Biomaterials Research Unit (d-BRU), Faculty of Medicine, University of Liège, Liège, Belgium
| | - M Gahlert
- Private Dental Clinic PD Dr. Gahlert & PD Dr. Roehling, Munich, Germany
- Sigmund Freud Private University, Vienna, Austria
- Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland
| | - M Bacevic
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
- Centre for Oral Clinical Research, Institute of Dentistry, Barts and the London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | - H Woelfler
- Professor for Demography, University of Bamberg, Bamberg, Germany
| | - S Roehling
- Private Dental Clinic PD Dr. Gahlert & PD Dr. Roehling, Munich, Germany
- Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Clinic for Oral and Cranio-Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
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Pjetursson BE, Sailer I, Merino-Higuera E, Spies BC, Burkhardt F, Karasan D. Systematic review evaluating the influence of the prosthetic material and prosthetic design on the clinical outcomes of implant-supported multi-unit fixed dental prosthesis in the posterior area. Clin Oral Implants Res 2023; 34 Suppl 26:86-103. [PMID: 37750526 DOI: 10.1111/clr.14103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE The objectives of the study were to assess the survival, failure, and technical complication rates of implant-supported fixed dental prosthesis (iFDPs) with pontic or splinted crown (iSp C) designs in the posterior area and compare the influence of prosthetic materials and prosthetic design on the outcomes. METHODS Electronic and manual searches were performed to identify randomized-, prospective-, and retrospective clinical trials with follow-up time of ≥12 months, evaluating the clinical outcomes of posterior iFDPs with pontic or iSp Cs. Survival and complication rates were analyzed using robust Poisson's regression models. RESULTS Thirty-two studies reporting on 42 study arms were included in the present systematic review. The meta-analysis of the included studies indicated estimated 3-year survival rates of 98.3% (95%CI: 95.6-99.3%) for porcelain-fused-to-metal (PFM) iFDPs, 97.5% (95%CI: 95.5-98.7%) for veneered zirconia (Zr) iFDPs with pontic, 98.9% (95%CI: 96.8-99.6%) for monolithic or micro-veneered zirconia iFDPs with pontic, and 97.0% (95%CI: 84.8-99.9%) for lithium disilicate iFDPs with pontics. The survival rates for different material combination showed no statistically significant differences. Veneered restorations, overall, showed significantly (p < .01) higher ceramic fracture and chipping rates compared with monolithic restorations. Furthermore, there was no significant difference in survival rates (98.3% [95%CI: 95.6-99.3%] vs. 99.1% [95%CI: 97.6-99.7%]) and overall complication rates between PFM iFDPs with pontic and PFM iSp Cs. CONCLUSIONS Based on the data identified by this systematic review, PFM, veneered Zr, and monolithic Zr iFDPs with pontic and iSp Cs showed similarly high short-term survival rates in the posterior area. Veneered restorations exhibit ceramic chipping more often than monolithic restorations, with the highest fracture rate reported for veneered Zr iFDPs.
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Affiliation(s)
- Bjarni E Pjetursson
- Department of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Elizabeth Merino-Higuera
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
- Department of Prosthodontics, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
| | - Benedikt Christopher Spies
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Felix Burkhardt
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
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Bruhnke M, Naumann M, Beuer F, Böse MWH, von Stein-Lausnitz M, Schwendicke F. Implant or tooth? - A cost-time analysis of managing "unrestorable" teeth ✰. J Dent 2023; 136:104646. [PMID: 37527727 DOI: 10.1016/j.jdent.2023.104646] [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: 06/02/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES Retaining and restoring severely compromised teeth with subcrestal defect extensions or removing and replacing them using implant-supported crowns (ISC) remains controversial, and economic analyses comparing both strategies remain scarce. We performed a cost-time analysis, comparing the expenditures for retaining "unrestorable" teeth using forced orthodontic extrusion and restoration (FOE) versus extraction and ISC, in a clinical prospective cohort study. METHODS Forty-two patients (n = 21 per group) were enrolled from clinical routine at a university into this study. Direct medical and indirect costs (opportunity costs) were assessed for all relevant steps (initial care, active care, restorative care, supportive care) using the private payer's perspective in German healthcare based on a micro-costing approach and/or national fee items. Statistical comparison was performed with Mann-Whitney-U test. RESULTS Patients were followed up for at least one year after initial treatment (n = 40). The drop-out rate was 5% (n = 2). Total direct medical costs were higher for ISC (median: 3439.05€) than FOE (median: 1601.46€) with p<0.001. We observed a higher number of appointments (p = 0.002) for ISC (median: 14.5) in comparison to FOE (median: 12), while cumulatively, FOE patients spent more time in treatment (median: 402.5 min) in comparison to ISC (median: 250 min) with p<0.001, resulting in comparable opportunity costs for both treatment groups (FOE: 304.50€; ISC: 328.98€). CONCLUSIONS ISC generated higher costs than FOE. More in-depth and long-term exploration of cost-effectiveness is warranted. CLINICAL SIGNIFICANCE ISCs were associated with higher initial medical costs and required more appointments than the restoration of severely compromised teeth after FOE. Treatment time was higher for patients with FOE, resulting in similar opportunity costs for both treatment approaches. Future research needs to investigate long-term cost-effectiveness.
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Affiliation(s)
- Maria Bruhnke
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders - Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany.
| | - Michael Naumann
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders - Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Florian Beuer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders - Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Mats Wernfried Heinrich Böse
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders - Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Manja von Stein-Lausnitz
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders - Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt - Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
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Bruhnke M, Naumann M, Böse MWH, Beuer F, Schwendicke F. Health economic evaluation of forced orthodontic extrusion of extensively damaged teeth: up to 6-year results from a clinical study. Clin Oral Investig 2023; 27:5587-5594. [PMID: 37498335 PMCID: PMC10492751 DOI: 10.1007/s00784-023-05178-w] [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: 03/17/2023] [Accepted: 07/17/2023] [Indexed: 07/28/2023]
Abstract
OBJECTIVES Clinical data on retaining extensively damaged teeth using forced orthodontic extrusion followed by restorative rehabilitation are scarce, and economic evaluations are basically absent. A health economic evaluation of this method was performed based on a clinical study. MATERIALS AND METHODS In a convenience sample of individuals recruited from routine care, extensively damaged teeth were orthodontically extruded prior to restoration. Patients were followed up for up to 6 years. The health outcome was tooth retention time. Direct medical, non-medical, and indirect initial and follow-up costs were estimated using the private payer's perspective in German healthcare. Association of initial direct medical treatment costs and cofounding variables was analyzed using generalized linear models. Success and survival were secondary outcomes. RESULTS A total of 35 teeth in 30 patients were followed over a mean ± SD of 49 ± 19 months. Five patients (14%) dropped out during that period. Median initial costs were 1941€ (range: 1284-4392€), median costs for follow-up appointments were 215€ (range: 0-5812€), and median total costs were 2284€ (range: 1453 to 7109€). Endodontic re-treatment and placement of a post had a significant impact on total costs. Three teeth had to be extracted and in three patients orthodontic relapse was observed. The survival and success rates were 91% and 83%, respectively. CONCLUSIONS Within the limitations of this clinical study, total treatment costs for orthodontic extrusion and subsequent restoration of extensively damaged teeth were considerable. Costs were by large generated initially; endodontic and post-endodontic therapies were main drivers. Costs for retreatments due to complications were limited, as only few complications arose. CLINICAL RELEVANCE The restoration of extensively damaged teeth after forced orthodontic extrusion comes with considerable initial treatment costs, but low follow-up costs. Overall and over the observational period and within German healthcare, costs are below those for tooth replacement using implant-supported crowns. TRIAL REGISTRATION ClinicalTrials.gov Identifier: DRK S00026697).
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Affiliation(s)
- Maria Bruhnke
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany.
| | - Michael Naumann
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Mats Wernfried Heinrich Böse
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Florian Beuer
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Aßmannshauser Straße 4-6, 14197, Berlin, Germany
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Juntavee N, Juntavee A, Rengpattanakij N. Bond strength of ceramic veneered CAD-milled alloy upon prolonged sintering. Clin Oral Investig 2023; 27:5377-5389. [PMID: 37462729 DOI: 10.1007/s00784-023-05157-1] [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: 05/06/2023] [Accepted: 07/11/2023] [Indexed: 09/10/2023]
Abstract
OBJECTIVES Ceramic-sintering affects bond strength and longevity of metal-ceramic. This study investigated the effect of sintering temperatures and times on metal-ceramic bond strength vis-a-vis interfacial fracture toughness. MATERIALS AND METHODS One hundred eighty rectangular-shaped (25 × 8 × 1 mm) casting (Auriloy® (CA)) and CAD-milling (Ceramill Sintron® (MA)) alloys were prepared and randomly veneered with ceramic at normal (930 °C; (TN)), increased (940 °C; (TI)), and extremely increased (950 °C; (TE)) sintering temperatures and normal (1 min; (HN)), increased (2 min; (HI)), and extremely increased (3 min; (HE)) sintering time (n = 10/group). Pre-cracked was subjected to four loading-unloading cycles at 0.05 mm/min speed to determine interfacial fracture toughness from strain energy release rate (G). Microstructures were examined with a scanning electron microscope (SEM), energy-dispersive X-ray (EDX), and atomic force microscopy (AFM). ANOVA and Tukey comparisons were determined for significant differences (α = 0.05). RESULTS Significant differences in G due to the effect of alloy, sintering temperature, and time (p < 0.05) were indicated. MA revealed higher G than CA. Raising temperatures enabled increasing G for CA, not for MA. Extended sintering permitted increasing G for both alloys. Rougher surface of MA than CA was observed. Interfacial ion exchange was differently indicated between CA and MA. CONCLUSIONS Bond strength was influenced by alloy, sintering temperature, and time. Ceramic has better adhesion to MA than CA. Enhancing bond for CA was succeeded through increasing sintering temperature and time, whereas through extended sintering for MA. CLINICAL RELEVANCE MA offers stronger bond than CA. Enhancing bond is suggested by extended sintering. Raising temperature can enhance bond for CA, not for MA.
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Affiliation(s)
- Niwut Juntavee
- Department of Prosthodontics, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand.
| | - Apa Juntavee
- Division of Pediatric Dentistry, Department of Preventive Dentistry, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
| | - Nuttida Rengpattanakij
- Division of Biomaterials and Prosthodontics Research, Faculty of Dentistry, Khon Kaen University, Khon Kaen, Thailand
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Benalcázar-Jalkh EB, de Carvalho LF, Alves LMM, Campos TMB, Sousa EDO, Bergamo ETP, Coelho PG, Gierthmuehlen PC, Spitznagel FA, Zahoui A, Bonfante EA. Reliability and Failure Mode of Ti-Base Abutments Supported by Narrow/Wide Implant Systems. Dent J (Basel) 2023; 11:207. [PMID: 37754327 PMCID: PMC10529977 DOI: 10.3390/dj11090207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/28/2023] Open
Abstract
To assess the reliability and failure modes of Ti-base abutments supported by narrow and wide-diameter implant systems. Narrow (Ø3.5 × 10 mm) and wide (Ø5 × 10 mm) implant systems of two different manufacturers with internal conical connections (16°) and their respective Ti-base abutments (3.5 and 4.5 mm) were evaluated. Ti-base abutments were torqued to the implants, standardized metallic maxillary incisor crowns were cemented, and step stress accelerated life testing of eighteen assemblies per group was performed in three loading profiles: mild, moderate, and aggressive until fracture or suspension. Reliability for missions of 100,000 cycles at 100 and 150 N was calculated, and fractographic analysis was performed. For missions at 100 N for 100,000 cycles, both narrow and wide implant systems exhibited a high probability of survival (≥99%, CI: 94-100%) without significant differences. At 150 N, wide-diameter implants presented higher reliability (≥99%, CI: 99-100%) compared to narrow implants (86%, CI: 61-95%), with no significant differences among manufacturers. Failure mode predominantly involved Ti-base abutment fractures at the abutment platform. Ti-base abutments supported by narrow and wide implant systems presented high reliability for physiologic masticatory forces, whereas for high load-bearing applications, wide-diameter implants presented increased reliability. Failures were confined to abutment fractures.
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Affiliation(s)
- Ernesto B. Benalcázar-Jalkh
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Laura F. de Carvalho
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Larissa M. M. Alves
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Tiago M. B. Campos
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Edisa de Oliveira Sousa
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Edmara T. P. Bergamo
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Paulo G. Coelho
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Petra C. Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Frank A. Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Abbas Zahoui
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Estevam A. Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
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Strasding M, Jeong Y, Marchand L, Hicklin SP, Sailer I, Sun M, Lee H. Three-Dimensional Peri-Implant Tissue Changes in Immediately vs. Early Placed Tapered Implants Restored with Two Different Ceramic Materials-1 Year Results. MATERIALS (BASEL, SWITZERLAND) 2023; 16:5636. [PMID: 37629928 PMCID: PMC10456968 DOI: 10.3390/ma16165636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 07/19/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
BACKGROUND A prospective multi-center randomized controlled clinical trial was performed to digitally analyze tissue volume changes in immediately and early placed implants with simultaneous bone augmentation restored with two different all-ceramic materials. METHODS A total of 60 patients received 60 bone-level tapered implants (BLT, Straumann AG) immediately (n = 30) or early placed, 8-10 weeks after tooth extraction, (n = 30). Implants were restored with all-ceramic single crowns fabricated out of zirconia (Lava Plus, 3M), or lithium disilicate (E.max CAD, Ivoclar Vivadent AG) bonded to titanium base abutments (Variobase for Cerec, Straumann AG). Impressions were taken at baseline (BL), 6 and 12 months, and STL data were used to define an area of interest (AOI) to analyze peri-implant volume changes and midfacial recessions. RESULTS For immediate placement, a mean volume loss of -5.56 mm3 (±5.83 mm3) was found at 6 months, and of -6.62 mm3 (±6.56 mm3) at 12 months. For early placement, a mean volume loss of -1.99 mm3 (±5.82 mm3) at 6 months, and of -3.7 mm3 (±5.62 mm3) at 12 months was found. The differences in volume loss at 12 months between the two implant placement protocols were significant (p = 0.005). In both groups, mean midfacial recessions of 0.48 mm (±0.52) occurred. CONCLUSIONS A more pronounced peri-implant volume loss can be expected 12 months after immediate implant placement compared with early placement.
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Affiliation(s)
- Malin Strasding
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland (I.S.)
| | - Yuwon Jeong
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul 03722, Republic of Korea; (Y.J.); (M.S.)
| | - Laurent Marchand
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland (I.S.)
| | - Stefan P. Hicklin
- Clinic of Conservative and Preventive Dentistry, Division of Periodontology and Peri-Implant Diseases, Center of Dental Medicine, University of Zürich, 8032 Zürich, Switzerland;
- Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zürich, 8032 Zürich, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland (I.S.)
| | - Minji Sun
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul 03722, Republic of Korea; (Y.J.); (M.S.)
| | - Hyeonjong Lee
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul 03722, Republic of Korea; (Y.J.); (M.S.)
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Martakoush-Saleh S, Salgado-Peralvo AO, Peña-Cardelles JF, Kewalramani N, Gallucci GO. Evaluating the clinical behavior of veneered zirconia in comparison with monolithic zirconia complete arch implant-supported prostheses: A systematic review and meta-analysis. J Prosthet Dent 2023:S0022-3913(23)00497-3. [PMID: 37696747 DOI: 10.1016/j.prosdent.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 09/13/2023]
Abstract
STATEMENT OF PROBLEM Because the use of zirconia in dentistry is relatively new, the number of published studies on the subject is scarce, even though material selection is an important factor in clinical performance. Therefore, a systematic assessment of the impact of the prosthetic material, framework design, veneering material, and manufacturing process is required. PURPOSE The purpose of this systematic review and meta-analysis was to investigate the survival and success rates of feldspathic porcelain veneered zirconia (VZir) in comparison with monolithic zirconia (MZir) complete arch implant-supported prostheses (CAISPs). A secondary objective was to assess the influence of the type of loading, the presence or absence of a cantilever, the type of zirconia used, the location, and the opposing arch on complications rates and patient satisfaction. MATERIAL AND METHODS An electronic search of the MEDLINE database (via PubMed), Scopus, Science Direct, Cochrane Library, and OpenGrey was carried out. The criteria described in the preferred reporting items for systematic reviews and meta-analyses statement were used. The search was restricted from January 2000 to January 2022. RESULTS The systematic search resulted in 20 articles that met the established criteria. In total, 751 patients (VZir=302; MZir=449) with 3038 CAISPs (VZir=368; MZir=2670) were analyzed. Higher prosthetic survival and success rates were found in MZir compared with VZir CAISPs (100% and 95.45%, respectively). The meta-analysis found significantly fewer complications related to MZir (9.4% [4.8%-14.1%]) compared with VZir (33.7% [17.5%-49.9%]). CONCLUSIONS Based on the findings of this systematic review, MZir CAISPs had higher survival and success rates than VZir CAISPs, with significantly fewer prosthetic complications. The influence of factors such as the type of functional loading, the presence of a cantilever, the material used in the prosthodontic workflow, the location of the CAISP, and the type of antagonist arch on the performance of Zir CAISPs remains unclear.
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Affiliation(s)
- Sara Martakoush-Saleh
- Postgraduate student, Department of Dental Clinical Specialties, Complutense University of Madrid, Spain
| | - Angel-Orión Salgado-Peralvo
- Professor, Department of Dental Clinical Specialties, Faculty of Odontology, Complutense University of Madrid, Spain.
| | - Juan-Francisco Peña-Cardelles
- Professor, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass
| | - Naresh Kewalramani
- Professor, Department of Nursery and Stomatology, Faculty of Dentistry, Rey Juan Carlos University, Madrid, Spain
| | - German O Gallucci
- Professor and Department Chair, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass
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Lee SJ, Alamri O, Cao H, Wang Y, Gallucci GO, Lee JD. Occlusion as a predisposing factor for peri-implant disease: A review article. Clin Implant Dent Relat Res 2023; 25:734-742. [PMID: 36373771 DOI: 10.1111/cid.13152] [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: 08/24/2022] [Revised: 10/23/2022] [Accepted: 10/25/2022] [Indexed: 08/04/2023]
Abstract
BACKGROUND The restoration of dental implants presents a unique challenge due to the intrinsic biomechanical differences between osseointegrated implants and natural teeth, and their subsequent responses to occlusal loading. However, controversy exists regarding the role that occlusion plays in the physiology of the peri-implant complex. PURPOSE To provide an overview of the scientific literature regarding occlusion as it relates to implant dentistry and peri-implant disease. MATERIALS AND METHODS This article presents a narrative review on occlusal loading and its potential effects on the peri-implant complex, as well as some generally accepted guidelines for occlusion in implant dentistry. RESULTS AND CONCLUSIONS Although there is strong evidence linking occlusal factors to mechanical complications of dental implants, the same cannot be said regarding biological complications. There is no clear scientific evidence on the relationship between occlusal overload and peri-implant disease. However, occlusal overload may be an accelerating factor for peri-implant disease in the presence of inflammation. As the biomechanical properties of dental implants differ from that of the natural dentition, modifications to classic concepts of occlusion may be necessary when dental implants are involved. Thus, clinical recommendations are proposed which function to minimize unfavorable occlusal forces on implant restorations and reduce the associated biological and mechanical complications.
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Affiliation(s)
- Sang J Lee
- Department of Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Osamah Alamri
- Department of Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Huilin Cao
- Department of Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Yujun Wang
- Department of Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - German O Gallucci
- Department of Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Jason D Lee
- Department of Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, Boston, Massachusetts, USA
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Bardis D, Agop-Forna D, Pelekanos S, Chele N, Dascălu C, Török R, Török B, Cristea I, Bardi PM, Forna N. Assessment of Various Risk Factors for Biological and Mechanical/Technical Complications in Fixed Implant Prosthetic Therapy: A Retrospective Study. Diagnostics (Basel) 2023; 13:2341. [PMID: 37510085 PMCID: PMC10378676 DOI: 10.3390/diagnostics13142341] [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: 06/19/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 07/30/2023] Open
Abstract
The goals of this research were to determine the influence of several factors on implants' biological and technical complications in posterior fixed implant prosthetic therapy. MATERIALS AND METHODS The study group consisted of 67 edentulous patients (mean age: 63.88 ± 11.709 yrs; 20 males, 47 females) with implant prosthetic therapy for posterior edentulism. A total of 76 implant-supported fixed partial dentures (IP-FPDs) and 178 implants were assessed using clinical and paraclinical assessments. Risk factors for biological complications (peri-implantitis) and technical complications were determined by using the Pearson Chi-squared test and multivariate analysis. RESULTS The implant success (the absence of biological and mechanical/technical complications) was 66.30%. The prevalence of biological complications was 13.5%. The prevalence of technical complications was 28.70%. Variables that were associated with a higher risk of peri-implantitis were poor oral hygiene and bruxism. In univariate analysis, poor oral hygiene increased the risk of peri-implantitis 5.778 times and bruxism 5.875 times. Variables that were associated with a higher risk of mechanical/technical complications were age group > 60 yrs, smoking, history of periodontal disease, and bruxism. In univariate analysis, the risk of technical complications increased 4.14 times for patients in the age group > 60 years (vs. age group 40-60 years) and 20.5 times for patients with bruxism. Bruxism and smoking were significant predictors of mechanical/technical complications in the multivariate model. CONCLUSIONS In univariate models, patients with poor oral hygiene and bruxism have an increased risk of peri-implantitis. In multivariate models, we did not identify significant predictors of peri-implantitis. Age group > 60 yrs, smoking, history of periodontal disease, bone grafting, and bruxism are risk factors for the increase in the mechanical/technical complication rate. In the multivariate model, smoking and bruxism are significant predictors of the mechanical/technical complications.
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Affiliation(s)
- Dimitrios Bardis
- Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Doriana Agop-Forna
- Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Stavros Pelekanos
- Independent Researcher, Leof. El. Venizelou 163b, 176 72 Athens, Greece
| | - Nicolae Chele
- Faculty of Dental Medicine, U.S.M.F. "Nicolae Testimitanu", Stefan cel Mare si Sfant Boulevard 165, 2004 Chisinau, Moldova
| | - Cristina Dascălu
- Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Roland Török
- Independent Researcher, 1712 Tafers, Switzerland
| | - Bianca Török
- Independent Researcher, 1712 Tafers, Switzerland
| | - Ioana Cristea
- Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | | | - Norina Forna
- Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
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Hickel R, Mesinger S, Opdam N, Loomans B, Frankenberger R, Cadenaro M, Burgess J, Peschke A, Heintze SD, Kühnisch J. Revised FDI criteria for evaluating direct and indirect dental restorations-recommendations for its clinical use, interpretation, and reporting. Clin Oral Investig 2023; 27:2573-2592. [PMID: 36504246 PMCID: PMC10264483 DOI: 10.1007/s00784-022-04814-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Accepted: 11/27/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES The FDI criteria for the evaluation of direct and indirect dental restorations were first published in 2007 and updated in 2010. Meanwhile, their scientific use increased steadily, but several questions from users justified some clarification and improvement of the living document. MATERIALS AND METHODS An expert panel (N = 10) initiated the revision and consensus process that included a kick-off workshop and multiple online meetings by using the Delphi method. During and after each round of discussion, all opinions were collected, and the aggregated summary was presented to the experts aiming to adjust the wording of the criteria as precisely as possible. Finally, the expert panel agreed on the revision. RESULTS Some categories were redefined, ambiguities were cleared, and the descriptions of all scores were harmonized to cross-link different clinical situations with possible management strategies: reviewing/monitoring (score 1-4), refurbishment/reseal (score 3), repair (score 4), and replacement (score 5). Functional properties (domain F: fracture of material and retention, marginal adaptation, proximal contact, form and contour, occlusion and wear) were now placed at the beginning followed by biological (domain B: caries at restoration margin, hard tissue defects, postoperative hypersensitivity) and aesthetic characteristics (domain A: surface luster and texture, marginal staining, color match). CONCLUSION The most frequently used eleven categories of the FDI criteria set were revised for better understanding and handling. CLINICAL RELEVANCE The improved description and structuring of the criteria may help to standardize the evaluation of direct and indirect restorations and may enhance their acceptance by researchers, teachers, and dental practitioners.
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Affiliation(s)
- Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany.
| | - Sabine Mesinger
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Niek Opdam
- Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Bas Loomans
- Department of Dentistry, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Roland Frankenberger
- Department of Operative Dentistry, Endodontics, and Pediatric Dentistry Medical Center for Dentistry, University Medical Center Giessen and Marburg, Campus Marburg, Marburg, Germany
| | - Milena Cadenaro
- Department of Medical Sciences, University of Trieste, Trieste, Italy and Children's Hospital "Burlo Garofolo," Institute for Maternal and Child Health, Trieste, Italy
| | - John Burgess
- Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - Arnd Peschke
- IvoclarVivadent AG, Research & Development, Schaan, Liechtenstein
| | | | - Jan Kühnisch
- Department of Conservative Dentistry and Periodontology, University Hospital, Ludwig-Maximilians-University of Munich, Munich, Germany
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Adabo GL, Longhini D, Baldochi MR, Bergamo ETP, Bonfante EA. Reliability and lifetime of lithium disilicate, 3Y-TZP, and 5Y-TZP zirconia crowns with different occlusal thicknesses. Clin Oral Investig 2023:10.1007/s00784-023-05001-6. [PMID: 37022529 DOI: 10.1007/s00784-023-05001-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/28/2023] [Indexed: 04/07/2023]
Abstract
OBJECTIVES To assess the probability of survival of crowns made with a 3Y-TZP, a 5Y-TZP, and a lithium disilicate. MATERIALS AND METHODS CAD-CAM premolar crowns with occlusal thicknesses of 1.0 mm or 1.5 mm and cemented on a metal dye. Step-stress accelerated life testing (SSALT) was performed to access the use level probability Weibull curves and reliability were calculated for the completion of a mission of 100,000 cycles at 300 to 1200 N. RESULTS All ceramics showed a high probability of survival (87-99%) at 300 N, irrespective of thickness. 3Y-TZP shows no significant decrease in the probability of survival up to 1200 N (83-96%). Lithium disilicate presented lower reliability than zirconia under the 600 N mission. 5Y-TZP showed lower reliability than 3Y-TZP at 1200 N. There was no significant difference in the Weibull modulus (3.23-7.12). 3Y-TZP had the highest characteristic strength (2483-2972 N), followed by 5Y-TZP (1512-1547 N) and lithium disilicate (971-1154 N). CONCLUSION Zirconia ceramics have a high probability of survival (up to 900 N-load), while lithium disilicate survives up to 300 N load only, irrespective of the thickness (1.0 mm or 1.5 mm). CLINICAL RELEVANCE The probability of survival of posterior crowns made with zirconia ceramics resists extreme loads while glass ceramics resist normal chewing loads. In addition, crowns with thinner occlusal face showed sufficient mechanical behavior.
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Grants
- 2016/09640-0, 2012/19078-7, 2021/06730-7, EMU 2016/18818-8, 2019/08693-1 Fundação de Amparo à Pesquisa do Estado de São Paulo
- 2016/09640-0, 2012/19078-7, 2021/06730-7, EMU 2016/18818-8, 2019/08693-1 Fundação de Amparo à Pesquisa do Estado de São Paulo
- 2016/09640-0, 2012/19078-7, 2021/06730-7, EMU 2016/18818-8, 2019/08693-1 Fundação de Amparo à Pesquisa do Estado de São Paulo
- Finance Code 001 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- Finance Code 001 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
- 307255/2021-2 Conselho Nacional de Desenvolvimento Científico e Tecnológico
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Affiliation(s)
- Gelson Luis Adabo
- School of Dentistry, Sao Paulo State University (Unesp), Araraquara, Sao Paulo, Brazil.
| | - Diogo Longhini
- School of Dentistry, Sao Paulo State University (Unesp), Araraquara, Sao Paulo, Brazil
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Al-Dwairi ZN, Al-Sardi M, Goodacre BJ, Goodacre CJ, Al Hamad KQ, Özcan M, Al-Haj Husain N, Baba NZ. Evaluation of Marginal and Internal Fit of Ceramic Laminate Veneers Fabricated with Five Intraoral Scanners and Indirect Digitization. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2181. [PMID: 36984061 PMCID: PMC10055617 DOI: 10.3390/ma16062181] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 06/18/2023]
Abstract
The long-term success of ceramic laminate veneers (CLVs) is influenced by the marginal and internal fit of the restorations. However, studies comparing the fit of CLVs using different intraoral scanners or the indirect digitization technique are lacking. The purpose of this study was therefore to assess the marginal and internal fit of CAD/CAM-milled CLVs using different intraoral scanners and the indirect digitalization technique. An ivorine typodont maxillary left-central incisor was prepared; the tooth and the neighboring teeth were scanned and used as a template to print ninety 3D partial models. Thereafter, ceramic laminate veneers (CLVs) (N = 90) were milled from IPS-Emax CAD blocks and divided into six equal groups (15 specimens each) according to the type of intraoral scanner (IOS), as follows: Omnicam IOS, SC3600 IOS, Trios 3 IOS, Emerald IOS, I500 IOS. Fifteen further CLVs were fabricated using the conventional indirect digitalization technique. After cementation on the resin dies and embedding in clear epoxy resin, specimens were sectioned inciso-gingivally and mesio-distally. At the incisal and cervical positions, the marginal discrepancy was measured and evaluated in addition to the internal gap at six locations using SEM (200×). Differences between gap measurements among the six groups were determined using ANOVA. Games-Howell multiple comparisons for homogenous variances and LSD multiple comparisons for non-homogenous variances were used with 95% confidence intervals. The significance level was set at 0.05. The lowest mean absolute marginal gap at the incisal margins (AMGI) was recorded for Omnicam group (203.28 ± 80.14) µm, while the highest mean absolute marginal gap at the cervical margins (AMGC) was recorded for Omnicam group (147.16 ± 59.78) µm. The mean AMGC was reported to be significantly different between the conventional technique (146.75 ± 38.43) µm and Trios 3 (91.86 ± (35.51) µm; p = 0.001) and between Emerald (112.37 ± (50.31) µm; p = 0.042) and I500 (86.95 ± (41.55) µm; p < 0.001). The mean MGI was found to be significantly different between the conventional technique (114.11 ± (43.45) µm and I500 group (186.99 ± (73.84) µm) only (p = 0.035). However, no significant differences were found in the mean MGI between all types of IOSs. The means of AMG and MG were significantly different at incisal or cervical areas between the conventional technique and IOSs and within the scanner groups (p > 0.05). Marginal gaps were higher in the incisal region compared to the cervical region with both the indirect digitization technique and the IOSs. Ceramic laminate veneers (CLVs) fabricated using IOSs produced overall internal and marginal fit adaptation results comparable to CLVs fabricated from the indirect digitalization method, and both techniques produced clinically acceptable results.
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Affiliation(s)
- Ziad N. Al-Dwairi
- Department of Prosthodontics, Faculty of Dentistry, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan
| | - Moataz Al-Sardi
- Department of Prosthodontics, Faculty of Dentistry, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan
| | - Brian J. Goodacre
- Division of General Dentistry, School of Dentistry, Loma Linda University, Loma Linda, CA 92350, USA
| | - Charles J. Goodacre
- Advanced Specialty Education Program in Implant Dentistry, School of Dentistry, Loma Linda University, Loma Linda, CA 92350, USA
| | - Khaled Q. Al Hamad
- Department of Prosthodontics, Faculty of Dentistry, Jordan University of Science and Technology (JUST), P.O. Box 3030, Irbid 22110, Jordan
| | - Mutlu Özcan
- Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Nadin Al-Haj Husain
- Division of Dental Biomaterials, Clinic for Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3010 Bern, Switzerland
- Clinic of Masticatory Disorders, Center of Dental Medicine, University of Zurich, 8032 Zurich, Switzerland
| | - Nadim Z. Baba
- Advanced Specialty Education Program in Implant Dentistry, School of Dentistry, Loma Linda University, Loma Linda, CA 92350, USA
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Cristea I, Agop-Forna D, Martu MA, Dascălu C, Topoliceanu C, Török R, Török B, Bardis D, Bardi PM, Forna N. Oral and Periodontal Risk Factors of Prosthetic Success for 3-Unit Natural Tooth-Supported Bridges versus Implant-Supported Fixed Dental Prostheses. Diagnostics (Basel) 2023; 13:diagnostics13050852. [PMID: 36899996 PMCID: PMC10001396 DOI: 10.3390/diagnostics13050852] [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: 02/04/2023] [Revised: 02/19/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
The goals of this research are: (1) to compare the survival and prosthetic success of metal-ceramic 3-unit tooth- versus implant-supported fixed dental prostheses; (2) to evaluate the influence of several risk factors on the prosthetic success of tooth- and implant-supported fixed dental prostheses (FPDs). A total of 68 patients with posterior short edentulous spaces (mean age 61.00 ± 1.325 years), were divided into two groups: 3-unit tooth-supported FPDs (40 patients; 52 FPD; mean follow-up 10.27 ± 0.496 years) and 3-unit implant-supported FPDs (28 patients; 32 FPD; mean follow-up 8.656 ± 0.718 years). Pearson-chi tests were used to highlight the risk factors for the prosthetic success of tooth- and implant-supported FPDs and multivariate analysis was used to determine significant risk predictors for the prosthetic success of the tooth-supported FPDs. The survival rates of 3-unit tooth- versus implant-supported FPDs were 100% and 87.5%, respectively, while the prosthetic success was 69.25% and 68.75%, respectively. The prosthetic success of tooth-supported FPDs was significantly higher for patients older than 60 years (83.3%) vs. 40-60 years old (57.1%) (p = 0.041). Periodontal disease history decreased the prosthetic success of tooth- versus implant-supported FPDs when compared with the absence of periodontal history (45.5% vs. 86.7%, p = 0.001; 33.3% vs. 90%, p = 0.002). The prosthetic success of 3-unit tooth- vs. implant-supported FPDs was not significantly influenced by gender, location, smoking, or oral hygiene in our study. In conclusion, similar rates of prosthetic success were recorded for both types of FPDs. In our study, prosthetic success of tooth- versus implant-supported FPDs was not significantly influenced by gender, location, smoking, or oral hygiene; however, history of periodontal disease is a significant negative predictor of success in both groups when compared with patients without periodontal history.
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Affiliation(s)
- Ioana Cristea
- Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Doriana Agop-Forna
- Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
- Correspondence: (D.A.-F.); (M.-A.M.); Tel.: +40-232301618 (M.-A.M.)
| | - Maria-Alexandra Martu
- Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
- Correspondence: (D.A.-F.); (M.-A.M.); Tel.: +40-232301618 (M.-A.M.)
| | - Cristina Dascălu
- Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Claudiu Topoliceanu
- Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | - Roland Török
- Implant Institute Török, 1712 Tafers, Switzerland
| | - Bianca Török
- Implant Institute Török, 1712 Tafers, Switzerland
| | - Dimitrios Bardis
- Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
| | | | - Norina Forna
- Faculty of Dental Medicine, Grigore T. Popa University of Medicine and Pharmacy Iasi, Universitatii Street 16, 700115 Iasi, Romania
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Jadaan O, Esquivel-Upshaw J, Nemeth NN, Baker E. Proof testing to improve the reliability and lifetime of ceramic dental prostheses. Dent Mater 2023; 39:227-234. [PMID: 36707313 DOI: 10.1016/j.dental.2023.01.004] [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: 09/12/2022] [Revised: 12/28/2022] [Accepted: 01/15/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Ceramic dental prostheses exhibit increasing failure rates with service time. In particular, veneered crowns and bridges are susceptible to chipping and other fracture modes of failure. The purpose of this manuscript is to introduce a computational methodology and associated software that can predict the time-dependent probability of failure for ceramic prostheses and subsequently design proof test protocols to significantly enhance their reliabilities and lifetimes. METHODS Transient reliability and corresponding proof testing theories are introduced. These theories are coded in the Ceramic Analysis and Reliability Evaluation of Structures (CARES/Life) code. This software will be used to demonstrate the predictive capability of the theory as well as its use in designing proof test protocols to significantly improve the reliability (survival probability) and lifetime for dental prostheses. A three-unit fixed dental prosthesis (FDP) with zirconia core (ZirCAD) and veneering ceramic (ZirPress) are used to compare the predicted probabilities of failure to general clinical results. In addition, the capability to use proof testing to significantly improve the performance (reliability and lifetime) for this restoration is demonstrated. RESULTS The probability of failure, Pf, after five years without proof testing is predicted to be 0.337. This compares to clinical studies showing the failure rate to be between 0.2 and 0.23 after 5 years. After 10 years, reference 18 found the clinical failure rate for similar bridges (but not the same) to be up to 0.28 compared to the predicted Pf of 0.38. The difference may be due to the analysis applying the load at an inclination of 75° which is more critical than vertical loading. In addition, clinical studies often report a simple survival rate instead of using Kaplan-Meier analysis to properly account for late enrollees. Therefore, true clinical failure rates may be higher than reported and may more closely match the predictions of this manuscript. The effectiveness of proof testing increases with selecting materials less susceptible to slow crack growth (higher SCG exponent, N). For example, proof testing the ZirPress glass-veneered bridges with N = 43.4 analyzed in this manuscript at 400 N bite force for 1 s which induces a failure rate during proof testing of 0.31, reduces the Pf of bridges not proof tested from 0.45 to an attenuated-proof-tested probability of failure Pfa of 0.21 after 20 years of usage. If another material is selected with improved resistance to SCG of N = 60 and the same loading conditions, the failure rate for the proof tested bridges after 20 years of service drops to 2 in 10,000 from 2.4 in 100 had they been not proof tested. The failure rate during proof testing for this material would be 5.1 in 100. Proof testing a material with absolutely no susceptibility to SCG at the same service load (in this case 285 N, not even the 400 N load used above) results in 0 % failure rate and is of course independent of time. SIGNIFICANCE The transient reliability and proof test theory presented in this paper and associated computational software CARES/Life were successful in predicting the performance of ceramic dental restorations when compared to clinical data. Well-designed proof test protocols combined with proper material selection can significantly enhance the reliabilities and lifetimes of ceramic prostheses. This proof test capability can be a translational technology if properly applied to dental restorations.
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Affiliation(s)
- Osama Jadaan
- Department of Mechanical Engineering, University of North Florida, Jacksonville, FL, USA.
| | | | | | - Eric Baker
- Connecticut Reserve Technologies, Inc., Cleveland, OH, USA
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Pozzi A, Arcuri L, Fabbri G, Singer G, Londono J. Long-term survival and success of zirconia screw-retained implant-supported prostheses for up to 12 years: A retrospective multicenter study. J Prosthet Dent 2023; 129:96-108. [PMID: 34187699 DOI: 10.1016/j.prosdent.2021.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 01/18/2023]
Abstract
STATEMENT OF PROBLEM Despite the broad clinical application of zirconia for fixed implant-supported prostheses, evidence of long-term performance is sparse. PURPOSE The purpose of this retrospective study was to evaluate the long-term clinical and radiographic outcomes of zirconia-based partial and complete screw-retained implant-supported zirconia fixed dental prostheses (ISZFDPs). MATERIAL AND METHODS Records of patients treated with dental implants and ISZFDPs between December 2004 and June 2017 were screened. Eligible study participants, according to inclusion criteria, were contacted and invited to undergo clinical and radiographic examinations. Outcomes were evaluated as implant and prosthetic survival rates, prosthetic success rate, complications, marginal bone level (MBL) change, and soft tissue condition. Along with the effects of zirconia prosthesis type and level, the effects of implant type and connection, type of loading, and follow-up on MBL were tested with a generalized linear effects model (GLEM) (α=.05). RESULTS A total of 118 patients were identified, of whom 20 (16.9%) were not available for clinical examination for various reasons. Ninety-eight participants (mean age 60.7 ±11.7 years) with 337 implants were included, of which 176 (52.2%) had been immediately loaded. A total of 111 ISZFDPs (96 zirconia connection and 15 titanium base) were investigated: 24 complete ISZFDPs with a zirconia connection (12.9 ±0.97 dental units, minimum 12, maximum 14), 72 partial with a zirconia connection (3.11 ±1.12, minimum 2, maximum 7), 15 partial with a titanium base (3.62 ±1.02, minimum 2, maximum 5). Forty ISZFDPs had been in function for ≥10 years (36%), 38 for 5 to 9 years (34.2%), and 33 for 2 to 4 years (22.8%). The mean follow-up time was 7.2 ±3.4 years. No zirconia fractures were identified. Two implants and 2 ISZFDPs failed, with chipping being the most common complication (13.5%). The implant survival rate was 99.4%, and the prosthetic survival rate was 98.2%. The cumulative prosthetic success rate was 91.9%. MBL change was -0.18 ±0.59 mm. Thirteen implants were treated for peri-implantitis (3.8%), and 9 for mucositis (2.7%), but presented healthy peri-implant soft tissues at the follow-up examination. A significant difference was found between the implant-level and abutment-level prostheses (P=.013), with less marginal bone loss observed in ISZFDPs delivered at the implant level. CONCLUSIONS Zirconia-based screw-retained implant-supported prosthesis can be considered a reliable long-term treatment option for partial and complete edentulism. No zirconia fractures were experienced. Stable bone levels and low peri-implantitis rates were reported regardless of the ISZFDP type and level, implant type and connection, and type of loading.
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Affiliation(s)
- Alessandro Pozzi
- Adjunct Associate Professor, Goldstein Center for Esthetic and Implant Dentistry, Department of Restorative Sciences, The Dental College of Georgia at Augusta University, Augusta, Ga; Private practice, Rome, Italy.
| | - Lorenzo Arcuri
- Assistant Professor, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, Rome, Italy
| | | | | | - Jimmy Londono
- Associate Professor, Director of Goldstein Center for Esthetic and Implant Dentistry, Department of Restorative Sciences, The Dental College of Georgia at Augusta University, Augusta, Ga
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Daou EE, Baba NZ. The Effect of Firing Cycles on the Fit of Cobalt-Chromium Multiunit Prostheses Fabricated by Additive Manufacturing. J Prosthodont 2023; 32:71-76. [PMID: 35304798 DOI: 10.1111/jopr.13506] [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: 09/08/2021] [Accepted: 03/02/2022] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The effect of annealing and firing cycle on the adaptation of cobalt-chromium (CoCr) restorations fabricated by additive manufacturing has been poorly documented. This study compared the marginal and internal fit of CoCr three-unit fixed dental prostheses before and after firing cycles. MATERIAL AND METHODS The first right maxillary premolar (MP) and molar (MM) on a typodont model, were prepared with a circumferential 1.2 mm chamfer, 2 mm occlusal reduction, and total taper of 8 degrees, to receive 3-unit fixed dental prostheses (FDP). After the framework design, 20 framework specimens were fabricated using CoCr metal powder by selective laser melting. The replica technique was used for marginal and internal fit measurements in mesiodistal and buccolingual planes. The specimens were submitted to an annealing process, and to ceramic firing protocol. Measurements were repeated after each firing cycle. The data were compared by using Levene test, t-test, and analysis of variance (ANOVA) (α = 0.05). RESULTS A significant difference was found in the total intaglio surface discrepancy between the 3 treatments. The annealing treatment induced a statistical difference in the discrepancy value compared to the as printed state (p = 0.028). A significant difference was detected between the initial manufacturing phase and the ceramic layering firing cycle (p = 0.003). CONCLUSIONS Firing cycles induced an alteration of the frameworks adaptation.
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Affiliation(s)
- Elie E Daou
- Department of Prosthodontics, Faculty of Dental Medicine, Lebanese University, Beirut, Lebanon.,Al-Ayen University, Nile Street, Nasiriyah
| | - Nadim Z Baba
- Advanced Specialty Education Program in Implant Dentistry, Loma Linda University, School of Dentistry, California, USA
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Bonfante EA, Calamita M, Bergamo ETP. Indirect restorative systems-A narrative review. J ESTHET RESTOR DENT 2023; 35:84-104. [PMID: 36688803 DOI: 10.1111/jerd.13016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The background and clinical understanding of the properties of currently available indirect restorative systems and fabrication methods is, along with manufacturer and evidence-based literature, an important starting point to guide the clinical selection of materials for tooth and/or implant supported reconstructions. Therefore, this review explores most indirect restorative systems available in the market, especially all-ceramic, along with aspects of manufacturing process, clinical survival rates, and esthetic outcomes. OVERVIEW Progressive incorporation of new technologies in the dental field and advancements in materials science have enabled the development/improvement of indirect restorative systems and treatment concepts in oral rehabilitation, resulting in reliable and predictable workflows and successful esthetic and functional outcomes. Indirect restorative systems have evolved from metal ceramics and polymers to glass ceramics, polycrystalline ceramics, and resin-matrix ceramics, aiming to improve not only biological and mechanical properties, but especially the optical properties and esthetic quality of the reconstructions, in attempt to mimic natural teeth. CONCLUSIONS Based on several clinical research, materials, and patient-related parameters, a decision tree for the selection of indirect restorative materials was suggested to guide clinicians in the rehabilitation process. CLINICAL SIGNIFICANCE The pace of materials development is faster than that of clinical research aimed to support their use. Since no single material provides an ideal solution to every case, professionals must continuously seek information from well designed, long-term clinical trials in order to incorporate or not new materials and technological advancements.
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Affiliation(s)
- Estevam A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
| | - Marcelo Calamita
- Department of Restorative Dental Sciences at the University of Florida, Gainesville, Florida, USA
| | - Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
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Strasding M, Hicklin SP, Todorovic A, Fehmer V, Mojon P, Sailer I. A multicenter randomized controlled clinical pilot study of buccally micro-veneered lithium-disilicate and zirconia crowns supported by titanium base abutments: 1-year outcomes. Clin Oral Implants Res 2023; 34:56-65. [PMID: 36321877 PMCID: PMC10098475 DOI: 10.1111/clr.14018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/07/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To investigate survival rates, technical and biologic outcomes of buccally micro-veneered all-ceramic single implant crowns. MATERIAL AND METHODS Sixty subjects randomly received immediately or early placed implants. Crowns out of lithium-disilicate (n = 30) and zirconia-ceramic (n = 30) were bonded to titanium-base-abutments. Restorations were inspected at baseline (BL) and during follow-up visits (6, 12 months). Technical and biologic parameters were recorded. Data were analysed descriptively. Differences between groups were tested with Student's t-test. Paired T-test was used when comparing data from the same implant or tooth over time. Linear model repeated measures were used to test differences between materials over time. Differences in counts were evaluated using Pearson Chi-square test. The level of significance was at p < .05. RESULTS After a mean observation time of 13.2 ± 2.4 months, 54 restorations were re-examined. The implant survival rate was 98.3%, and the restoration survival rate was 100%. One early implant failure occurred. Two minor chippings occurred in lithium-disilicate restorations. No chippings or fractures occurred in any zirconia restorations at 1 year (0%). The technical complication rate was 3.7%, with 7.7% complications among the lithium-disilicate restorations and no differences between the two materials (p = .558). At 1-year follow-up, mean Bleeding on Probing (BOP) was higher at implants (0.27 ± 0.3) than adjacent teeth (0.17 ± 0.18) (p = .046) with no differences between materials (p = .36). Differences in pocket probing depth (PPD) between implants and adjacent teeth were significant (p < .01). Jemt Index improved significantly from BL to 1-y-follow-up (p < .001). CONCLUSIONS Preliminary results were good, suggesting that the ceramic type does not impact technical and biologic parameters.
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Affiliation(s)
- Malin Strasding
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva 4, Switzerland
| | - Stefan Paul Hicklin
- Clinic of Preventive Dentistry, Periodontology and Cariology, and Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ana Todorovic
- Division of Prosthodontics, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Vincent Fehmer
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva 4, Switzerland
| | - Philippe Mojon
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva 4, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva 4, Switzerland
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D'Albis G, D'Albis V, Susca B, Palma M, Al Krenawi N. Implant-supported zirconia fixed partial dentures cantilevered in the lateral-posterior area: A 4-year clinical results. J Dent Res Dent Clin Dent Prospects 2022; 16:258-263. [PMID: 37560497 PMCID: PMC10407873 DOI: 10.34172/joddd.2022.041] [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: 04/21/2022] [Accepted: 09/23/2022] [Indexed: 08/11/2023] Open
Abstract
Background Implant-supported cantilever prostheses enable a more straightforward rehabilitation and may be a therapeutic option to reduce treatment morbidity, costs, and time. This study evaluated the clinical outcomes of fixed implant-supported partial dentures made of monolithic zirconia with a cantilever design to replace missing posterior teeth. Methods Fifteen partially edentulous patients received 34 implants and were provided with 16 zirconia fixed partial prostheses (FPPs) with one cantilever extension replacing mandibular or maxillary missing posterior and lateral teeth. Patients were re-examined for up to 4 years. Patient ages ranged from 41 to 65 years, with a mean age of 53±12 years; 47% were female, and 53% were male. The patients were observed for a mean period of 42±6 months with a minimum of 3 years and a maximum of 4 years. Results Peri-implantitis was observed in two cases. No chipping or fracture of any FPP was detected. Loosening of the abutment screw was a technical complication in one case. The rehabilitation survival rate was 100%. Implant-supported zirconia FPP with one mesial cantilever extension provides an aesthetic, functional treatment alternative to replace missing molars, premolars, and canines. These excellent clinical outcomes occurred over a mean observation time of 42±6 months. Conclusion Using monolithic zirconia milled with CAD-CAM technology might be an alternative to the metal-ceramic restoration in implant-supported FPP with one cantilever.
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Affiliation(s)
- Giuseppe D'Albis
- Periodontology and Implantology Department, University of Federico II of Naples, Naples, Italy
| | - Vincenzo D'Albis
- Department of Orthodontics, University of Rome “Tor Vergata”, Rome, Italy
| | - Bart Susca
- Dental Technician, Mola di Bari (BA), Italy
| | - Micol Palma
- Interdisciplinary Department of Medicine, University of Bari, Bari, Italy
| | - Nizar Al Krenawi
- Periodontology and Implantology Department, University of Federico II of Naples, Naples, Italy
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