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Çakmak G, Cuellar AR, Treviño Santos A, Johnston WM, Dönmez MB, Yilmaz B. Color and translucency of milled polymethyl methacrylate crowns on non-tooth-colored interim abutments with different surface treatments. J Prosthet Dent 2024; 131:102-109. [PMID: 35341600 DOI: 10.1016/j.prosdent.2022.01.005] [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: 05/04/2021] [Revised: 01/11/2022] [Accepted: 01/11/2022] [Indexed: 10/18/2022]
Abstract
STATEMENT OF PROBLEM The interim rehabilitation of implants has become a necessity, particularly for those placed in the esthetic regions. However, the optical properties of computer-aided design and computer-aided manufacturing (CAD-CAM) polymethyl methacrylate (PMMA) crowns on interim abutments with different surface treatments are unclear. PURPOSE The purpose of this in vitro study was to investigate the color and translucency of CAD-CAM PMMA crowns when different surface treatments were used on titanium interim abutments. MATERIAL AND METHODS A maxillary dentate stone cast with a narrow-diameter implant analog at the left lateral incisor site was used. Three titanium interim abutments (blue) were divided into 3 groups according to the surface treatment they received: control (steam cleaning), opaqued (120-μm Al2O3 airborne-particle abrasion and opaque application), and airborne-particle abraded (120-μm Al2O3). Thirty PMMA crowns (A2 shade) were milled (n=10). The color coordinates of the crown-interim abutment pairs and a shade tab (A2) were measured by using a colorimeter. The color differences (ΔE00) between the crowns and the shade tab and the relative translucency parameter (RTP) values of the crowns were calculated by using the CIEDE2000 formula. One-way ANOVA was used to analyze the ΔE00 and RTP values with subsequent Tukey honestly significant difference tests (α=.05). RESULTS The abutment surface treatment significantly affected the ΔE00 of interim crowns from the shade tab (P<.001), but no significant effect was found on RTP (P=.26). The control group had the highest ΔE00 from the shade tab (P≤.011). No significant difference (P=.14) was found between the opaqued and the ΔE00 of the airborne-particle abraded groups from the shade tab. CONCLUSIONS The surface treatments of interim abutments affected the color of CAD-CAM PMMA crowns, which differed from that of the shade tab. The color of crowns on opaqued or airborne-particle abraded interim abutments was closer to the color of the shade tab. Abutment surface treatments did not affect the translucency of crown-interim abutment pairs.
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Affiliation(s)
- Gülce Çakmak
- Buser Foundation Scholar for Implant Dentistry, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.
| | | | - Alejandro Treviño Santos
- Professor, Postdoctoral and Research Division, Faculty of Dentistry, National Autonomous University of Mexico UNAM, Mexico City, Mexico
| | - William M Johnston
- Professor Emeritus, Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio
| | - Mustafa Borga Dönmez
- Assistant Prosfessor, Department of Prosthodontics, Faculty of Dentistry, İstinye University, İstanbul, Turkey; Visiting Researcher, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Burak Yilmaz
- Associate Professor, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland; Associate Professor, Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland; Adjunct Professor, Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio
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Zandinejad A, Khurana S, Liang Y, Liu X. Comparative evaluation of gingival fibroblast growth on 3D-printed and milled zirconia: An in vitro study. J Prosthodont 2024; 33:54-60. [PMID: 36693242 DOI: 10.1111/jopr.13650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 01/03/2023] [Accepted: 01/09/2023] [Indexed: 01/25/2023] Open
Abstract
PURPOSE The purpose of this study was to analyze the fibroblast growth and proliferation on 3D-printed zirconia in presence and absence of porosities. MATERIAL AND METHODS A total of 40 bars (8 × 4 × 3) were included in this study. Thirty 3D-printed and 10 milled zirconia samples were prepared. The 3D-printed samples had different porosities, 0% (PZ0), 20% (PZ20), and 40% (PZ40) with 10 specimens in each group. Milled zirconia samples were used as the control (MZ). Rat gingival fibroblasts were cultured for 48 h, and the proliferation of fibroblasts on each sample in each group (n = 10) was determined by MTT assays. The differences among the four groups were compared by one-way ANOVA. To test the significance of the observed differences between two groups, an unpaired Student's t-test was applied. The significance level was set at p < 0.05. Qualitative analysis for the cell culture was performed using scanning electron microscopy. RESULTS One-way ANOVA showed that the numbers of the fibroblasts among the four groups had a statistical difference. Post hoc Bonferroni test revealed that there was no significant difference between PZ0 and MZ; however, all other groups and among groups were significantly different. CONCLUSIONS Fibroblasts had a better affinity toward the MZ and PZ0 in a short period of cell culture time.
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Affiliation(s)
- Amirali Zandinejad
- Implant Dentistry Associations of Arlington, Arlington, Texas, USA
- Department of Comprehensive Dentistry, College of Dentistry, Texas A&M University, Dallas, Texas, USA
| | - Saumya Khurana
- Department of Biomedical Science, College of Dentistry, Texas A&M University, Dallas, Texas, USA
| | - Yongxi Liang
- Department of Biomedical Science, College of Dentistry, Texas A&M University, Dallas, Texas, USA
| | - Xiaohua Liu
- Department of Biomedical Science, College of Dentistry, Texas A&M University, Dallas, Texas, USA
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Pesce P, Del Fabbro M, Menini M, De Giovanni E, Annunziata M, Khijmatgar S, Canullo L. Effects of abutment materials on peri-implant soft tissue health and stability: A network meta-analysis. J Prosthodont Res 2023; 67:506-517. [PMID: 37081626 DOI: 10.2186/jpr.jpr_d_22_00223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
PURPOSE This systematic review aimed to evaluate the effect of the abutment material on peri-implant soft tissue health and stability. STUDY SELECTION An electronic and hand search was conducted until February 2022. Only prospective randomized trials (RCTs) and controlled clinical trials (CCTs) comparing titanium abutments with abutments made of different materials, with a follow-up of at least 6 months, were selected by two independent reviewers. Data on marginal bone loss (MBL) and peri-implant tissue indexes, i.e., plaque index (PI), bleeding on probing (BOP), probing depth (PD), and recession (REC), were collected. The risk of bias for RCTs and non-RCTs was evaluated according to the tool reported in the Cochrane Handbook for Systematic Reviews of Interventions and the ROBINS-I tool, respectively. Both pairwise and network meta-analyses (NMA) were performed. RESULTS We included 18 relevant studies from 1,437 identified studies. Overall, 612 patients were treated, and 848 abutments were inserted. Five studies presented a low risk of bias. Pairwise meta-analysis showed that, as compared to titanium, zirconia abutments presented a significantly reduced MBL (0.20 mm, 95% Confidence Interval CI [0.14-0.26], P < 0.00001). No significant differences were found for the other outcomes. In the NMA, zirconia abutments demonstrated an 83.3% probability of achieving the highest rank in PI, an 87.0% in BOP, and a 65.0% in PD outcome, suggesting that zirconia abutments generally performed better than titanium and alumina abutments. CONCLUSIONS Within the limits of the present study, zirconia abutments seem a viable alternative to titanium ones.
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Affiliation(s)
- Paolo Pesce
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, L. Rosanna Benzi, Genoa, Italy
| | - Massimo Del Fabbro
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Maria Menini
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, L. Rosanna Benzi, Genoa, Italy
| | - Emanuele De Giovanni
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, L. Rosanna Benzi, Genoa, Italy
| | - Marco Annunziata
- Multidisciplinary Department of Medical-Surgical and Dental Specialties, University of Campania Luigi Vanvitelli, Naples, Italy
| | - Shahnawaz Khijmatgar
- Department of Biomedical, Surgical, and Dental Sciences, University of Milan, Milan, Italy
| | - Luigi Canullo
- Department of Surgical Sciences (DISC), Division of Prosthodontics and Implant Prosthodontics, University of Genoa, L. Rosanna Benzi, Genoa, Italy
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4
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Batyrbekova G, Hekimoğlu C. Evaluation of gingival porcelains: Color change and surface properties. J Prosthodont 2023. [PMID: 37795925 DOI: 10.1111/jopr.13779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 09/25/2023] [Accepted: 10/01/2023] [Indexed: 10/06/2023] Open
Abstract
PURPOSE This in vitro study aimed to evaluate the effect of thermal cycling (TC) on the color stability, translucency, and surface roughness of two different gingival porcelain materials. MATERIALS AND METHODS The gingival porcelains IPS e.max Ceram Gingiva (Ceram) and IPS InLine Gingiva (InLine) were tested. A total of 66 disc-shaped specimens were prepared and glazed using porcelain powders of G1, G3, and G5 colors. The samples were divided into two porcelain groups by their types and into three subgroups (n11) by their colors. Thermal cycling was performed at 6000 cycles simulating an oral environment of 5 years. The color and surface roughness measurements of the samples were made before and after the thermal cycling. Color measurements were made with a spectrophotometer. Surface roughness (mean surface roughness [Ra; μm]) was measured using a contact profilometer. Data before thermal cycling were evaluated using the Kruskal-Wallis test followed by the Dunn Bonferonni paired comparison test. Two-way ANOVA with repeated measurements and a pairwise comparison test with Bonferroni correction were used to evaluate the change in roughness and translucency parameter (TP) data between groups due to thermal cycling. RESULTS The color change was below the clinically perceptible color change threshold (∆E00 = 2.1) in all groups after thermal cycling. However, all materials had significantly increased roughness (p < 0.05). An increase in roughness was detected in the Ceram group and was higher than that in the InLine group. The change in the translucency parameters of the samples after thermal cycling was not statistically significant; a small increase was observed in all groups. The highest translucency values were seen in the G1, G3, and G5 colors. CONCLUSIONS Thermal cycling caused a significant increase in the roughness values (Ra) of all materials and a minimal increase in their translucency. The color change of gingival porcelains after thermal cycling was less than the clinically perceptible threshold.
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Affiliation(s)
- Gulaiym Batyrbekova
- Department of Prosthodontics, Hacettepe University, Faculty of Dentistry, Ankara, Türkiye
| | - Canan Hekimoğlu
- Department of Prosthodontics, Hacettepe University, Faculty of Dentistry, Ankara, Türkiye
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Del Castillo R, Gutiérrez-Garrido L, Padial-Molina M, Galindo-Moreno P. Screw-retained internal connection zirconia CAD-CAM abutments in single implant reconstructions: Results of a 1-year prospective case series study. J Prosthodont 2023; 32:679-688. [PMID: 36882991 DOI: 10.1111/jopr.13674] [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: 08/01/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/09/2023] Open
Abstract
PURPOSE To evaluate the clinical and radiographic outcomes of single-tooth implant restorations using one-piece, internally connected, screw-retained, computer-aided design and computer-aided manufactured monolithic zirconia restorations fabricated on regular diameter implants. MATERIAL AND METHODS Following a 2-stage surgical procedure, 22 implants placed in anterior and posterior areas in 21 partially edentulous patients (mean age of 55 years; 9 males/12 females) were evaluated in terms of plaque index, pocket probing depth, bleeding on probing, level of oral hygiene (OH), signs of mucositis/peri-implantitis, esthetic score (ES), gingival zenith position (GZP), papilla index score, the thickness of peri-implant gingiva, radiographic marginal bone loss, and technical complications. Implants and restorations were prospectively followed from the insertion of the restoration (baseline), up to 12-months post-loading. RESULTS A 100% implant survival rate resulted after loading; one implant was lost before loading. Clinically, patients performed an adequate OH, and tissues were kept healthy. Probing depth showed a slightly lower value at baseline compared to any follow-up examination (2.26 [0.94] at baseline vs. 2.53 [0.66] mm at 12 months). ES, GZP, and the thickness of the peri-implant gingiva improved throughout the course of the study. Radiographically, average marginal bone level (MBL) was 0.40 (0.40) mm after 1-year follow-up with no differences in average MBL at all time points. Technically, after 1 year of clinical function, neither abutment fracture nor any other serious complications occurred. Hence, prosthetic reconstruction survival rate was 100%. CONCLUSIONS Clinical outcomes of single-tooth implant restorations using internally connected, screw-retained, computer-aided design and computer-aided manufacturing monolithic zirconia abutments can be considered a reliable treatment alternative after 1-year clinical observation.
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Affiliation(s)
- Rafael Del Castillo
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | | | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria., IBS, University of Granada., Granada, Spain
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria., IBS, University of Granada., Granada, Spain
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Nguyen O, Lee SJ, Lee JD. Influence of varying titanium base abutment heights on retention of zirconia restorations: An in vitro study. J Prosthet Dent 2023; 130:604.e1-604.e5. [PMID: 37633730 DOI: 10.1016/j.prosdent.2023.07.034] [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: 05/22/2023] [Revised: 07/27/2023] [Accepted: 07/31/2023] [Indexed: 08/28/2023]
Abstract
STATEMENT OF PROBLEM Implant manufacturers have introduced titanium base (Ti-Base) abutments with increased abutment heights, ostensibly, to increase the retention of the bonded restoration and to improve overall strength. However, evidence regarding the effects of increasing Ti-Base height on improving retention is lacking. PURPOSE The purpose of this in vitro study was to evaluate the effect of different Ti-Base abutment heights on the retention of zirconia implant-supported crowns. MATERIAL AND METHODS Thirty Ti-Base abutments of the same diameter and heights of 3.5 mm (n=10), 4.5 mm (n=10), and 5.5 mm (n=10), were used for testing. Zirconia restorations were cemented onto the Ti-Base abutments with a resin cement after treatment with a 10-methacryloyloxydecyl dihydrogen phosphate primer by a single operator using a positioning device. The zirconia-Ti-Base restorations were tightened to an implant analog embedded in an autopolymerizing resin block. The specimens were placed and tested in a universal testing machine for pull-out testing. Retention was measured by recording the force at load drop. Statistical analysis was performed using 1-way analysis of variance with the Tukey method for pairwise comparisons. RESULTS The abutment height had a significant effect on retention (P=.010). Ti-Base abutments of 4.5 and 5.5 mm had significantly greater retention than Ti-Base abutments of 3.5 mm (P=.020, P=.040, respectively). However, Ti-Base abutments of 4.5 and 5.5 mm in height were statistically similar (P=.890). CONCLUSIONS An increase in the height of Ti-Base abutments above the standard 3.5 mm height significantly improved the retention of the overlying restoration.
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Affiliation(s)
- Olivia Nguyen
- Graduate student, Advanced Graduate Education in Prosthodontics, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass
| | - Sang J Lee
- Associate Professor, Department of Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, Boston, Mass
| | - Jason D Lee
- Instructor, Department of Restorative Dentistry and Biomaterial Sciences, Harvard School of Dental Medicine, Boston, Mass.
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Del Castillo R, Ata-Ali J. The clinical use of computer aided designed/computer aided manufactured titanium nitride coated implant abutments: Surgical and prosthetic considerations-A case series. J ESTHET RESTOR DENT 2023; 35:1008-1021. [PMID: 36932837 DOI: 10.1111/jerd.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/12/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To describe the clinical use of nitride-coated titanium CAD/CAM implant abutments in the maxillary esthetic zone in two patients with high esthetic and functional demands and, to highlight the advantages of nitride-coated milled titanium abutments when compared to stock/custom titanium, one-piece monolithic zirconia, and hybrid metal-zirconia implant abutments. CLINICAL CONSIDERATIONS Due to the inherent mechanical and esthetic clinical challenges, single implant-supported reconstructions in the maxillary esthetic zone are a complex restorative treatment. While CAD/CAM technology has been suggested to enhance and ease implant abutment design and manufacturing, implant abutment material selection remains as a critical decision affecting restoration's long-term clinical outcomes. To date, considering the esthetic disadvantages of conventional titanium implant abutments, the mechanical limitations of one-piece zirconia abutments and the manufacturing time and costs associated with hybrid metal-zirconia abutments, no abutment material can be considered "ideal" for all clinical scenarios. Due to their biocompatibility, biomechanical characteristics (hardness and wear resistance), optical properties (yellow color), and peri-implant soft tissue esthetic integration, the use of CAD/CAM titanium nitride-coated implant abutments has been suggested as a predictable implant abutment material in mechanically challenging but esthetically demanding clinical situations, as the maxillary esthetic zone. CONCLUSIONS Two patients requiring a combined tooth-implant restorative treatment in the maxillary esthetic zone were treated using CAD/CAM nitride coated titanium implant abutments. The principal advantages of TiN coated abutments include comparable clinical outcomes to stock abutments, optimal biocompatibility, adequate fracture, wear, and corrosion resistance, reduced bacterial adhesion, and excellent esthetic integration with adjacent soft tissues. CLINICAL SIGNIFICANCE Clinical reports and short term mechanical, biological and esthetic clinical outcomes indicate that CAD/CAM nitride coated titanium implant abutments can represent a predictable restorative alternative to stock/custom and metal/zirconia implant abutments and be considered a clinical relevant option in mechanically challenging but esthetically demanding situations, as often found in the maxillary esthetic zone.
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Affiliation(s)
- Rafael Del Castillo
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | - Javier Ata-Ali
- Department of Dentistry, Faculty of Health Sciences, Universidad Europea de Valencia, Public Dental Health Service, Conselleria de Sanitat Universal i Salut Pública, Valencia, Spain
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Lopo Barros JH, de Oliveira MN, Cardoso IO, de Oliveira GJPL, do Prado CJ, Neves FDD. Computer-Aided Design/Computer-Aided Manufacturing of Customized Abutment for Rehabilitating a Malpositioned Implant Using Digital Flow: A Case Report. Healthcare (Basel) 2023; 11:2472. [PMID: 37761669 PMCID: PMC10530779 DOI: 10.3390/healthcare11182472] [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: 07/06/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023] Open
Abstract
This study presented a rehabilitation option for malpositioned implants; this involved obtaining their position and inclination through intraoral scanning, and producing a customized abutment with CAD/CAM technology. The patient in this case report presented a root fracture in tooth 21 and was subjected to extraction, implant installation, and immediate provisional prosthesis. The implant was installed with a distal inclination due to anatomical limitations. After osseointegration, an intraoral scanning transfer provided a digital model (file extension .stl), which reproduced the implant's position and inclination. Then, the file was sent so that a customized abutment (CAD/CAM) could be manufactured, promoting the final rehabilitation of the case; this allowed for good hygiene, load distribution in the dynamic interocclusal relationship, and favorable esthetics, whereas many would otherwise recommend implant removal. The result presented lower costs, a shorter time frame, and a lower morbidity for the patient.
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Affiliation(s)
- José Henrique Lopo Barros
- Department of Occlusion, Fixed Prosthodontics and Dental Materials, School of Dentistry, Federal University of Uberlandia, Uberlandia 38405-320, MG, Brazil;
| | | | - Igor Oliveiros Cardoso
- College of Dentistry, University Center of Triangle (UNITRI), Uberlandia 38411-849, MG, Brazil;
| | | | - Célio Jesus do Prado
- Department of Occlusion, Fixed Prosthodontics and Dental Materials, School of Dentistry, Federal University of Uberlandia, Uberlandia 38405-320, MG, Brazil;
| | - Flávio Domingues Das Neves
- Department of Occlusion, Fixed Prosthodontics and Dental Materials, School of Dentistry, Federal University of Uberlandia, Uberlandia 38405-320, MG, Brazil;
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Khorshed A, Vilarrasa J, Monje A, Nart J, Blasi G. Digital evaluation of facial peri-implant mucosal thickness and its impact on dental implant aesthetics. Clin Oral Investig 2023; 27:581-590. [PMID: 36260169 DOI: 10.1007/s00784-022-04753-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 10/07/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of the present study was to describe and compare the features of the buccal peri-implant mucosa to natural gingiva in the aesthetic area. MATERIAL AND METHODS Forty-nine periodontally healthy patients were included in this cross-sectional study. Mucosal and gingival dimensions at the mid-facial aspect were evaluated clinically and radiographically. Color assessments were performed using a reflectance spectrophotometer, and patient aesthetic satisfaction was further checked. RESULTS Implant sites revealed significant thicker mucosa when compared to tooth sites both at 1.5 (p < 0.001) and 3 mm (p < 0.001) apical to the mucosal margin. Both conventional and digital methods presented a good reliability. The spectrophotometric data revealed a statistically significant color difference between the peri-implant mucosa and the gingiva. However, there was no further significant relation between these color changes and the mucosal thickness. CONCLUSIONS Peri-implant mucosa revealed a darkish, greenish, and bluish discoloration when compared to the gingiva. More satisfactory patient´s aesthetic evaluation was reported in sites with thicker and comparatively lighter mucosa when compared to the adjacent dentition. CLINICAL RELEVANCE This article focuses on variables affecting color stability and aesthetics around dental implants. These can be assessed to identify the need for peri-implant phenotypic modification.
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Affiliation(s)
- Amr Khorshed
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 - Sant Cugat del Vallès, Barcelona, Spain.,School of Dental Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Javi Vilarrasa
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 - Sant Cugat del Vallès, Barcelona, Spain
| | - Alberto Monje
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 - Sant Cugat del Vallès, Barcelona, Spain.,Department of Periodontology, School of Dental Medicine, University of Michigan, Ann Arbor, USA
| | - Jose Nart
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 - Sant Cugat del Vallès, Barcelona, Spain.
| | - Gonzalo Blasi
- Department of Periodontology, Universitat Internacional de Catalunya, C/ Josep Trueta s/n, 08195 - Sant Cugat del Vallès, Barcelona, Spain.,Division of Periodontics, Department of Advanced Oral Sciences and Therapeutics, University of Maryland, Baltimore School of Dentistry, Baltimore, MD, USA
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10
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Mancini L, Barootchi S, Thoma DS, Jung RE, Gallucci GO, Wang HL, Tavelli L. The peri-implant mucosa color: A systematic appraisal of methods for its assessment and clinical significance. Clin Implant Dent Relat Res 2023; 25:224-240. [PMID: 36646440 DOI: 10.1111/cid.13180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/21/2022] [Accepted: 12/28/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Peri-implant mucosa color (PMC) seems to be one of the main parameters affecting the esthetic outcome of implant therapy. However, more emphasis should be given to its assessment and reporting. PURPOSE To describe the available evidence on methods to assess and report the color of the peri-implant mucosa (PMC) and the respective clinical relevance. MATERIAL AND METHODS A comprehensive electronic and manual search was performed to identify clinical studies reporting on PMC. RESULTS A total of 121 studies were included. PMC was evaluated at the time of the follow-up visit (chairside) in 45.5% studies. PMC assessment was performed qualitatively, by comparing PMC with adjacent and/or contralateral gingiva (78.6%) or quantitatively, using spectrophotometry (20.7%) or a software on clinical photographs (0.8%). The most performed method to assess PMC was through esthetic indices (76.9%), either at the time of the follow-up visit (chairside) or at later time point using photographs. Quantitative reporting of PMC included averages of points from esthetic indices or color differences to natural gingiva expressed with the CIELAB color system. PMC assessment allowed describing color discrepancies compared to natural gingiva, evaluating color changes over time, and comparing the outcomes of different treatment modalities. PMC assessment through spectrophotometry was additionally utilized to assess the role of mucosal thickness (MT) on PMC. CONCLUSIONS Various methods for PMC assessment and reporting were described, including visual assessment, mainly through esthetic indices, and spectrophotometry. PMC evaluation has allowed to demonstrate the factors affecting the color of the peri-implant soft tissue, such as the type of abutment/restoration, MT, and soft tissue augmentation.
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Affiliation(s)
- Leonardo Mancini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.,Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland.,Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA.,Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Shayan Barootchi
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA.,Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland.,Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, South Korea
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - German O Gallucci
- Department of Restorative Dentistry and Biomaterial Science, Harvard School of Dental Medicine, Boston, Massachusetts, USA
| | - Hom-Lay Wang
- Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Lorenzo Tavelli
- Center for Clinical Research and Evidence Synthesis in Oral Tissue Regeneration (CRITERION), Boston, Massachusetts, USA.,Department of Oral Medicine, Infection, and Immunity, Division of Periodontology, Harvard School of Dental Medicine, Boston, Massachusetts, USA.,Department of Periodontics & Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Del Castillo R, Chochlidakis K, Galindo-Moreno P, Ercoli C. Titanium Nitride Coated Implant Abutments: From Technical Aspects And Soft tissue Biocompatibility to Clinical Applications. A Literature Review. J Prosthodont 2022; 31:571-578. [PMID: 34731520 DOI: 10.1111/jopr.13446] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To review the most up to date scientific evidence concerning the technical implications, soft tissue biocompatibility, and clinical applications derived from the use of titanium nitride hard thin film coatings on titanium alloy implant abutments. MATERIALS AND METHODS A review was performed to answer the following focused question: "What is the clinical reliability of nitride coated titanium alloy abutments?". A MEDLINE search between 1980 and 2021 was performed for investigations pertaining to the clinical use of nitride coated titanium alloy implant abutments (TiN) in case reports, case series, and short- and long-term non/randomized controlled clinical trials. Literature analysis led to addition evaluation of research related to the technical and biological aspects, as well as the physicochemical characteristics of TiN hard thin film coatings and their impact on titanium abutment biocompatibility, mechanical properties, macroscopic surface topography, and optical properties. Therefore, preclinical data from biomechanical and in vitro investigations were also considered as inclusion criteria. RESULTS The limited number of clinical investigations published made a systematic review and meta-analysis not possible, therefore a narrative review was conducted. TiN coatings have been applied to dental materials and instruments to improve their clinical longevity. Implant abutments are coated with titanium nitride to mask the titanium oxide surface and enhance its surface characteristics providing the TiN abutment surface with a low friction coefficient and a very high chemical inertness. TiN coating is suggested to reduce early bacterial colonization and biofilm formation and enhance fibroblast cell proliferation, attachment and adhesion when compared to Ti controls. Additionally, studies indicate that hard thin film coatings enhance the mechanical properties (hardness and wear resistance) of titanium alloy and appears as a yellow color when deposited on the titanium alloy substrate. To date, clinical investigations show that nitride coated titanium abutments provide promising short-term clinical outcomes. CONCLUSIONS Published research on nitride-coated abutments is still limited, however, the available biomedical research, mechanical engineering tests, in vitro investigations, and short-term clinical trials have, to date, reported promising mechanical, biological, and esthetic outcomes.
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Affiliation(s)
- Rafael Del Castillo
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Konstantinos Chochlidakis
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Carlo Ercoli
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
- Department of Prosthodontics and Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
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Bending moment of implants restored with CAD/CAM polymer-based restoration materials with or without a titanium base before and after artificial aging. Dent Mater 2022; 38:e245-e255. [PMID: 35715247 DOI: 10.1016/j.dental.2022.06.009] [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: 07/14/2021] [Revised: 05/05/2022] [Accepted: 06/05/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To test and compare two types of implant systems restored with four monolithic polymer-based materials with regard to their bending moments (BM) before and after aging. METHODS A total of 192 tissue-level implants (TRI Dental Implants) differing in the presence (TiB, Octa line, n = 96) or absence (NTiB, Matrix line, n = 96) of a titanium base were restored with mandibular right first molar crowns manufactured from composite (CC), polymer-infiltrated ceramic (VE), PMMA (PM) and a 3D printed resin (ND) (n = 24). Half of the specimens (n = 12) were loaded for 1,200,000 cycles (50 N, 1.3 Hz, TC: 5/55 °C, 6000×) and examined for failures. Fracture load was measured according to ISO standard 14801, BM was calculated, and fracture types were examined. Data were analyzed using parametric statistics (p < 0.05). RESULTS No failures were observed after 600,000 cycles. After 1,200,000 cycles, wear traces were recorded in all groups except PM, VE and CC on TiB implants. In group CC on NTiB implants, three specimens were rated zero in BM testing as they showed fracture of the screw. Regarding BM, TiB implants exhibited higher values than NTiB implants with aged CC (p = 0.023), aged PM (p < 0.001), initial PM (p = 0.011) and initial VE (p < 0.001). No differences occurred among the implant types with initial CC, initial ND, aged ND and aged VE. With regard to initial BM values, NTiB implants showed higher values for ND and CC compared with PM and VE (p < 0.001). No differences in initial BM values were found for the tested materials on TiB implants (p > 0.116). When aged, restoration material had no impact on the BM values of NTiB implants (p ≥ 0.233). Aged TiB implants showed higher values in combination with CC than with ND (p = 0.001). PM and VE showed similar values as ND and CC. Artificial aging led to a decrease of BM within PM, CC and ND on NTiB implants and ND on TiB implants. The majority of failures after testing were characterized by crown fractures in two to four pieces. Fractures in more pieces with smaller fragments occurred primarily for ND. SIGNIFICANCE The use of NTiB implants with the polymer-based materials tested can only be recommended for clinical use as interim prostheses. CC seems to show a positive effect on the BM. Clinical research investigating the in vivo behavior is necessary to confirm these findings.
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De Annuntiis C, Testarelli L, Guarnieri R. Use of Xenogenic Collagen Matrices in Peri-Implant Soft Tissue Volume Augmentation: A Critical Review on the Current Evidence and New Technique Presentation. MATERIALS 2022; 15:ma15113937. [PMID: 35683237 PMCID: PMC9182004 DOI: 10.3390/ma15113937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 05/20/2022] [Accepted: 05/27/2022] [Indexed: 02/01/2023]
Abstract
Plastic peri-implant surgical procedures aiming to increase soft tissue volume around dental implants have long been well-described. These are represented by: pedicle soft tissue grafts (rotational flap procedures and advanced flap procedures) and free soft tissue grafts (epithelialized, also called free gingival graft (FGG), and non-epithelialized, also called, connective tissue graft (CTG) or a combination of both. To bypass the drawback connected with autologous grafts harvesting, xenogenic collagen matrices (XCM)s and collagen-based matrices derived from porcine dermis (PDXCM)s have been introduced, as an alternative, in plastic peri-implant procedures. Aim: This review is aimed to evaluate and to critically analyze the available evidence on the effectiveness of XCMs and PDXCMs in soft tissue volume augmentation around dental implants. Moreover, a clinical case with a new soft tissue grafting procedure technique (Guided Soft Tissue Regeneration, GSTR) is presented. Material and Methods: An electronic search was performed on the MEDLINE database, SCOPUS, Cochrane Library and Web of Science. The electronic search provided a total of 133 articles. One hundred and twenty-eight not meeting the inclusion criteria were excluded. Seven articles of human randomized clinical trials were selected. A total number of 108 patients were treated with CTG, and 110 patients with XCM. Results: in peri-implant soft tissue augmentation procedures, XCMs seem an effective alternative to CTGs, associated with lower patient morbidity and lower operative times.
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Affiliation(s)
| | - Luca Testarelli
- Department of Oral and Maxillofacial Sciences, University La Sapienza, 00100 Rome, Italy;
| | - Renzo Guarnieri
- Department of Oral and Maxillofacial Sciences, University La Sapienza, 00100 Rome, Italy;
- Correspondence:
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Hjerppe J, Jung RE, Hämmerle CH, Özcan M, Mühlemann S. Mechanical stability of fully personalized, abutment-free zirconia implant crowns on a novel implant-crown interface. J Dent 2022; 121:104121. [PMID: 35395344 DOI: 10.1016/j.jdent.2022.104121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/24/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To test the failure load and failure mode of a novel implant-crown interface specifically designed for the fabrication of fully personalized, abutment-free monolithic zirconia CAD-CAM crowns compared to conventional implant-abutment interfaces involving prefabricated or centrally manufactured abutments for zirconia CAD-CAM crowns. METHODS Implants (N=48) were divided into groups (n=12) according to different implant-abutment interface designs: (1) internal implant connection with personalized, abutment-free CAD-CAM crowns (Abut-Free-Zr), (2) internal conical connection with customized, centrally manufactured zirconia CAD-CAM abutments (Cen-Abut-Zr), (3) prefabricated titanium base abutments from manufacturer 1 (Ti-Base-1), (4) additional prefabricated titanium base abutments from manufacturer 2 (Ti-Base-2). All specimens were restored with a screw-retained monolithic zirconia CAD-CAM molar crown and subjected to thermomechanical aging (1.200.000 cycles, 49 N, 1.67 Hz, 30° angulation, thermocycling 5-50°C). Static load until failure was applied in a universal testing machine. Failure modes were analyzed descriptively under digital microscope. Mean failure load values were statistically analyzed at a significance level of p<0.05. RESULTS All specimens survived thermomechanical aging. The mean failure loads varied between 1332 N (Abut-Free-Zr) and 1601 N (Ti-Base-2), difference being significant between these groups (p<0.05). No differences between the other groups were seen. The predominant failure mode per group was crown fracture above implant connection (Abut-Free-Zr, 75%), abutment fracture below implant neck (Cen-Abut-Zr, 83%), crown fracture leaving an intact abutment (Ti-Base-1/Ti-Base-2 100%). CONCLUSIONS Implant-crown interface with fully personalized, abutment-free monolithic CAD-CAM zirconia crowns exhibited similar failure loads as conventional implant-abutment interfaces (except group Ti-Base-2) involving CAD-CAM crowns with prefabricated or centrally manufactured abutment. CLINICAL SIGNIFICANCE The new implant connection simplifies the digital workflow for all-ceramic implant reconstructions. The specific design of the implant-crown interface allows the fabrication of fully personalized, abutment-free zirconia implant crowns both in-house and in-laboratory without the need of a prefabricated abutment or central manufacturing.
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Affiliation(s)
- Jenni Hjerppe
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland.
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Christoph Hf Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Mutlu Özcan
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
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Happe A, Schmidt A, Neugebauer J. Peri-implant soft-tissue esthetic outcome after immediate implant placement in conjunction with xenogeneic acellular dermal matrix or connective tissue graft: A randomized controlled clinical study. J ESTHET RESTOR DENT 2022; 34:215-225. [PMID: 35043553 DOI: 10.1111/jerd.12866] [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: 10/05/2021] [Revised: 10/31/2021] [Accepted: 12/07/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES This randomized comparative study evaluated the clinical esthetic outcome of the peri-implant mucosa following extraction and immediate implant placement in conjunction with anorganic bovine bone mineral (ABBM) and the use of a porcine acellular dermal matrix (pADM) versus an autogenous connective tissue graft (CTG) in the anterior maxilla. MATERIALS AND METHODS Twenty patients (11 men, 9 women) with a mean age of 48,9 years (range 21-72) were included in the study and randomly assigned to either the test (pADM) or control group (CTG). They underwent extraction and immediate implant placement together with ABBM for socket grafting and either pADM or CTG for soft tissue augmentation. Twelve months after implant placement color measurements of the peri-implant mucosa and a reference tooth were performed using a spectophotometer and the color difference (ΔE) was calculated. The overall esthetic appearance of the peri-implant soft tissue was evaluated using the Pink Esthetic Score (PES). Statistical analysis was performed using Student's T-Test, the alpha was set to 0.05. RESULTS All implants received osseointegration and were restored. The mean color difference of the peri-implant mucosa 1 year after surgery amounted ΔE 4.06 ± 1.6 for the test group (pADM) and ΔE 3.58 ± 1.36 mm for the control group (CTG), showing no statistically significant difference (p = 0.47). The mean PES of the pADM group was 11.4 ± 1.4 and for the CTG group 10.7 ± 1.5, showing no statistically significant difference (p = 0.29). CONCLUSION Twelve months after surgery, a porcine acellular dermal matrix for soft tissue augmentation in conjunction with immediate implant placement showed no difference in the overall esthetic appearance regarding color match and Pink Esthetic Score in comparison to autogenous soft tissue graft. CLINICAL SIGNIFICANCE Connective tissue grafts have become a standard in order to enhance the soft tissue quality and esthetic appearance in immediate implant placement. The use of new biomaterials like porcine acellular dermal matrices may avoid the need to harvest autogenous grafts resulting in simplified treatment and less postoperative morbidity.
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Affiliation(s)
- Arndt Happe
- Dr. Happe & Kollegen, Münster, Germany.,Department of Prosthetic Dentistry, Center of Dentistry, University of Ulm, Ulm, Germany
| | - Alexander Schmidt
- Department of Oral and Maxillofacial Surgery, University of Münster, Münster, Germany
| | - Jörg Neugebauer
- Department of Oral and Maxillofacial Plastic Surgery, University of Cologne, Köln, Germany
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Genetti L, Ercoli C, Kotsailidi EA, Feng C, Tsigarida A, Russo LL, Chochlidakis K. Clinical Evaluation of Pink Esthetic Score of Immediately Impressed Posterior Dental Implants. J Prosthodont 2022; 31:496-501. [PMID: 35000248 DOI: 10.1111/jopr.13479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2022] [Indexed: 11/30/2022] Open
Abstract
PURPOSE While comparative outcome results for peri-implant crestal bone levels, mucosal margin position, and peri-implant indices have been reported, no studies are available that evaluate and compare the esthetic result of impressions performed immediately with that of impressions performed of healed implants. The purpose of this cross-sectional study was to evaluate the Pink Esthetic Score (PES) of posterior implants restored with an immediate impression workflow compared to implants restored with a delayed impression workflow. MATERIAL AND METHODS Twenty-eight eligible participants who had received a single implant crown either in the premolar or molar regions at least 4 months before the study, were identified by an electronic health record review and scheduled for a single-visit study appointment. Esthetic outcomes were measured using the Pink Esthetic Score (PES). Several local- and prosthesis-related factors were recorded and their association with the selected outcome was assessed. Two-sample t-test was used for comparisons between the groups. RESULTS PES ranged between 4 and 12 (mean: 8). No significant difference between immediate (8.36 ± 1.12) and delayed (7.76 ± 2.14) impression workflow groups were seen for the total PES (p = 0.25). In addition, individual comparisons between immediately and delayed impressed implants for mesial papilla (1.27 ± 0.47; 0.88 ± 0.78), distal papilla (0.73 ± 0.65; 0.76 ± 0.83), tissue margin (1.73 ± 0.47; 1.47 ± 0.51), tissue contour (1.27 ± 0.65; 0.82 ± 0.64), alveolar process (0.82 ± 0.60; 1.00 ± 0.87), color (1.27 ± 0.65; 1.29 ± 0.69), and texture (1.36 ± 0.50; 1.53 ± 0.62) did not show significant differences. CONCLUSIONS The current study suggests that the Pink Esthetic Score is not significantly different between single posterior implants impressed with the immediate and delayed implant workflows. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Loren Genetti
- Resident, Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY, Now Private Practice, Lancaster, PA
| | - Carlo Ercoli
- Professor, Departments of Prosthodontics and Periodontology, Chairman, Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Elli Anna Kotsailidi
- Gerald N. Graser Fellow, Departments of Prosthodontics and Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Changyong Feng
- Professor, Department of Biostatistics and Computational Biology, University of Rochester, Rochester, NY
| | - Alexandra Tsigarida
- Associate Professor and Program Director, Department of Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Lucio Lo Russo
- Associate Professor of Oral Diseases, Department of Clinical and Experimental Medicine, University of Foggia, Italy
| | - Konstantinos Chochlidakis
- Associate Professor and Program Director, Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
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Farrag KM, Khamis MM. Effect of anodized titanium abutment collars on peri-implant soft tissue: A split-mouth clinical study. J Prosthet Dent 2021:S0022-3913(21)00518-7. [PMID: 34756606 DOI: 10.1016/j.prosdent.2021.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
STATEMENT OF PROBLEM Anodic oxidation of titanium implant abutment collars has been used to mask their unesthetic grayish color. However, the effect of anodic oxidation on the health and appearance of peri-implant soft tissues is unclear. PURPOSE The purpose of this split-mouth clinical study was to investigate the effect of anodized titanium on the health and esthetics of peri-implant soft tissues. MATERIAL AND METHODS A total of 60 osseointegrated implants placed in 30 participants were included in the present study. Each participant received 2 randomly allocated abutments, one with a pink anodized collar and the other with an unanodized one to form 2 groups: unanodized group (control group) and anodized group (experimental group). All implants were restored with lithium disilicate restorations. Evaluations of the peri-implant soft tissues were performed at the time of definitive restoration insertion (baseline) and after 3, 6, 12, and 18 months: peri-implant probing depth, soft tissue recession, modified sulcus bleeding index, modified plaque index, and modified gingival index. The esthetics of peri-implant soft tissues were evaluated by using the modified pink esthetic score. The paired t test or Wilcoxon signed-rank test was used for comparing the 2 study groups at each point of time depending on the normality of the variables (α=.05). To compare each variable at different time points within each group separately, repeated measures ANOVA or Friedman tests were used according to the normality of the variables, followed by post hoc pairwise comparisons by using the Bonferroni adjusted significance (α=.05). RESULTS Five peri-implant soft tissue indices were followed up throughout the study. No statistically significant differences were found among the mean values of the tested indices in the anodized and unanodized groups throughout the evaluation periods (P>.05). The collective mean values of the modified pink esthetic score also showed no statistically significant differences between the groups (P>.05). CONCLUSIONS Based on this split-mouth clinical study, pink anodized titanium abutment collars do not produce a clinically significant effect on the health or esthetics of peri-implant soft tissues.
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Affiliation(s)
- Khaled Mohamed Farrag
- Demonstrator of Fixed Prosthodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Moataz Khamis
- Professor and Chairman, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
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Totou D, Naka O, Mehta SB, Banerji S. Esthetic, mechanical, and biological outcomes of various implant abutments for single-tooth replacement in the anterior region: a systematic review of the literature. Int J Implant Dent 2021; 7:85. [PMID: 34494174 PMCID: PMC8423965 DOI: 10.1186/s40729-021-00370-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background The choice of the appropriate implant abutment is a critical step for a successful outcome. Titanium abutments have demonstrated high survival rates, due to their excellent biocompatibility and high mechanical strength, although they often result in a grayish discoloration of the peri-implant mucosa. This esthetic concern culminated in the introduction of ceramic abutments. The aim of this review was to assess the esthetic, mechanical, and biological outcomes as well as the survival of the different types of abutments used for single-implant restorations in the anterior area. Material and methods An electronic search was conducted in Medline, Embase, and Cochrane Central databases using the appropriate Mesh terms and predetermined eligibility criteria. The quality of the studies was assessed using the ROB 2 tool. The last search was conducted on 18th of March 2020. Results From the 2074 records initially identified, 23 randomized controlled trials (32 publications) were included for qualitative analysis. Data were classified based on study information, specific characteristics of the intervention and comparator, and information related to the outcome measures. Seven studies exhibited an overall low risk of bias, while twelve studies raised some concerns. Conclusions The rate of abutment failure was low and was associated with the ceramic abutments, especially those with internal connection. Limited correlation was noted between soft tissue thickness and color difference. Titanium abutments caused significantly more discoloration to the soft tissues than ceramic abutments, while hueing (gold or pink) slightly improved their color performance. Zirconia allowed a better color match than titanium or gold abutments, still discolored slightly the soft tissues. The submucosally modified zirconia abutments exhibited encouraging results. No significant difference was reported between materials or different types of retention on recession, papillary fill, and biological outcomes.
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Affiliation(s)
- Dimitra Totou
- Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, UK
| | - Olga Naka
- Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, UK. .,School of Dentistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Shamir B Mehta
- Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, UK
| | - Subir Banerji
- Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, UK
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Development of Custom Anatomic Healing Abutment Based on Cone-Beam Computer Tomography Measurement on Human Teeth Cross-Section. MATERIALS 2021; 14:ma14164570. [PMID: 34443093 PMCID: PMC8401006 DOI: 10.3390/ma14164570] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/27/2021] [Accepted: 08/09/2021] [Indexed: 11/18/2022]
Abstract
Introduction: Nowadays, the final success of implantation is not only based on obtaining osseointegration of the implant but is also determined by achieving a satisfactory aesthetic effect of the soft tissues surrounding the implant, which can be defined as an aesthetic integration. The process of obtaining this aesthetic integration already begins at the stage of placing the healing abutment, which allows us to obtain the emergence profile necessary for our prosthetic reconstruction. Materials and Methods: The study used cone-beam computer tomography (CBCT) scans of 51 patients. The measurements of the maxillary teeth (central incisor, lateral incisor, canine, first premolar, and first molar) were performed from cross-sections of the individual teeth at the transition zone to design a custom anatomic healing abutment milled from zirconium and luted to the non-index Ti-base. Results: The obtained results allowed to design and create the shape of the anatomic healing abutment. Conclusions: The use of laboratory-produced anatomical healing abutments is possible and may allow to obtain the desired and planned emergence profiles of prosthetic restorations. In addition, it might be a method of reducing work time at the dental chair but further clinical trials are necessary.
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Freifrau von Maltzahn N, Holstermann J, Stiesch M, Kohorst P. In vitro evaluation of the influence of titanium nitride coating on the retention force between components of two-part abutments. BMC Oral Health 2021; 21:285. [PMID: 34078345 PMCID: PMC8173788 DOI: 10.1186/s12903-021-01636-7] [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: 06/18/2020] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Two-part abutments are typically made up of a base composed of titanium and a ceramic build-up. The long-term outcomes are affected by the mechanical durability. The purpose of the present investigation was to evaluate and compare the retention force of two-part abutment systems with titanium or titanium nitride bases—as fixed with zirconia components and with various surface treatments. Methods A total of 60 two-part abutments were investigated—with a titanium base (n = 30) or titanium nitride coated bases (n = 30) and bonded with zirconia ceramic build-ups. The bonding surfaces were treated with aluminium oxide blasting, with an average particle size of 110 µm. The titanium bases were then pretreated with Alloy Primer or Clearfil Ceramic Primer. The ceramic build-ups were only treated with Clearfil Ceramic Primer. For twenty test specimens, no chemical pretreatment was performed. Test specimens were classified into six groups in accordance with the pretreatment (A–F; n = 10). A resin-based luting agent was employed to attach the two parts. Specimens were then subjected to artificial thermal aging (104 cycles with 5 °C/55 °C). The retention force between the two parts was then investigated with a pull-off test. The findings were analyzed by ANOVA statistics. Fracture patterns were examined by electron microscopy. Results In the absence of primer, titanium nitride coated bases gave significantly greater retention forces than other samples (p < 0.05). Chemical preconditioning with silane coupling agents did not effect on the retention force of coated bases. Conclusions The results of the current study suggested that modifying metal surfaces by coating the base with titanium nitride not only has esthetic and biological advantages, but also enhances the mechanical properties of the adhesive bond of two-part abutments.
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Affiliation(s)
- Nadine Freifrau von Maltzahn
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | | | - Meike Stiesch
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Elsayed A, Yazigi C, Kern M, Chaar MS. Mechanical behavior of nano-hybrid composite in comparison to lithium disilicate as posterior cement-retained implant-supported crowns restoring different abutments. Dent Mater 2021; 37:e435-e442. [PMID: 33875247 DOI: 10.1016/j.dental.2021.03.015] [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: 05/30/2020] [Revised: 02/26/2021] [Accepted: 03/29/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Resin-based materials are gaining popularity in implant dentistry due to their shock absorption capacity. Therefore, the aim of this study was to evaluate the fracture strength and failure mode of resilient materials for both crowns and abutments and compare them to the most widely used materials in different combinations after subjection to long-term fatigue loading. METHODS Forty-eight cement-retained implant-restorations were assembled on titanium implants. Identical custom-made CAD/CAM abutments were milled out of 3 different materials (n = 16); T: titanium, Z: zirconia and P: ceramic-reinforced PEEK. Each group was subdivided, according to the restorative crown material, into two subgroups (n = 8); C: nano-hybrid composite and L: Lithium disilicate. Specimens were subjected to dynamic load of 98 N for 1,200,000 cycles with integrated thermal cycling. The surviving specimens were subjected to quasi-static loading until failure. Shapiro-Wilk test was used to test for normality. One-way ANOVA followed by Tukey's post-hoc test was used to detect statistically significant differences between groups. RESULTS All specimens withstood 1,200,000 load cycles. The fracture strength values varied from a minimum of 1639 ± 205 N for group PL to a maximum of 2949 ± 478 N for group ZL. SIGNIFICANCE The abutment material influenced the fracture strength and failure mode of the restoration. A combination of zirconia abutments and nano-hybrid composite showed the most favorable mode of failure within the test groups. Therefore, this combination might be recommended as an alternative for restoring single implants in the posterior area.
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Affiliation(s)
- Adham Elsayed
- Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University at Kiel, Germany.
| | - Christine Yazigi
- Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University at Kiel, Germany
| | - Matthias Kern
- Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University at Kiel, Germany
| | - Mohamed Sad Chaar
- Department of Prosthodontics, Propaedeutics and Dental Materials, School of Dentistry, Christian-Albrechts University at Kiel, Germany.
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22
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An In Vivo Spectrophotometric Analysis of Gingival Acrylic Shade Guide. MATERIALS 2021; 14:ma14071768. [PMID: 33916651 PMCID: PMC8038330 DOI: 10.3390/ma14071768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/26/2021] [Accepted: 03/31/2021] [Indexed: 11/17/2022]
Abstract
Selecting shades of acrylic gingival restorative material is challenging. This study examined the shade appropriateness of five acrylic gingival restorative materials. The color was analyzed using an intraoral spectrophotometer (Crystaleye®, Olympus). The gingival color of maxillary incisors for eighty-nine patients was measured. CIELAB color coordinates (L*, a* and b*) were obtained, and the color difference ∆E (Coverage Error: CE) between shade tabs and natural gingival color of patient samples for each shade guide system were compared. Repeated ANOVA and post hoc analyses with Tukey's HSD were performed. There was a significant difference among the mean minimum CEs of the tab sets (p < 0.01). GC Acrylic (CE = 5.89 ∆E ± 2.97) and Lucitone 199® (CE = 6.55 ± 3.33) groups exhibited CEs significantly lower than all other groups (all p < 0.001). The IvoCap® system exhibited the highest CE (10.78 ± 3.80), significantly greater than all other groups (p < 0.001). No significant differences were observed based on sex (p = 0.055) or ethnicity (p = 0.327). The GC Acrylic and Lucitone 199® shade guides showed the lowest CEs. All guides had coverage errors above 5.89 ∆E, which is larger than ∆E thresholds of acceptability. Of the materials evaluated in this study, GC Acrylic and Lucitione 199® are best able to reproduce the clinical appearance of the gingival tissue. Many patients have tissue that cannot be reproduced accurately with currently available materials.
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Wang ICI, Barootchi S, Tavelli L, Wang HL. The peri-implant phenotype and implant esthetic complications. Contemporary overview. J ESTHET RESTOR DENT 2021; 33:212-223. [PMID: 33459483 DOI: 10.1111/jerd.12709] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 01/04/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To provide a contemporary and comprehensive overview of the hard and soft tissue biological structures surrounding an osseointegrated dental implant (peri-implant referred to as the peri-implant phenotype), in the context of peri-implant esthetic complications. OVERVIEW The individual components of the peri-implant phenotype (keratinized mucosa width, mucosal thickness, supracrestal tissue height, and the peri-implant buccal bone) have been linked to different aspects of implant esthetics, as well as health-related aspects. At the time of implant therapy, respecting the biology of the peri-implant hard and soft tissues, and anticipating their remodeling patterns can alleviate future esthetic complications. CONCLUSIONS While the current literature may not allow for a point-by-point evidence based-recommendation for the required amount of each peri-implant structure, bearing in mind the proposed values for the components of the peri-implant phenotype, at the time of and prior to implant therapy can lead to more predictable treatment outcomes, and the avoidance of esthetic complications. CLINICAL SIGNIFICANCE Knowledge of hard and soft tissue components surrounding and osseointegrated dental implant, and their underlying biological remodeling process is crucial for carrying out a successful therapy and alleviating possible future esthetic challenges.
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Affiliation(s)
- I-Ching Izzie Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Shayan Barootchi
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Lorenzo Tavelli
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA
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Wang T, Wang L, Lu Q, Fan Z. Influence of anodized titanium abutments on the esthetics of the peri-implant soft tissue: A clinical study. J Prosthet Dent 2020; 125:445-452. [PMID: 32204926 DOI: 10.1016/j.prosdent.2019.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 11/27/2022]
Abstract
STATEMENT OF PROBLEM The grayish appearance of a titanium abutment discolors the peri-implant soft tissue, especially if the gingiva is thin. Whether an anodized titanium abutment can prevent the discoloration is unclear. PURPOSE The purpose of this clinical study was to investigate the color change of peri-implant soft tissue surrounding a titanium abutment that had been colored by anodic oxidation. MATERIAL AND METHODS Commercially available titanium abutments were anodized to form a gold and pink titanium abutment and formed the experimental groups. Unanodized titanium and zirconia abutment were used as the control groups. Four types of abutments were fabricated for each participant who received dental implants in the anterior maxilla. The abutments and corresponding definitive crowns were inserted, and the color of the peri-implant soft tissue and contralateral gingiva were measured with a spectrophotometer. The thickness of the peri-implant soft tissue was recorded after probing with an endodontic file. RESULTS Eleven participants were included in this study. The color differences caused by all tested abutments were higher than the critical threshold of ΔE=3.7. The mean color difference (ΔE), from low to high, was the zirconia, pink-anodized titanium, gold-anodized titanium, and unanodized titanium abutment; their values of (ΔE) were 6.81, 7.63, 7.90, and 8.74, respectively. The mean thickness of the peri-implant soft tissue was 2.41 ±0.52 mm. CONCLUSIONS Within the limitation of the small sample size in this study, the gold-anodized and pink-anodized titanium abutment achieved better esthetics for peri-implant soft tissue than the unanodized titanium abutment. Zirconia was the optimal abutment material for the esthetic region.
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Affiliation(s)
- Tingting Wang
- Resident, Department of Oral Implant, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, PR China
| | - Lina Wang
- Doctoral student, Department of Oral Implant, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, PR China
| | - Qianqian Lu
- Postgraduate student, Department of Oral Implant, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, PR China
| | - Zhen Fan
- Professor, Department of Oral Implant, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, PR China.
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25
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Avila‐Ortiz G, Gonzalez‐Martin O, Couso‐Queiruga E, Wang H. The peri‐implant phenotype. J Periodontol 2020; 91:283-288. [DOI: 10.1002/jper.19-0566] [Citation(s) in RCA: 47] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 11/12/2019] [Accepted: 11/17/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Gustavo Avila‐Ortiz
- Department of Periodontics University of Iowa College of Dentistry Iowa City IA
| | - Oscar Gonzalez‐Martin
- Department of Periodontics University of Iowa College of Dentistry Iowa City IA
- Department of Periodontology Complutense University of Madrid Madrid Spain
| | | | - Hom‐Lay Wang
- Department of Periodontics and Oral Medicine University of Michigan School of Dentistry Ann Arbor MI
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Chen JY, Pan YH. Zirconia implant abutments supporting single all-ceramic crowns in anterior and premolar regions: A six-year retrospective study. Biomed J 2019; 42:358-364. [PMID: 31783997 PMCID: PMC6888705 DOI: 10.1016/j.bj.2019.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 03/27/2019] [Accepted: 05/02/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Clinical studies regarding zirconia implant abutments reported good survival rates in the short-term observation period. The purpose of this study was to assess the six-year clinical performance of zirconia abutments supporting all-ceramic crowns in anterior and premolar regions. METHODS The patients received zirconia implant abutments to support all-ceramic crowns in Chang-Gung Medical Center during the period August 2010 to August 2011 were enrolled. In the following six years of observation period after the implant-crown had finished, the clinical parameters of all of the included patients were registered on a special form. The records regarding the following variables: age, gender, implant location, the condition of edentulous site before implant placement, esthetic performance at baseline, presence or absence of technical complications, and biological outcomes were registered and scrutinized for evaluation. RESULTS Out of the 32 zirconia implant abutments and 32 all-ceramic crowns that were followed for six years. Neither abutments nor crowns were lost, yielding 100% survival rates for both zirconia abutments and crowns. The esthetic outcomes were excellent except that a score of 2 was given to two restorations. With regard to technical complications, there was one instance of abutment screw loosening, two cases of veneering ceramic chipping, one restoration with occlusal roughness, and three instances of crowns loosening. Overall, the success rates were 96.8% and 81.2% for abutments and crowns respectively. In biological performance, only 1 implant was classified in group II (satisfactory survival) in the Misch classification, while all the others were classified in group I (excellent). CONCLUSIONS Zirconia abutments supporting all-ceramic crowns demonstrated high survival rate, good biological and esthetic results. While some technical complications were frequently observed, the complication-free rates were 96.8% for abutments and 81.2% for crowns in the medium-term observation period.
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Affiliation(s)
- Jo-Yu Chen
- Department of General Dentistry, ChangGung Memorial Hospital at Taipei, Taipei, Taiwan
| | - Yu-Hwa Pan
- Department of General Dentistry, ChangGung Memorial Hospital at Taipei, Taipei, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; School of Dentistry, College of Medicine, China Medical University, Taichung, Taiwan.
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27
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Hosseini M, Worsaae N, Gotfredsen K. Tissue changes at implant sites in the anterior maxilla with and without connective tissue grafting: A five‐year prospective study. Clin Oral Implants Res 2019; 31:18-28. [DOI: 10.1111/clr.13540] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 08/20/2019] [Accepted: 09/10/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Mandana Hosseini
- Section of Oral Rehabilitation Department of Odontology Faculty of Health Science University of Copenhagen Copenhagen Denmark
| | - Nils Worsaae
- Department of Oral and Maxillofacial Surgery University Hospital, Rigshospitalet Copenhagen Denmark
| | - Klaus Gotfredsen
- Section of Oral Rehabilitation Department of Odontology Faculty of Health Science University of Copenhagen Copenhagen Denmark
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28
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Cao Y, Yu C, Wu Y, Li L, Li C. Long-Term Survival and Peri-Implant Health of Titanium Implants with Zirconia Abutments: A Systematic Review and Meta-Analysis. J Prosthodont 2019; 28:883-892. [PMID: 31282107 DOI: 10.1111/jopr.13097] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the long-term implant survival rate of titanium implants with zirconia abutments, and the effects of implants with zirconia abutments on marginal bone loss (MBL) and pocket probing depth (PPD) compared with all-titanium implants. MATERIALS AND METHODS The searched electronic database included the Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, and the Chinese Biomedical Literature Database. Two types of studies were included: clinical studies reporting the survival rate of titanium implants with zirconia abutments with at least a mean/median 5-year follow-up, and clinical trials reporting the effects of implants with zirconia abutments on MBL and PPD compared with all-titanium implants. Two reviewers screened and selected the records, assessed quality, and extracted data of included studies independently. RESULTS This review included 16 studies from 18 publications. None of the comparative studies was assessed at a low risk of bias. The overall implant survival rate of implants with zirconia abutments was estimated to be 96% (confidence intervals [CIs] [94%, 98%], I2 = 0%). For the comparison between implants with zirconia abutments and all-titanium implants, the results significantly favored implants with zirconia abutments (for MBL, mean difference [MD] = -0.09, CIs [-0.17, 0.00], p = 0.05, I2 = 40%; for PPD, MD = -0.18, CIs [-0.32, -0.05], p = 0.008, I2 = 0%). Zirconia abutments were favored more when the prosthesis was an implant-supported overdenture rather than a single crown. CONCLUSIONS Implants with zirconia abutments may have an acceptable performance on peri-implant health compared with all-titanium implants; however, the implant survival rate of implants with zirconia abutments is slightly lower than all-titanium implants in the long-term follow-up. Additional studies are needed to explain this dichotomy.
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Affiliation(s)
- Yubin Cao
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Changhao Yu
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Yingyi Wu
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Longjiang Li
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
| | - Chunjie Li
- Department of Head and Neck Oncology, West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, Sichuan University, Chengdu, China
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29
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Cooper LF, De Kok IJ, Thalji G, Bryington MS. Prosthodontic Management of Implant Therapy: Esthetic Complications. Dent Clin North Am 2019; 63:199-216. [PMID: 30825986 DOI: 10.1016/j.cden.2018.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The essential promise of implant dentistry is the ability to imperceptibly replace missing teeth. To achieve this, careful planning, execution, and maintenance is required by the dentist and patient to maintain a long-term esthetic and functional result. Unfortunately, as a result of biological, prosthetic, and iatrogenic factors, unesthetic results can occur. This article explores the potential causes for the unesthetic dental implant and the possible solutions that may improve the clinical situation. Whereas relatively simple errors may be corrected through prosthetic means, greater complications may require surgical intervention to achieve the desired result.
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Affiliation(s)
- Lyndon F Cooper
- Department of Oral Biology, University of Illinois at Chicago, 801 South Paulina Street, 402E, Chicago, IL 60612, USA.
| | - Ingeborg J De Kok
- Department of Restorative Sciences, University of North Carolina, CB #7450, Chapel Hill, NC 27599-7450, USA
| | - Ghadeer Thalji
- Department of Restorative Sciences, University of Illinois at Chicago, 801 South Paulina Street, Room 365B, Chicago, IL 60612, USA
| | - Matthew S Bryington
- Department of Restorative Dentistry, West Virginia University, School of Dentistry, PO Box 9495, One Medical Center Drive, Morgantown, WV 26506-9495, USA
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30
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Gehrke P, Spanos E, Fischer C, Storck H, Tebbel F, Duddeck D. Influence of scaling procedures on the integrity of titanium nitride coated CAD/CAM abutments. J Adv Prosthodont 2018; 10:197-204. [PMID: 29930789 PMCID: PMC6004353 DOI: 10.4047/jap.2018.10.3.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 12/07/2017] [Accepted: 02/27/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To determine the extent of treatment traces, the roughness depth, and the quantity of titanium nitride (TiN) removed from the surface of CAD/CAM abutments after treatment with various instruments. MATERIALS AND METHODS Twelve TiN coated CAD/CAM abutments were investigated for an in vitro study. In the test group (9), each abutment surface was subjected twice (150 g vs. 200 g pressure) to standardized treatment in a simulated prophylaxis measure with the following instruments: acrylic scaler, titanium curette, and ultrasonic scaler with steel tip. Three abutments were used as control group. Average surface roughness (Sa) and developed interfacial area ratio (Sdr) of treated and untreated surfaces were measured with a profilometer. The extent of treatment traces were analyzed by scanning electron microscopy. RESULTS Manipulation with ultrasonic scalers resulted in a significant increase of average surface roughness (Sa, P<.05) and developed interfacial area ratio (Sdr, P<.018). Variable contact pressure did not yield any statistically significant difference on Sa-values for all instruments (P=.8). Ultrasonic treatment resulted in pronounced surface traces and partially detachment of the TiN coating. While titanium curettes caused predominantly moderate treatment traces, no traces or detectable substance removal has been determined after manipulation with acrylic curettes. CONCLUSION Inappropriate instruments during regular plaque control may have an adverse effect on the integrity of the TiN coating of CAD/CAM abutments. To prevent defects and an increased surface roughness at the transmucosal zone of TiN abutments, only acrylic scaling instruments can be recommended for regular maintenance care.
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Affiliation(s)
| | | | - Carsten Fischer
- Dental Laboratory, Sirius Ceramics, Frankfurt am Main, Germany
| | | | | | - Dirk Duddeck
- Medical Materials Research Institute, Berlin, Germany
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31
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Sanz-Sánchez I, Sanz-Martín I, Carrillo de Albornoz A, Figuero E, Sanz M. Biological effect of the abutment material on the stability of peri-implant marginal bone levels: A systematic review and meta-analysis. Clin Oral Implants Res 2018; 29 Suppl 18:124-144. [DOI: 10.1111/clr.13293] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 05/05/2018] [Accepted: 05/08/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Ignacio Sanz-Sánchez
- Section of Graduate Periodontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | | | | | - Elena Figuero
- Section of Graduate Periodontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
| | - Mariano Sanz
- Section of Graduate Periodontology; University Complutense; Madrid Spain
- ETEP (Etiology and Therapy of Periodontal Diseases) Research Group; University Complutense; Madrid Spain
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Abstract
The aims of the study were: to describe the gingival color surrounding the upper incisors in three sites in the keratinized gingiva, analyzing the effect of possible factors which modulate (socio-demographic and behavioral) intersubject variability; to study whether the gingiva color is the same in all three locations and to describe intrasubject color differences in the keratinized gingiva band. Using the CIELAB color system, three reference areas (free gingival margin, keratinized gingival body, and birth or upper part of the keratinized gingiva) were studied in 259 individuals, as well as the related socio-demographic factors, oral habits and the chronic intake of medication. Shadepilot™ spectrophotometer was used. Descriptive and inferential statistical analysis was performed. There are statistically significant differences between males and females for coordinates L* and a* in the middle and free gingival margin. For the b* coordinate, there are differences between males and females in the three locations studied (p < 0.05). The minimum and maximum coordinates in which the CIELAB natural gingival space is delimited are L* minima 28.3, L* maximum 65.4, a* minimum 11.1, a* maximum 37.2, b* minimum 6.9, and b* maximum 25.2*. Age, smoking, and the chronic intake of medication had no significant effect on gum color. There are perceptible color differences within the keratinized gingiva band. These chromatic differences must be taken into account if the prosthetic characterization of gingival tissue is to be considered acceptable. There are significant differences between the color coordinates of the three sites studied in the keratinized gingiva of men and women.
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33
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Moilanen P, Hjerppe J, Lassila LVJ, Närhi TO. Fracture Strength and Precision of Fit of Implant-Retained Monolithic Zirconia Crowns. J ORAL IMPLANTOL 2018; 44:330-334. [PMID: 29763362 DOI: 10.1563/aaid-joi-d-17-00249] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
New monolithic zirconia materials can be used to fabricate full-contour fixed dental prostheses with the computer-aided design/computer-aided manufacturing (CAD/CAM) method. The aim of this study was to examine the fracture strength and precision of fit of screw-retained monolithic zirconia crowns made directly on implants or by cementing on prefabricated titanium (Ti) bases. Monolithic screw-retained implant crowns (n = 6) were produced by CAD/CAM method using partially (PSZ) and fully stabilized (FSZ) zirconia. Industrially produced zirconia crowns were used as a reference. A lateral incisor study model was made onto an implant replica. Crowns were produced either directly on the implant or through cementing on a prefabricated titanium base (PSZ+Ti, FSZ+Ti). The crowns were tightened to implant replicas with a torque of 35 Ncm. The gap between the replica and the abutment or crown was measured from ×400 scanning electron microscope images for precision of fit. Mechanical testing until failure was completed with a universal testing machine with loading angle of 45°. Statistical analysis was performed (analysis of variance). Mean (±SD) failure loads were 259 ± 23 (PSZ), 140 ± 13 (FSZ), 453 ± 25 (PSZ+Ti), 439 ± 41 (FSZ+Ti), and 290 ± 39 (Procera). Mean (±SD) gap values were 2.2 ± 0.2 (PSZ), 2.5 ± 1.0 (FSZ), 7.0 ± 1.0 (PSZ+Ti), 7.7 ± 1.6 (FSZ+Ti), and 6.7 ± 1.7 (Procera). Monolithic zirconia crowns with a Ti base clearly show higher fracture strengths than the crowns fixed directly on the implant surface. Better marginal fit can be achieved with direct zirconia crowns than with crowns on a titanium base or industrially produced zirconia crowns.
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Affiliation(s)
- Pauliina Moilanen
- 1 Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Turku, Turku, Finland
| | - Jenni Hjerppe
- 1 Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Turku, Turku, Finland.,2 Departments of Oral and Maxillofacial Diseases, Helsinki University Hospital, Helsinki, Finland
| | - Lippo V J Lassila
- 3 Turku Clinical Biomaterials Centre, University of Turku, Turku, Finland.,4 Turku University of Applied Sciences, Faculty of Health and Well-Being, Turku, Finland
| | - Timo O Närhi
- 1 Department of Prosthetic Dentistry and Stomatognathic Physiology, Institute of Dentistry, University of Turku, Turku, Finland.,5 Clinic of Oral Diseases, Turku University Central Hospital, Turku, Finland
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Sikora CL, Alfaro MF, Yuan JCC, Barao VA, Sukotjo C, Mathew MT. Wear and Corrosion Interactions at the Titanium/Zirconia Interface: Dental Implant Application. J Prosthodont 2018. [PMID: 29521461 DOI: 10.1111/jopr.12769] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
PURPOSE Dental implants have been shown to have predictable success, but esthetic complications often arise. To reduce tissue shadowing from titanium, zirconia abutments may be used; however, the literature suggests that the use of zirconia leads to greater destruction of the implant interface that may result in biological complications such as titanium tattoos and heavy metal toxicity. Previous studies have examined the mechanical aspects of this implant/abutment relationship, but they have not accounted for the corrosive degradation that also takes place in the dynamic environment of the oral cavity. This study investigated the combined effect of both wear and corrosion on the materials at the implant and abutment interface. MATERIALS AND METHODS Using a simulated oral tribocorrosive environment, titanium (Ti) and zirconia (Zr) abutment materials were slid against titanium and Roxolid implant alloys. The four couplings (Ti/Ti, Ti/Rox, Zr/Ti, Zr/Rox) were selected for the tribocorrosion tests (N = 3). The testing was conducted for 25K cycles, and the coefficient of friction (CoF) and voltage evolution were recorded simultaneously. Following the tribocorrosion assays, the wear volume loss was calculated, and surface characterization was performed. Statistical analysis was completed using a one-way ANOVA followed by post-hoc Bonferroni comparisons. RESULTS Zr/Ti groups had the highest CoF (1.1647), and Ti/Ti had the lowest (0.5033). The Zr/Ti coupling generated significantly more mechanical damage than the Ti/Ti group (p = 0.021). From the corrosion aspect, the Ti/Ti groups had the highest voltage drop (0.802 V), indicating greater corrosion susceptibility. In comparison, the Zr/Roxolid group had the lowest voltage drop (0.628 V) and significantly less electrochemical degradation (p = 0.019). Overall, the Ti/Ti group had the largest wear volume loss (15.1 × 107 μm3 ), while the Zr/Ti group had the least volume loss (2.26 × 107 μm3 ). Both zirconia couplings had significantly less wear volume than the titanium couplings (p < 0.001). CONCLUSIONS This study highlights the synergistic interaction between wear and corrosion, which occurs when masticatory forces combine with the salivary environment of the oral cavity. Overall, the zirconia groups outperformed the titanium groups. In fact, the titanium groups generated 5 to 6 times more wear to the implant alloys as compared with the zirconia counterparts. The best performing group was Zr/Ti, and the worst performing group was Ti/Ti.
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Affiliation(s)
- Craig L Sikora
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, IL
| | - Maria F Alfaro
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, IL
| | - Judy Chia-Chun Yuan
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, IL
| | - Valentim A Barao
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Sao Paulo, Brazil
| | - Cortino Sukotjo
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, IL
| | - Mathew T Mathew
- Department of Restorative Dentistry, College of Dentistry, University of Illinois at Chicago, IL.,Department of Biomedical Sciences, University of Illinois College of Medicine at Rockford, IL
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35
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Influence of Restorative Materials on Color of Implant-Supported Single Crowns in Esthetic Zone: A Spectrophotometric Evaluation. BIOMED RESEARCH INTERNATIONAL 2018; 2017:5034358. [PMID: 29349075 PMCID: PMC5733965 DOI: 10.1155/2017/5034358] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 09/12/2017] [Accepted: 09/25/2017] [Indexed: 11/17/2022]
Abstract
Restorations of 98 implant-supported single crowns in anterior maxillary area were divided into 5 groups: zirconia abutment, titanium abutment, and gold/gold hue abutment with zirconia coping, respectively, and titanium abutment with metal coping as well as gold/gold hue abutment with metal coping. A reflectance spectrophotometer was used to evaluate the color difference between the implant crowns and contralateral/neighboring teeth, as well as the color difference between the peri-implant soft tissue and the natural marginal mucosa. The mucosal discoloration score was used for subjective evaluation of the esthetic outcome of soft tissue around implant-supported single crowns in the anterior zone, and the crown color match score was used for subjective evaluation of the esthetic outcome of implant-supported restoration. ANOVA analysis was used to compare the differences among groups and Spearman correlation was used to test the relationships. A gold/gold hue abutment with zirconia coping was the best choice for an esthetic crown and the all-ceramic combination was the best for peri-implant soft tissue. Significant correlation was found between the spectrophotometric color difference of peri-implant soft tissue and mucosal discoloration score, while no significant correlation was found between the total spectrophotometric color difference of implant crown and crown color match score.
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Quantitative discoloration assessment of peri-implant soft tissue around zirconia and other abutments with different colours: A systematic review and meta-analysis. J Dent 2018; 70:110-117. [PMID: 29371043 DOI: 10.1016/j.jdent.2018.01.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 01/04/2018] [Accepted: 01/06/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The implant abutments, which had their own colour, might cause the discoloration of peri-implant mucosa. We aimed to appraise trails comparing the discoloration of peri-implant soft tissue around zirconia and titanium or golden abutments, the tints of which were vastly different. DATA We included randomized controlled trials (RCTs), controlled clinical trials (CCTs), cohort studies with patients rehabilitated with zirconia, titanium or golden implant abutments, quantitatively comparing the discoloration of peri-implant soft tissue according to CIE-Lab colour scale. SOURCES A systematic search was conducted in PubMed, EMBASE, CDSR, and CENTRAL databases without any restriction on September 23, 2017. "Grey" literatures were also searched. A manual search was carried out as well. STUDY SELECTION Of 584 articles initially retrieved, eight were eligible for inclusion. After data extraction, meta-analyses with mean differences (MDs) and their 95% confidence intervals (CIs) were employed. Moreover, the risk of bias within or across studies was assessed by Cochrane Collaboration's tool for assessing risk, the Newcastle-Ottawa scale, funnel plots, or Egger's test. RESULTS Four RCTs and four cohort studies were included. Soft-tissue discoloration around zirconia abutments was significantly less likely compared to that around titanium abutments (MD = -1.84; 95% CI = -3.62 to -0.07; P = 0.04 < 0.05) or golden abutments (MD = -0.90; 95% CI = -1.60 to -0.20; P = 0.01 < 0.05). CONCLUSIONS Zirconia abutments with white tint compared to grey titanium or golden abutments seem to restore a more appropriate colour match between peri-implant mucosa and natural teeth. CLINICAL SIGNIFICANCE Based on the present evidence, the "nature-like" zirconia abutments should be applied more often in the clinic. PROSPERO REGISTRATION NUMBER CRD42017075930.
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MIEDA M, ATSUTA I, MATSUSHITA Y, MORITA T, AYUKAWA Y, TSUKIYAMA Y, SAWAE Y, KOYANO K. The effective design of zirconia coping on titanium base in dental implant superstructure. Dent Mater J 2018; 37:237-243. [DOI: 10.4012/dmj.2017-022] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Maiko MIEDA
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Ikiru ATSUTA
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Yasuyuki MATSUSHITA
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Takehiro MORITA
- Machine Elements and Design Engineering Laboratory, Department of Mechanical Engineering, Kyushu University
| | - Yasunori AYUKAWA
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Yoshihiro TSUKIYAMA
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
| | - Yoshinori SAWAE
- Machine Elements and Design Engineering Laboratory, Department of Mechanical Engineering, Kyushu University
| | - Kiyoshi KOYANO
- Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, Kyushu University
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Jirajariyavej B, Wanapirom P, Anunmana C. Influence of implant abutment material and ceramic thickness on optical properties. J Prosthet Dent 2017; 119:819-825. [PMID: 28923546 DOI: 10.1016/j.prosdent.2017.05.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/24/2017] [Accepted: 05/24/2017] [Indexed: 10/18/2022]
Abstract
STATEMENT OF PROBLEM Anterior shade matching is an essential factor influencing the esthetics of a ceramic restoration. Dentists face a challenge when the color of an implant abutment creates an unsatisfactory match with the ceramic restoration or neighboring teeth. PURPOSE The purpose of this in vitro study was to evaluate the influence of abutment material and ceramic thickness on the final color of different ceramic systems. MATERIAL AND METHODS Four experimental and control ceramic specimens in shade A3 were cut from IPS e.max CAD, IPS Empress CAD, and VITA Suprinity PC blocks. These specimens had thicknesses of 1.0 mm, 1.5 mm, 2.0 mm, and 2.5 mm, respectively, for the experimental groups, and 4 mm for the controls. Background abutment specimens were fabricated to yield 3 different shades: white zirconia, yellow zirconia, and titanium at a 3-mm thickness. All 3 ceramic specimens in each thickness were placed in succession on different abutment backgrounds with glycerin optical fluid in between, and the color was measured. A digital spectrophotometer was used to record the specimen color value in the Commission Internationale De L'éclairage (CIELab) color coordinates system and to calculate the color difference (ΔE) between the control and experimental groups. The Kruskal-Wallis test was used to analyze the effect of ceramic thickness on different abutments, and the pair-wise test was used to evaluate within the group (α=.05). RESULTS The color differences between the test groups and the control decreased with increasing ceramic thickness for every background material. In every case, significant differences were found between 1.0- and 2.5-mm ceramic thicknesses. Only certain 2.5-mm e.max CAD, VITA Suprinity PC, and Empress CAD specimens on yellow-shade zirconia or VITA Suprinity PC on titanium were identified as clinically acceptable (ΔE<3). CONCLUSIONS Increasing ceramic restoration thickness over the abutment background decreased the color mismatch. Increasing the thickness of ceramic on a yellow-shaded zirconia abutment rather than on titanium or white zirconia yielded a more esthetic color for the whole restoration.
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Affiliation(s)
- Bundhit Jirajariyavej
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Peeraphorn Wanapirom
- Doctoral student, Master of Science in Implant Dentistry, Dental Implant Center, Faculty of Dentistry, Mahidol University, Bangkok, Thailand
| | - Chuchai Anunmana
- Assistant Professor, Department of Prosthodontics, Faculty of Dentistry, Mahidol University, Bangkok, Thailand.
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Negahdari R, Rahbar M, Fakhrzadeh V, Eslami H, Akbari T, Bohluli S. Comparison of Proinflammatory Cytokine Levels in Gingival Crevicular Fluid around Dental Implants with Ceramic and Titanium Abutments. J Contemp Dent Pract 2017; 18:831-836. [PMID: 28874650 DOI: 10.5005/jp-journals-10024-2135] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Considering the high success rate of osseoin-tegration, there is ever-increasing use of dental implants. The mechanisms and biologic response of peri-implant tissues are different depending on the biocompatibility of the implant material. The aim of this study was to compare the proinflammatory cytokine levels in the gingival crevicular fluid (GCF) around dental implants with ceramic and titanium abutments. MATERIALS AND METHODS All the patients with dental implants referring to two private offices of two prosthodontists from June to August 2016 were examined in relation to implant health, and eligible subjects, based on inclusion criteria, were included in this study with a slit-mouth design. In this context, on one side titanium implants and, on the other side, ceramic implants were used. Samples were collected from the peri-implant sulcus in each patient and sent to the immunology laboratory for determination of interleukin (IL)-6 and IL-1β proinflammatory cytokine levels using an enzyme-linked immunosorbent assay kit. Data were analyzed with Statistical Package for the Social Sciences version 16. Statistical significance was set at p < 0.05. RESULTS The results showed lower levels of IL-1β and IL-6 in the GCF around ceramic abutments compared with titanium implants. In addition, statistical comparison between IL-6 and IL-1β levels showed higher levels of IL-6 around titanium and ceramic abutments compared with IL-1β levels. CONCLUSION Based on the results of this study, the human body immune response to ceramic abutments is much better than that to titanium implants. CLINICAL SIGNIFICANCE Considering that proinflammatory cytokine levels in GCF around ceramic abutments are lower than titanium ones, ceramic abutments are preferred for clinical usage.
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Affiliation(s)
- Ramin Negahdari
- Department of Prosthodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahdi Rahbar
- Department of Operative and Esthetic Dentistry, Faculty of Dentistry, Tabriz University of Medical Science, Tabriz, Iran
| | - Vahid Fakhrzadeh
- Department of Prosthodontics, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Hosein Eslami
- Department of Oral Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Sepideh Bohluli
- Department of Oral Medicine, Faculty of Dentistry, Tabriz University of Medical Sciences, Tabriz, Iran, Phone: +04133355965, e-mail:
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Elsayed A, Wille S, Al-Akhali M, Kern M. Effect of fatigue loading on the fracture strength and failure mode of lithium disilicate and zirconia implant abutments. Clin Oral Implants Res 2017; 29:20-27. [DOI: 10.1111/clr.13034] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Adham Elsayed
- Department of Prosthodontics, Propaedeutics and Dental Materials; School of Dentistry; Christian-Albrechts University; Kiel Germany
| | - Sebastian Wille
- Department of Prosthodontics, Propaedeutics and Dental Materials; School of Dentistry; Christian-Albrechts University; Kiel Germany
| | - Majed Al-Akhali
- Department of Prosthodontics, Propaedeutics and Dental Materials; School of Dentistry; Christian-Albrechts University; Kiel Germany
| | - Matthias Kern
- Department of Prosthodontics, Propaedeutics and Dental Materials; School of Dentistry; Christian-Albrechts University; Kiel Germany
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Gil MS, Ishikawa-Nagai S, Elani HW, Da Silva JD, Kim DM, Tarnow D, Schulze-Späte U, Bittner N. A prospective clinical trial to assess the optical efficacy of pink neck implants and pink abutments on soft tissue esthetics. J ESTHET RESTOR DENT 2017; 29:409-415. [DOI: 10.1111/jerd.12309] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mindy S. Gil
- Department Oral Medicine; Infection and Immunity, Division of Periodontology, Harvard School of Dental Medicine; 188 Longwood Avenue, Boston Massachusetts 02115
| | - Shigemi Ishikawa-Nagai
- Department of Restorative Dentistry and Biomaterials Sciences; Harvard School of Dental Medicine; Boston Massachusetts 02115
| | - Hawazin W. Elani
- Department of Restorative Dentistry and Biomaterials Sciences; Harvard School of Dental Medicine; Boston Massachusetts 02115
| | - John D. Da Silva
- Department of Restorative Dentistry and Biomaterials Sciences; Harvard School of Dental Medicine; Boston Massachusetts 02115
| | - David M. Kim
- Department Oral Medicine; Infection and Immunity, Division of Periodontology, Harvard School of Dental Medicine; 188 Longwood Avenue, Boston Massachusetts 02115
| | - Dennis Tarnow
- Department of Periodontics, Columbia University, College of Dental Medicine, New York; New York
| | - Ulrike Schulze-Späte
- Department of Periodontics, Columbia University, College of Dental Medicine, New York; New York
- Department of Conservative Dentistry and Periodontology; Center of Dental Medicine University Hospital Jena, Friedrich Schiller University; Jena Germany
| | - Nurit Bittner
- Department of Prosthodontics; Columbia University, College of Dental Medicine, New York; New York
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Thoma DS, Gamper FB, Sapata VM, Voce G, Hämmerle CHF, Sailer I. Spectrophotometric analysis of fluorescent zirconia abutments compared to “conventional” zirconia abutments: A within subject controlled clinical trial. Clin Implant Dent Relat Res 2017; 19:760-766. [DOI: 10.1111/cid.12488] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/20/2017] [Accepted: 04/04/2017] [Indexed: 02/04/2023]
Affiliation(s)
- Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zürich Switzerland
| | - Felix B. Gamper
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zürich Switzerland
| | - Vítor M. Sapata
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zürich Switzerland
| | - Giuseppe Voce
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zürich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zürich Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials; University Clinics of Dental Medicine, University of Geneva, Geneva; Switzerland
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Abstract
PURPOSE To assess the impact of implant system on color harmonization of periimplant mucosa. MATERIALS AND METHODS In this case series, color of periimplant mucosa was compared with color of natural tooth gingiva. Seventeen intercanine implants were analyzed (11 bone level [BL], 6 tissue level [TL] implants). Colorimetric data, at 2, 4, and 6 mm from gingival margin, were collected through fiber optics reflectance spectroscopy, and color differences calculated as ΔE. Dentists, dental students, and lay people, in blind, performed an additional visual color analysis on clinical images. RESULTS Independently from implant system, the color of periimplant mucosa was significantly different from gingiva (ΔE = 8.2 ± 0.7), resulting darker at L* comparison (P ≤ 0.05). TL periimplant mucosa showed higher ΔE than BL (9.0 ± 1.0 vs 6.6 ± 0.8, respectively; P ≤ 0.05). Observers correctly identified where the implant was placed in about half of the cases, with no significant difference between implant systems. CONCLUSION Within the limitations of this study, the color of periimplant soft tissues appears different from gingiva, at spectroscopic analysis. Color discrepancy results higher in the presence of TL implants than in BL implants, although the difference may not be clinically significant.
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Han JM, Hong G, Lin H, Shimizu Y, Wu Y, Zheng G, Zhang H, Sasaki K. Biomechanical and histological evaluation of the osseointegration capacity of two types of zirconia implant. Int J Nanomedicine 2016; 11:6507-6516. [PMID: 27994456 PMCID: PMC5153287 DOI: 10.2147/ijn.s119519] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The purpose of this study was to evaluate the biomechanical and histological behavior of a ceria-stabilized zirconia-alumina nanocomposite (NanoZr) in comparison with that of 3 mol% yttria-stabilized tetragonal zirconia polycrystalline (3Y-TZP) in Sprague Dawley rats. Cylindrical NanoZr and 3Y-TZP implants (diameter 1 mm, length 2 mm) were used. Implant-surface morphology and surface roughness were determined by scanning white-light interferometry and scanning electron microscopy, respectively. The cylindrical zirconia implants were placed at the distal edge of the femur of Sprague Dawley rats. At weeks 2, 4, and 8, the interfacial shear strength between implant and bone was measured by push-in test. Histological analysis was performed using hard-tissue sections. Bone-implant contact (BIC), the thickness of new bone around the implant within the bone marrow area, and osteoclast numbers were evaluated. The average surface roughness of 3Y-TZP (Sa 0.788 μm) was significantly higher than that of NanoZr (Sa 0.559 μm). The shear strengths of 3Y-TZP and NanoZr were similar at 2 weeks, but at 4 and 8 weeks the shear strength of NanoZr was higher than that of 3Y-TZP. The average BIC values within the bone marrow area for 3Y-TZP and NanoZr were 25.26% and 31.51% at 2 weeks, 46.78% and 38% at 4 weeks, and 47.88% and 56.81% at 8 weeks, respectively. The average BIC values within the cortical area were 38.86% and 58.42% at 2 weeks, 66.82% and 57.74% at 4 weeks, and 79.91% and 78.97% at 8 weeks, respectively. The mean BIC value did not differ significantly between the two zirconia materials at any time point. The NanoZr implants were biocompatible, capable of establishing close BIC, and may be preferred for metal-free dental implants.
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Affiliation(s)
- Jian-min Han
- Department of Dental Materials, National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, People’s Republic of China
- Division of Advanced Prosthetic Dentistry
| | | | - Hong Lin
- Department of Dental Materials, National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, People’s Republic of China
| | - Yoshinaka Shimizu
- Department of Oral Pathology, Graduate School of Dentistry, Tohoku University, Sendai, Japan
| | - Yuhan Wu
- Division of Advanced Prosthetic Dentistry
| | - Gang Zheng
- Department of Dental Materials, National Engineering Laboratory for Digital and Material Technology of Stomatology, Peking University School and Hospital of Stomatology, Beijing, People’s Republic of China
| | - Hongyu Zhang
- State Key Laboratory of Tribology, Department of Mechanical Engineering, Tsinghua University, Beijing, People’s Republic of China
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Sala L, Bascones-Martínez A, Carrillo-de-Albornoz A. Impact of abutment material on peri-implant soft tissue color. An in vitro study. Clin Oral Investig 2016; 21:2221-2233. [PMID: 27878464 DOI: 10.1007/s00784-016-2015-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 11/16/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES The objectives of the present study is to determine the differences in peri-implant soft tissue color with the utilization of titanium, titanium gold-plated, white zirconia, Vita Classical (VC) A4-shaded zirconia, and fluorescent white zirconia abutments and to establish the influence of gingival thickness on the resulting color. METHODS Four implants were contralaterally inserted in 19 fresh pig mandibles, and the color of the peri-implant mucosa with the different abutments was spectrophotometrically measured at 1-, 2-, and 3-mm height from the margin. RESULTS At 1-mm height, titanium significantly differed from all zirconia abutments in lightness (L*), chroma along red axis (a*), and chroma along yellow-blue axis (b*) parameters. At 2 mm, all zirconia abutments differed from titanium in b* but only fluorescent zirconia in a*. At 3 mm, titanium differed from VC A4-shaded and fluorescent zirconia abutments in b*. At soft tissue thicknesses <1 and 1-2 mm, titanium differed from fluorescent zirconia in a* and b* and from VC A4-shaded zirconia in b*; at thickness >2 mm, no differences were found among abutments. All abutments differed from natural teeth in a* and b* at all heights and thicknesses except for fluorescent zirconia at thickness >2 mm. The Euclidean distance (ΔΕ) differed between titanium abutments and gold, VC A4, and fluorescent zirconia at <1- and 1-2-mm thicknesses. CONCLUSION The natural gingival color was not reproduced with any abutment at gingival thicknesses <2 mm. The worst color match was with titanium abutments and the best with fluorescent zirconia, followed by VC A4-shaded zirconia. At gingival thicknesses >2 mm, no differences were detected among abutments. CLINICAL RELEVANCE This study demonstrates that the type of abutment and the gingival thickness affect the resulting peri-implant gingival color.
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Affiliation(s)
- Leticia Sala
- Department of Periodontology, School of Dentistry, Complutense University of Madrid, Madrid, Spain.
- Departmento de Estomatología III, Facultad de Odontología, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain.
| | - Antonio Bascones-Martínez
- Department of Periodontology, School of Dentistry, Complutense University of Madrid, Madrid, Spain
- Departmento de Estomatología III, Facultad de Odontología, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
| | - Ana Carrillo-de-Albornoz
- Department of Periodontology, School of Dentistry, Complutense University of Madrid, Madrid, Spain
- Departmento de Estomatología III, Facultad de Odontología, Universidad Complutense de Madrid, Plaza Ramón y Cajal S/N, 28040, Madrid, Spain
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Dede DÖ, Armağanci A, Ceylan G, Celik E, Cankaya S, Yilmaz B. Influence of implant abutment material on the color of different ceramic crown systems. J Prosthet Dent 2016; 116:764-769. [DOI: 10.1016/j.prosdent.2016.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 04/10/2016] [Accepted: 04/11/2016] [Indexed: 11/17/2022]
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Lops D, Stellini E, Sbricoli L, Cea N, Romeo E, Bressan E. Influence of abutment material on peri-implant soft tissues in anterior areas with thin gingival biotype: a multicentric prospective study. Clin Oral Implants Res 2016; 28:1263-1268. [DOI: 10.1111/clr.12952] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Diego Lops
- Department of Prosthodontics; Dental Clinic; School of Dentistry; University of Milan; Milan Italy
| | - Edoardo Stellini
- Department of Prosthetic Dentistry; School of Dentistry; University of Padova; Padova Italy
- Department of Neuroscience; Dental Clinic; School of Dentistry; University of Padova; Padova Italy
| | - Luca Sbricoli
- Department of Periodontology; School of Dentistry; University of Padova; Padova Italy
- Department of Neuroscience; Dental Clinic; School of Dentistry; University of Padova; Padova Italy
| | - Niccolò Cea
- Department of Prosthodontics; Dental Clinic; School of Dentistry; University of Milan; Milan Italy
| | - Eugenio Romeo
- Department of Prosthodontics; Dental Clinic; School of Dentistry; University of Milan; Milan Italy
| | - Eriberto Bressan
- Department of Prosthetic Dentistry; School of Dentistry; University of Padova; Padova Italy
- Department of Neuroscience; Dental Clinic; School of Dentistry; University of Padova; Padova Italy
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Basílio MDA, Cardoso KV, Antonio SG, Rizkalla AS, Santos Junior GC, Arioli Filho JN. Effects of artificial aging conditions on yttria-stabilized zirconia implant abutments. J Prosthet Dent 2016; 116:277-85. [DOI: 10.1016/j.prosdent.2016.01.011] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Revised: 01/12/2016] [Accepted: 01/12/2016] [Indexed: 11/16/2022]
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Cooper LF, Stanford C, Feine J, McGuire M. Prospective assessment of CAD/CAM zirconia abutment and lithium disilicate crown restorations. J Prosthet Dent 2016; 116:33-9. [DOI: 10.1016/j.prosdent.2015.08.023] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 08/26/2015] [Accepted: 08/28/2015] [Indexed: 11/30/2022]
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Galvão GH, Grossi JA, Zielak JC, Giovanini AF, Furuse AY, Gonzaga CC. Influence of Metal and Ceramic Abutments on the Stress Distribution Around Narrow Implants: A Photoelastic Stress Analysis. IMPLANT DENT 2016; 25:499-503. [PMID: 26963745 DOI: 10.1097/id.0000000000000406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
PURPOSE This study aimed to compare, through photoelastic analysis, the distribution of stresses around narrow implants with external hexagon (EH) and Morse taper (MT) connections, when single crowns made with metal and ceramic abutments were used. MATERIALS AND METHODS Six photoelastic models were prepared, simulating the use of narrow EH and MT implants replacing a lateral incisor. These 2 groups received 3 different abutments: prefabricated metal abutments, customized metal abutments, and customized zirconia abutments. All crowns were identical and made with a leucite reinforced glass-ceramic. Vertical loads of 0 to 100 N were applied on the palatal surface of the crowns, and the photoelastic stress fringes developed in each model were captured in a high-definition video, and digital photographs were taken at 100 N. RESULTS The abutment type and material influenced the stress distribution patterns around narrow implants with EH and MT connections. Stresses were generated mainly around the apical and lingual regions of the implants. CONCLUSIONS For both connections, the prefabricated metal abutments presented better stress distribution around the implants when compared to customized metal and zirconia abutments because low stress levels were developed in smaller areas around the implants.
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Affiliation(s)
- Gustavo Holtz Galvão
- *MSc Student, Graduate Program in Dentistry, Positivo University, Curitiba, PR, Brazil. †PhD Student, Graduate Program in Dentistry, Positivo University, Curitiba, PR, Brazil. ‡Full Professor, Graduate Program in Dentistry, Positivo University, Curitiba, PR, Brazil. §Assistant Professor, Department of Operative Dentistry, Endodontics and Dental Materials, Bauru School of Dentistry, University of São Paulo, Bauru, SP, Brazil
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