The effects of height and surface roughness of abutments and the type of cement on bond strength of cement-retained implant restorations

Impact of cement type and abutment height on pull-off force of zirconia reinforced lithium silicate crowns on titanium implant stock abutments: an in vitro study

Background

Pull-off forces of cement-retained zirconia reinforced lithium silicate (ZLS) in implant-supported single crowns on stock titanium abutments with respect to abutment height and implant cement were evaluated and compared.

Methods

Pull-off force of ZLS crowns on stock titanium abutments was evaluated concerning dental cement and abutment height. A total sample size of 64 stock abutments with heights of 3 mm (n = 32) and 5 mm (n = 32) was used. The ZLS crowns were cemented with four different types of cement (one temporary, two semi-permanent, and one permanent). After cementation, water storage, and thermocycling each sample was subjected to a pull-off test using a universal testing machine.

Results

The temporary cement showed the least pull-off force regardless of abutment height (3/5 mm: means 6 N/23 N), followed by the semi-permanent methacrylate-infiltrated zinc oxide cement (28 N/55 N), the semi-permanent methacrylate-based cement (103 N/163 N), and the permanent resin composite cement (238 N/820 N). Results of all types of cement differed statistically significantly from each other (p ≤ .012). The type of implant cement has an impact on the pull-off force of ZLS crowns and titanium abutments.

Conclusions

Permanent cements present higher retention than semi-permanent ones, and temporary cements present the lowest values. The abutment height had a subordinate impact.

In Vitro Simulation of Dental Implant Bridges Removal: Influence of Luting Agent and Abutments Geometry on Retrievability

Implant fixed dental prostheses are widely used for the treatment of edentulism, often preferred over the screw-retained ones. However, one of the main features of an implant-supported prosthesis is retrievability, which could be necessary in the case of implant complications. In this study, the retrievability of implant-fixed dental prostheses was investigated considering two of the main factors dental practitioners have to deal with: the abutments geometry and the luting agent. Impulsive forces were applied to dental bridge models to simulate crowns’ retrievability in clinical conditions. The number of impulses and the impulsive force delivered during each test were recorded and used as retrievability indexes. One-hundred-and-five tests were conducted on 21 combinations of bridges and luting agents, and a Kruskal-Wallis test was performed on the results. The abutment geometry significantly influenced the number of impulses needed for retrieval (p < 0.05), and a cement-dependent trend was observed as well. On the other hand, the forces measured during tests showed no clear correlation with bridge retrievability. The best retrievability was obtained with long, slightly tapered abutments and a temporary luting agent.

Effect of different surface treatments on the shear bond strength of luting cements used with implant-supported prosthesis: An in vitro study

PURPOSE

The aim of this study was to investigate the shear bond strength of luting cements used with implant retained restorations on to titanium specimens after different surface treatments.

MATERIALS AND METHODS

One hundred twenty disc shaped specimens were used. They were divided into three groups considering the surface treatments (no treatment, sandblasting, and oxygen plasma treatment). Water contact angle of specimens were determined. The specimens were further divided into four subgroups (n=10) according to applied cement types: polycarboxylate cement (Adhesor Carbofine-AC), temporary zinc oxide free cement (Temporary Cement-ZOC), non eugenol provisional cement for implant retained prosthesis (Premier Implant Cement-PI), and non eugenol acrylic-urethane polymer based provisional cement for implant luting (Cem Implant Cement-CI). Shear bond strength values were evaluated. Two-way ANOVA test and Regression analysis were used to statistical analyze the results.

RESULTS

Overall shear bond strength values of luting cements defined in sandblasting groups were considerably higher than other surfaces (P<.05). The cements can be ranked as AC > CI > PI > ZOC according to shear bond strength values for all surface treatment groups (P<.05). Water contact angles of surface treatments (control, sandblasting, and plasma treatment group) were 76.17° ± 3.99, 110.45° ± 1.41, and 73.80° ± 4.79, respectively. Regression analysis revealed that correlation between the contact angle of different surfaces and shear bond strength was not strong (P>.05).

CONCLUSION

The retentive strength findings of all luting cements were higher in sandblasting and oxygen plasma groups than in control groups. Oxygen plasma treatment can improve the adhesion ability of titanium surfaces without any mechanical damage to titanium structure.

In Vitro Impact Testing to Simulate Implant-Supported Prosthesis Retrievability in Clinical Practice: Influence of Cement and Abutment Geometry

Cement-retained implant-supported prosthetics are gaining popularity compared to the alternative screw-retained type, a rise that serves to highlight the importance of retrievability. The aim of the present investigation is to determine the influence of luting agent, abutment height and taper angle on the retrievability of abutment–coping cementations. Abutments with different heights and tapers were screwed onto an implant and their cobalt-chrome copings were cemented on the abutments using three different luting agents. The removals were performed by means of Coronaflex^®. The number of impulses and the forces were recorded and analyzed with a Kruskal–Wallis test. Harvard cement needed the highest number of impulses for retrieval, followed by Telio CS and Temp Bond. However, abutment height and taper showed a greater influence on the cap’s retrievability (p < 0.05). Long and tapered abutments provided the highest percentage of good retrievability. The influence of the luting agent and the abutment geometry on the cap’s retrieval performed by Coronaflex^® reflects data from literature about the influence of the same factor on the maximum force reached during uniaxial tensile tests. The impulse force was slightly affected by the same factors.

Evaluation of the wear and retention performance of a shape-memory alloy abutment system after 6 months of clinical use

STATEMENT OF PROBLEM

A nitinol sleeve that uses shape memory to rapidly unlock dental restorations from implant abutments has been developed to allow prosthesis removal for assessment and maintenance, and clinical treatment has been promising. However, objective studies that evaluate the wear and retention performance after short-term clinical use are lacking.

PURPOSE

The purpose of this clinical study was to evaluate the wear and retention performance of a shape-memory abutment system after 6 months of clinical use.

MATERIAL AND METHODS

Shape-memory alloy sleeves on posterior osseointegrated implants were retrieved after 6 months of clinical use. Scanning electron microscopy (SEM) was used to evaluate the surfaces of the retention sleeve's arms for wear. Uniaxial tensile testing was performed to measure the change in retention force after clinical use. Average retention values of the shape-memory abutment system were compared with previously reported in vitro retention values for definitive and interim cements used in titanium abutment and coping assemblies by using the Welch t test.

RESULTS

No evidence of wear, fracture, or chipping was observed during SEM analysis on the shape-memory alloy sleeves. Additionally, no statistically significant difference was found in the median retention force for new (484.5 N) and clinically retrieved (476 N) nitinol sleeve specimens. Compared with a commercially available resin cement, the mean retention force for the control sleeves (480 ±37 N) was higher than that for the freshly cemented specimens (336.3 ±188 N). After 5000 cycles of compressive loads, the mean retention force for cement specimens decreased (209.4 ±83 N), while the clinical sleeves (476 ±50 N) remained unchanged.

CONCLUSIONS

According to the results of this study, after 6 months of clinical use, the engaging surfaces of the shape-memory alloy sleeve did not show signs of wear, and the retention force was unchanged.

Marginal Discrepancy of Cast Copings to Abutments with Three Different Luting Agents

Aim

The purpose of this study was to evaluate the MD (marginal discrepancy) on the calcinable copings in abutments for cemented prostheses with three luting agents.

Methods

Sixty-four analogs of CeraOne-type abutments (NACONIH code, Titanium Fix Implant Sytem SP, Brazil) were divided into four groups (n = 16). The copings were cast and placed on the CeraOne abutment analogs and cemented with eugenol-free zinc oxide (EfZO) (n = 16), with glass ionomer (GI) (n = 16), and with zinc phosphate (ZP) (n = 16), and as a control group, there were CeraOne plastic copings (NACOC code, Titanium Fix Implant Sytem SP, Brazil) (n = 16) which were not cemented with any material. After 24 hours, the MD of the four groups was measured. MD was evaluated using a stereoscopic microscope (Leica EZ4 W, Leica Microsystems, Germany) with an increase of ×100. MD was measured at four predetermined and equidistant sites with respect to the marginal line of the cast adaptation. The measurement was made from the distance between the free edge of the cast cylinder and the margin of preparation of the titanium abutment, with a level of statistical significance of p < 0.05.

Results

Of the three fixing agents, the ZP was found to have the highest MD (53.59 ± 14.21 μm); however, the lowest MD (41.72 ± 9.10 μm) was found in the GI group. These differences are statistically significant at p < 0.001.

Conclusions

In summary, according to our results, it was found that ZP cement showed the highest MD after cementation, followed by the glass ionomer, while EfZO showed the lowest MD.

Effect of Implant Abutment Acid Etching on the Retention of Crowns Luted with Different Cements: An In Vitro Comparative Evaluation

Background:

Air abrasion of the implant abutment surface improves the bond strength of luting agents. However, the effect of acid etching and combination of air abrasion and acid etching on the bond strength of various luting agents under masticatory load is yet to be documented.

Purpose:

The purpose of this study was to evaluate the effect of implant abutment surface modifications on the tensile bond strength (TBS) of cast metal copings (CMCs) luted with different luting agents, subjected to cyclic fatigue loads.

Materials and Methods:

A total of 150 Ni-Cr CMCs were made on commercially pure titanium (Cp-Ti) laboratory analogues. The samples were categorized into three groups based on surface modifications and five subgroups for luting agents. The CMCs were cemented to the respective surface-modified groups, stored in distilled water at 37°C for 24 hours, and then subjected to load cycling, followed by tensile loading. One-way analysis of variance (ANOVA) was used to compare the mean bond strength between luting agents.

Results:

Self-adhesive resin cement showed the highest TBS followed by resin-modified glass ionomer cement, zinc polycarboxylate, and zinc phosphate cement. Non-eugenol temporary cement showed least TBS values on all modified abutment surfaces.

Conclusion:

Air abrasion + acid etching (HY) provided the greatest TBS followed by acid-etched (AE) surface only. Air-abraded (AA) surface yielded the least TBS for luting agents.

What is the Best Available Luting Agent for Implant Prosthesis?

Cement-retention is a viable option in restoring dental implants. A wide range of dental cements with different properties are commercially available for use in the cementation of implant prostheses. The selection of a dental cement for proper clinical application can be challenging. This article overviews the commercially available dental cements used in cement-retained implant-supported prostheses. Guidelines for cement selection are presented according to abutment and prosthetic material. Cementation techniques to reduce excess cement in peri-implant tissues are also mentioned.

Retention of zirconia copings over smooth and airborne-particle-abraded titanium bases with different resin cements

STATEMENT OF PROBLEM

How cement type and the surface treatment of a titanium base affect the retention of zirconia copings on titanium bases is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the dislodging forces of zirconium oxide copings cemented on implant-supported titanium bases with different luting agents and to examine the influence of airborne-particle abrasion on titanium surfaces.

MATERIAL AND METHODS

Thirty implant laboratory analogs (BioHorizons) were fixed in metal blocks, and 30 prosthetic titanium bases (BioHorizons) were tightened with 35 Ncm of torque. Zirconium oxide copings with a luting-gap size of 30 μm were produced by using the Lava (3M ESPE) technology. The specimens were bonded to the titanium bases with 3 different resin cements (G-CEM LinkAce, RelyX U200, and Ceka Site). The specimens were kept in artificial saliva at 37°C for 24 hours and then subjected to a dynamic loading of 5000 cycles with a mastication simulator (SD Mechatronic) with thermocycling between 5°C and 55°C. The tensile force was measured by using a universal testing machine (Zwick/Roell) at a crosshead speed of 5 mm/min. After the measurement, the cement was cleaned from the titanium bases and zirconia copings. The titanium bases were airborne-particle abraded with 50-μm aluminum oxide (Al₂O₃) particles, and the bonding process was repeated. The statistical analysis included descriptive analysis, 2-way ANOVA, the Tukey post hoc, and simple main effect tests (α=.05).

RESULTS

Bond strengths were significantly different according to the cement type used and before and after airborne-particle abrasion (P<.05). The cement retentiveness before airborne-particle abrasion was as follows: G-CEM LinkAce (1338 ±69 N)>RelyX U200 (665 ±36 N)>Ceka Site (469 ±22 N). The differences among all the cement types before airborne-particle abrasion were statistically significant (P<.05). After airborne-particle abrasion, retention decreased in all the groups, and the ranking of the cements' retentiveness remained the same: G-CEM LinkAce (662 ±65 N)>RelyX U200 (352 ±21 N)>Ceka Site (122 ±17 N). After airborne-particle abrasion, the differences among all the cements remained statistically significant (P<.05). The comparison within the groups before and after airborne-particle abrasion revealed that abrading the titanium bases with 50-μm Al₂O₃ decreased the bond strength for all the tested cements.

CONCLUSIONS

The cement type had a significant influence on the retention of the zirconia copings, and abrading the titanium bases with 50-μm Al₂O₃ significantly decreased the dislodging force of the coping from the titanium base.

An in vitro study to compare the influence of newer luting cements on retention of cement-retained implant-supported prosthesis

Purpose:

The study was conducted to evaluate the retentiveness of specifically formulated implant cements and compare its retentiveness with a commonly used noneugenol zinc oxide luting cement and also to assess the influence of abutment height on the retentiveness of these cements.

Materials and Methods:

A master stainless steel mold was used to mount snappy abutment-implant analog complex in acrylic resin. A total of six snappy abutments (Nobel Biocare^®) of 4 mm and 5.5 mm height with their analogs were used. A total of 66 ceramill^® Sintron metal copings fabricated using computer-aided design/computer-aided manufacturing system and divided into six groups (n = 11) according to the height (three 4 mm abutment and three 5.5 mm abutment). The cements that were compared were a Noneugenol zinc oxide provisional cement (Temp-Bond™ NE), a Noneugenol temporary resin cement (Premier^® Implant Cement) and a resin based acrylic urethane cement (Implalute^® Implant Cement). After cementation samples were immersed in artificial saliva for 7 days and subjected to a pull-out test using a universal testing machine at a crosshead speed of 1 mm/min. The load required to de-cement each coping was recorded and analyzed using one-way ANOVA, post hoc multiple comparison, and independent t-test.

Results:

Noneugenol temporary resin cement had the highest tensile strength followed by noneugenol zinc oxide cement and the least retentive strength was observed in resin-based acrylic urethane cement.

Conclusion:

The results suggest that noneugenol temporary resin cement may be considered as a better choice for cementation of implant prosthesis, as it has shown to have better mechanical properties.

The Effect of Milling Metal Versus Milling Wax on Implant Framework Retention and Adaptation

PURPOSE

The metal framework of implant-supported restorations can be made using different methods. For a successful outcome, the acceptability of each method depends on the retention and fit of the restoration. The aim of this study was to evaluate and compare the retention and adaptation of copings fabricated using two methods: casting wax patterns made by computer-aided design/computer-aided manufacturing (CAD/CAM) technology, and milling sintered chromium-cobalt (Cr-Co) blocks.

MATERIALS AND METHODS

Twenty-four abutment analogs (height, 5.5 mm) were divided into two groups according to the framework fabrication method. In one group, wax patterns were prepared using a CAM milling machine, and they were cast with a Ni-Cr-Ti metal alloy. In the second group, the copings were milled from Cr-Co blocks using a CAD/CAM milling machine. All copings were equal in contour, thickness, and internal relief and were seated on the abutment analogs after the necessary adjustments. The vertical marginal discrepancy was investigated using a silicone replica method and stereomicroscope with 75× magnification. After copings were cemented onto the abutment analogs using zinc phosphate, a tensile resistance test was performed using a universal testing machine. Mann-Whitney U and Student's t-test were used for statistical analyses at a significance level of 0.05.

RESULTS

An independent sample t-test revealed a significant difference between the two groups for retention (p = 0.010), and the milled wax group showed higher tensile resistance compared with the milled metal group. There was also a significant difference between the two groups in marginal discrepancy (p < 0.001), with a larger marginal gap in the milled metal group compared with the milled wax group. The milled metal copings required more adjustments to fit on the abutment analogs compared with the wax milled copings (p < 0.001).

CONCLUSIONS

The CAD/CAM technique for wax milling resulted in more retentive copings with better marginal and internal adaptations compared with milling the metal blocks.

Effect of surface treatments on the retention of implant-supported cement-retained bridge with short abutments: An in vitro comparative evaluation

Statement of Problem:

In clinical situations, short implant abutments create lack of retention with overlying cemented prosthesis.

Aims:

The aim of this study is to evaluate the impact of different surface treatments on the retention of implant-supported cement-retained bridge with short implant abutments.

Materials and Methods:

Six straight Adin implant abutments of similar sizes (3 mm diameter × 3 mm height) were selected. All were divided into three groups (n = 2): with circumferential grooves and sandblasting (G + SB), with a circumferential groove and bur modification (G + B) and third one taken as control. The framework simulating three-unit bridge was casted in each group. A total of 30 such frameworks (10 for each group) were fabricated. Each casting was cemented with a zinc phosphate cement (Dentsply). The cemented frameworks were then being stored in 100% humidity at 37°C for 24 h. Retention tests were conducted with a universal testing machine (5 mm/min), and retentive forces were recorded. Data were subjected to one-way analysis of variance, Tukey's honestly significant difference test, (α = 0.05).

Results:

For the first group, retentive value increased by 619.30 N, the second group increased the retention by approximately 749.80 N (P < 0.001). The null hypothesis was rejected, the abutments with G + B showed significantly higher retention, than the G + SB and control group (F = 15.95, df = 29, P < 0.001).

Conclusion:

The addition of G + B to implant abutments significantly increased the retention of cement-retained frameworks. For long-term prognosis of the prosthesis; G + B modification can be a better option as compared to G + SB.

Effect of Surface Modifications on the Retention of Cement-retained Implant Crowns under Fatigue Loads: An In vitro Study

Background:

Masticatory forces cause fatigue to the dental luting agents, adversely affecting the retention of these cement-retained crowns. Sandblasting (SB) and diamond abrading the abutment surface improves the bond strength of luting agents. However, the effect of acid etching (AE) on the implant abutment surface and the effect of other surface modifications under masticatory load are yet to be documented.

Purpose:

The aim of the study was to evaluate the effect of abutment surface modifications on the retention of cement-retained restorations subjected to cyclic fatigue loads.

Materials and Methods:

Forty Ni-Cr copings were made on Cp-titanium laboratory analogs. The specimens were divided into two groups as Group I: Uniaxial tensile loading (UTL) and Group II: Offaxial cyclic loading followed by uniaxial tensile loading [CTL]. Further subgrouped as, subgroup I: Control (C), subgroup II: SB, subgroup III: AE, and subgroup IV: SB + AE. The copings were luted with Zn₂(PO₄)₃ and subjected to uniaxial tensile loading. Copings were recemented, and CTL was conducted. Two-way analysis of variance was used as the statistical test of significance.

Results:

In relation to the subgroups, the bond strength of Zn₂(PO₄)₃ was higher in Group I than in Group II. The bond strength in subgroup IV was superior in both Group I and Group II (547.170 N ± 5.752 and 531.975 N ± 6.221 respectively).

Conclusions:

For both UTL and CTL, abutment SB + AE elicited maximum coping retention followed by AE. Off-axial cyclic loading adversely affected the retention irrespective of the surface modifications.

Zinc phosphate as a definitive cement for implant-supported crowns and fixed dentures

Implant-supported dental prostheses can be retained by a screw or cement. Implant-supported fixed partial dentures have a passive fit. A passive fit means there is an internal gap between the abutment surface and the intaglio of the retainer to insure that there is no lateral pressure on the supporting implants or friction upon seating of the prosthesis. This gap is filled with cement for retention of the prosthesis. Any lateral pressure may cause marginal bone loss or periimplantitis. Also, there is usually a microscopic gap at the margin of a crown retainer that exposes the cement to oral fluids. The solubility of zinc phosphate (ZOP) cement is a definite liability due to the risk for cement dissolution. In fixed prostheses, the dissolution of the cement of one or more retainers would cause a transfer of the occlusal load to the retained unit(s). The resulting rotation and lifting of the cement-retained implants from occlusal and parafunctional loads could cause loss of osseointegration of the abutment-retained implant(s). ZOP cement may not be indicated for implant-supported fixed partial dentures or splints. Cement dissolution in single unit probably only involves re-cementation, if the patient does not swallow or aspirate the crown.

Effect of using nano and micro airborne abrasive particles on bond strength of implant abutment to prosthesis

Connecting prostheses to the implant abutments has become a concern and achieving a satisfactory retention has been focused in cement-retention prostheses recently. Sandblasting is a method to make a roughened surface for providing more retention. The aim of this study was to compare effects of nano and micro airborne abrasive particles (ABAP) in roughening surface of implant abutments and further retention of cemented copings. Thirty Xive abutments and analogues (4.5 D GH1) were mounted vertically in self-cured acrylic blocks. Full metal Ni-Cr copings with a loop on the top were fabricated with appropriate marginal adaptation for each abutment. All samples were divided into 3 groups: first group (MPS) was sandblasted with 50 µm Al2O3 micro ABAP, second group (NSP) was sandblasted with 80 nm Al2O3 nano ABAP, and the third group (C) was assumed as control. The samples were cemented with provisional cement (Temp Bond) and tensile bond strength of cemented copings was evaluated by a universal testing machine after thermic cycling. The t test for independent samples was used for statistical analysis by SPSS software (version 15) at the significant level of 0.05. Final result showed significant difference among all groups (p<0.001) and MPS manifested the highest mean retention (207.88 ± 45.61 N) with significant difference among other groups (p<0.001). The control group showed the lowest bond strength as predicted (48.95 ± 10.44 N). Using nano or micro ABAP is an efficient way for increasing bond strengths significantly, but it seems that micro ABAP was more effective.

Retentive strength of implant-supported CAD-CAM lithium disilicate crowns on zirconia custom abutments using 6 different cements

STATEMENT OF PROBLEM

The optimal retention of implant-supported ceramic crowns on zirconia abutments is a goal of prosthodontic treatment.

PURPOSE

The purpose of this in vitro study was to evaluate the retentive strength of implant-supported IPS e.max CAD-CAM (e.max) crowns bonded to custom zirconia implant abutments with different cements.

MATERIAL AND METHODS

An optical scan of a zirconia custom abutment and a complete-coverage modified crown was designed using an intraoral E4D scanner. One hundred twenty lithium disilicate crowns (IPS e.max CAD) were cemented to 120 zirconia abutment replicas with 1 of 6 cements: Panavia 21 (P21), Multilink Hybrid Abutment (MHA), RelyX Unicem 2 (RXU), RelyX Luting Plus (RLP), Ketac Cem (KC), and Premier Implant (PI). The specimens were stored at 37°C in 100% humidity for 24 hours. Half of the specimens were thermocycled for 500 cycles. The retentive force was measured using a pull-out test with a universal testing machine. Mean retentive strengths (MRS) were calculated using 2-way ANOVA and the Tukey-Kramer test (α=.05).

RESULTS

The MRS (MPa) after 24-hour storage were P21 (3.1), MHA (2.5), RXU (2.5), RLP (1.3), KC (0.9), and PI (0.5). The MRS after thermocycling were MHA (2.5), P21 (2.2), RLP (1.8), KC (1.4), RXU (1.1), and PI (0.3). P21 had the highest MRS after 24-hour storage (P<.001), but after thermocycling MHA had the highest MRS (P<.001). RXU showed a significant decrease in MRS after thermocycling (P<.05). Cement residue was mostly retained on the zirconia abutments for P21, while for the other cements' residue was retained on the lithium disilicate crowns.

CONCLUSIONS

The cements tested presented a range of retentive strengths, providing the clinician with a choice of more or less retentive cements. MHA was the most retentive cement after thermocycling. Thermocycling significantly affected the retentive strengths of the P21 and RXU cements.