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Chai H. Edge chipping patterns in posterior teeth of hominins and apes. J Mech Behav Biomed Mater 2024; 156:106582. [PMID: 38781774 DOI: 10.1016/j.jmbbm.2024.106582] [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: 02/20/2024] [Revised: 05/11/2024] [Accepted: 05/14/2024] [Indexed: 05/25/2024]
Abstract
Chip scars in fossil teeth are a lasting evidence that bears on human evolution. Chip dimensions in posterior teeth of hominins, apes and white-lipped peccary (Tayassu pecari) are measured from published occlusal images. The results are plotted as D/Dm vs. h/Dm, where h, D and Dm denote indent distance, chip width and mean tooth crown diameter. The hominin species follow a similar pattern where D/Dm monotonically increases up to h/Dm ≈ 0.3. The behavior for the apes is characterized by two phases. In the first, h/Dm monotonically increases up to h/Dm ≈ 0.26 while in the second (h/Dm ≈ 0.26 to 0.42), D/Dm experiences a drastic change in behavior. The interpretation of chip morphology is assisted by results from controlled spherical indentation tests on extracted human molars. This study shows that in addition to the commonly recognized chipping due to cusp loading, a chip may also initiate from the inner wall of the tooth's central fossa. Accordingly, it is suggested that the chipping in hominins generally initiates from a (worn) cusp while that in apes involves cusp loading up to h/Dm ≈ 0.26 and fossa loading thereafter. The behavior for T. pecari is much similar to that of the apes. The fossa chipping is facilitated by a consumption of hard, large-size diet (e.g., plants, roots, barks and nuts) and presence of broad central fossa, conditions that are met in apes. Finally, a simple expression for the critical chipping force Pch due to fossa loading is developed.
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Affiliation(s)
- Herzl Chai
- School of Mechanical Engineering, Tel-Aviv University, Tel-Aviv, Israel.
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Zaninovich M, Drago C. Prosthodontic criteria for maxillary immediate occlusal loading, surgical classifications of atrophic maxillae, and presentation of a new implant/anatomic classification system for immediate maxillary rehabilitation. J Prosthodont 2024. [PMID: 39008359 DOI: 10.1111/jopr.13898] [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: 12/22/2023] [Accepted: 06/06/2024] [Indexed: 07/16/2024] Open
Abstract
PURPOSE Immediate full-arch occlusal loading for patients with atrophic edentulous maxillae satisfies critical needs for this specific type of edentulous patient after placement of implants with high levels of primary implant stability. The needs include improved aesthetics, limited immediate improved function, and elimination of removable prostheses. Classification systems exist for edentulous maxillae but they do not include specifics regarding posterior implant placement. In conjunction with anterior implants, posterior implants improve Anterior/Posterior (A/P) spreads, decrease cantilevered segments (CLs), and likely will improve implant and prosthetic success rates. The purposes of this article include presenting a new classification system that outlines the different types of implants now available which will likely achieve the requisite primary stability for immediate fixed rehabilitation. This proposed classification system identifies a relationship between different implant options currently available and the remaining quantity of bone in the first and second maxillary molar zones. MATERIALS AND METHODS The available literature regarding current classification systems was reviewed. The benefits and limitations of each system were described. The parameters associated with Immediate Occlusal Loading (IOL) for full arch maxillary prostheses include: posterior cantilever lengths of full arch fixed prostheses; existing A/P spread considerations for full arch prostheses; and introduction of a new classification system for atrophic posterior maxillary edentulous ridges were identified. RESULTS Currently, there are no available classification systems that outline specific implant options for posterior maxillae which will likely achieve the minimum primary stability needed for immediate rehabilitation. A new classification system was proposed where the rationale was to show clinicians that when a certain amount of bone remains in the posterior maxilla, there are specific implants designed to maximize primary stability. High implant primary stability is required for rehabilitation with immediate fixed implant-supported provisional prostheses. The proposed classification system assists clinicians in understanding what implant geometry is available and can be expected to achieve the requisite primary stability for immediate occlusal loading based on the available bone in the posterior maxillary molar zone. CONCLUSIONS This article reviewed current classification systems for edentulous maxillary patients, as well as clinical parameters required for full arch, immediate occlusal loading. It also presented a new classification system to assist clinicians in selecting appropriate implants and surgical techniques for immediate fixed rehabilitation of patients with atrophic maxillae.
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Affiliation(s)
- Michael Zaninovich
- Aria Dental Specialist Implant Centre, Perth, Western Australia, Australia
| | - Carl Drago
- Greenbrook Dental Group, Brookfield, Wisconsin, USA
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Kim JH, Yoon JH, Jeon HI, Kim DW, Park YB, Oh N. Prediction of lifespan and assessing risk factors of large-sample implant prostheses: a multicenter study. J Adv Prosthodont 2024; 16:151-162. [PMID: 38957292 PMCID: PMC11215039 DOI: 10.4047/jap.2024.16.3.151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 05/13/2024] [Accepted: 06/14/2024] [Indexed: 07/04/2024] Open
Abstract
PURPOSE This study aimed to analyze factors influencing the success and failure of implant prostheses and to estimate the lifespan of prostheses using standardized evaluation criteria. An online survey platform was utilized to efficiently gather large samples from multiple institutions. MATERIALS AND METHODS During the one-year period, patients visiting 16 institutions were assessed using standardized evaluation criteria (KAP criteria). Data from these institutions were collected through an online platform, and various statistical analyses were conducted. Risk factors were assessed using both the Cox proportional hazard model and Cox regression analysis. Survival analysis was conducted using Kaplan-Meier analysis and nomogram, and lifespan prediction was performed using principal component analysis. RESULTS The number of patients involved in this study was 485, with a total of 841 prostheses evaluated. The median survival was estimated to be 16 years with a 95% confidence interval. Factors found to be significantly associated with implant prosthesis failure, characterized by higher hazard ratios, included the 'type of clinic', 'type of antagonist', and 'plaque index'. The lifespan of implant prostheses that did not fail was estimated to exceed the projected lifespan by approximately 1.34 years. CONCLUSION To ensure the success of implant prostheses, maintaining good oral hygiene is crucial. The estimated lifespan of implant prostheses is often underestimated by approximately 1.34 years. Furthermore, standardized form, online platform, and visualization tool, such as nomogram, can be effectively utilized in future follow-up studies.
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Affiliation(s)
- Jeong Hoon Kim
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Joon-Ho Yoon
- Department of Prosthodontics, NHIS Ilsan Hospital, Goyang, Republic of Korea
| | - Hae-In Jeon
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Dong-Wook Kim
- Department of Information and Statistics, Research Institute of Natural Science, Gyeongsang National University, Jinju, Republic of Korea
- Department of Bio & Medical Bigdata (BK21 Plus), Gyeongsang National University, Jinju, Republic of Korea
| | - Young-Bum Park
- Department of Prosthodontics, College of Dentistry, Yonsei University, Seoul, Republic of Korea
| | - Namsik Oh
- Department of Dentistry, School of Medicine, Inha University, Incheon, Republic of Korea
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Liang L, Wu X, Yan Q, Shi B. Are short implants (≤8.5 mm) reliable in the rehabilitation of completely edentulous patients: A systematic review and meta-analysis. J Prosthet Dent 2024; 131:826-832. [PMID: 35469646 DOI: 10.1016/j.prosdent.2022.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/21/2022]
Abstract
STATEMENT OF PROBLEM Limited data are available regarding the reliability of short implants (≤8.5 mm) in patients with resorbed completely edentulous jaws. PURPOSE The purpose of this systematic review and meta-analysis was to compare the clinical outcomes of short implants (intervention) versus long implants (≥10 mm, comparison) in the rehabilitation of completely edentulous jaws. MATERIAL AND METHODS The PubMed, Embase, and Cochrane CENTRAL databases were searched for randomized controlled trials (RCTs) comparing short and long implants supporting fixed or removable prostheses in completely edentulous jaws. Outcome measures included implant survival, marginal bone loss (MBL), and biological and technical complications. The risks of bias within and across the studies were assessed, and meta-analyses, sensitivity analyses, and subgroup analyses by types of prostheses, jaw locations, and follow-up length were performed. RESULTS A total of 4 RCTs with 158 participants were included. No significant difference was found between short implants and long implants regarding implant survival (RR=1.01, 95% CI: 0.97 to 1.05, P=.710, I2=70%) or MBL (MD=-0.19 mm, 95% CI: -0.39 to 0.02, P=.070, I2=94%). In subgroup analyses, when supporting fixed prostheses, short implants showed significantly less MBL than long implants (P<.001). In the mandible, short implants showed higher implant survival (P=.008) and less MBL (P<.001). Participants receiving long implants combined with bone augmentation procedures reported more postsurgery pain. CONCLUSIONS For completely edentulous jaws, short implants provide a reliable treatment alternative, as survival and MBL were not different when compared with those of long implants. However, additional high-level evidence is still needed to determine the long-term clinical outcomes of short implants in completely edentulous jaws.
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Affiliation(s)
- Liang Liang
- Graduate student, The State Key Laboratory Breeding Base of Basic Sciences of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China; Department of Oral Implantology, Jianli Stomatology Hospital, Dongguan, PR China
| | - Xinyu Wu
- Graduate student, The State Key Laboratory Breeding Base of Basic Sciences of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Qi Yan
- Lecturer, The State Key Laboratory Breeding Base of Basic Sciences of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China
| | - Bin Shi
- Professor, The State Key Laboratory Breeding Base of Basic Sciences of Stomatology & Key Laboratory of Oral Biomedicine, Ministry of Education (Hubei-MOST KLOS & KLOBM), Department of Oral Implantology, School & Hospital of Stomatology, Wuhan University, Wuhan, PR China.
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Shemtov-Yona K, Arieli A, Barhum M, Pilo R, Levartovsky S. The effect of contaminating media on the static and dynamic mechanical resilience of dental implant abutments' screws: In vitro study. Clin Implant Dent Relat Res 2024; 26:289-298. [PMID: 37675656 DOI: 10.1111/cid.13271] [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: 06/06/2023] [Revised: 07/15/2023] [Accepted: 08/21/2023] [Indexed: 09/08/2023]
Abstract
INTRODUCTION This in vitro study aims to biomechanically evaluate the influence of medium contamination for example, saliva, blood, chlorhexidine (liquid and gel), and fluoride mouthwash on the biomechanical behavior of implant abutments' screws under static and dynamic loading. METHODS Forty five Ti6Al4V commercial dental implants and abutments were tested in this study. Two main mechanical tests were carried out in the selected media. The first, static, aimed to evaluate the torque loss after the first tightening. The second, dynamic, involved a random cyclic load range between 0 and 200 N to evaluate torque loss due to mastication. In addition, metallographic longitudinal and cross-sections of the abutment-implant apparatus were examined to evaluate the abutment screw-abutment-implant interface. RESULTS The static torque test showed that irrespective of the media, no statistical difference in static torque loss was found prior to dynamic loading. For the dynamic tests, torque-angle evolution analysis during tightening to 30 Ncm and after the spectrum loading, showed the same global mechanical behavior for all media, but the statistical analysis indicated a difference between the groups in reverse torque values (RTV) and in the torque loss due to dynamic loading. The medium groups CHX, CHX-gel, and Fluoride mouthwash, showed a meaningful torque loss due to loading, but the medium groups, control (no medium), blood and saliva showed an opposite trend and required a higher torque to open the abutment screws. The microstructural analysis revealed clear signs of cold-welding/galling, post-dynamic loading in these latter groups. CONCLUSIONS The presence of lubrication/contamination media (CHX mouthwash/CHX-gel/Fluoride mouthwash) reduces the preload generated due to tightening but prevents damage due to galling. The observed reduction of RTV clearly emphasizes the need for frequent abutment screw retightening for implant-supported prosthetic long-term stability.
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Affiliation(s)
- Keren Shemtov-Yona
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Arieli
- Department of Oral Rehabilitation, the Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Mohana Barhum
- The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Raphael Pilo
- Department of Oral Biology, The Maurice and Gabriela Goldschleger School of Dental Medicine, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shifra Levartovsky
- Department of Oral Rehabilitation, the Maurice and Gabriela Goldschleger School of Dental Medicine, Tel Aviv University, Tel Aviv, Israel
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Molinero-Mourelle P, Abou-Ayash S, Brägger U, Schimmel M, Özcan M, Yilmaz B, Buser R, Al-Haj Husain N. Load bearing capacity of 3-unit screw-retained implant-supported fixed dental prostheses with a mesial and distal cantilever on a single implant: A comparative in vitro study. J Mech Behav Biomed Mater 2024; 151:106395. [PMID: 38244420 DOI: 10.1016/j.jmbbm.2024.106395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 01/08/2024] [Accepted: 01/08/2024] [Indexed: 01/22/2024]
Abstract
OBJECTIVES To assess the mechanical durability of monolithic zirconia implant-supported fixed dental prostheses (iFDP) design on one implant, with a distal and a mesial extension cantilever bonded to a titanium base compared to established designs on two implants. MATERIALS AND METHODS Roxolid Tissue level (TL), and tissue level x (TLX) implants were used to manufacture screw-retained 3-unit iFDPs (n = 60, n = 10 per group), with following configurations (X: Cantilever; I: Implant, T: Test group, C: Control group): T1: X-I-X (TL); T2: X-I-X (TLX); T3: I-I-X (TL); T4: I-I-X (TLX); C1: I-X-I (TL); C2: I-X-I (TLX). The iFDPs were thermomechanically aged and subsequently loaded until fracture using a universal testing machine. The failure load at first crack (Finitial) and at catastrophic fracture (Fmax) were measured and statistical evaluation was performed using two-way ANOVA and Tukey's post-hoc tests. RESULTS The mean values ranged between 190 ± 73 and 510 ± 459 N for Finitial groups, and between 468 ± 76 and 1579 ± 249 N for Fmax, respectively. Regarding Finitial, neither the implant type, nor the iFDP configuration significantly influenced measured failure loads (all p > 0.05). The choice of implant type did not show any significant effect (p > 0.05), while reconstruction design significantly affected Fmax data (I-I-Xa < X-I-Xb < I-X-Ic) (p < 0.05). The mesial and distal extension groups (X-I-X) showed fractures only at the cantilever extension site, while the distal extension group (I-I-X) showed one abutment and one connector fracture at the implant/reconstruction interface. CONCLUSION Results suggest that iFDPs with I-X-I design can be recommended regardless of tested implant type followed by the mesial and distal extension design on one implant abutment (X-I-X).
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Affiliation(s)
- Pedro Molinero-Mourelle
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Switzerland
| | - Samir Abou-Ayash
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Switzerland
| | - Urs Brägger
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Switzerland
| | - Martin Schimmel
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Switzerland; Division of Gerodontology and Removable Prosthodontics, University Clinics of Dental Medicine, University of Geneva, Switzerland
| | - Mutlu Özcan
- Clinic of Masticatory Disorders and Dental Biomaterials, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Burak Yilmaz
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Switzerland; Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland; Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, OH, USA
| | - Ramona Buser
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Switzerland
| | - Nadin Al-Haj Husain
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Switzerland; Clinic of Masticatory Disorders and Dental Biomaterials, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
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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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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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Chai H. On edge chipping in molar teeth from blunt occlusal contact. J Mech Behav Biomed Mater 2023; 148:106206. [PMID: 37944225 DOI: 10.1016/j.jmbbm.2023.106206] [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: 09/20/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 11/12/2023]
Abstract
Edge chipping is a leading failure mode in dental teeth. Virtually all chipping studies are limited to Vickers indentation on polished cusps of molar teeth. Such works are here extended to spherical contact. Occlusal loads are applied on the tooth's central fossa or a polished cusp using ball radii ranging from 0.4 to 5.16 mm. The chip dimensions are characterized by h/Dm and D/Dm, where h, D and Dm denote indent distance, chip size and tooth crown diameter. For the fossa loading, h/Dm, D/Dm and the least chipping force Pch are virtually independent of ball radius r for r < ≈ 4 mm. In this range, h/Dm and D/Dm lie between ≈0.30 to 0.36 and 0.51 to 0.69, respectively, while Pch equals ≈1330 N. For r > ≈ 4 mm, the failure occurs by debonding of enamel sectors from the dentin core. In the case of cusp loading, h/Dm < ≈ 0.3 while D/Dm and Pch vary with r. For relatively small h or large r, the failure occurs as soon as radial cracks initiate under the loading point. For a load applied near a cusp tip, the failure occurs by enamel debonding. Finally, the present work is easily extendable to fossil teeth of hominins and apes as well as prosthetic teeth. The morphological features obtained in such studies should provide quantitative means to assess the relationships between chip dimensions, chipping force and diet characteristics.
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Affiliation(s)
- Herzl Chai
- School of Mechanical Engineering, Tel-Aviv University, Tel-Aviv, Israel.
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10
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Fernandes D, Marques T, Borges T, Montero J. Volumetric analysis on the use of customized healing abutments with or without connective tissue graft at flapless maxillary immediate implant placement: A randomized clinical trial. Clin Oral Implants Res 2023; 34:934-946. [PMID: 37386752 DOI: 10.1111/clr.14119] [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: 11/23/2022] [Revised: 06/07/2023] [Accepted: 06/11/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVES To evaluate buccal volume change after using a customized healing abutment with or without connective tissue grafts (CTG) in flapless maxillary immediate implant placement (IIP). MATERIALS AND METHODS The present study was designed as a randomized clinical trial (RCT). Patients treated with flapless maxillary IIP were allocated into two groups, both receiving a customized healing abutment, and additionally, the test group received a CTG. A cone-beam computerized tomography (CBCT) allowed to access the initial buccal bone thickness (BT). Digital impressions were taken prior to extractions (T0), 1 month (T1), 4 months (T2), and 12 months (T3) after implant insertion and superimposed with computer software allowing to compute variables related to buccal volume variation (BVv) and total volume variation (TVv) (ClinicalTrials.gov: NCT05060055). RESULTS Thirty-two patients (mean age 48 ± 11 years), sixteen in each group, were evaluated after a 12-month period. After 1 year of treatment, no significant differences were found between groups, although in participants with BT ≤1 mm, control and test groups showed a BVv of -14.18 ± 3.49% and -8.30 ± 3.78%, respectively (p = .033). Regarding mucosa height variation variables, the control group showed approximately the triple vertical recession in both papillae. CONCLUSIONS The placement of a CTG was not capable of completely maintaining the initial peri-implant tissue architecture, although in thin-bone phenotypes, less dimensional changes are expected when a CTG was used.
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Affiliation(s)
- Danilo Fernandes
- Department of Surgery, Faculty of Medicine, University of Salamanca, Salamanca, Spain
- Center for Interdisciplinary Research in Health, Faculty of Dental Medicine, Universidade Católica Portuguesa, Viseu, Portugal
| | - Tiago Marques
- Center for Interdisciplinary Research in Health, Faculty of Dental Medicine, Universidade Católica Portuguesa, Viseu, Portugal
| | - Tiago Borges
- Center for Interdisciplinary Research in Health, Faculty of Dental Medicine, Universidade Católica Portuguesa, Viseu, Portugal
| | - Javier Montero
- Department of Surgery, Faculty of Medicine, University of Salamanca, Salamanca, Spain
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11
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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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12
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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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13
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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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14
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PEREIRA RM, RIBAS RG, MONTANHEIRO TLDA, SCHATKOSKI VM, RODRIGUES KF, KITO LT, KOBO LK, CAMPOS TMB, BONFANTE EA, GIERTHMUEHLEN PC, SPITZNAGEL FA, THIM GP. An engineering perspective of ceramics applied in dental reconstructions. J Appl Oral Sci 2023; 31:e20220421. [PMID: 36820784 PMCID: PMC9972857 DOI: 10.1590/1678-7757-2022-0421] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 01/04/2023] [Indexed: 02/22/2023] Open
Abstract
The demands for dental materials continue to grow, driven by the desire to reach a better performance than currently achieved by the available materials. In the dental restorative ceramic field, the structures evolved from the metal-ceramic systems to highly translucent multilayered zirconia, aiming not only for tailored mechanical properties but also for the aesthetics to mimic natural teeth. Ceramics are widely used in prosthetic dentistry due to their attractive clinical properties, including high strength, biocompatibility, chemical stability, and a good combination of optical properties. Metal-ceramics type has always been the golden standard of dental reconstruction. However, this system lacks aesthetic aspects. For this reason, efforts are made to develop materials that met both the mechanical features necessary for the safe performance of the restoration as well as the aesthetic aspects, aiming for a beautiful smile. In this field, glass and high-strength core ceramics have been highly investigated for applications in dental restoration due to their excellent combination of mechanical properties and translucency. However, since these are recent materials when compared with the metal-ceramic system, many studies are still required to guarantee the quality and longevity of these systems. Therefore, a background on available dental materials properties is a starting point to provoke a discussion on the development of potential alternatives to rehabilitate lost hard and soft tissue structures with ceramic-based tooth and implant-supported reconstructions. This review aims to bring the most recent materials research of the two major categories of ceramic restorations: ceramic-metal system and all-ceramic restorations. The practical aspects are herein presented regarding the evolution and development of materials, technologies applications, strength, color, and aesthetics. A trend was observed to use high-strength core ceramics type due to their ability to be manufactured by CAD/CAM technology. In addition, the impacts of COVID-19 on the market of dental restorative ceramics are presented.
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Affiliation(s)
- Raíssa Monteiro PEREIRA
- Instituto Tecnológico de AeronáuticaLaboratório de Plasma e ProcessosSão José dos CamposBrasilInstituto Tecnológico de Aeronáutica (ITA), Laboratório de Plasma e Processos (LPP), São José dos Campos, Brasil
| | - Renata Guimarães RIBAS
- Instituto Tecnológico de AeronáuticaLaboratório de Plasma e ProcessosSão José dos CamposBrasilInstituto Tecnológico de Aeronáutica (ITA), Laboratório de Plasma e Processos (LPP), São José dos Campos, Brasil
| | - Thaís Larissa do Amaral MONTANHEIRO
- Instituto Tecnológico de AeronáuticaLaboratório de Plasma e ProcessosSão José dos CamposBrasilInstituto Tecnológico de Aeronáutica (ITA), Laboratório de Plasma e Processos (LPP), São José dos Campos, Brasil
| | - Vanessa Modelski SCHATKOSKI
- Instituto Tecnológico de AeronáuticaLaboratório de Plasma e ProcessosSão José dos CamposBrasilInstituto Tecnológico de Aeronáutica (ITA), Laboratório de Plasma e Processos (LPP), São José dos Campos, Brasil
| | - Karla Faquine RODRIGUES
- Instituto Tecnológico de AeronáuticaLaboratório de Plasma e ProcessosSão José dos CamposBrasilInstituto Tecnológico de Aeronáutica (ITA), Laboratório de Plasma e Processos (LPP), São José dos Campos, Brasil
| | - Letícia Terumi KITO
- Instituto Tecnológico de AeronáuticaLaboratório de Plasma e ProcessosSão José dos CamposBrasilInstituto Tecnológico de Aeronáutica (ITA), Laboratório de Plasma e Processos (LPP), São José dos Campos, Brasil
| | - Lucas Kazunori KOBO
- Instituto Tecnológico de AeronáuticaLaboratório de Plasma e ProcessosSão José dos CamposBrasilInstituto Tecnológico de Aeronáutica (ITA), Laboratório de Plasma e Processos (LPP), São José dos Campos, Brasil
| | - Tiago Moreira Bastos CAMPOS
- Instituto Tecnológico de AeronáuticaLaboratório de Plasma e ProcessosSão José dos CamposBrasilInstituto Tecnológico de Aeronáutica (ITA), Laboratório de Plasma e Processos (LPP), São José dos Campos, Brasil
| | - Estevam Augusto BONFANTE
- Universidade de São PauloFaculdade de Odontologia de BauruDepartamento de Prótese e PeriodontiaBauruSPBrasilUniversidade de São Paulo, Faculdade de Odontologia de Bauru, Departamento de Prótese e Periodontia, Bauru, SP, Brasil.
| | - Petra Christine GIERTHMUEHLEN
- Heinrich-Heine-UniversityMedical FacultyUniversity Hospital DüsseldorfDüsseldorfGermanyHeinrich-Heine-University, Medical Faculty and University Hospital Düsseldorf, Düsseldorf, Department of Prosthodontics, Germany.
| | - Frank Akito SPITZNAGEL
- Heinrich-Heine-UniversityMedical FacultyUniversity Hospital DüsseldorfDüsseldorfGermanyHeinrich-Heine-University, Medical Faculty and University Hospital Düsseldorf, Düsseldorf, Department of Prosthodontics, Germany.
| | - Gilmar Patrocínio THIM
- Instituto Tecnológico de AeronáuticaLaboratório de Plasma e ProcessosSão José dos CamposBrasilInstituto Tecnológico de Aeronáutica (ITA), Laboratório de Plasma e Processos (LPP), São José dos Campos, Brasil
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Revilla-León M, Yilmaz B, Kois JC, Att W. Prevention of peri-implant disease in edentulous patients with fixed implant rehabilitations. Clin Implant Dent Relat Res 2023. [PMID: 36707075 DOI: 10.1111/cid.13182] [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: 11/14/2022] [Accepted: 01/07/2023] [Indexed: 01/29/2023]
Abstract
OBJECTIVES To provide an overview about the current approaches to prevent peri-implant diseases in edentulous patients with complete-arch implant-supported prostheses, and to review the clinical applications of the latest digital technologies for implant prosthodontics. METHODS A review of the guidelines to prevent peri-implant diseases in patient's receiving complete-arch implant-supported prostheses including facially driven treatment planning procedures using either conventional or digital methods, computer-aided implant planning procedures, and prosthodontic design variables including the optimal number and distribution of dental implants, implant to abutment connection type, implant or abutment level design, screw- or cement-retained alternatives, prostheses contours, and material selection is provided. Furthermore, an outline of the current therapeutic management approaches to address peri-implant diseases is reviewed. CONCLUSIONS Clinicians should understand and know different planning and design-related variables that can affect biological and mechanical complication rates of complete-arch implant-supported prostheses. Maintenance protocols are fundamental for minimizing biological and mechanical complications.
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Affiliation(s)
- Marta Revilla-León
- Graduate Prosthodontics, Department of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, Washington, USA.,Kois Center, Seattle, Washington, USA.,Department of Prosthodontics, Tufts University, Boston, Massachusetts, USA
| | - Burak Yilmaz
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland.,Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio, USA
| | - John C Kois
- Kois Center, Seattle, Washington, USA.,Graduate Prosthodontics, Department of Restorative Dentistry, University of Washington, Seattle, Washington, USA.,Private Practice, Seattle, Washington, USA
| | - Wael Att
- Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
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16
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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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17
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Cheng YC, Bergamo ETP, Murcko L, Hirayama M, Perpetuini P, Speratti D, Bonfante EA. Fiber-reinforced composite partial fixed dental prostheses supported by short or extra-short implants: A 10 year retrospective study. Clin Implant Dent Relat Res 2022; 24:854-861. [PMID: 36205843 DOI: 10.1111/cid.13133] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 09/04/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION This study evaluated the 10-year survival and success of partial fixed dental prostheses (P-FDPs) fabricated with a milled fiber-reinforced composite (FRC) framework, supported by short or extra-short implants. METHODS Patients restored with FRC P-FDPs supported by short or extra-short implants were included in this retrospective study. Kaplan-Meier analysis was used to calculate the survival and success rates of the prostheses. Univariate and multivariate Cox regression models, clustered to adjust for multiple implants and prostheses being placed in the same patient, were used to correlate changes in peri-implant bone levels with patient, implant, and prosthesis-related covariates. RESULTS This study followed 121 FRC P-FDPs supported by 261 implants, placed in 96 patients. At 118 months in function, the P-FDP survival rate was 95.9% (95% CI: 87.5%-98.7%), and the success rate was 89.8% (95%CI: 80.4%-94.8%). Differences in prosthesis span length, abutment/pontic ratio, and the presence of distal extensions (cantilevers) did not affect the prosthetic outcomes. Bone levels around implants were stable, with an average rate of change of -0.01 ± 0.05 mm/month. Cox regression revealed that grafted sites were correlated with peri-implant bone loss, while longer prosthetic spans were correlated with bone gain. CONCLUSION P-FDPs comprised of milled fiber-reinforced composite frameworks, supported by short and extra-short implants, had high survival and success rates for up to 10 years.
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Affiliation(s)
- Yu-Chi Cheng
- Department of Biology, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of Sao Paulo-Bauru School of Dentistry, Bauru, Brazil
| | - Laura Murcko
- Implant Dentistry Centre, Boston, Massachusetts, USA
| | | | | | | | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of Sao Paulo-Bauru School of Dentistry, Bauru, Brazil
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18
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Sailer I, Barbato L, Mojon P, Pagliaro U, Serni L, Karasan D, Cairo F. Single and partial tooth replacement with fixed dental prostheses supported by dental implants: a systematic review of outcomes and outcome measures used in clinical trials in the last 10 years. Clin Oral Implants Res 2022; 34 Suppl 25:22-37. [PMID: 35332952 DOI: 10.1111/clr.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/01/2022] [Accepted: 02/20/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate outcome measures, methods of assessment and analysis in clinical studies on fixed single- and multiple- unit implant restorations. METHODS Three independent electronic database searches (MEDLINE, EMBASE, COCHRANE) were done to identify prospective and retrospective clinical studies published from January 2011 up to June 2021 with ≥20 patients and minimum 1 year follow-up period on technical and clinical outcomes of implant-supported single crowns (SCs) and partial fixed dental prostheses (P-FDPs). An entire data extraction was performed to identify primarily the most reported outcome measures and later to define the choice of assessment methods of those outcome measures. The outcomes were analysed descriptively, and the strength of association was evaluated using Pearson Chi-square test (p≤0.05). RESULTS In total 531 studies, 368 on SCs (69.3%), 70 on P-FDPs (13.1%), and 93 on both restoration types (17.5%) were included. 56.3% of all studies did not clearly define a primary outcome. The most frequent primary outcome was marginal bone-level (MBL) (55.2%) followed by implant survival (5.3%), professional esthetic evaluation (3.4%) and technical complications (2.1%). Peri-implant indices were the most reported secondary outcome (55.1%) followed by implant survival (39.9%), MBL (36%) and implant success (26.4%). Prosthetic failure (7 studies - 3.9%) was one of the least reported outcome measures CONCLUSIONS: Outcome measures and their assessment methods exhibited high heterogeneity among studies. Primary outcomes were not often defined clearly, and the most frequently selected primary outcome was marginal bone loss. Prosthetic outcomes, implant survival and patient related outcomes remained infrequently reported.
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Affiliation(s)
- Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Philippe Mojon
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Umberto Pagliaro
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Lapo Serni
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
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19
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Vahnström M, Johansson PH, Svanborg P, Stenport VF. Comparison of porcelain veneer fracture in implant-supported fixed full-arch prostheses with a framework of either titanium, cobalt-chromium, or zirconia: An in vitro study. Clin Exp Dent Res 2022; 8:544-551. [PMID: 35313086 PMCID: PMC9033539 DOI: 10.1002/cre2.558] [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: 04/13/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives The aim of this study was to compare porcelain veneer strength on screw‐retained implant‐supported fixed full‐arch prostheses with a framework of either milled titanium (Ti), cobalt–chromium (CoCr), and yttria‐stabilized zirconia (Y‐TZP) in an in vitro loading model. Materials and Methods Fifteen screw‐retained maxillary implant‐supported full‐arch prostheses (FDP), five each of Ti, CoCr, and Y‐TZP frameworks with porcelain veneers were included. All FDPs were subjected to thermocycling before loading until fracture of the veneer. The load was applied at the distal fossa of the occlusal area of the pontic replacing 24. Fracture loads were analyzed, and the fracture quality was assessed. Statistical analysis on the fracture load was performed using Kruskal–Wallis test. The statistical significance was set at p < .05. Results There was no statistical significance found between the groups regarding fracture load. The highest and lowest load was seen within the CoCr FDP, varying between 340 and 1484 N. Different types of fracture appearances were seen. The Y‐TZP FDPs had a higher number of fractures locally in the loaded area while CoCr and Ti more often showed cracks in the anterior region, at a distance from the loaded area. Conclusions Within the limitations of this study, the conclusion was that framework material may affect the fracture behavior of maxillary full‐arch bridges; however, there were no differences in veneer fracture strength when frameworks of Ti, CoCr, or Y‐TZP were compared.
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Affiliation(s)
- Märta Vahnström
- The Brånemark Clinic, Public Health Service, Region of Västra Götaland, Gothenburg, Sweden
| | - Petra H Johansson
- Department of Prostodontics/Dental Materials Science, Institute of Odontology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Per Svanborg
- Department of Prostodontics/Dental Materials Science, Institute of Odontology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Victoria F Stenport
- Department of Prostodontics/Dental Materials Science, Institute of Odontology, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
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de Araújo-Júnior ENS, Bergamo ETP, Bastos TMC, Benalcázar Jalkh EB, Lopes ACO, Monteiro KN, Cesar PF, Tognolo FC, Migliati R, Tanaka R, Bonfante EA. Ultra-translucent zirconia processing and aging effect on microstructural, optical, and mechanical properties. Dent Mater 2022; 38:587-600. [PMID: 35272865 DOI: 10.1016/j.dental.2022.02.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 02/18/2022] [Accepted: 02/22/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVES To evaluate the effect of the ceramic processing and aging method on the microstructure, optical, and mechanical properties of a third generation ultra-translucent zirconia, yttria partially stabilized zirconia (5Y-PSZ). METHODS In-house discs were obtained through uniaxial and isostatic pressing an ultra-translucent Y-PSZ powder and sintering at 1450 °C for 2 h. As control, a commercial disc was milled from pre-sintered blocks fabricated with the same 5Y-PSZ powder through isostatic pressing and sintered under the same protocol. Discs were allocated into three groups according to aging condition as immediate (non-aged) and aged using autoclave or hydrothermal reactor at 134ºC for 20 h at 2.2 bar. Crystalline content and microstructure were evaluated using X-ray diffraction (XRD) and scanning electron microscopy (SEM), respectively. Optical properties were determined using reflectance data to calculate the contrast ratio (CR) and translucency parameter (TP). Mechanical properties were assessed by Vickers hardness, fracture toughness and biaxial flexural strength tests. RESULTS XRD spectra revealed a prevalence of cubic (70%) and tetragonal (30%) phases, and the SEM images showed a dense fully crystalline ceramic matrix for both materials. Crystalline content and microstructure of the in-house and commercial 5Y-PSZs were not affected by aging. As-sintered 5Y-PSZs demonstrated similar CR (~0.6) and TP (~18) values, as well as Vickers hardness (~14 GPa) and fracture toughness (~3.8 Mpa.m1/2), with no significant alteration after both aging methods. In-house and commercial Y-PSZs Weibull moduli ranged from 3.0 to 5.3. 5Y-PSZ processing methods resulted in similar characteristic strength after sintering (592-618 Mpa). While commercial 5Y-PSZ showed no significant influence of aging on strength, hydrothermal reactor aging significantly decreased the in-house Y-PSZ characteristic strength (474 Mpa). Both 5Y-PSZs demonstrated high reliability up to 300-Mpa strength missions, with no detrimental effect of aging (88-100%). SIGNIFICANCE Irrespective of the processing method, ultra-translucent 5Y-PSZ showed high aging resistance and translucency stability, as well as strength corresponding to the indication up to short-span anterior prostheses.
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Affiliation(s)
- Everardo N S de Araújo-Júnior
- 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 C Bastos
- Department of Physics, Technological Institute of Aeronautics, São José dos Campos, SP, Brazil
| | - Ernesto B Benalcázar Jalkh
- 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
| | - Kelli N Monteiro
- Department of Biomaterial and Oral Biology, University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Paulo F Cesar
- Department of Biomaterial and Oral Biology, University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Fernanda C Tognolo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Rafael Migliati
- 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
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
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21
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Sailer I, Barbato L, Mojon P, Pagliaro U, Serni L, Karasan D, Cairo F. Single and partial tooth replacement with fixed dental prostheses supported by dental implants: A systematic review of outcomes and outcome measures used in clinical trials in the last 10 years. J Clin Periodontol 2022; 50 Suppl 25:22-37. [PMID: 35246885 DOI: 10.1111/jcpe.13612] [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: 11/16/2021] [Revised: 02/01/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
AIM To evaluate outcome measures, methods of assessment, and analysis in clinical studies on fixed single- and multiple-unit implant restorations. MATERIALS AND METHODS Three independent electronic database searches (MEDLINE, EMBASE, and Cochrane) were done to identify prospective and retrospective clinical studies published from January 2011 up to June 2021 with ≥20 patients and minimum 1-year follow-up period on technical and clinical outcomes of implant-supported single crowns (SCs) and partial fixed dental prostheses (P-FDPs). An entire data extraction was performed to identify primarily the most reported outcome measures and later to define the choice of assessment methods of those outcome measures. The outcomes were analysed descriptively, and the strength of association was evaluated using the Pearson chi-square test (p ≤ .05). RESULTS In a total 531 studies, 368 on SCs (69.3%), 70 on P-FDPs (13.1%), and 93 on both restoration types (17.5%) were included; 56.3% of all studies did not clearly define a primary outcome. The most frequent primary outcome was marginal bone level (MBL) (55.2%) followed by implant survival (5.3%), professional aesthetic evaluation (3.4%), and technical complications (2.1%). Peri-implant indices were the most reported secondary outcome (55.1%), followed by implant survival (39.9%), MBL (36%), and implant success (26.4%). Prosthetic failure (seven studies [3.9%]) was one of the least reported outcome measures. CONCLUSIONS Outcome measures and their assessment methods showed high heterogeneity among studies. Primary outcomes were not often defined clearly, and the most frequently selected primary outcome was marginal bone loss. Prosthetic outcomes, implant survival, and patient-related outcomes were only infrequently reported.
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Affiliation(s)
- Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Philippe Mojon
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Umberto Pagliaro
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Lapo Serni
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
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22
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Sailer I, Karasan D, Todorovic A, Ligoutsikou M, Pjetursson BE. Prosthetic failures in dental implant therapy. Periodontol 2000 2022; 88:130-144. [PMID: 35103329 PMCID: PMC9305548 DOI: 10.1111/prd.12416] [Citation(s) in RCA: 65] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Both fixed and removable implant‐supported prostheses are well‐established methods for replacing missing teeth in partially or fully edentulous patients. Numerous systematic reviews have been performed in recent years to evaluate the survival and complication rates of implant‐retained fixed dental prostheses and implant‐retained overdentures, displaying high 5‐year survival rates ranging from 97.1% for fixed dental prostheses to 95%‐100% for implant‐retained overdentures. However, the survival rates only represent the prostheses remaining in use for a defined follow‐up time, and do not account for the potential prosthetic complications that may have arisen and influence the general success of the implant treatment. The most common technical complications of fixed implant‐retained single crowns are crown fracture, fractures of ceramic implant abutments, and esthetic problems. The predominant technical complication at multiple‐unit, implant‐retained fixed dental prostheses is fracture/chipping of the veneering ceramic. Reported technical complications for implant‐retained overdentures are overdenture fracture or chipping of the veneer materials, whereas mechanical complications include implant fracture, attachment failure, and attachment housing or insert complications. To reduce the risk of such failures, a comprehensive pretreatment diagnostic work‐up is essential, including defining the prosthetic goal with the aid of a wax‐up or set‐up and the associated ideal, prosthetically oriented three‐dimensional implant position. Furthermore, selection of the ideal type of prosthesis, including the respective implant components and materials, is important for clinical long‐term treatment success.
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Affiliation(s)
- Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Ana Todorovic
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Division of Prosthodontics, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Maria Ligoutsikou
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Bjarni Elvar Pjetursson
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland
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23
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Zupancic Cepic L, Frank M, Reisinger AG, Sagl B, Pahr DH, Zechner W, Schedle A. Experimental validation of a micro-CT finite element model of a human cadaveric mandible rehabilitated with short-implant-supported partial dentures. J Mech Behav Biomed Mater 2021; 126:105033. [PMID: 34933158 DOI: 10.1016/j.jmbbm.2021.105033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 11/30/2021] [Accepted: 12/06/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE This study aimed to address the predictive value of a micro-computed tomography (μCT)-based finite element (μFE) model of a human cadaveric edentulous posterior mandible, rehabilitated by short dental implants. Hereby, three different prosthetic/implant configurations of fixed partial dentures ("Sp"-3 splinted crowns on 3 implants, "Br" - Bridge: 3 splinted crowns on 2 implants, and "Si"- 3 single crowns) were analysed by comparing the computational predictions of the global stiffness with experimental data. METHODS Experimental displacement of the bone/implant/prosthesis system was measured under axial and oblique loads of 100 N using an optical deformation system (GOM Aramis) and the overall movement of the testing machine (Zwick Z030). Together with the measured machine force, an "Aramis" (optical markers) and "Zwick" (test machine) stiffness were calculated. FE models were created based on μCT-scans of the cadaveric mandible sample (n = 1) before and after implantation and using stl-files of the crowns. The same load tests and boundary conditions were simulated on the models and the μFE-results were compared to experimental data using linear regression analysis. RESULTS The regression line through a plot of pooled stiffness values (N/mm) for the optical displacement recording (true local displacement) and the test machine (machine compliance included) had a slope of 0.57 and a correlation coefficient R2 of 0.82. The average pooled correlation of global stiffness between the experiment and FE-analysis (FEA) showed a R2 of 0.80, but the FEA-stiffness was 7.2 times higher. The factor was highly dependent on the test configuration. Sp-configuration showed the largest stiffness followed by Br-configuration (17% difference in experiment and 21% in FEA). CONCLUSIONS The current study showed good qualitative agreement between the experimental and predicted global stiffness of different short implant configurations. It could be deduced that 1:1 splinting of the short implants by the crowns is most favorable for the stiffness of the implant/prosthesis system. However, in the clinical context, the absolute in silico readings must be interpreted cautiously, as the FEA showed a considerable overestimation of the values.
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Affiliation(s)
- Lana Zupancic Cepic
- Department of Prosthodontics, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria
| | - Martin Frank
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, 1090, Vienna, Austria
| | - Andreas G Reisinger
- Institute of Lightweight Design and Structural Biomechanics, TU Wien, 1090, Vienna, Austria; Department of Anatomy und Biomechanics, Division Biomechanics, Karl Landsteiner University of Health Sciences, 3500, Krems, Austria
| | - Benedikt Sagl
- Center of Clinical Research, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria
| | - Dieter H Pahr
- Department of Anatomy und Biomechanics, Division Biomechanics, Karl Landsteiner University of Health Sciences, 3500, Krems, Austria.
| | - Werner Zechner
- Department of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria
| | - Andreas Schedle
- Competence Center for Dental Materials, University Clinic of Dentistry, Medical University of Vienna, 1090, Vienna, Austria
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24
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Spitznagel FA, Balmer M, Wiedemeier DB, Jung RE, Gierthmuehlen PC. Clinical outcomes of all-ceramic single crowns and fixed dental prostheses supported by ceramic implants: A systematic review and meta-analyses. Clin Oral Implants Res 2021; 33:1-20. [PMID: 34665900 PMCID: PMC9297865 DOI: 10.1111/clr.13871] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/17/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
Objective To analyze the clinical outcomes of all‐ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants. Materials and Methods Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all‐ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient‐related outcome measurements. Meta‐analyses were performed after 1, 2, and 5 years using random‐effect meta‐analyses. Results Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement‐retained reconstructions (mean observation: 12.0–61.0 months). Meta‐analyses estimated a 5‐year survival rate of 94% (95% confidence interval [CI]: 82%–100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%–100%); veneered zirconia SCs, 89% (95%CI: 62%–100%); and veneered zirconia FDPs 94% (95%CI: 81%–100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%–11%); veneered zirconia SCs, 38% (95%CI: 24%–54%); and veneered zirconia FDPs, 57% (95%CI: 38%–76%). Further outcomes were summarized descriptively. Conclusions Due to the limited data available, only tendencies could be identified. All‐ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid‐term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants.
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Affiliation(s)
- Frank Akito Spitznagel
- Department of Prosthodontics, School of Dentistry, Heinrich-Heine-University, Düsseldorf, Germany
| | - Marc Balmer
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel B Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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25
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Bergamo ETP, Yamaguchi S, Lopes ACO, Coelho PG, de Araújo-Júnior ENS, Benalcázar Jalkh EB, Zahoui A, Bonfante EA. Performance of crowns cemented on a fiber-reinforced composite framework 5-unit implant-supported prostheses: in silico and fatigue analyses. Dent Mater 2021; 37:1783-1793. [PMID: 34588130 DOI: 10.1016/j.dental.2021.09.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 09/02/2021] [Accepted: 09/13/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize the biomechanical performance of fiber-reinforced composite 5-unit implant-supported fixed dental prostheses (FDPs) receiving individually milled crowns by insilico and fatigue analyses. METHODS Eighteen implant-supported five-unit fiber-reinforced composite frameworks with an individually prepared abutment design were fabricated, and ninety resin-matrix ceramic crowns were milled to fit each abutment. FDPs were subjected to step-stress accelerated-life testing with load delivered at the center of the pontic and at 2nd molar and 1st premolar until failure. The reliability of the prostheses combining all loaded data and of each loaded tooth was estimated for a mission of 50,000 cycles at 300, 600 and 900 N. Weibull parameters were calculated and plotted. Fractographic and finite element analysis were performed. RESULTS Fatigue analysis demonstrated high probability of survival at 300 N, with no significant differences when the set load was increased to 600 and 900 N. 1st and 2nd molar dataset showed high reliability at 300 N, which remained high for the higher load missions; whereas 1st premolar dataset showed a significant decrease when the reliability at 300 N was compared to higher load missions. The characteristic-strength of the combined dataset was 1252 N, with 1st molar dataset presenting higher values relative to 2nd molar and 1st premolar, both significantly different. Failure modes comprised chiefly cohesive fracture within the crown material originated from cracks at the occlusal area, matching the maximum principal strain location. SIGNIFICANCE Five-unit implant-supported FDP with crowns individually cemented in a fiber-reinforced composite framework presented a high survival probability. Crown fracture comprised the main failure mode.
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Affiliation(s)
- Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
| | - Satoshi Yamaguchi
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, 565-0871, Suita, Osaka, Japan
| | - Adolfo C O Lopes
- Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
| | - Paulo G Coelho
- Department of Biomaterials, New York University College of Dentistry, New York, NY, USA; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA; Mechanical and Aerospace Engineering, NYU Tandon School of Engineering, Brooklyn, NY, USA
| | - Everardo N S de Araújo-Júnior
- 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; Department of Biomaterials, New York University College of Dentistry, New York, NY, USA.
| | - Abbas Zahoui
- 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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26
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Fernandes D, Nunes S, López-Castro G, Marques T, Montero J, Borges T. Effect of customized healing abutments on the peri-implant linear and volumetric tissue changes at maxillary immediate implant sites: A 1-year prospective randomized clinical trial. Clin Implant Dent Relat Res 2021; 23:745-757. [PMID: 34423560 DOI: 10.1111/cid.13044] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/07/2021] [Accepted: 08/07/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Immediate implant placement (IIP) associated with the use of bone substitutes and collagen matrices (CM) seems to reduce the amount of resorption at peri-implant areas. Recently, customized healing abutments (CA) appeared as another solution in order to seal the socket and preserve the original soft tissue contour. PURPOSE To evaluate peri-implant tissues dimensional changes after using customized healing abutments compared with the use of xenogeneic collagen matrices as socket sealing options in flapless maxillary immediate implant placement. MATERIAL AND METHODS The present study was designed as a prospective, randomized, controlled clinical trial. Patients were allocated into two groups depending on the socket sealing option: in the CM group a collagen matrix was used and in the CA group a customized abutment. Digital impressions were taken prior to extraction, 1, 4, and 12 months after implant insertion and the digital files allowed to evaluate linear buccal changes (MBC) and the buccal volumetric variation (BVv) between the different time points at peri-implant tissue areas. Additionally, mucosa variation was computed assessing the papilla presence and the midfacial mucosa height. Statistical significance was set at 0.05. RESULTS Twenty-eight patients were observed during a 12-month period. Significant differences between mean values of BVv at the first month were observed at the CM and CA group (-9.75 ± 6.65% and -4.76 ± 5.29%, respectively) (p = 0.043). At the 1-year follow-up, no significant differences were found in terms of BVv between the two groups, although the thin bone phenotype (≤1 mm) significantly influenced the volumetric variations that occurred in each group. No significant differences were noticed in midfacial mucosa and papillae alteration between groups, after 1 year of treatment. CONCLUSION Both treatment options are predictable solutions for socket sealing in IIP, although a higher volumetric variation can be expected in the presence of thin bone phenotypes.
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Affiliation(s)
- Danilo Fernandes
- Department of Surgery, Faculty of Medicine, University of Salamanca, Salamanca, Spain.,Faculty of Dental Medicine, Universidade Católica Portuguesa, Viseu, Portugal
| | - Sílvia Nunes
- Faculty of Dental Medicine, Universidade Católica Portuguesa, Viseu, Portugal
| | - Gonzalo López-Castro
- Faculty of Medicine and Dental Medicine, Universidad de Santiago de Compostela, Santiago, Spain
| | - Tiago Marques
- Faculty of Dental Medicine, Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Viseu, Portugal
| | - Javier Montero
- Department of Surgery, Faculty of Medicine, University of Salamanca, Salamanca, Spain
| | - Tiago Borges
- Faculty of Dental Medicine, Center for Interdisciplinary Research in Health, Universidade Católica Portuguesa, Viseu, Portugal
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Nanoscale physico-mechanical properties of an aging resistant ZTA composite. J Mech Behav Biomed Mater 2021; 123:104690. [PMID: 34385065 DOI: 10.1016/j.jmbbm.2021.104690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/26/2021] [Accepted: 07/02/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To characterize the effects of aging on the nanomechanical properties and 3D surface topographical parameters of an experimental Zirconia Toughened Alumina (ZTA) composite compared to its respective individual counterpart materials. METHODS Disk-shaped specimens comprised of three material groups were processed: 1) ZTA 70/30 (70% alumina reinforced with 30% second-generation 3Y-TZP); 2) Zpex (Second-generation 3Y-TZP), and; 3) Al2O3 (High purity Alumina) (n = 10/material, 12 × 1 mm). After synthesis, ceramic powders were pressed, the green-body samples were sintered and polished. Nanoindentation testing was performed to record elastic modulus (E) and hardness (H). Interferometry was utilized to assess 3D surface roughness parameters (Sa, Sq), while X-ray diffraction (XRD) and scanning electron microscope (SEM) assessed the crystalline content and microstructure. All tests were performed before and after simulated aging (134°C, 2.2 bar, 20 h). Statistical analyses were performed using linear mixed-model and least square difference pos-hoc tests (α = 5%). RESULTS XRD spectra indicated increase of monoclinic peaks for Zpex (~18%) relative to ZTA 70/30 (~2.5%) after aging. Additionally, aging did not affect the surface roughness parameters of ZTA 70/30 and Al2O3, although a significant increase in Sa was recorded for Zpex following aging (~90 nm) (p < 0.001). Al2O3 yielded the highest H and E values (H:21 GPa, E: 254 GPa), followed by ZTA 70/30 (H: 13 GPa, E: 214 GPa) and Zpex (H:11 GPa, E: 167 GPa), all significantly different (p < 0.03). CONCLUSION ZTA 70/30 and Al2O3 presented high hydrothermal stability with respect to all evaluated variables, where artificial aging significantly increased the monoclinic content and surface roughness of Zpex.
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Tirone F, Salzano S, Rolando E, Pozzatti L, Rodi D. Framework Fracture of Zirconia Supported Full Arch Implant Rehabilitation: A Retrospective Evaluation of Cantilever Length and Distal Cross-Sectional Connection Area in 140 Patients Over an Up-To-7 Year Follow-Up Period. J Prosthodont 2021; 31:121-129. [PMID: 33963652 DOI: 10.1111/jopr.13388] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/06/2021] [Indexed: 12/01/2022] Open
Abstract
PURPOSE To evaluate the relationship between different dimensional parameters in implant-supported monolithic zirconia fixed complete dental prostheses (IFCDPs) and the incidence of framework fracture in a large sample of cases in vivo. MATERIALS AND METHODS This retrospective observational study evaluated all patients rehabilitated with screw-retained zirconia IFCDPs between January 2013 and April 2019 at a private practice. The minimum follow-up period was 1 year after occlusal loading. Fractures were classified as: type I-fractures that happened between but not involving the two most posterior screw-access openings (SAOs) and type II-fractures of the distal cantilever. Cantilever length, distal connector cross-sectional area, and screw access opening length were measured using data obtained from digital scans. Logistic regression was performed to evaluate the relationship between types I and II fractures and the independent variables (dimensional parameters). Using the receiver operating characteristic curves, two parameters were identified to be useful for establishing a cut-off and predicting type II fractures. RESULTS A total of 180 prostheses delivered to 140 patients were analyzed. Five implants failed in three patients: three before delivery of the definitive prostheses and two after. Ten prostheses failed (5.6% prosthetic failure rate): 2 because of implant failures, and 8 because of framework fractures. Five fractures were classified as type I and three as type II. Significant associations were found between cantilever length and type I fractures (Wald = 5.772, df = 1, p = 0.016), distal connector cross-sectional area and type II fractures (Wald = 3.806, df = 1, p = 0.051), and cantilever length and the total number of fractures (Wald = 6.117, df = 1, p = 0.013). CONCLUSION Zirconia IFCDPs may be reliable medium-term solutions if some dimensional parameters are followed. The ratios between the cantilever length and cross-sectional connector area should be <0.51, while the ratio between the cantilever length and screw access opening length should be <1.48.
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Affiliation(s)
| | | | - Erik Rolando
- Laboratorio Odontoprotesico Rolando Cerato, Cuneo, Italy
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Bergamo ETP, Bastos TMC, Lopes ACO, de Araujo Júnior ENS, Coelho PG, Benalcazar Jalkh EB, Zahoui A, Bonfante EA. Physicochemical and mechanical characterization of a fiber-reinforced composite used as frameworks of implant-supported prostheses. Dent Mater 2021; 37:e443-e453. [PMID: 33865619 DOI: 10.1016/j.dental.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/31/2020] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To characterize the physicochemical and mechanical properties of a milled fiber-reinforced composite (FRC) for implant-supported fixed dental prostheses (FDPs). METHODS For FRC characterization, scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), X-ray diffraction, Fourier-transformed infrared spectrometry, simultaneous thermogravimetric analysis and differential scanning calorimetry were performed. For fatigue testing, 3-unit FRC frameworks were fabricated with conventional (9 mm2 connector area) and modified designs (12 mm2 connector area and 2.5 mm-height lingual extension). A hybrid resin composite was veneered onto the frameworks. FDPs were subjected to step-stress accelerated-life fatigue testing until fracture or suspension. Use level probability Weibull curves at 300 N were plotted and the reliability for 100,000 cycles at 300, 600 and 800 N was calculated. Fractographic analysis was performed by stereomicroscope and SEM. RESULTS The FRC consisted of an epoxy resin (∼25%) matrix reinforced with inorganic particles and glass fibers (∼75%). Multi-layer continuous regular-geometry fibers were densely arranged in a parallel and bidirectional fashion in the resin matrix. Fatigue analysis demonstrated high probability of survival (99%) for FDPs at 300 N, irrespective of framework design. Conventional FDPs showed a progressive decrease in the reliability at 600 (84%) and 800 N (19%), whereas modified FDPs reliability significantly reduced only at 800 N (75%). The chief failure modes for FRC FDPs were cohesive fracture of the veneering composite on lower loads and adhesive fracture of the veneering composite at higher loads. SIGNIFICANCE Milled epoxy resin matrix reinforced with glass fibers composite resulted in high probability of survival in the implant-supported prosthesis scenario.
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Affiliation(s)
- Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil.
| | - Tiago M C Bastos
- Department of Physics, Technological Institute of Aeronautics, 50 Marechal Eduardo Gomes, 12228-900, São José dos Campos, SP, Brazil
| | - Adolfo C O Lopes
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Everardo N S de Araujo Júnior
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, Hansjorg Wyss Department of Plastic Surgery, Mechanical and Aerospace Engineering, New York University, 345 24th Street, 10010, New York City, NY, USA
| | - Ernesto B Benalcazar Jalkh
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil; Department of Biomaterials and Biomimetics, Hansjorg Wyss Department of Plastic Surgery, Mechanical and Aerospace Engineering, New York University, 345 24th Street, 10010, New York City, NY, USA
| | - Abbas Zahoui
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
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Performance of fixed dental prostheses up to 6 years-A massive data analysis. J Prosthet Dent 2021; 128:350-354. [PMID: 33622552 DOI: 10.1016/j.prosdent.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 01/06/2021] [Accepted: 01/06/2021] [Indexed: 11/22/2022]
Abstract
STATEMENT OF PROBLEM Metal and metal-ceramic fixed dental prostheses (FDPs) have been clinically determined to provide long-term durable restorations. However, data on their performance under practice conditions are sparse. PURPOSE The purpose of this clinical study was to evaluate the longevity of FDPs under practice conditions by analyzing a large insurance claims database. MATERIAL AND METHODS Data were extracted from the data warehouse of a major German national health insurance company (BARMER). The analysis focused on the FDP types with the lowest deductibles in the insurance system. All metal-based FDPs replacing up to 3 adjacent teeth were included. Ceramic veneering was optional and only approved on the labial surfaces of maxillary teeth mesial to the first molar and mandibular teeth mesial to the second premolar. Fee codes allowed clinical courses to be traced on a day count basis. Three groups with FDPs replacing 1 tooth, 2 teeth, and 3 teeth were formed. Kaplan-Meier survival analyses were conducted for the target events removal or extraction, indicating FDP failure and extraction of an abutment tooth. RESULTS The sample comprised 124 660 FDPs that replaced 1 tooth (76.5%), 2 teeth (19.8%), or 3 teeth (3.7%). The cumulative survival rates for removal or extraction at 6 years differed significantly, with 83.0% for 1-pontic FDPs, 78.1% for 2-pontic FDPs, and 74.0% for 3-pontic FDPs. Thus, approximately 1 of 6 one-pontic FDPs, 1 of 5 two-pontic FDPs, and 1 of 4 three-pontic FDPs failed. The cumulative survival rates for extraction of an abutment tooth at 6 years showed no significant difference, with 96.0% for 1-pontic FDPs, 95.6% for 2-pontic FDPs, and 95.1% for 3-pontic FDPs. CONCLUSIONS The survival rates of FDPs according to insurance data were lower than those reported by clinical studies, indicating a gap between efficacy and effectiveness.
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Pieralli S, Spies BC, Schweppe F, Preissner S, Nelson K, Heiland M, Nahles S. Retrospective long-term clinical evaluation of implant-prosthetic rehabilitations after head and neck cancer therapy. Clin Oral Implants Res 2021; 32:470-486. [PMID: 33501694 DOI: 10.1111/clr.13716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/24/2020] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess clinical and patient-reported outcomes of implant-prosthetic rehabilitations in patients with a history of head-neck cancer (HNC), treated with tumor resection without (TR) or with adjuvant radiotherapy (TR/RT). A healthy cohort rehabilitated with the same reconstructive protocols served as control group (C). MATERIALS AND METHODS A total of 28 women and 29 men were considered in the present retrospective study. Participants received 322 implants, finally supporting 79 prosthetic reconstructions. Primary outcome was the assessment of implant and prosthetic survival rates. Furthermore peri-implant soft tissue parameters (attached peri-implant mucosa, AM; modified bleeding and plaque indices, mBI/mPI; probing depth, PD) and prosthetic technical complications were documented. Patient-reported outcome measures (PROMs) by means of visual analog scales (VAS) and the Oral Health Impact Profile German 14 form (OHIP G14) were collected. For statistical purposes Chi-square and Mann-Whitney-U-Test were adapted. RESULTS After a mean follow-up of 81.2 ± 50.3 months, implant survival rate was 98.1% (HNC-TR), 98.2% (HNC-TR/RT) and 100.0% (C), respectively (four implants failed in the HNC groups). HNC-TR/RT showed significant higher mPI and mBI compared to C. Within HNC-TR/RT, vestibuloplasty significantly reduced mBI and PD values. No failures occurred at the prosthetic level. Overall, higher VAS scores were reported for bar- compared with Locator-retained prostheses. Furthermore, increased OHIP G14 values resulted for HNC-TR/RT. CONCLUSIONS High survival rates on implant and prosthetic level were observed. The use of soft tissue grafts resulted in stabilization of the peri-implant mucosa in irradiated patients. In terms of retention and chewing ability, participants preferred bars over Locator attachments.
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Affiliation(s)
- Stefano Pieralli
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Benedikt Christopher Spies
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Felix Schweppe
- Department of Oral and Maxillofacial Surgery, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Saskia Preissner
- Department of Oral and Maxillofacial Surgery, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susanne Nahles
- Department of Oral and Maxillofacial Surgery, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
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Barbin T, Silva LDR, Velôso DV, Borges GA, Presotto AGC, Barão VAR, Groppo FC, Ferraz Mesquita M. Biomechanical behavior of CAD/CAM cobalt-chromium and zirconia full-arch fixed prostheses. J Adv Prosthodont 2021; 12:329-337. [PMID: 33489016 PMCID: PMC7790600 DOI: 10.4047/jap.2020.12.6.329] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/17/2020] [Accepted: 07/20/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To verify the influence of computer-aided design/computer-aided manufacturing (CAD/CAM) implant-supported prostheses manufactured with cobalt-chromium (Co-Cr) and zirconia (Zr), and whether ceramic application, spark erosion, and simulation of masticatory cycles modify biomechanical parameters (marginal fit, screw-loosening torque, and strain) on the implant-supported system. MATERIALS AND METHODS Ten full-arch fixed frameworks were manufactured by a CAD/CAM milling system with Co-Cr and Zr (n=5/group). The marginal fit between the abutment and frameworks was measured as stated by single-screw test. Screw-loosening torque evaluated screw stability, and strain analysis was explored on the implant-supported system. All analyses were performed at 3 distinct times: after framework manufacturing; after ceramic application in both materials' frameworks; and after the spark erosion in Co-Cr frameworks. Afterward, stability analysis was re-evaluated after 106 mechanical cycles (2 Hz/150-N) for both materials. Statistical analyses were performed by Kruskal-Wallis and Dunn tests (α=.05). RESULTS No difference between the two materials was found for marginal fit, screw-loosening torque, and strain after framework manufacturing (P>.05). Ceramic application did not affect the variables (P>.05). Spark erosion optimized marginal fit and strain medians for Co-Cr frameworks (P<.05). Screw-loosening torque was significantly reduced by masticatory simulation (P<.05) regardless of the framework materials. CONCLUSION Co-Cr and Zr frameworks presented similar biomechanical behavior. Ceramic application had no effect on the biomechanical behavior of either material. Spark erosion was an effective technique to improve Co-Cr biomechanical behavior on the implant-supported system. Screw-loosening torque was reduced for both materials after masticatory simulation.
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Affiliation(s)
- Thaís Barbin
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Letícia Del Rio Silva
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Daniele Valente Velôso
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Guilherme Almeida Borges
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | | | | | - Francisco Carlos Groppo
- Department of Physiological Sciences, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Marcelo Ferraz Mesquita
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
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Michelinakis G, Apostolakis D, Kamposiora P, Papavasiliou G, Özcan M. The direct digital workflow in fixed implant prosthodontics: a narrative review. BMC Oral Health 2021; 21:37. [PMID: 33478459 PMCID: PMC7819204 DOI: 10.1186/s12903-021-01398-2] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/13/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The purpose of this narrative review was to examine the applicability of IOS procedures regarding single and multiple fixed implant restorations. Clinical outcomes for monolithic zirconia and lithium disilicate restorations produced through a direct digital workflow were reported. METHODS A MEDLINE (Pubmed) search of the relevant English-language literature spanning from January 1st 2015 until March 31st 2020 was conducted. In vitro studies comparing digital implant impression accuracy by different IOS devices or in vitro studies examining differences in accuracy between digital and conventional impression procedures were included. Also, RCTs, clinical trials and case series on the success and/or survival of monolithic zirconia and lithium disilicate restorations on implants, manufactured completely digitally were included. In vitro and in vivo studies reporting on restorations produced through an indirect digital workflow, case reports and non-English language articles were excluded. The aim was to investigate the accuracy of IOS for single and multiple fixed implant restorations compared to the conventional impression methods and report on the variables that influence it. Finally, this study aimed to report on the survival and success of fixed implant-retained restorations fabricated using the direct digital workflow. RESULTS For the single and short-span implant sites, IOS accuracy was high and the deviations in the position of the virtual implant fell within the acceptable clinical limits. In the complete edentulous arch with multiple implants, no consensus regarding the superiority of the conventional, splinted, custom tray impression procedure compared to the IOS impression was identified. Moreover, complete-arch IOS impressions were more accurate than conventional, non-splinted, open or close tray impressions. Factors related to scanbody design as well as scanner generation, scanning range and interimplant distance were found to influence complete-arch scanning accuracy. Single implant-retained monolithic restorations exhibited high success and survival rates and minor complications for short to medium follow-up periods. CONCLUSIONS The vast majority of identified studies were in vitro and this limited their clinical significance. Nevertheless, intraoral scanning exhibited high accuracy both for single and multiple implant restorations. Available literature on single-implant monolithic restorations manufactured through a complete digital workflow shows promising results for a follow-up of 3-5 years.
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Affiliation(s)
| | | | - Phophi Kamposiora
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - George Papavasiliou
- Department of Prosthodontics, School of Dentistry, National and Kapodistrian University of Athens, Athens, Greece
| | - Mutlu Özcan
- Division of Dental Biomaterials, Center for Dental and Oral Medicine, Clinic for Reconstructive Dentistry, University of Zürich, Zurich, Switzerland
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Bergamo ETP, Yamaguchi S, Coelho PG, Lopes ACO, Lee C, Bonfante G, Benalcázar Jalkh EB, de Araujo-Júnior ENS, Bonfante EA. Survival of implant-supported resin-matrix ceramic crowns: In silico and fatigue analyses. Dent Mater 2021; 37:523-533. [PMID: 33483102 DOI: 10.1016/j.dental.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/20/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the fatigue survival, failure mode, and maximum principal stress (MP Stress) and strain (MP Strain) of resin-matrix ceramic systems used for implant-supported crowns. METHODS Identical molar crowns were milled using four resin-matrix ceramics (n = 21/material): (i) Shofu Hard, (ii) Cerasmart (iii) Enamic, and (iv) Shofu HC. Crowns were cemented on the abutments, and the assembly underwent step-stress accelerated-life testing. Use level probability Weibull curves at 300 N were plotted and the reliability at 300, 500 and 800 N was calculated for a mission of 50,000 cycles. Fractographic analysis was performed using stereomicroscope and scanning electron microscope. MP Stress and MP Strain were determined by finite element analysis. RESULTS While fatigue dictated failures for Cerasmart (β > 1), material strength controlled Shofu Hard, Enamic, and Shofu HC failures (β < 1). Shofu HC presented lower reliability at 300 N (79%) and 500 N (59%) than other systems (>90%), statistically different at 500 N. Enamic (57%) exhibited a significant reduction in the probability of survival at 800 N, significantly lower than Shofu Hard and Cerasmart; however, higher than Shofu HC (12%). Shofu Hard and Cerasmart (>93%) demonstrated no significant difference for any calculated mission (300-800 N). Failure mode predominantly involved resin-matrix ceramic fracture originated from occlusal cracks, corroborating with the MP Stress and Strain location, propagating through the proximal and cervical margins. SIGNIFICANCE All resin-matrix ceramics crowns demonstrated high probability of survival in a physiological molar load, whereas Shofu Hard and Cerasmart outperformed Enamic and Shofu HC at higher loads. Material fracture comprised the main failure mode.
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Affiliation(s)
- Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry. 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil.
| | - Satoshi Yamaguchi
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, 565-0871, Suita, Osaka, Japan
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, Hansjorg Wyss Department of Plastic Surgery, Mechanical and Aerospace Engineering, New York University, 345 24th Street, 10010, New York City, NY, USA
| | - Adolfo C O Lopes
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry. 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Chunwoo Lee
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, 565-0871, Suita, Osaka, Japan
| | - Gerson Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry. 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Ernesto B Benalcázar Jalkh
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry. 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Everardo N S de Araujo-Júnior
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry. 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry. 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
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Benalcázar Jalkh EB, Neto JDS, Bergamo ETP, Maia CF, Bonfante EA. Mechanical testing of four-unit implant-supported prostheses with extensive pink gingiva porcelain: The dentogingival prostheses proof of concept. J ESTHET RESTOR DENT 2021; 33:605-612. [PMID: 33423375 DOI: 10.1111/jerd.12704] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 11/18/2020] [Accepted: 12/17/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the probability of survival and failure modes of four-unit implant-supported porcelain fused to metal (PFM) dentogingival prostheses subjected to step-stress accelerated life testing (SSALT). MATERIALS AND METHODS Eighteen implant-supported PFM dentogingival prostheses with thin metallic infrastructures, which provided minimal ceramic support and improved esthetics were fabricated over external hexagonal connection UCLA abutments. SSALT was performed until specimen failure. Use level probability Weibull curve and reliability were calculated and plotted. Weibull modulus (m) and characteristic strength (η) were also calculated. Polarized light microscope and scanning electron microscope were used to characterize fractures. RESULTS Failures were dictated by material strength rather than fatigue damage accumulation. The probability of survival for loads reaching 100 and 150 N in 100,000 cycles was 92 and 61%, respectively. No cracks or fractures were identified in the veneered porcelain, whereas abutment fixation screw fracture was the chief failure mode. CONCLUSION Implant-supported PFM four-unit dentogingival prostheses with minimum metal framework dimensions presented favorable lifetime prediction under fatigue testing. Fractures were restricted to fixation screws. CLINICAL SIGNIFICANCE In-vitro fatigue testing and failure mode analyses evidenced favorable lifetime prediction for 4-unit implant-supported dentogingival prostheses with minimum metal frameworks. Abutment fixation screw fracture might be the most frequent clinical complication. Since this proof of concept has been tested in-vitro, further studies including different restorative materials, as well as long-term clinical trials are warranted.
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Affiliation(s)
- 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
| | | | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
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Bergamo ETP, Cardoso KB, Lino LFO, Campos TMB, Monteiro KN, Cesar PF, Genova LA, Thim GP, Coelho PG, Bonfante EA. Alumina-toughened zirconia for dental applications: Physicochemical, mechanical, optical, and residual stress characterization after artificial aging. J Biomed Mater Res B Appl Biomater 2020; 109:1135-1144. [PMID: 33314536 DOI: 10.1002/jbm.b.34776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 01/01/2023]
Abstract
To characterize the physicomechanical properties of an alumina-toughened zirconia (ATZ). ATZ synthesis consisted of the addition of alumina particles in an yttria-stabilized tetragonal zirconia polycrystals (3Y-TZP) matrix. Specimens were obtained by uniaxial and isostatic pressing ATZ and 3Y-TZP powders and sintering at 1600°C/1 h and 1550°C/1 h, respectively. Crystalline content and residual stress were evaluated using X-ray diffraction (XRD). Microstructure was characterized by scanning electron microscopy (SEM). Optical properties were determined by reflectance test. Mechanical properties were assessed by biaxial flexural strength test. All analyses were performed before and after aging (134°C, 20 h, 2 bar). XRD and SEM revealed a typical ATZ and 3Y-TZP crystalline content, chiefly tetragonal phase, with a dense polycrystalline matrix, though a smaller grain size for ATZ. Aging triggered a similar monoclinic transformation for both systems; however, ATZ exhibited higher residual compressive stresses than 3Y-TZP. While as-processed 3Y-TZP demonstrated significantly higher characteristic strength relative to ATZ, no significant difference was observed after aging (~215 MPa increase in the ATZ strength). ATZ presented significantly higher opacity relative to 3Y-TZP, although aging significantly increased the translucency of both systems (increase difference significantly higher in the 3Y-TZP compared to ATZ). ATZ physicomechanical properties support its applicability in the dental field, with a lower detrimental effect of aging relative to 3Y-TZP.
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Affiliation(s)
- Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
| | - Karina B Cardoso
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
| | - Lucas F O Lino
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
| | - Tiago M B Campos
- Department of Physics, Aeronautics Technological Institute, São José dos Campos, SP, Brazil
| | - Kelli N Monteiro
- Department of Biomaterials and Oral Biology, University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Paulo F Cesar
- Department of Biomaterials and Oral Biology, University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Luis A Genova
- Center of Materials Science and Technology, Institute of Research in Nuclear Energy, São Paulo, SP, Brazil
| | - Gilmar P Thim
- Department of Physics, Aeronautics Technological Institute, São José dos Campos, SP, Brazil
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, Hansjörg Wyss Department of Plastic Surgery, Mechanical and Aerospace Engineering, New York University, New York City, NY, USA
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
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Retrospective Clinical Study of a Freely Removable Implant-Supported Fixed Dental Prosthesis by a Microlocking System. BIOMED RESEARCH INTERNATIONAL 2020; 2020:7929585. [PMID: 33204715 PMCID: PMC7655254 DOI: 10.1155/2020/7929585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/23/2020] [Accepted: 10/26/2020] [Indexed: 11/17/2022]
Abstract
This retrospective clinical study was conducted to evaluate the clinical usefulness of a freely removable microlocking implant prosthesis (MLP) that was developed to overcome the problems with conventional implant prostheses. A total of 54 patients (male: 31, female: 23) and 100 implant prostheses were included. Patients were divided into three groups such as 6-12 months, 12-18 months, and 18-24 months according to the used period after implant prosthesis delivery, and the patients in each group were recalled for examinations of survival rate, marginal bone resorption, peri-implant soft tissue indices, and complications. The prosthetic complications were analysed by combining the recorded chart data during the periodic checks including the last call for this study. During a 2-year observation period, all the implants showed a 100% survival rate without clinical mobility and functional problems. There was no significant difference in marginal bone resorption, plaque index, and bleeding index over the observation period after implant prosthesis delivery. Probing depth of the 18-24 months group (1.5 ± 0.19 mm) was significantly lower than that of the 6-12 months group (p < 0.05). The main complication was abutment loosening (4%), followed by implant prosthesis fracture (2%) and food impaction (2%) which were recorded. Within the limits of the present study, the implant prostheses with MLP are considered to be an applicable and predictable treatment method.
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Del Rio Silva L, Velôso DV, Barbin T, Borges GA, Presotto AGC, Mesquita MF. Can ceramic veneer spark erosion and mechanical cycling affect the accuracy of milled complete-arch frameworks supported by 6 implants? J Prosthet Dent 2020; 126:772-778. [PMID: 33087248 DOI: 10.1016/j.prosdent.2020.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
Abstract
STATEMENT OF PROBLEM Milling is a well-established method for manufacturing prosthetic frameworks. However, information about the influence of ceramic veneer and spark erosion on the accuracy of the all-on-six complete-arch fixed frameworks manufactured from different materials is lacking. PURPOSE The purpose of this in vitro study was to compare the accuracy of milled complete-arch fixed frameworks with zirconia, cobalt-chromium, and titanium at different steps of their manufacturing process and the influence of mechanical cycling. MATERIAL AND METHODS Fifteen milled complete-arch fixed frameworks, supported by 6 implants, were made in zirconia, cobalt-chromium, and titanium (n=5). The fit was measured by the single-screw test protocol. Stress was measured by photoelastic analysis. The loosening torque was evaluated by tightening the screws, retightening them after 10 minutes, and then evaluating the loosening torque 24 hours later. Thereafter, all frameworks received ceramic veneer, and the previous tests were repeated. Cobalt-chromium and titanium frameworks received spark erosion after ceramic veneer, and all analyses were repeated. Before and after mechanical cycling, loosening torque was evaluated. The results were subjected to 2-way repeated-measures ANOVA and the Bonferroni test (α=.05). RESULTS Titanium presented higher fit values than zirconia (P=.037) and similar to cobalt-chromium frameworks (P>.05) at baseline. After ceramic veneer, higher fit levels were observed for zirconia (P=.001) and cobalt-chromium (P=.008). Titanium showed higher stress values (P<.05) regardless of time. Baseline for all materials presented lower stress values (P<.05). Higher loosening torque values were found for the titanium group at baseline (P<.001) and after ceramic veneer (P<.001). Spark erosion improved fit and loosening torque values only for cobalt-chromium (P<.05). Mechanical cycling did not influence the loosening torque (P>.05). CONCLUSIONS Titanium milled complete-arch fixed frameworks presented poorer fit values than zirconia, although the loosening torque at baseline was higher. Ceramic veneer increased the fit levels for zirconia and cobalt-chromium, decreased the loosening torque values for cobalt-chromium, and enhanced stress levels. Spark erosion can be a reliable technique to improve fit and loosening torque for cobalt-chromium frameworks. Mechanical cycling did not decrease loosening torque.
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Affiliation(s)
- Letícia Del Rio Silva
- PhD student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Daniele Valente Velôso
- PhD student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Thaís Barbin
- PhD student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Guilherme Almeida Borges
- PhD student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Anna Gabriella Camacho Presotto
- Research Fellow, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Marcelo Ferraz Mesquita
- Full Professor, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.
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Failure Modes and Survival of Anterior Crowns Supported by Narrow Implant Systems. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1057846. [PMID: 32964016 PMCID: PMC7495162 DOI: 10.1155/2020/1057846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022]
Abstract
The reduced hardware design of narrow implants increases the risk of fracture not only of the implant itself but also of the prosthetic constituents. Hence, the current study is aimed at estimating the probability of survival of anterior crowns supported by different narrow implant systems. Three different narrow implant systems of internal conical connections were evaluated (Ø3.5 × 10 mm): (i) Active (Nobel Biocare), (ii) Epikut (S.I.N. Implant System), and (iii) BLX (Straumann). Abutments were torqued to the implants, and standardized maxillary incisor crowns were cemented. The assemblies were subjected to step-stress accelerated life testing (SSALT) in water through load application of 30 degrees off-axis lingually at the incisal edge of the crowns using a flat tungsten carbide indenter until fracture or suspension. The use level probability Weibull curves and reliability for completion of a mission of 100,000 cycles at 80 N and 120 N were calculated and plotted. Weibull modulus and characteristic strength were also calculated and plotted. Fractured samples were analyzed in a stereomicroscope. The beta (β) values were 1.6 (0.9-3.1) and 1.4 (0.9-2.2) for BLX and Active implants, respectively, and 0.5 (0.3-0.8) for the Epikut implant, indicating that failures were mainly associated with fatigue damage accumulation in the formers, but more likely associated with material strength in the latter. All narrow implant systems showed high probability of survival (≥95%, CI: 85-100%) at 80 and 120 N, without significant difference between them. Weibull modulus ranged from 6 to 14. The characteristic strength of Active, Epikut, and BLX was 271 (260-282) N, 216 (205-228) N, and 275 (264-285) N, respectively. The failure mode predominantly involved abutment and/or abutment screw fracture, whereas no narrow implant was fractured. Therefore, all narrow implant systems exhibited a high probability of survival for anterior physiologic masticatory forces, and failures were restricted to abutment and abutment screw.
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de Araújo-Júnior ENS, Bergamo ETP, Campos TMB, Benalcázar Jalkh EB, Lopes ACO, Monteiro KN, Cesar PF, Tognolo FC, Tanaka R, Bonfante EA. Hydrothermal degradation methods affect the properties and phase transformation depth of translucent zirconia. J Mech Behav Biomed Mater 2020; 112:104021. [PMID: 32882676 DOI: 10.1016/j.jmbbm.2020.104021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To characterize the optical and mechanical properties of a commercial and in-house translucent Y-TZP before and after aging in autoclave or hydrothermal reactor. METHODS In-house experimental discs were obtained through uniaxial and isostatic pressing a translucent Y-TZP powder and sintering at 1,550 °C/1 h. Commercial discs were milled from pre-sintered blocks fabricated with the same powder through uniaxial and isostatic pressing and sintering. Discs were allocated into three groups according to aging condition: immediate, aged via autoclave, or reactor (134 °C, 20 h, 2.2 bar). Crystalline content and microstructure were evaluated using X-ray diffraction (XRD) and scanning electron microscopy (SEM). Residual compressive stress (CS) was determined by Raman spectroscopy. Optical properties were determined by the contrast ratio (CR) and translucency parameter (TP) using reflectance data. Mechanical properties were assessed by Vickers hardness, fracture toughness and biaxial flexural strength tests. RESULTS XRD and SEM revealed a typical Y-TZP crystalline content, chiefly tetragonal phase, and a dense crystalline matrix for both processing protocols. Reactor aging triggered a more pronounced t-m transformation relative to autoclave. In-house and commercial Y-TZPs demonstrated similar CR and TP, with reactor aging significantly increasing their translucency. Similarly, reactor aging influenced Vickers hardness and fracture toughness. In-house processed Y-TZP clearly demonstrated the presence of CS, whereas commercial Y-TZP showed no presence of CS. Non-aged in-house Y-TZP resulted in significantly lower characteristic strength relative to commercial Y-TZP. While aging protocols significantly increased the characteristic strength of in-house Y-TZP, reactor significantly decreased commercial Y-TZP characteristic strength. Both Y-TZP processing protocols demonstrated high reliability at high-stress missions, with no detrimental effect of aging. CONCLUSIONS Laboratory aging methodology significantly influenced optical and mechanical properties of a commercial and in-house translucent Y-TZP.
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Affiliation(s)
- Everardo N S de Araújo-Júnior
- 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 Physics, Technological Institute of Aeronautics, São José Dos Campos, SP, Brazil
| | - Ernesto B Benalcázar Jalkh
- 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
| | - Kelli N Monteiro
- Department of Biomaterials and Oral Biology, University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Paulo F Cesar
- Department of Biomaterials and Oral Biology, University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Fernanda C Tognolo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Ricardo Tanaka
- TNK Lab, Rua João de Santa Maria, 129 - Jardim da Saúde - São Paulo, 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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Rammelsberg P, Meyer A, Lorenzo-Bermejo J, Kappel S, Zenthöfer A. Long-term chipping and failure rates of implant-supported and combined tooth-implant-supported metal-ceramic and ceramic fixed dental prostheses: A cohort study. J Prosthet Dent 2020; 126:196-203. [PMID: 32800577 DOI: 10.1016/j.prosdent.2020.05.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Revised: 05/29/2020] [Accepted: 05/29/2020] [Indexed: 11/18/2022]
Abstract
STATEMENT OF PROBLEM Combined tooth-implant-supported fixed dental prostheses have been associated with an increased risk of long-term failure. Furthermore, high chipping rates have been reported for ceramic fixed dental prostheses. However, clinical data are sparse. PURPOSE The purpose of this observational cohort study was to evaluate the chipping and failure rates of metal-ceramic and ceramic implant-supported and combined tooth-implant-supported fixed dental prostheses. MATERIAL AND METHODS Four hundred thirty-four fixed dental prostheses placed in 324 patients (mean age: 60.8 years) were selected from a prospective clinical long-term study comprising 213 implant-supported fixed dental prostheses, 66 implant-supported cantilever fixed dental prostheses, and 155 tooth-implant-supported fixed dental prostheses. Metal-ceramic fixed dental prostheses (n=260) were fabricated with a high noble metal alloy (n=225) or Co-Cr base metal alloy (n=35) frameworks. Ceramic fixed dental prostheses (n=174) were all zirconia based and had monolithic (n=68), completely veneered (n=43), or partially veneered frameworks (n=63). Kaplan-Meier curves were used to estimate the survival probability and the chipping-free survival rate of the fixed dental prostheses. RESULTS During the observation period of 0.5 to 12.6 years (mean: 4.26 years), 17 fixed dental prostheses failed because of implant failure (n=6), tooth loss (n=5), major chipping (n=5), or abutment screw loosening (n=1). Survival probability was 96% after 5 years and 91% after 10 years. Cox regression analysis showed that age, sex, fixed dental prosthesis location, type of fixed dental prosthesis support, and fixed dental prosthesis material had no significant effect on fixed dental prosthesis failure. Chipping (n=61) was significantly affected by the framework material and type of veneer (P=.001). After 5 years, the greatest incidence of chipping (39%) was observed for zirconia fixed dental prostheses with a complete veneer compared with an 18% incidence of chipping for metal-ceramic fixed dental prostheses with a high noble metal framework. A lower incidence of chipping was observed for zirconia fixed dental prostheses with a partial veneer or monolithic design. CONCLUSIONS Implant-implant-supported and combined tooth-implant-supported fixed dental prostheses have promising long-term survival rates. Chipping seems to occur less frequently in monolithic or partially veneered fixed dental prostheses than in fixed dental prostheses with complete veneers.
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Affiliation(s)
- Peter Rammelsberg
- Professor, Department of Prosthodontics, University of Heidelberg, Heidelberg, Germany.
| | - André Meyer
- Associate Professor, Department of Prosthodontics, University of Heidelberg, Heidelberg, Germany
| | - Justo Lorenzo-Bermejo
- Professor, Institute for Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Stefanie Kappel
- Professor, Department of Prosthodontics, University of Heidelberg, Heidelberg, Germany
| | - Andreas Zenthöfer
- Professor, Department of Prosthodontics, University of Heidelberg, Heidelberg, Germany
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A Prospective Clinical Cohort Investigation on Zirconia Implants: 5-Year Results. J Clin Med 2020; 9:jcm9082585. [PMID: 32785031 PMCID: PMC7464596 DOI: 10.3390/jcm9082585] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/21/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022] Open
Abstract
Mid-term data on zirconia oral implants is very rare. Therefore, the aim of this prospective clinical investigation was to evaluate the survival rate and the marginal bone loss of a one-piece zirconia implant after five years. Patient-reported outcomes were also recorded. Zirconia implants to support single crowns (SC) or a 3-unit fixed dental prosthesis (FDP) were placed and subsequently restored. After the insertion of the implants, at prosthetic delivery, and after five years, standardized radiographs were taken to evaluate marginal bone loss (MBL). For bone tissue evaluation, linear mixed models with random intercepts were fitted. Twenty-seven patients received one implant for an SC and 13 patients received two implants for a 3-unit FDP. Three patients each lost one implant for an SC before prosthetic delivery. Thirty-five patients were seen after five years, and no further implant was lost. The cumulative five-year implant survival rate was 94.3%. The MBL from implant installation up to five years was 0.81 mm. The MBL from implant installation to prosthetic delivery was statistically significant (p < 0.001). Patients perceived a significant improvement in function, esthetics, sense, speech, and self-esteem from pretreatment up to the five-year follow-up. The present findings substantiate the clinical applicability of this implant system.
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Granato R, Bergamo ETP, Witek L, Bonfante EA, Marin C, Greenberg M, Kurgansky G, Coelho PG. Clinical, histological, and nanomechanical parameters of implants placed in healthy and metabolically compromised patients. J Dent 2020; 100:103436. [PMID: 32738285 DOI: 10.1016/j.jdent.2020.103436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/04/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the clinical outcomes, histological parameters, and bone nanomechanical properties around implants retrieved from healthy and metabolic syndrome (MS) patients. METHODS Twenty-four patients with edentulous mandibles (12/condition), received four implants between the mental foramina. An additional implant prototype was placed for retrieval histology. The following clinical outcomes were evaluated: insertion torque (IT), implant stability quotient (ISQ) values at baseline and after 60 days of healing, and implant survival. The prototype was retrieved after the healing and histologically processed for bone morphometric evaluation of bone-to-implant contact (%BIC) and bone area fraction occupancy (%BAFO), and bone nanoindentation to determine the elastic modulus (Em) and hardness (H). Descriptive statistical procedures and survival tests were used to analyze the data. RESULTS The final study population was comprised of 10 women and 11 men (∼64 years). A total of 105 implants were placed, 21 retrieved for histology. Implant survival rates were similar between groups (>99 %). Similarly, IT and ISQ analyses showed no significant association with systemic condition (p > 0.216). Histological micrographs depicted similar bone morphology, woven bone, for both conditions. While MS (33 ± 5.3 %) and healthy (39 ± 6.5 %) individuals showed no significant difference for %BIC (p = 0.116), significantly higher %BAFO was observed for healthy (45 ± 4.6 %) relative to MS (30 ± 3.8 %) (p < 0.001). No significant differences on bone nanomechanical properties was observed (p > 0.804). CONCLUSIONS Although no significant influence on clinical parameters and bone nanomechanical properties was observed, MS significantly reduced bone formation in the peri-implant area in the short-term. CLINICAL SIGNIFICANCE A lower amount of bone formation in the peri-implant area was observed in comparison to healthy patients, although the other short-term clinical outcomes were not significantly different. Considering the escalating prevalence of MS patients in need for implant treatment, it becomes crucial to understand bone-to-implant response to determine the ideal loading time in this population.
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Affiliation(s)
- Rodrigo Granato
- Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, RJ, Brazil
| | - Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil.
| | - 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
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Charles Marin
- Department of Oral Surgery, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Michael Greenberg
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA
| | - Gregory Kurgansky
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA
| | - Paulo G Coelho
- Department of Mechanical and Aerospace Engineering - NYU Tandon School of Engineering, Brooklyn, NY, USA; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health School of Medicine, New York, NY, USA
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Pieralli S, Spies BC, Hromadnik V, Nicic R, Beuer F, Wesemann C. How Accurate Is Oral Implant Installation Using Surgical Guides Printed from a Degradable and Steam-Sterilized Biopolymer? J Clin Med 2020; 9:jcm9082322. [PMID: 32707759 PMCID: PMC7463912 DOI: 10.3390/jcm9082322] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 01/25/2023] Open
Abstract
3D printed surgical guides are used for prosthetically-driven oral implant placement. When manufacturing these guides, information regarding suitable printing techniques and materials as well as the necessity for additional, non-printed stock parts such as metal sleeves is scarce. The aim of the investigation was to determine the accuracy of a surgical workflow for oral implant placement using guides manufactured by means of fused deposition modeling (FDM) from a biodegradable and sterilizable biopolymer filament. Furthermore, the potential benefit of metal sleeve inserts should be assessed. A surgical guide was designed for the installation of two implants in the region of the second premolar (SP) and second molar (SM) in a mandibular typodont model. For two additive manufacturing techniques (stereolithography [SLA]: reference group, FDM: observational group) n = 10 surgical guides, with (S) and without (NS) metal sleeves, were used. This resulted in 4 groups of 10 samples each (SLA-S/NS, FDM-S/NS). Target and real implant positions were superimposed and compared using a dedicated software. Sagittal, transversal, and vertical discrepancies at the level of the implant shoulder, apex and regarding the main axis were determined. MANOVA with posthoc Tukey tests were performed for statistical analyses. Placed implants showed sagittal and transversal discrepancies of <1 mm, vertical discrepancies of <0.6 mm, and axial deviations of ≤3°. In the vertical dimension, no differences between the four groups were measured (p ≤ 0.054). In the sagittal dimension, SLA groups showed decreased deviations in the implant shoulder region compared to FDM (p ≤ 0.033), whereas no differences in the transversal dimension between the groups were measured (p ≤ 0.054). The use of metal sleeves did not affect axial, vertical, and sagittal accuracy, but resulted in increased transversal deviations (p = 0.001). Regarding accuracy, biopolymer-based surgical guides manufactured by means of FDM present similar accuracy than SLA. Cytotoxicity tests are necessary to confirm their biocompatibility in the oral environment.
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Affiliation(s)
- Stefano Pieralli
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine—University of Freiburg, 79106 Freiburg, Germany;
| | - Benedikt Christopher Spies
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine—University of Freiburg, 79106 Freiburg, Germany;
- Correspondence: ; Tel.: +49-761-270-49060
| | - Valentin Hromadnik
- Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany; (V.H.); (R.N.); (F.B.); (C.W.)
| | - Robert Nicic
- Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany; (V.H.); (R.N.); (F.B.); (C.W.)
| | - Florian Beuer
- Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany; (V.H.); (R.N.); (F.B.); (C.W.)
| | - Christian Wesemann
- Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany; (V.H.); (R.N.); (F.B.); (C.W.)
- Department of Orthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Dentofacial Orthopedics and Pedodontics, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
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AL‐Rabab'ah MA, AlTarawneh S, Jarad FD, Devlin H. Methodological Quality of Systematic Reviews Relating to Performance of All‐Ceramic Implant Abutments, Frameworks, and Restorations. J Prosthodont 2020; 30:36-46. [DOI: 10.1111/jopr.13206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 05/26/2020] [Accepted: 05/27/2020] [Indexed: 01/07/2023] Open
Affiliation(s)
- Mohammad A. AL‐Rabab'ah
- Department of Conservative Dentistry, School of Dentistry The University of Jordan Amman Jordan
- School of Dentistry University of Liverpool UK
- Division of Dentistry The University of Manchester UK
| | - Sandra AlTarawneh
- Department of Removable Prosthodontics, School of Dentistry The University of Jordan Amman Jordan
- Department of Restorative Dentistry UIC College of Dentistry Chicago IL
| | | | - Hugh Devlin
- Division of Dentistry The University of Manchester UK
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Chochlidakis K, Fraser D, Lampraki E, Einarsdottir ER, Barmak AB, Papaspyridakos P, Ercoli C, Tsigarida A. Prosthesis Survival Rates and Prosthetic Complications of Implant-Supported Fixed Dental Prostheses in Partially Edentulous Patients. J Prosthodont 2020; 29:479-488. [PMID: 32364656 DOI: 10.1111/jopr.13185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To determine the prevalence and distribution of prosthetic complications affecting implant-supported fixed dental prostheses (ISFDPs). MATERIALS AND METHODS Subjects previously treated with one or more ISFDP(s) were identified from an electronic health record search and recalled for comprehensive clinical examination. Past prosthesis failures and complications were identified from the patient records while any existing complications, not previously recorded, were assessed during examination. ISFDP survival and failure rates were calculated with Kaplan-Meier curves and life table analysis, while regression Poisson analysis was used to identify associations between outcomes and possible patient- and prosthesis-based risk factors. RESULTS Seventy-four subjects with 107 ISFDPs were enrolled in the study with a mean time between prosthesis delivery and exam of 3.14 years (range: 1.00-9.00 years). Four prostheses failed, resulting in a cumulative prosthesis survival rate of 96.26%. Prosthetic complications affected 48.59% of ISFDPs, the majority (94.87%) of them minor complications. Only the use of a nightguard was associated with a lower prevalence of prosthetic screw loosening (HR 0.11, 95% CI 0.02-0.59, p = 0.007) while no outcome differences were noted for other variables. Patient satisfaction was high regardless of presence or number of complications. CONCLUSIONS ISFDPs demonstrated a high survival rate and overall high, patient-reported satisfaction. Minor prosthetic complications were common but were only significantly associated with nightguard use.
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Affiliation(s)
- Konstantinos Chochlidakis
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - David Fraser
- Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | | | | | - Abdul Basir Barmak
- Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Panos Papaspyridakos
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY.,Department of Prosthodontics, Tufts School of Dental Medicine, Boston, MA
| | - Carlo Ercoli
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Alexandra Tsigarida
- Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
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Ceramic Materials and Technologies Applied to Digital Works in Implant-Supported Restorative Dentistry. MATERIALS 2020; 13:ma13081964. [PMID: 32331379 PMCID: PMC7216107 DOI: 10.3390/ma13081964] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/14/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022]
Abstract
Computer-aided design and manufacturing technology has been closely associated with implant-supported restoration. The digital system employed for prosthodontic restorations comprises data acquisition, processing, and manufacturing using subtractive or additive methods. As digital implantology has developed, optical scanning, computer-based digital algorithms, fabricating techniques, and numerical control skills have all rapidly improved in terms of their accuracy, which has resulted in the development of new ceramic materials with advanced esthetics and durability for clinical application. This study reviews the application of digital technology in implant-supported dental restoration and explores two globally utilized ceramic restorative materials: Yttria-stabilized tetragonal zirconia polycrystalline and lithium disilicate glass ceramics.
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Rayyan MM, Abdallah J, Segaan LG, Bonfante EA, Osman E. Static and Fatigue Loading of Veneered Implant-Supported Fixed Dental Prostheses. J Prosthodont 2020; 29:679-685. [PMID: 32271486 DOI: 10.1111/jopr.13173] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Revised: 04/03/2020] [Accepted: 04/03/2020] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study aimed to compare the load to failure and the probability of survival of porcelain fused to zirconia (PFZ) three-unit, implant-supported, fixed dental prostheses (FDPs) to those of indirect composites veneered to either zirconia (CVZ) or milled fiber-reinforced composite (FRC) frameworks under static and fatigue loading. MATERIALS AND METHODS One-hundred and twenty posterior three-unit FDP (second premolar pontic) frameworks were fabricated via milling from a single Standard Tessellation Language (STL) file. The FDPs were divided into three groups. Each group (n = 40) was subjected to static (n = 20) and fatigue (n = 20) loading tests, as follows: (1) PFZ: zirconia framework layered with porcelain veneer; (2) CVZ: zirconia framework veneered with indirect composite resin; and (3) FRC: FRC framework veneered with indirect composite resin. After porcelain veneering onto sintered zirconia frameworks, or resin composite veneering onto zirconia or FRC frameworks, FDPs were cemented on their abutments using self-adhesive resin cement. After thermal cycling, half of the FDPs were subjected to an accelerated fatigue test. The other half of the FDPs were subjected to single load-to-failure (SLF) testing at a crosshead speed (1 mm/min). Lifetime analysis was conducted to determine the probability of survival, and fractographic analysis was performed. RESULTS Significant differences were observed among the studied groups for SLF with the highest characteristic strength values observed for PFZ (2154 N), followed by 1905.47 N for CVZ and 1679.56 N for FRC. The probability of survival for 100,000 cycles at 500 N was the highest for FRC (98%) and CVZ (100%) and was significantly lower for PFZ (88%). Different fracture patterns were observed in the fractography. CONCLUSIONS In fatigue testing, which simulates masticatory function better than static tests, a higher probability of survival was observed for FRC and CVZ than for PFZ. Framework fractures were not observed only for the FRC group, indicating that chairside repair with the addition of indirect composite could be performed for continued function.
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Affiliation(s)
- Mohammad M Rayyan
- Professor, Department of Oral Rehabilitation Sciences, Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon
| | - Jihad Abdallah
- Clinical Professor, Department of Oral and Surgical Sciences, Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon
| | - Lucette G Segaan
- Professor, Department of Oral Rehabilitation Sciences, Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon
| | - Estevam A Bonfante
- Assistant Professor, Department of Prosthodontics and Periodontology, University of São Paulo - Bauru School of Dentistry, Bauru, SP, Brazil
| | - Essam Osman
- Professor, Department of Oral Rehabilitation Sciences, Faculty of Dentistry, Beirut Arab University, Beirut, Lebanon
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Aging resistance of an experimental zirconia-toughened alumina composite for large span dental prostheses: Optical and mechanical characterization. J Mech Behav Biomed Mater 2020; 104:103659. [DOI: 10.1016/j.jmbbm.2020.103659] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 01/21/2020] [Accepted: 01/27/2020] [Indexed: 02/04/2023]
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Jang YS, Lim CH, Song UC, Noh HR, Joo KJ, Lee MH, Ahn SG, Bae TS. Debonding/crack initiation and flexural strengths of bilayered zirconia core and veneering ceramic composites. Dent Mater J 2020; 39:206-213. [PMID: 31694997 DOI: 10.4012/dmj.2018-321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The aim of this study was to evaluate the effects of the kinds of veneering ceramics and veneering methods on the debonding/crack initiation and 3-point flexural strengths in bilayered zirconia core and veneering ceramic composites. Zirconia block was used as core material, and Cerabien ZR and Lava Ceram for the layering technique and IPS e.max ZirPress and Amber LiSi-POZ for the heat pressing technique were used as veneering materials. Both debonding/crack initiation and 3-point flexural strengths of bilayered zirconia core and veneering ceramic composites as well as the bi-axial flexural strengths of veneering materials, were higher when using heat pressing technique than layering technique. It was identified that not only bonding strength between zirconia core and veneering materials but also the intrinsic strength of veneering ceramic should be high to prevent chipping of veneering material.
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Affiliation(s)
- Yong-Seok Jang
- Department of Dental Biomaterials, Institute of Biodegradable Materials, BK21 plus Program, School of Dentistry, Chonbuk National University
| | - Chung-Ha Lim
- Department of Dental Biomaterials, Institute of Biodegradable Materials, BK21 plus Program, School of Dentistry, Chonbuk National University
| | - Ung-Cheol Song
- Department of Dental Biomaterials, Institute of Biodegradable Materials, BK21 plus Program, School of Dentistry, Chonbuk National University
| | - Hyeong-Rok Noh
- Department of Dental Biomaterials, Institute of Biodegradable Materials, BK21 plus Program, School of Dentistry, Chonbuk National University
| | - Kyu-Ji Joo
- Department of Dental Technology, Gwangju Health College
| | - Min-Ho Lee
- Department of Dental Biomaterials, Institute of Biodegradable Materials, BK21 plus Program, School of Dentistry, Chonbuk National University
| | - Seung-Geun Ahn
- Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital.,Department of Prosthodontics, School of Dentistry, Chonbuk National University
| | - Tae-Sung Bae
- Department of Dental Biomaterials, Institute of Biodegradable Materials, BK21 plus Program, School of Dentistry, Chonbuk National University.,Research Institute of Clinical Medicine of Chonbuk National University, Biomedical Research Institute of Chonbuk National University Hospital
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