Retention of telescopic denture in elderly patients with maximum partially edentulous arch

Correlation between Friction and Wear in Cylindrical Anchorages Simulated with Wear Machine and Analyzed with Scanning Probe and Electron Microscope

This paper presents the possibilities of applying atomic force microscopy (AFM) techniques to the study of the wear of prosthetic biomaterials. In the conducted research, a zirconium oxide sphere was used as a test piece for mashing, which was moved over the surface of selected biomaterials: polyether ether ketone (PEEK) and dental gold alloy (Degulor M). The process was carried out with constant load force in an artificial saliva environment (Mucinox). An atomic force microscope with an active piezoresistive lever was used to measure wear at the nanoscale. The advantage of the proposed technology is the high resolution of observation (less than 0.5 nm) in the three-dimensional (3D) measurements in a working area of 50 × 50 × 10 µm. The results of nano wear measurements in two measurement setups are presented: zirconia sphere (Degulor M and zirconia sphere) and PEEK were examined. The wear analysis was carried out using appropriate software. Achieved results present a tendency coincident with the macroscopic parameters of materials.

Parameters Affecting the Retention Force of CAD/CAM Telescopic Crowns: A Focused Review of In Vitro Studies

Telescopic systems constructed using computer aided design and computer aided manufacture (CAD/CAM) can overcome many drawbacks associated with conventionally constructed ones. Since retention is considered the most important function of these retainers, this scoping review aimed to discuss and summarize the parameters that affect this function in CAD/CAM-manufactured telescopic crowns and to compare their retention force values with the recommended retention force. An electronic search was done in Pubmed and Google Scholar databases using different keyword combinations to find the related articles. Seventeen articles that follow the eligibility criteria for this review were selected and analyzed for detection of each of the tested parameters and their effect on retention force. The parameters tested in these articles were divided into parameters related to design, manufacturing, material type, and test condition. Regardless of the effect of these parameters, the retention force values recorded in most of the selected studies laid within or were higher than the recommended retention force (2.5-10 N), which indicated the need to design and set the combination of materials of telescopic systems according to oral biomechanics.

Adhesion as a component of retention force of overdenture prostheses-study on selected Au based dental materials used for telescopic crowns using atomic force microscopy and contact angle techniques

Contemporary prosthetic materials are characterized by highly specific preparation for a given application. This means that at the stage of their creation, not only their function is taken into account, but also the long-term behavior of this material during use. In the case of telescopic crowns, an important factor not yet appearing in the research is the aspect of adhesion force and its dependence on the type of biomaterial, but also the properties of human saliva. The use of artificial saliva, which creates a lubricating layer, reduces the wear on the surface of the telescopic crowns by reducing friction. The impact of artificial saliva on the formation of chemical bonds between prosthetic elements, thus contributing to the so-called retention force has not yet been studied. In this work, two types of measurements of gold telescopic crown materials in the aspect of the adhesion process are presented. Obtained results allowed to fully characterize this phenomenon. We modeled the load force between the microcircuit and the surface under study to suit the conditions between the primary and secondary crowns in the patient's mouth.

Retention forces between primary and secondary CAD/CAM manufactured telescopic crowns: an in vitro comparison of common material combinations

OBJECTIVES

To analyze the retention forces between primary and secondary telescopic crowns milled from various materials and to compare them with the retention forces between cast telescopic crowns made of precious metal alloys.

MATERIALS AND METHODS

Primary and secondary crowns (N = 60; n = 10 per group) were fabricated using various material combinations (1: zirconia [ZIR]/polyether ether ketone [PEEK]; 2: titanium grade IV [TI]/PEEK; 3: PEEK/PEEK; 4: non-precious alloy [NPA]/PEEK; 5:NPA/NPA), while precious alloy (PA) was used for the control group (6: PA/PA). The retention forces at 10, 1000, 5000, and 10,000 connection and disconnection cycles and the relative weights were analyzed, applying nonparametric repeated measures ANOVA and post hoc Mann-Whitney and Wilcoxon signed-rank tests (α < 0.05).

RESULTS

Globally, significant differences in the retention forces among the materials (p < 0.0001), time points (p < 0.0001), and wear resistance for the various materials (p < 0.0001) were observed. No significant changes in retention forces compared to baseline were observed in groups 2, 4, 5, and 6. A significantly higher weight loss for both primary and secondary crowns was observed in groups 4 and 6.

CONCLUSIONS

The material combination in telescopic attachments influences retention forces and wear. Interactions between materials and time were evident, indicating that the change in retention forces differs among the materials. The combinations of milled TI/PEEK and NPA/NPA qualify for further preclinical testing in a more clinically realistic setup, determining a material-specific double-crown design.

CLINICAL RELEVANCE

The design of precious alloy telescopic crowns cannot be directly transferred to other milled material combinations due to different retention behaviors.

In vitro investigations on retention force behavior of conventional and modern double crown systems

OBJECTIVE

This study aimed to investigate the effects of long-term use on the retention force and wear behavior of double crown systems.

METHODS

Based on a common double crown design sixty pairs of telescopic crowns were fabricated and divided into six groups, each consisting ten samples: "Gold standard" cast gold alloy primary and secondary crown (GG) and cast non-precious alloy (NN), computer-aided design (CAD)/computer-aided manufacturing (CAM)-milled zirconia primary crown and galvanoformed secondary crown (ZG), CAD/CAM-milled non-precious alloy primary and secondary crown (CC NN), CAD/CAM-milled zirconia primary crown and non-precious alloy secondary crown (CC ZN) and CAD/CAM-milled zirconia primary crown and polyetheretherketone (PEEK) secondary crown (CC ZP). In the constant presence of artificial saliva, all samples were subjected to 10,000 joining-separation cycles at a velocity of 120 mm/min. Wear was analyzed by reflected light microscopy and confocal microscopy before and after artificial aging.

RESULTS

Retention force losses were observed in each group after long-term use, with significant losses in the groups ZG and CC ZP (p_ZG = 0.01, p_{CC ZP} = 0.049). During artificial aging, no significant differences in pull-off force were recorded for groups GG, NN and CC ZN. Regarding wear, merely the Y-TZP primary crowns of the CC ZP group displayed no surface changes.

SIGNIFICANCE

All tested production methods and material combinations seem to be suitable for clinical practice. CAD/CAM technology allows similarly predictable results to be achieved as the gold standard. Confocal microscopy is recommended for surface examinations of double crowns.

Assessment of Force Retention between Milled Metallic and Ceramic Telescopic Crowns with Different Taper Angles Used for Oral Rehabilitation

The present study assessed the retention forces corresponding to different telescopic systems used in removable prosthetic dentures. The telescopic systems were represented by Co–Cr alloy or zirconia-based primary crowns and Co–Cr secondary crowns. All crowns were manufactured using computer-aided design/computer-aided manufacturing technology (CAD/CAM). Two types of reference abutment teeth (upper canine and first upper molar) were selected in order to obtain the telescopic crowns and two taper angles—of 0° and 2°—were used for the design of the crowns. A number of 120 samples of telescopic crowns were obtained and subjected to mechanical tests, following a specific protocol, on a mechanical testing equipment. The retention of the telescopic systems was evaluated for different sets of cycles (up to 360), represented by movements that simulate the intraoral insertion and disinsertion of the telescopic systems. The present study highlights that the telescopic systems in which the primary crown is made of zirconia ceramics presents more advantages than those made of Co–Cr. All telescopic systems studied, highlighted that by modifying the taper angle from 0° to 2°, the retention forces have decreased, irrespective of the materials used for the fabrication of the primary crown, suggesting that by using a taper angle of 0°, which is known to be ideal, more efficient, and reliable prosthesis can be developed. Thus, even though the ceramic–metallic telescopic system exhibited the highest retention, all telescopic crowns evaluated registered values between 2–7 N, indicating that they are suitable for clinical use.

Selective Laser Sintering versus Selective Laser Melting and Computer Aided Design - Computer Aided Manufacturing in Double Crowns Retention

Purpose This in vitro study aimed at ascertaining the retention forces for telescopic crowns fabricated with Selective Laser Manufacturing (SLM) and Selective Laser Sintering (SLS) additive technologies, and Computer Aided Design - Computer Aided Manufacturing (CAD-CAM) subtractive technology, by using suitable materials for each.Materials and Methods Full-factorial design was employed for experimental testing, considering the following three factors: (a) inner crown material ‒ technology (zirconia ‒ CAD-CAM; metal-alloy ‒ SLS; metal-alloy ‒ SLM); (b) tooth type (canine or molar); (c) wet vs. dry conditions (i.e. either with or without artificial saliva). The roughness of the inner crowns was analyzed through atomic force microscopy. Three-way analysis of variance (ANOVA) was applied for statistical analysis, followed by Tukey's post-hoc comparisons between the crown types.Results The retention force mean values were between 3.8 N (dry, SLM) and 14.8 N (artificial saliva, SLS), with statistically significant (p<0.001) differences between the three types of inner crowns and interaction with the tooth type. No significant interaction was found between crown or tooth types and the wet vs. dry testing conditions. The zirconia crowns' retention force was significantly (p<0.001) higher compared to similar SLM crowns, with 95% CI (3.62; 5.55) N for the differences. Zirconia was significantly (p<0.001) less retentive compared to similar SLS crowns, with 95% CI (-5.99; -4.06) N for the differences. The roughness decrease and subsequent loss of retention force was the largest in zirconia.Conclusions The SLS inner crowns showed the best retention, followed by zirconia and SLM inner crows.

Investigation of the retention forces of secondary telescopic crowns made from Pekkton® ivory in combination with primary crowns made from four different dental alloys: an in vitro study

The aim of this study was to investigate the retention forces of secondary telescopic crowns made of polyetherketoneketone (PEKK) in combination with primary crowns made of four different dental alloys and to determine whether the retention forces change in the course of up to 5000 simulated wear cycles. A total of four groups of telescopic crowns were investigated: group 1: 10 primary crowns made of a gold alloy (NEOCAST®3), group 2: 10 primary crowns made of a non-precious metal alloy (Girobond NB), group 3: 10 primary crowns made of zirconium (Cercon®base) and group 4: 10 primary crowns made from PEKK (Pekkton®ivory). The corresponding secondary crowns were made from PEKK in all the four groups. Each pair was fixed axially in a wear simulator specifically designed for the study. Overall, 10,000 joining and separating cycles were performed for each group. To simulate intraoral conditions, a saliva substitute served as a lubricant. Force transducers were used to record the retention forces and after completing 10,000 cycles, the surface of each primary crown was examined using a scanning electron microscope (SEM). All groups showed an increase in the retention force for the first 2000 cycles which stayed constant for the remaining 8000 cycles. The Pekkton®ivory/Pekkton®ivory and NEOCAST®3/Pekkton®ivory combinations displayed mean retention force values of 16 N after a slight increase in the retention force. The Cercon®base/Pekkton®ivory and Girobond NB/Pekkton®ivory combinations displayed an initially high increase in the retention force and then showed a mean retention force of up to 29 N. All primary crowns displayed surface wear. Zirconium primary crowns showed the least wear compared to PEKK and the gold and non-precious metal alloys.

Locator® versus ceramic/electroplated double-crown attachments: a prospective study on the intraindividual comparison of implant-supported mandibular prostheses

OBJECTIVES

Implant-supported overdentures are an established dental treatment mode. The aim of this prospective study was and interindividual comparison of patient satisfaction with restorations retained by a prefabricated and thus inexpensive attachment system (Locator®) or with a technologically complex and thus expensive attachment system (ceramic/electroplated double crowns) with similar retentive performance.

MATERIALS AND METHODS

Twelve patients received a Locator and a double-crown prosthesis in a crossover study for test periods of 3 months each. The main target parameter was the patient's final decision in favor of one of the two prosthesis types.

RESULTS

After completing both test phases, seven patients opted for the Locator prosthesis and five patients opted for the double-crown prosthesis.

CONCLUSION

Given the predominant lack of statistically significant differences, the two types of prostheses can be described as equivalent. A recommendation in favor of the Locator prosthesis can be motivated by its lower cost.

CLINICAL RELEVANCE

The results of the study show that the more cost-effective variant was comparable to the more expensive double-crown prosthesis under the conditions prevailing in the study. Depending on the indication, this may influence the decision-making process in daily clinical practice and support the clinician's patient information and consultation efforts.

Telescopic Denture

Aim:

This article explains the concept of telescopic denture.

Procedure:

It describes the different types of telescopic attachment (or double crown), and provides an overview of the advantages and the disadvantages of this type of prosthodontic treatment.

Conclusion:

The indications and the clinical applications of telescopic denture are discussed.

Comparison of retention forces with various fabrication methods and materials in double crowns

PURPOSE

The purpose of this study was to analyze the retention force changes and wear behaviours of double-crown systems over long-term use.

MATERIALS AND METHODS

Ten groups, each consisting of six samples, were evaluated. Specifically, casting gold alloy primary crown - casting gold alloy secondary crown (AA), laser sintering primary crown - laser sintering secondary crown (LL), casting Cr alloy primary crown - casting Cr alloy secondary crown, (CC) zirconia primary crown - electroformed secondary crown (ZA), and CAD/CAM titanium alloy primary crown - CAD/CAM titanium alloy secondary crown (TT) groups were evaluated at cone angles of 4° and 6°. The samples were subjected to 5,000 insertion-separation cycles in artificial saliva, and the retention forces were measured every 500 cycles. The wear levels were analyzed via SEM at the beginning and end of the 5,000 cycles.

RESULTS

In all samples, the retention forces increased when the conus angle decreased. The highest initial and final retention force values were found in the LL-4° group (32.89 N-32.65 N), and the lowest retention force values were found in the ZA6° group (5.41 N-6.27 N). The ZA groups' samples showed the least change in the retention force, and no wear was observed. In the other groups, wear was observed mostly in the primary crowns.

CONCLUSION

More predictable, clinically relevant, and less excursive retention forces can be observed in the ZA groups. The retention force values of the LL groups were statically similar to those of the other groups, except the ZA groups.

A method and a device for the evaluation of the retention of telescopic dental crowns

Telescopic crowns are used as support for removable dental prostheses' construction. A distinctive feature of crowns often used in their description and comparison is retention, which is understood as resistance when removing the prosthesis or a force needed to disconnect crowns. The article describes a method for the evaluation of retention in simulated conditions using a dedicated testing device. By subjecting the crown to cyclic loads in the range of forces occurring during clinical use and in the range of cycles leading to visible effects of wear, the method provides the evaluation of crowns in a wide range of duration, up to the loss of functionality. It also facilitates the identification of dominant phases of crown behaviour, which may be correlated with the results of clinical trials.

Wear of double crown systems: electroplated vs. casted female part

OBJECTIVES

The wear of telescopic crowns is a common problem often reducing the patient's satisfaction with the denture and resulting in a renewal of the denture. The study aims to compare the wear behavior of conical crowns using electroplated copings (group E ) with standard telescopic crowns with cast female parts (group C).

MATERIAL AND METHODS

10 conical crowns were milled for each group of a cast gold alloy. The specimen of group E had a conicity of 2º. The cast secondary crowns of group C had a 0º design. The electroplated coping was established by direct electroforming. An apparatus accomplishing 10,000 wear cycles performed the wear test. The retentive forces and the correlating distance during insertion and separation were measured. The wear test was separated in a start phase, an initial wear phase and the long term wear period. The retention force value and the force-distance integral of the first 0.33 mm of each cycle were calculated.

RESULTS

The retentive forces were significantly higher for group E and the integrals were significantly lower for this group except the integral at cycle 10,000. The changes of retention force and integral did not differ significantly between both groups in all phases. The change of the integrals as well as the integral at the particular cycles showed higher interquartile distances for group C.

CONCLUSIONS

Within the limitations of this study the tested conical crowns showed clinically acceptable retentive properties. The values reached a range comparable to retentive elements tested in recent literature. The values of group C showed higher ranges. The force measured for group E was significantly higher than for group C but the integrals showed an opposite tendency. The results indicate that an exclusive analysis of the force is not sufficient as the integral is not equivalent to the force although it describes the retentive property of the system in a better way than the force over a distance is described. Both systems seem to be suitable for clinical practice.

Telescopic crowns: extra-oral and intra-oral retention force measurement--in vitro/in vivo correlation

OBJECTIVE

This study deals with the determination of the retentive forces of telescopic crowns measured extra- and intra-orally and the correlation of these values.

BACKGROUND

The telescopic denture is a well-documented solution for prosthetic rehabilitation for a partially edentulous jaw. Acceptable retention forces are needed to avoid inadvertent removal of the denture during movement of the jaws. Recent literature suggests 3-7 N per attachment to be acceptable. These values are only supported by in vitro studies. In vivo data are scarce, and a correlation of the in vitro and in vivo values is lacking.

MATERIAL AND METHODS

Twenty-five combined fixed-removable prostheses with a total of 72 double crowns were used for extra-oral retention force measurement prior to cementation (in vitro). The intra-oral measurement was performed at 72 defined measuring points of the dentures 4-6 weeks after prosthetic rehabilitation (in vivo). A specifically designed measuring device was used.

RESULTS

The rank correlation showed that the in vitro and in vivo values correlate with each other (Spearman's ρ = 0.5052). Additionally, it was found that the median values measured before (1.97N) insertion of the dentures were significantly lower than after (4.70N) insertion (Mann-Whitney test, p ≤ 0.0001).

CONCLUSION

The retention forces measured before and after insertion of the denture correlate with each other although their dimension is significantly higher after insertion. The reason for this behaviour might be some tilting during removal. Nevertheless, the correlation allows a prediction of the clinically relevant forces by a measurement of the extra-orally measured retentive values.