1
|
da Silva AMP, Horta Dos Santos FA, Mota RF, Teixeira MKS, Telles DM, Lourenço EJV. Clinical and radiographic outcomes of a two-piece ceramic implant: one year results from a prospective clinical trial. Clin Oral Investig 2024; 28:380. [PMID: 38886209 DOI: 10.1007/s00784-024-05783-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To describe the clinical and radiographic performance and survival rate of a new two-piece ceramic implant system after at least 12 months of follow-up. MATERIALS AND METHODS Sixty-five implants were placed and followed up for at least 12 months (12.3 ± 1.5), in 50 patients. The implants were installed both in fresh extraction sockets and in healed sites and received provisional restoration when the clinical insertion torque was greater than 35Ncm. The primary results describe the survival rate of these implants. Clinical performance was evaluated through the evaluation of the Pink Esthetic Score (PES) and the degree of satisfaction of the patients. Bone loss was measured through radiographic measurements of the marginal bone loss in the mesial (MBLM) and distal (MBLD) sites. RESULTS The survival rate was 98.5%. The average MBLM was 0.24 mm (± 0.53) and the MBLD was 0.27 mm (± 0.57). A statistical difference was observed only when comparing immediate implants with delayed ones (MBLM - p = 0.046 and MBLD - p = 0.028) and when they received immediate provisionalization or not (MBLM - p = 0.009 and MBLD - p = 0.040). The PES before the intervention (T0) was 13.4 (± 0.8) and the PES at T2 (12-month follow-up) was 12.9 (± 1.5) (p = 1.14). CONCLUSION The new two-piece ceramic implant used in the present study showed predictable and reliable results, similar to those found with titanium implants after one year of follow-up. CLINICAL RELEVANCE These implants can be used as an alternative to titanium implants in terms of the marginal bone loss and the degree of patient satisfaction.
Collapse
Affiliation(s)
- Alexandre Marques Paes da Silva
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | | | - Rodrigo Franco Mota
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | - Mayla Kezy Silva Teixeira
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil.
| | - Daniel Moraes Telles
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | - Eduardo José Veras Lourenço
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| |
Collapse
|
2
|
de Beus JHW, Cune MS, Slot JWA, Jensen-Louwerse C, la Bastide-van Gemert S, Meijer HJA, Raghoebar GM, Schepke U. A randomized clinical trial on zirconia versus titanium implants in maxillary single tooth replacement. Clin Oral Implants Res 2024; 35:630-640. [PMID: 38567929 DOI: 10.1111/clr.14258] [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: 11/08/2023] [Revised: 03/08/2024] [Accepted: 03/14/2024] [Indexed: 06/11/2024]
Abstract
OBJECTIVES This RCT aimed to compare zirconia and titanium dental implants in the maxillary premolar region. The comparison was based on marginal bone level (MBL) changes, clinical parameters, aesthetic outcomes, and patient related outcome measures (PROMs) 1 year after prosthetic loading. MATERIALS AND METHODS Fifty patients were randomly assigned to receive either a zirconia (ZrO2, n = 25) implant or a titanium (Ti, n = 25) bone-level implant. Implants were provided with a lithium disilicate crown 3 months after placement. Follow-up was at 1 month and after 1 year. The primary outcome pertained to changes in MBL. Reported secondary outcomes consisted of implant survival, peri-implant tissue health, aesthetics, and PROMs. RESULTS Mean MBL change after 1 year was 0.01 mm (SD = 0.45; min = 0.72, max = 0.86) for ZrO2 and -0.09 mm (SD = 0.34; min = 0.53, max = -1.06) for Ti (p = .439). Scores for the other clinical outcome parameters and PROMs were generally favorable, with no significant differences. However, significant differences were found for the aesthetic outcomes regarding two criteria: (a) level of facial mucosa (p = .022), in favor of Ti, and (b) root convexity/soft tissue color and texture (p = .005) in favor of ZrO2. CONCLUSION AND CLINICAL IMPLICATIONS The ZrO2 and Ti implant types used in this study, replacing a single missing maxillary premolar, show a comparable outcome in terms of MBL change after 1 year. Clinical and aesthetic parameters, as well as PROMs, are favorable and similar between both implant types after 1 year of prosthetic loading. These short-term study results suggest that both are suitable for clinical use.
Collapse
Affiliation(s)
- J H W de Beus
- Department of Restorative Dentistry, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, University of Groningen, Groningen, The Netherlands
- Department of Oral Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M S Cune
- Department of Restorative Dentistry, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, University of Groningen, Groningen, The Netherlands
- Department of Oral Maxillofacial Surgery, St. Antonius Hospital, Prosthodontics and Special Dental Care, Nieuwegein, The Netherlands
| | - J W A Slot
- Department of Restorative Dentistry, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, University of Groningen, Groningen, The Netherlands
| | - C Jensen-Louwerse
- Department of Restorative Dentistry, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, University of Groningen, Groningen, The Netherlands
| | - S la Bastide-van Gemert
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - H J A Meijer
- Department of Restorative Dentistry, University Medical Center Groningen, Center for Dentistry and Oral Hygiene, University of Groningen, Groningen, The Netherlands
- Department of Oral Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G M Raghoebar
- Department of Oral Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - U Schepke
- Department of Oral Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
3
|
Yu YM, Lu YP, Zhang T, Zheng YF, Liu YS, Xia DD. Biomaterials science and surface engineering strategies for dental peri-implantitis management. Mil Med Res 2024; 11:29. [PMID: 38741175 DOI: 10.1186/s40779-024-00532-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 04/29/2024] [Indexed: 05/16/2024] Open
Abstract
Peri-implantitis is a bacterial infection that causes soft tissue inflammatory lesions and alveolar bone resorption, ultimately resulting in implant failure. Dental implants for clinical use barely have antibacterial properties, and bacterial colonization and biofilm formation on the dental implants are major causes of peri-implantitis. Treatment strategies such as mechanical debridement and antibiotic therapy have been used to remove dental plaque. However, it is particularly important to prevent the occurrence of peri-implantitis rather than treatment. Therefore, the current research spot has focused on improving the antibacterial properties of dental implants, such as the construction of specific micro-nano surface texture, the introduction of diverse functional coatings, or the application of materials with intrinsic antibacterial properties. The aforementioned antibacterial surfaces can be incorporated with bioactive molecules, metallic nanoparticles, or other functional components to further enhance the osteogenic properties and accelerate the healing process. In this review, we summarize the recent developments in biomaterial science and the modification strategies applied to dental implants to inhibit biofilm formation and facilitate bone-implant integration. Furthermore, we summarized the obstacles existing in the process of laboratory research to reach the clinic products, and propose corresponding directions for future developments and research perspectives, so that to provide insights into the rational design and construction of dental implants with the aim to balance antibacterial efficacy, biological safety, and osteogenic property.
Collapse
Affiliation(s)
- Ya-Meng Yu
- Department of Dental Materials, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, 100081, China
| | - Yu-Pu Lu
- Department of Dental Materials, Peking University School and Hospital of Stomatology, Beijing, 100081, China
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, 100081, China
| | - Ting Zhang
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China
| | - Yu-Feng Zheng
- School of Materials Science and Engineering, Peking University, Beijing, 100871, China.
| | - Yun-Song Liu
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, 100081, China.
- Department of Prosthodontics, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
| | - Dan-Dan Xia
- Department of Dental Materials, Peking University School and Hospital of Stomatology, Beijing, 100081, China.
- National Center for Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices, Beijing Key Laboratory of Digital Stomatology & NHC Key Laboratory of Digital Stomatology & NMPA Key Laboratory for Dental Materials, Beijing, 100081, China.
| |
Collapse
|
4
|
Kohal RJ, Riesterer E, Vach K, Patzelt SBM, Iveković A, Einfalt L, Kocjan A, Hillebrecht AL. Fracture Resistance of a Bone-Level Two-Piece Zirconia Oral Implant System-The Influence of Artificial Loading and Hydrothermal Aging. J Funct Biomater 2024; 15:122. [PMID: 38786633 PMCID: PMC11122605 DOI: 10.3390/jfb15050122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 04/24/2024] [Accepted: 05/04/2024] [Indexed: 05/25/2024] Open
Abstract
Preclinical and clinical research on two-piece zirconia implants are warranted. Therefore, we evaluated the in vitro fracture resistance of such a zirconia oral implant system. The present study comprised 32 two-piece zirconia implants and abutments attached to the implants using a titanium (n = 16) or a zirconia abutment screw (n = 16). Both groups were subdivided (n = 8): group T-0 comprised implants with a titanium abutment screw and no artificial loading; group T-HL was the titanium screw group exposed to hydro-thermomechanical loading in a chewing simulator; group Z-0 was the zirconia abutment screw group with no artificial loading; and group Z-HL comprised the zirconia screw group with hydro-thermomechanical loading. Groups T-HL and Z-HL were loaded with 98 N and aged in 85 °C hot water for 107 chewing cycles. All samples were loaded to fracture. Kruskal-Wallis tests were executed to assess the loading/bending moment group differences. The significance level was established at a probability of 0.05. During the artificial loading, there was a single occurrence of an implant fracture. The mean fracture resistances measured in a universal testing machine were 749 N for group T-0, 828 N for group Z-0, 652 N for group T-HL, and 826 N for group Z-HL. The corresponding bending moments were as follows: group T-0, 411 Ncm; group Z-0, 452 Ncm; group T-HL, 356 Ncm; and group Z-HL, 456 Ncm. There were no statistically significant differences found between the experimental groups. Therefore, the conclusion was that loading and aging did not diminish the fracture resistance of the evaluated implant system.
Collapse
Affiliation(s)
- Ralf J. Kohal
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (E.R.)
| | - Ellen Riesterer
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (E.R.)
| | - Kirstin Vach
- Medical Center—University of Freiburg, Institute of Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany;
| | - Sebastian B. M. Patzelt
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (E.R.)
- Private Dental Clinic, 78658 Zimmern ob Rottweil, Germany
| | - Aljaž Iveković
- Department for Nanostructured Materials, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (A.I.); (L.E.)
| | - Lara Einfalt
- Department for Nanostructured Materials, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (A.I.); (L.E.)
- Jožef Stefan International Postgraduate School, Jamova 39, 1000 Ljubljana, Slovenia
| | - Andraž Kocjan
- Department for Nanostructured Materials, Jožef Stefan Institute, Jamova 39, 1000 Ljubljana, Slovenia; (A.I.); (L.E.)
| | - Anna-Lena Hillebrecht
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (E.R.)
| |
Collapse
|
5
|
Gul A, Papia E, Naimi-Akbar A, Ruud A, Vult von Steyern P. Zirconia dental implants; the relationship between design and clinical outcome: A systematic review. J Dent 2024; 143:104903. [PMID: 38437977 DOI: 10.1016/j.jdent.2024.104903] [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: 11/17/2023] [Revised: 02/09/2024] [Accepted: 02/26/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVE To evaluate the clinical outcome of different designs of zirconia dental implants. DATA This systematic review adhered to the PRISMA checklist and followed the PICO framework. The protocol is registered in PROSPERO (CRD42022337228). SOURCES The search was conducted in March 2023 through four databases (PubMed, Web of Science, Cochrane Library, and Google Scholar) along with a search of references in the related reviews. Three authors reviewed on title, and abstract level and analysed the risk of bias, and all authors reviewed on a full-text level. STUDY SELECTION Clinical studies excluding case reports for patients treated with different designs of zirconia dental implants were included. From a total of 2728 titles, 71 full-text studies were screened, and 27 studies were included to assess the risk of bias (ROBINS-I tool) and data extraction. After quality assessment, four studies were included, and the remaining 23 excluded studies were narratively described. RESULT The included prospective studies with moderate risk of bias reported success and survival rates of one-piece implants that ranged between 95 and 98.4 % with no difference between different lengths and diameters. The acid-etched roughened surface showed higher clinical outcomes compared to other surface roughness designs. CONCLUSION Promising 5-year clinical outcomes were found for one-piece zirconia implants with no difference between different diameters and lengths. Concerning surface roughness, better outcomes were found when using the acid-etched implant surface. However, due to the limited available studies, further high-quality clinical studies comparing zirconia one-piece and two-piece implants with different diameters, lengths, and surface roughness are needed. CLINICAL SIGNIFICANCE Based on this systematic review, under suitable clinical situations, the one-piece zirconia implants with diameters of 4.0 mm, 4.5 mm, or 5.5 mm and lengths of 8 mm, 10 mm, 12 mm, or 14 mm have similar promising clinical outcomes. Additionally, the acid-etched roughened implant surface may be preferable.
Collapse
Affiliation(s)
- Abdulaziz Gul
- Department of Materials Science and Technology, Division 2, Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Oral and Maxillofacial Surgery, Faculty of Dental Medicine, Umm Al-Qura University, Makkah, Saudi Arabia.
| | - Evaggelia Papia
- Department of Materials Science and Technology, Division 2, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Aron Naimi-Akbar
- Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden; Department of Oral and Maxillofacial Surgery and Oral Medicine, Division 2, Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Amund Ruud
- Nordic Institute of Dental Materials, NIOM, Oslo, Norway
| | - Per Vult von Steyern
- Department of Materials Science and Technology, Division 2, Faculty of Odontology, Malmö University, Malmö, Sweden; Nordic Institute of Dental Materials, NIOM, Oslo, Norway
| |
Collapse
|
6
|
Leandro LNR, Barra Grande MF, Pelegrine AA, Nishioka RS, Teixeira ML, Basting RT. Stress distribution on implant- supported zirconia crown of maxillary first molar: effect of oblique load on natural and antagonist tooth. Comput Methods Biomech Biomed Engin 2024; 27:599-608. [PMID: 37022099 DOI: 10.1080/10255842.2023.2195962] [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: 11/17/2022] [Accepted: 03/22/2023] [Indexed: 04/07/2023]
Abstract
This study evaluated the stress distribution on an implant-supported zirconia crown of a mandibular first molar subjected to oblique loading by occlusal contact with the natural maxillary first molar by using the 3D finite element method. Two virtual models were made to simulate the following situations: (1) occlusion between maxillary and mandibular natural first molars; (2) occlusion between zirconia implant-supported ceramic crown on a mandibular first molar and maxillary natural first molar. The models were designed virtually in a modeling program or CAD (Computer Aided Design) (Rhinoceros). An oblique load of 100 N was uniformly applied to the zirconia framework of the crown. The results were obtained by the Von Mises criterion of stress distribution. Replacement of the mandibular tooth by an implant caused a slight increase in stress on portions of the maxillary tooth roots. The crown of the maxillary model in occlusion with natural antagonist tooth showed 12% less stress when compared with the maxillary (model in occlusion with the) implant-supported crown. The mandibular crown of the implant show 35% more stress when compared with the mandibular antagonist crown on the natural tooth. The presence of the implant to replace the mandibular tooth increased the stresses on the maxillary tooth, especially in the region of the mesial and distal buccal roots.
Collapse
|
7
|
Jiang C, Ding M, Zhang J, Zhu C, Qin W, Zhao Z, Jiao T. 3D Printed Porous Zirconia Biomaterials based on Triply Periodic Minimal Surfaces Promote Osseointegration In Vitro by Regulating Osteoimmunomodulation and Osteo/Angiogenesis. ACS APPLIED MATERIALS & INTERFACES 2024. [PMID: 38501200 DOI: 10.1021/acsami.3c18799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
The triply periodic minimal surface (TPMS) is a highly useful structure for bone tissue engineering owing to its nearly nonexistent average surface curvature, high surface area-to-volume ratio, and exceptional mechanical energy absorption properties. However, limited literature is available regarding bionic zirconia implants using the TPMS structure for bone regeneration. Herein, we employed the digital light processing (DLP) technology to fabricate four types of zirconia-based TPMS structures: P-cell, S14, IWP, and Gyroid. For cell proliferation, the four porous TPMS structures outperformed the solid zirconia group (P-cell > S14 > Gyroid > IWP > ZrO2). In vitro assessments on the biological responses and osteogenic properties of the distinct porous surfaces identified the IWP and Gyroid structures as promising candidates for future clinical applications of porous zirconia implants because of their superior osteogenic capabilities (IWP > Gyroid > S14 > P-cell > ZrO2) and mechanical properties (ZrO2 > IWP > Gyroid > S14 > P-cell). Furthermore, the physical properties of the IWP/Gyroid surface had more substantial effects on bone immune regulation by reducing macrophage M1 phenotype polarization while increasing M2 phenotype polarization compared with the solid zirconia surface. Additionally, the IWP and Gyroid groups exhibited enhanced immune osteogenesis and angiogenesis abilities. Collectively, these findings highlight the substantial impact of topology on bone/angiogenesis and immune regulation in promoting bone integration.
Collapse
Affiliation(s)
- Chunlan Jiang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200062, P. R. China
| | - Mengting Ding
- Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200062, P. R. China
| | - Jin Zhang
- Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200062, P. R. China
| | - Chenyuan Zhu
- Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200062, P. R. China
| | - Wei Qin
- Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200062, P. R. China
| | - Zhe Zhao
- Jiaxing CeramPlus Technology Co. Ltd., Jiashan 314100, Zhejiang, P. R. China
| | - Ting Jiao
- Department of Prosthodontics, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, P. R. China
- Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai 200062, P. R. China
| |
Collapse
|
8
|
Le Ferrand H, Goh BT, Teoh SH. Nacre-like ceramic composites: Properties, functions and fabrication in the context of dental restorations. Acta Biomater 2024; 173:66-79. [PMID: 38016510 DOI: 10.1016/j.actbio.2023.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 11/02/2023] [Accepted: 11/22/2023] [Indexed: 11/30/2023]
Abstract
Dental restorations are in increasing demand, yet their success rate strongly decreases after 5-10 years post-implantation, attributed in part to mismatching properties with the surrounding buccal environment that causes failures and wear. Among current research to address this issue, biomimetic approaches are promising. Nacre-like ceramic composites are particularly interesting because they combine multiple antagonistic properties making them more resistant to failure in harsh environment than other materials. With the rapid progress in 3D printing producing nacre-like structures has open up new opportunities not yet realised. In this paper, nacre-like composites of various compositions are reviewed in the context of hypothetical biomimetic dental restorations. Their structural, functional and biological properties are compared with those of dentin, enamel, and bone to determine which composition would be the most suitable for each of the 3 mineralized regions found in teeth. The role of complex microstructures and mineral orientations are discussed as well as 3D printing methods that allow the design and fabrication of such complex architectures. Finally, usage of these processes and anticipated prospects for next generation biomimetic dental replacements are discussed to suggest future research directions in this area. STATEMENT OF SIGNIFICANCE: With the current ageing population, dental health is a major issue and current dental restorations still have shortcomings. For the next generation of dental restorations, more biomimetic approaches would be desirable to increase their durability. Among current materials, nacre-like ceramic composites are interesting because they can approach the various structural properties found in the different parts of our teeth. Furthermore, it is also possible to embed self-sensing functionalities to enable monitoring of oral health. Finally, new recent 3D printing technologies now permit the fabrication of complex shapes with local compositions and local microstructures. With this current status of the research, we anticipate new dental restorations designs and highlight the remaining gaps and issues to address.
Collapse
Affiliation(s)
- Hortense Le Ferrand
- School of Mechanical and Aerospace Engineering, 50 Nanyang Avenue, Nanyang Technological University, 639798 Singapore; Singapore 3D Printing Centre, 50 Nanyang Avenue, Nanyang Technological University, 639798 Singapore.
| | - Bee Tin Goh
- National Dental Research Institute Singapore (NDRIS), National Dental Centre Singapore, 5 Second Hospital Avenue, 168938, Singapore
| | - Swee-Hin Teoh
- Centre for Advanced Medical Engineering, School of Materials Science and Engineering, Hunan University, China
| |
Collapse
|
9
|
Kohal RJ, Schikofski T, Adolfsson E, Vach K, Patzelt SBM, Nold J, Wemken G. Fracture Resistance of a Two-Piece Zirconia Implant System after Artificial Loading and/or Hydrothermal Aging-An In Vitro Investigation. J Funct Biomater 2023; 14:567. [PMID: 38132821 PMCID: PMC10743638 DOI: 10.3390/jfb14120567] [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: 10/09/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
The purpose of the present study was to assess the fracture resistance of a two-piece alumina-toughened zirconia implant system with a carbon-reinforced PEEK abutment screw. METHODS Thirty-two implants with screw-retained zirconia abutments were divided into four groups of eight samples each. Group 0 (control group) was neither loaded nor aged in a chewing simulator; group H was hydrothermally aged; group L was loaded with 98 N; and group HL was subjected to both hydrothermal aging and loading in a chewing simulator. One sample of each group was evaluated for t-m phase transformation, and the others were loaded until fracture. A one-way ANOVA was applied to evaluate differences between the groups. RESULTS No implant fracture occurred during the artificial chewing simulation. Furthermore, there were no statistically significant differences (p > 0.05) between the groups in terms of fracture resistance (group 0: 783 ± 43 N; group H: 742 ± 43 N; group L: 757 ± 86 N; group HL: 740 ± 43 N) and bending moment (group 0: 433 ± 26 Ncm; group H: 413 ± 23 Ncm; group L: 422 ± 49 Ncm; group HL: 408 ± 27 Ncm). CONCLUSIONS Within the limitations of the present investigation, it can be concluded that artificial loading and hydrothermal aging do not reduce the fracture resistance of the investigated implant system.
Collapse
Affiliation(s)
- Ralf-Joachim Kohal
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (T.S.); (J.N.); (G.W.)
| | - Tim Schikofski
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (T.S.); (J.N.); (G.W.)
| | - Erik Adolfsson
- RISE Research Institutes of Sweden, 431 53 Mölndal, Sweden;
| | - Kirstin Vach
- Medical Center—University of Freiburg, Institute for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany;
| | - Sebastian Berthold Maximilian Patzelt
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (T.S.); (J.N.); (G.W.)
- Private Dental Clinic, 78658 Zimmern ob Rottweil, Germany
| | - Julian Nold
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (T.S.); (J.N.); (G.W.)
| | - Gregor Wemken
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (T.S.); (J.N.); (G.W.)
| |
Collapse
|
10
|
Khaohoen A, Sornsuwan T, Chaijareenont P, Poovarodom P, Rungsiyakull C, Rungsiyakull P. Biomaterials and Clinical Application of Dental Implants in Relation to Bone Density-A Narrative Review. J Clin Med 2023; 12:6924. [PMID: 37959389 PMCID: PMC10649288 DOI: 10.3390/jcm12216924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Titanium has been the material of choice for dental implant fixtures due to its exceptional qualities, such as its excellent balance of rigidity and stiffness. Since zirconia is a soft-tissue-friendly material and caters to esthetic demands, it is an alternative to titanium for use in implants. Nevertheless, bone density plays a vital role in determining the material and design of implants. Compromised bone density leads to both early and late implant failures due to a lack of implant stability. Therefore, this narrative review aims to investigate the influence of implant material/design and surgical technique on bone density from both biomechanical and biological standpoints. Relevant articles were included for analysis. Dental implant materials can be fabricated from titanium, zirconia, and PEEK. In terms of mechanical and biological aspects, titanium is still the gold standard for dental implant materials. Additionally, the macro- and microgeometry of dental implants play a role in determining and planning the appropriate treatment because it can enhance the mechanical stress transmitted to the bone tissue. Under low-density conditions, a conical titanium implant design, longer length, large diameter, reverse buttress with self-tapping, small thread pitch, and deep thread depth are recommended. Implant material, implant design, surgical techniques, and bone density are pivotal factors affecting the success rates of dental implant placement in low-density bone. Further study is required to find the optimal implant material for a clinical setting's bone state.
Collapse
Affiliation(s)
- Angkoon Khaohoen
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| | - Tanapon Sornsuwan
- Department of Restorative Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok 65000, Thailand;
| | - Pisaisit Chaijareenont
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| | - Pongsakorn Poovarodom
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| | - Chaiy Rungsiyakull
- Department of Mechanical Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Pimduen Rungsiyakull
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| |
Collapse
|
11
|
Padhye NM, Calciolari E, Zuercher AN, Tagliaferri S, Donos N. Survival and success of zirconia compared with titanium implants: a systematic review and meta-analysis. Clin Oral Investig 2023; 27:6279-6290. [PMID: 37740825 PMCID: PMC10630218 DOI: 10.1007/s00784-023-05242-5] [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: 11/11/2022] [Accepted: 09/05/2023] [Indexed: 09/25/2023]
Abstract
OBJECTIVE This systematic review assessed the available evidence on the survival and success rate of zirconia and titanium implants. As secondary outcomes, aesthetic, radiographic and clinical parameters, as well as biological and mechanical complications, were considered. MATERIALS AND METHODS A systematic search was performed up to March 2022 to identify CCTs/RCTs comparing zirconia and titanium implants with a minimum of 12 months of follow-up. Meta-analysis was performed when ≥ 2 articles with similar characteristics were retrieved. RESULTS Four published articles with two RCTs (2 different patient populations) with 100 zirconia and 99 titanium implants that were followed up over 12-80 months were selected out of the 6040 articles. A non-statistically significant difference between zirconia and titanium implant survival at 12 months was suggested (P = 0.0938). The success rates were 57.5-93.3% and 57.1-100% for zirconia and titanium implants, respectively. The pink aesthetic score (PES) was higher for zirconia (10.33 ± 2.06 to 11.38 ± 0.92) compared to titanium implants (8.14 ± 3.58 to 11.56 ± 1.0). CONCLUSION Based on the 2 RCTs retrieved in the literature, similar survival rates were reported for zirconia and titanium implants in the short term (12 months of follow-up). Future RCTs are warranted to evaluate the long-term outcomes of zirconia implants. CLINICAL RELEVANCE Zirconia implants may be the procedure of choice, particularly in the aesthetic zone, since they show a similar survival and success rate as titanium implants on a short-term follow-up. TRIAL REGISTRATION Systematic review registration number-CRD42021288704 (PROSPERO).
Collapse
Affiliation(s)
- Ninad Milind Padhye
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | - Elena Calciolari
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
- Department of Medicine and Surgery, Centre of Dentistry, University of Parma, Parma, Italy
| | - Anina Nives Zuercher
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
- Clinic of Reconstructive Dentistry, Centre of Dental Medicine, Zurich, Switzerland
| | - Sara Tagliaferri
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Center of Excellence for Toxicological Research, CERT, University of Parma, Parma, Italy
| | - Nikos Donos
- Centre for Oral Clinical Research, Institute of Dentistry, Faculty of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK.
| |
Collapse
|
12
|
Helal E, Gierthmuehlen PC, Bonfante EA, Campos TMB, Prott LS, Langner R, Spitznagel FA. Influence of straight versus angulated screw channel titanium bases on failure loads of two-piece ceramic and titanium implants restored with screw-retained monolithic crowns: An in-vitro study. Clin Oral Implants Res 2023; 34:1217-1229. [PMID: 37565379 DOI: 10.1111/clr.14157] [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: 05/13/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE To analyze the influence of titanium-base (straight [SSC]/angulated-screw-channel [ASC]) on failure-loads and bending-moments of two-piece ceramic and titanium-zirconium implants restored with monolithic-zirconia crowns after fatigue. MATERIALS AND METHODS Thirty-two anterior monolithic-screw-retained zirconia crowns were divided into four groups (n = 8/group) according to the factors: (1) type of implant material: two-piece titanium-zirconium implant (Ti-Zr; control-group) versus two-piece ceramic implant (CI; test-group) and (2) type of titanium-base: SSC (0° angle) versus ASC (25°). An intact implant was used for field emission gun-scanning electronic microscopy (FEG-SEM) characterization and Raman spectroscopy for phase analyses and residual stress quantification. All samples were exposed to fatigue with thermodynamic loading (1.2-million-cycles, 49 N, 1.6 Hz, 5-55°C) at a 30° angle. Surviving specimens were loaded until failure (SLF) and bending moments were recorded. Failed samples were examined using light microscope and SEM. Statistical analyses included ANOVA and Mann-Whitney U-test. RESULTS Raman-spectroscopy revealed the presence of residual compressive stresses. FEG-SEM revealed a roughened surface between threads and polished surface at the cervical-collar of the ceramic implant. All samples survived fatigue and were free of complications. Mean bending-moments (±SD) were: Ti-Zr-0: 241 ± 45 N cm, Ti-Zr-25: 303 ± 86 N cm, CI-0: 326 ± 58 N cm, CI-25: 434 ± 71 N cm. Titanium-base and implant-material had significant effects in favor of ASC titanium bases (p = .001) and ceramic-implants (p < .001). Failure analysis after SLF revealed severe fractures in ceramic implants, whereas titanium implants were restricted to plastic deformation. CONCLUSIONS Ceramic and titanium implants exhibited high reliability after fatigue, with no failures. From a mechanical perspective, titanium bases with ASC can be recommended for both ceramic and titanium implants and are safe for clinical application.
Collapse
Affiliation(s)
- E Helal
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - P C Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - E A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
| | - T M B Campos
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, Brazil
| | - L S Prott
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - R Langner
- Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behavior (INM-7), Research Center Jülich, Jülich, Germany
| | - F A Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
13
|
Dewan H, Sayed ME, Jundus A, Gharawi M, Baeshen S, Alali M, Almarzouki M, Jokhadar HF, AlResayes SS, Al Wadei MHD, Thubab A, Abu Illah MJ, Moafa A. Shear Strength of Repaired 3D-Printed and Milled Provisional Materials Using Different Resin Materials with and without Chemical and Mechanical Surface Treatment. Polymers (Basel) 2023; 15:4284. [PMID: 37959963 PMCID: PMC10648486 DOI: 10.3390/polym15214284] [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: 09/30/2023] [Revised: 10/28/2023] [Accepted: 10/29/2023] [Indexed: 11/15/2023] Open
Abstract
The aim of this study was to assess the shear bond strength of 3D-printed and milled provisional restorations using various resin materials and surface finishes. There were 160 preliminary samples in all, and they were split into two groups: the milled group and the 3D-printed group. Based on the resin used for repair (composite or polymethylmethacrylate (PMMA)) and the type of surface treatment utilized (chemical or mechanical), each group was further divided into subgroups. The specimens were subjected to thermocycling from 5 °C to 55 °C for up to 5000 thermal cycles with a dwell time of 30 s. The mechanical qualities of the repaired material underwent testing for shear bond strength (SBS). To identify the significant differences between the groups and subgroups, a statistical analysis was carried out. Three-way ANOVA was used to analyze the effects of each independent component (the material and the bonding condition), as well as the interaction between the independent factors on shear bond strength. Tukey multiple post-hoc tests were used to compare the mean results for each material under various bonding circumstances. The shear bond strengths of the various groups and subgroups differed significantly (p < 0.05). When compared to the milled group, the 3D-printed group had a much greater mean shear bond strength. When compared to PMMA repair, the composite resin material showed a noticeably greater shear bond strength. In terms of surface treatments, the samples with mechanical and chemical surface treatments had stronger shear bonds than those that had not received any. The results of this study demonstrate the effect of the fabrication method, resin type, and surface treatment on the shear bond strength of restored provisional restorations. Particularly when made using composite material and given surface treatments, 3D-printed provisional restorations showed exceptional mechanical qualities. These results can help dentists choose the best fabrication methods, resin materials, and surface treatments through which to increase the durability and bond strength of temporary prosthesis.
Collapse
Affiliation(s)
- Harisha Dewan
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Mohammed E. Sayed
- Department of Prosthetic Dental Sciences, College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia
| | - Asayil Jundus
- College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (A.J.); (M.G.); (S.B.); (M.A.); (A.T.); (M.J.A.I.); (A.M.)
| | - Mafaz Gharawi
- College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (A.J.); (M.G.); (S.B.); (M.A.); (A.T.); (M.J.A.I.); (A.M.)
| | - Safeyah Baeshen
- College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (A.J.); (M.G.); (S.B.); (M.A.); (A.T.); (M.J.A.I.); (A.M.)
| | - Maimonah Alali
- College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (A.J.); (M.G.); (S.B.); (M.A.); (A.T.); (M.J.A.I.); (A.M.)
| | - Mai Almarzouki
- Department of Restorative Dentistry, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Hossam F. Jokhadar
- Department of Oral and Maxillofacial Prosthodontics, Faculty of Dentistry, King Abdulaziz University, Jeddah 21589, Saudi Arabia;
| | - Saad Saleh AlResayes
- Department of Prosthetic Dental Sciences, College of Dentistry, King Saud University, Riyadh 12372, Saudi Arabia;
| | - Mohammed H. D. Al Wadei
- Department of Restorative Dental Sciences, College of Dentistry, King Khalid University, Abha 61413, Saudi Arabia;
| | - Abdulaziz Thubab
- College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (A.J.); (M.G.); (S.B.); (M.A.); (A.T.); (M.J.A.I.); (A.M.)
| | - Mohammed Jabril Abu Illah
- College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (A.J.); (M.G.); (S.B.); (M.A.); (A.T.); (M.J.A.I.); (A.M.)
| | - Alkhansa Moafa
- College of Dentistry, Jazan University, Jazan 45142, Saudi Arabia; (A.J.); (M.G.); (S.B.); (M.A.); (A.T.); (M.J.A.I.); (A.M.)
| |
Collapse
|
14
|
Suzumura T, Matsuura T, Komatsu K, Sugita Y, Maeda H, Ogawa T. Vacuum Ultraviolet (VUV) Light Photofunctionalization to Induce Human Oral Fibroblast Transmigration on Zirconia. Cells 2023; 12:2542. [PMID: 37947620 PMCID: PMC10647316 DOI: 10.3390/cells12212542] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/26/2023] [Accepted: 10/27/2023] [Indexed: 11/12/2023] Open
Abstract
Soft tissue adhesion and sealing around dental and maxillofacial implants, related prosthetic components, and crowns are a clinical imperative to prevent adverse outcomes of periodontitis and periimplantitis. Zirconia is often used to fabricate implant components and crowns. Here, we hypothesized that UV treatment of zirconia would induce unique behaviors in fibroblasts that favor the establishment of a soft tissue seal. Human oral fibroblasts were cultured on zirconia specimens to confluency before placing a second zirconia specimen (either untreated or treated with one minute of 172 nm vacuum UV (VUV) light) next to the first specimen separated by a gap of 150 µm. After seven days of culture, fibroblasts only transmigrated onto VUV-treated zirconia, forming a 2.36 mm volume zone and 5.30 mm leading edge. Cells migrating on VUV-treated zirconia were enlarged, with robust formation of multidirectional cytoplastic projections, even on day seven. Fibroblasts were also cultured on horizontally placed and 45° and 60° tilted zirconia specimens, with the latter configurations compromising initial attachment and proliferation. However, VUV treatment of zirconia mitigated the negative impact of tilting, with higher tilt angles increasing the difference in cellular behavior between control and VUV-treated specimens. Fibroblast size, perimeter, and diameter on day seven were greater than on day one exclusively on VUV-treated zirconia. VUV treatment reduced surface elemental carbon and induced superhydrophilicity, confirming the removal of the hydrocarbon pellicle. Similar effects of VUV treatment were observed on glazed zirconia specimens with silica surfaces. One-minute VUV photofunctionalization of zirconia and silica therefore promotes human oral fibroblast attachment and proliferation, especially under challenging culture conditions, and induces specimen-to-specimen transmigration and sustainable photofunctionalization for at least seven days.
Collapse
Affiliation(s)
- Toshikatsu Suzumura
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative and Reconstructive Sciences, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA
- Department of Oral Pathology/Forensic Odontology, School of Dentistry, Aichi Gakuin University, Nagoya 464-8650, Japan
| | - Takanori Matsuura
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative and Reconstructive Sciences, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA
| | - Keiji Komatsu
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative and Reconstructive Sciences, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA
| | - Yoshihiko Sugita
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative and Reconstructive Sciences, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA
- Department of Oral Pathology/Forensic Odontology, School of Dentistry, Aichi Gakuin University, Nagoya 464-8650, Japan
| | - Hatsuhiko Maeda
- Department of Oral Pathology/Forensic Odontology, School of Dentistry, Aichi Gakuin University, Nagoya 464-8650, Japan
| | - Takahiro Ogawa
- Weintraub Center for Reconstructive Biotechnology, Division of Regenerative and Reconstructive Sciences, UCLA School of Dentistry, Los Angeles, CA 90095-1668, USA
| |
Collapse
|
15
|
Roehling S, Gahlert M, Bacevic M, Woelfler H, Laleman I. Clinical and radiographic outcomes of zirconia dental implants-A systematic review and meta-analysis. Clin Oral Implants Res 2023; 34 Suppl 26:112-124. [PMID: 37750521 DOI: 10.1111/clr.14133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES For the present review, the following focused question was addressed: In patients with root-analog dental implants, what is the effect of implants made of other materials than titanium (alloy) on implant survival, marginal bone loss (MBL), and technical and biological complications after at least 5 years. MATERIALS AND METHODS An electronic (Medline, Embase, Web of Science) search was performed to identify observational clinical studies published from January 2000 investigating a minimum of 20 commercially available zirconia implants with a mean follow-up of at least 60 months. Primary outcome was implant survival, secondary outcomes included peri-implant MBL, probing depths (PDs), and technical and biological complications. Meta-analyses were performed to evaluate implant survival, MBL, and PD. RESULTS From 5129 titles, 580 abstracts were selected, and 111 full-text articles were screened. Finally, 4 prospective and 2 retrospective observational clinical cohort studies were included for data extraction. Meta-analyses estimated after 5 years of loading mean values of 97.2% (95% CI 94.7-99.1) for survival (277 implants, 221 patients), 1.1 mm (95% CI: 0.9-1.3) for MBL (229 implants, 173 patients), and 3.0 mm (95% CI 2.5-3.4) for PDs (231 implants, 175 patients). CONCLUSIONS After 5 years, commercially available zirconia implants showed reliable clinical performance based on survival rates, MBL, and PD values. However, more well-designed prospective clinical studies and randomized clinical trials investigating titanium and zirconia implants are needed to confirm the presently evaluated promising outcomes.
Collapse
Affiliation(s)
- S Roehling
- Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Clinic for Oral and Cranio-Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
- Private Dental Clinic PD Dr. Gahlert & PD Dr. Roehling, Munich, Germany
| | - M Gahlert
- Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Private Dental Clinic PD Dr. Gahlert & PD Dr. Roehling, Munich, Germany
- Sigmund Freud Private University, Vienna, Austria
| | - M Bacevic
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
- Centre for Oral Clinical Research, Institute of Dentistry, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | | | - I Laleman
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
- Dental Biomaterials Research Unit (d-BRU), Faculty of Medicine, University of Liège, Liège, Belgium
| |
Collapse
|
16
|
Staehlke S, Brief J, Senz V, Eickner T, Nebe JB. Optimized Gingiva Cell Behavior on Dental Zirconia as a Result of Atmospheric Argon Plasma Activation. MATERIALS (BASEL, SWITZERLAND) 2023; 16:4203. [PMID: 37374388 DOI: 10.3390/ma16124203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 06/01/2023] [Accepted: 06/03/2023] [Indexed: 06/29/2023]
Abstract
Several physico-chemical modifications have been developed to improve cell contact with prosthetic oral implant surfaces. The activation with non-thermal plasmas was one option. Previous studies found that gingiva fibroblasts on laser-microstructured ceramics were hindered in their migration into cavities. However, after argon (Ar) plasma activation, the cells concentrated in and around the niches. The change in surface properties of zirconia and, subsequently, the effect on cell behavior is unclear. In this study, polished zirconia discs were activated by atmospheric pressure Ar plasma using the kINPen®09 jet for 1 min. Surfaces were characterized by scanning electron microscopy, X-ray photoelectron spectroscopy (XPS), and water contact angle. In vitro studies with human gingival fibroblasts (HGF-1) focused on spreading, actin cytoskeleton organization, and calcium ion signaling within 24 h. After Ar plasma activation, surfaces were more hydrophilic. XPS revealed decreased carbon and increased oxygen, zirconia, and yttrium content after Ar plasma. The Ar plasma activation boosted the spreading (2 h), and HGF-1 cells formed strong actin filaments with pronounced lamellipodia. Interestingly, the cells' calcium ion signaling was also promoted. Therefore, argon plasma activation of zirconia seems to be a valuable tool to bioactivate the surface for optimal surface occupation by cells and active cell signaling.
Collapse
Affiliation(s)
- Susanne Staehlke
- Institute for Cell Biology, Rostock University Medical Center, 18057 Rostock, Germany
| | - Jakob Brief
- VITA Zahnfabrik H. Rauter GmbH & Co. KG, 79713 Bad Säckingen, Germany
| | - Volkmar Senz
- Institute for Biomedical Engineering, Rostock University Medical Center, 18119 Rostock, Germany
| | - Thomas Eickner
- Institute for Biomedical Engineering, Rostock University Medical Center, 18119 Rostock, Germany
| | - J Barbara Nebe
- Institute for Cell Biology, Rostock University Medical Center, 18057 Rostock, Germany
- Department Science and Technology of Life, Light and Matter, University of Rostock, 18059 Rostock, Germany
| |
Collapse
|
17
|
Martinez-Gonzalez M, Fidalgo-Pereira RC, Torres O, Silva F, Henriques B, Özcan M, Souza JCM. Toxicity of resin-matrix cements in contact with fibroblast or mesenchymal cells. Odontology 2023; 111:310-327. [PMID: 36370322 DOI: 10.1007/s10266-022-00758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
The main aim of this study was to perform an integrative review on the toxic effects of resin-matrix cements and their products in contact with fibroblasts or mesenchymal cells. A bibliographic search was performed on PubMed using the following search terms: "cytotoxicity" AND "fibroblast" OR "epithelial" OR "mesenchymal" AND "polymerization" OR "degree of conversion" OR "methacrylate" OR "monomer" AND "resin cement" OR "resin-based cement". The initial search in the available database yielded a total of 277 articles of which 21 articles were included in this review. A decrease in the viability of mouse fibroblasts ranged between 13 and 15% that was recorded for different resin-matrix cements after light curing exposure for 20 s. The viability of human fibroblasts was recorded at 83.11% after light curing for 20 s that increased up to 90.9% after light curing exposure for 40 s. Most of the studies linked the highest toxicity levels when the cells were in contact with Bis-GMA followed by UDMA, TEGDMA and HEMA. Resin-matrix cements cause a cytotoxic reaction when in contact with fibroblasts or mesenchymal cells due to the release of monomers from the polymeric matrix. The amount of monomers released from the resin matrix and their cytotoxicity depends on the polymerization parameters.
Collapse
Affiliation(s)
| | - Rita C Fidalgo-Pereira
- University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra PRD, Portugal
- Faculty of Dental Medicine, Universidade Católica Portuguesa, 3504-505, Viseu, Portugal
| | - Orlanda Torres
- University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra PRD, Portugal
| | - Filipe Silva
- Center for Micro Electro Mechanical Systems (CMEMS-UMINHO), University of Minho, Campus Azurém, 4800-058, Guimarães, Portugal
- Associate Laboratory (LABBELS), University of Minho, 4710-057, Guimarães, Braga, Portugal
| | - Bruno Henriques
- Center for Micro Electro Mechanical Systems (CMEMS-UMINHO), University of Minho, Campus Azurém, 4800-058, Guimarães, Portugal
- Ceramic and Composite Materials Research Group (CERMAT), Federal University of Santa Catarina (UFSC), Campus Trindade, Florianópolis, SC, 88040-900, Brazil
| | - Mutlu Özcan
- Division of Dental Biomaterials, Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, 8032, Zurich, Switzerland
| | - Júlio C M Souza
- University Institute of Health Sciences (IUCS), CESPU, 4585-116, Gandra PRD, Portugal.
- Center for Micro Electro Mechanical Systems (CMEMS-UMINHO), University of Minho, Campus Azurém, 4800-058, Guimarães, Portugal.
- Associate Laboratory (LABBELS), University of Minho, 4710-057, Guimarães, Braga, Portugal.
| |
Collapse
|
18
|
Lee SH, Kang MS, Jeon S, Jo HJ, Hong SW, Kim B, Han DW. 3D bioprinting of human mesenchymal stem cells-laden hydrogels incorporating MXene for spontaneous osteodifferentiation. Heliyon 2023; 9:e14490. [PMID: 36994406 PMCID: PMC10040522 DOI: 10.1016/j.heliyon.2023.e14490] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/16/2023] Open
Abstract
Contemporary advances in three-dimensional (3D) bioprinting technologies have enabled the fabrication of tailored live 3D tissue mimetics. Furthermore, the development of advanced bioink materials has been highlighted to accurately reproduce the composition of a native extracellular matrix and mimic the intrinsic properties of laden cells. Recent research has shown that MXene is one of promising nanobiomaterials with osteogenic activity for bone grafts and scaffolds due to its unique atomic structure of three titanium layers between two carbon layers. In this study, the MXene-incorporated gelatin methacryloyl (GelMA) and hyaluronic acid methacryloyl (HAMA) (i.e., GelMA/HAMA-MXene) bioinks were prepared to explore if they have the potential to enable the spontaneous osteodifferentiation of human mesenchymal stem cells (hMSCs) when the hMSCs-laden GelMA/HAMA-MXene bioinks were 3D printed. The physicochemical and rheological characteristics of the GelMA/HAMA-MXene hydrogels were proven to be unprecedentedly favorable supportive matrices suited for the growth and survival of hMSCs. Furthermore, hMSCs were shown to spontaneously differentiate into osteoblasts within GelMA-HAMA/MXene composites to provide favorable microenvironments for osteogenesis. Therefore, our results suggest that the remarkable biofunctional advantages of the MXene-incorporated GelMA/HAMA bioink can be utilized in a wide range of strategies for the development of effective scaffolds in bone tissue regeneration.
Collapse
Affiliation(s)
- Seok Hyun Lee
- Department of Cogno-Mechatronics Engineering, College of Nanoscience and Nanotechnology, Pusan National University, Busan, 46241, Republic of Korea
| | - Moon Sung Kang
- Department of Cogno-Mechatronics Engineering, College of Nanoscience and Nanotechnology, Pusan National University, Busan, 46241, Republic of Korea
| | - Sangheon Jeon
- Department of Cogno-Mechatronics Engineering, College of Nanoscience and Nanotechnology, Pusan National University, Busan, 46241, Republic of Korea
| | - Hyo Jung Jo
- Department of Cogno-Mechatronics Engineering, College of Nanoscience and Nanotechnology, Pusan National University, Busan, 46241, Republic of Korea
| | - Suck Won Hong
- Department of Cogno-Mechatronics Engineering, College of Nanoscience and Nanotechnology, Pusan National University, Busan, 46241, Republic of Korea
- Engineering Research Center for Color-Modulated Extra-Sensory Perception Technology, Pusan National University, Busan, 46241, Republic of Korea
| | - Bongju Kim
- Dental Life Science Research Institute / Innovation Research & Support Center for Dental Science, Seoul 8 National University Dental Hospital, Seoul, 03080, Republic of Korea
- Corresponding author.
| | - Dong-Wook Han
- Department of Cogno-Mechatronics Engineering, College of Nanoscience and Nanotechnology, Pusan National University, Busan, 46241, Republic of Korea
- BIO-IT Fusion Technology Research Institute, Pusan National University, Busan, 46241, Republic of Korea
- Corresponding author. Department of Cogno-Mechatronics Engineering, College of Nanoscience and Nanotechnology, Pusan National University, Busan 46241, Republic of Korea.
| |
Collapse
|
19
|
Miotk N, Schwindling FS, Zidan M, Juerchott A, Rammelsberg P, Hosseini Z, Nittka M, Heiland S, Bendszus M, Hilgenfeld T. Reliability and accuracy of intraoral radiography, cone beam CT, and dental MRI for evaluation of peri-implant bone lesions at zirconia implants - an ex vivo feasibility study. J Dent 2023; 130:104422. [PMID: 36649822 DOI: 10.1016/j.jdent.2023.104422] [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: 05/14/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To determine the reliability and accuracy of intraoral radiography (IR), cone-beam-computed tomography (CBCT), and dental magnetic resonance imaging (dMRI) in measuring peri‑implant bone defects around single zirconia implants. METHODS Twenty-four zirconia implants were inserted in bovine ribs with various peri‑implant defect sizes and morphologies. True defect extent was measured without implant in CBCT. Defects were measured twice in IR, CBCT, and dMRI with the inserted implant by three experienced readers. Reliability was assessed by ICC, accuracy by the Friedman test, and post-hoc-Tukey's test. RESULTS A comparable good to excellent intra- and inter-reader reliability was observed for all modalities (intra-/inter-rater-CC range for IR; CBCT; dMRI: 0.81-0.91/0.79;0.87-0.97/0.96;0.87-0.95/0.94). Accuracy was generally high, with mean errors below 1 mm in all directions. However, measuring defect depth in the mesiodistal direction was significantly more accurate in dMRI (0.65 ± 0.38 mm) compared to IR (2.71 ± 1.91 mm), and CBCT (1.98 ± 1.97 mm), p-values ≤ 0.0001 respectively ≤ 0.01. CONCLUSIONS Osseous defects around zirconia implants can be reliably measured in IR/CBCT/dMRI in the mesiodistal directions. In addition, CBCT and dMRI allow assessment of the buccolingual directions. dMRI provides a comparable accuracy in all directions, except for the mesiodistal defect depth, where it outperforms IR and CBCT.
Collapse
Affiliation(s)
- Nikolai Miotk
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany.
| | - Franz Sebastian Schwindling
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany.
| | - Moussa Zidan
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany.
| | - Alexander Juerchott
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany.
| | - Peter Rammelsberg
- Department of Prosthodontics, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany.
| | - Zahra Hosseini
- MRI-sequence developer, Magnetic Resonance R&D Collaborations, Siemens Medical Solutions, Atlanta, 3139 Mae Ave NE, Atlanta, GA - Georgia 30319, United States.
| | - Mathias Nittka
- MRI-sequence developer, Magnetic Resonance, Siemens Healthcare GmbH, Erlangen, Enkestraße 127, Erlangen 91052, Germany.
| | - Sabine Heiland
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany.
| | - Martin Bendszus
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany.
| | - Tim Hilgenfeld
- Department of Neuroradiology, Heidelberg University Hospital, Im Neuenheimer Feld 400, Heidelberg 69120, Germany.
| |
Collapse
|
20
|
Kohal RJ, Burkhardt F, Chevalier J, Patzelt SBM, Butz F. One-Piece Zirconia Oral Implants for Single Tooth Replacement: Five-Year Results from a Prospective Cohort Study. J Funct Biomater 2023; 14:jfb14020116. [PMID: 36826915 PMCID: PMC9964460 DOI: 10.3390/jfb14020116] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/06/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
The intention of this 5-year prospective cohort investigation was to clinically and radiographically investigate the outcomes of a one-piece zirconia implant system for single tooth replacement. Sixty-five patients received a total of 66 single-tooth implants. All implants immediately received temporary restorations and were finally restored with all-ceramic crowns. Follow-ups were performed at the prosthetic delivery, after 1, 3, and 5 years. Peri-implant and dental soft-tissue parameters were evaluated and patient-reported outcomes recorded. To monitor peri-implant bone remodelling, standardised radiographs were taken at the implant insertion and at the 1-, 3-, and 5-year follow-ups. In the course of 5 years, 14 implants were lost, resulting in a cumulative implant survival rate of 78.2%. The mean marginal bone loss from the implant insertion to the 5-year follow-up amounted to 1.12 mm. Probing depth, clinical attachment level, bleeding, and plaque index increased over time. In 91.5% of the implants, the papilla index showed levels of 1 or 2, respectively. At the end of the study, the patient satisfaction was higher compared to the pre-treatment measurements. Due to the low survival rate after five years and the noticeably high frequency of advanced bone loss observed in this study, the implant has not met the launch criteria, as it would have not been recommended for routine clinical use.
Collapse
Affiliation(s)
- Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Felix Burkhardt
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Jerome Chevalier
- INSA-Lyon, MATEIS Laboratory, University of Lyon, UMR CNRS 5510, 20 Avenue Albert Einstein, CEDEX, 69621 Villeurbanne, France
| | - Sebastian Berthold Maximilian Patzelt
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Private Dental Clinic, Am Dorfplatz 3, 78658 Zimmern ob Rottweil, Germany
| | - Frank Butz
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Private Dental Clinic, Belchenstrasse 6a, 79189 Bad Krozingen, Germany
- Correspondence:
| |
Collapse
|
21
|
Nueesch R, Karlin S, Fischer J, Rohr N. In Vitro Investigation of Material Combinations for Meso- and Suprastructures in a Biomimetic Approach to Restore One-Piece Zirconia Implants. MATERIALS (BASEL, SWITZERLAND) 2023; 16:1355. [PMID: 36836985 PMCID: PMC9960926 DOI: 10.3390/ma16041355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
The aim of this study was to find a suitable material combination to avoid cement excess in the marginal region of one-piece zirconia implant-supported restorations by means of a hybrid crown consisting of a meso- and a suprastructure. One-piece zirconia implants (n = 120) were embedded in epoxy resin. Microfilled resin composite mesostructures (n = 60), designed as caps, were bonded on the implant abutment with a primer only. A molar crown was constructed and cemented with a resin cement on top of the mesostructure as a suprastructure out of feldspar ceramic (n = 12), lithium-disilicate (n = 24), or zirconia (n = 24). Fracture load (n = 6) and retention force (n = 6) were measured immediately after storage in distilled water at 37 °C for 24 h, as well as after an additional exposure to artificial aging in a chewing simulator and simultaneous thermal cycling. For the measurement of the fracture load, monolithic crowns made of the employed restorative materials and identical in shape to the hybrid crowns served as controls (n = 6 each). Fracture load values for feldspar ceramic and lithium-disilicate hybrid crowns were slightly higher than those for the respective monolithic crowns at baseline and after aging, which was statistically significant only for feldspar crowns after aging. In contrast, fracture load values for zirconia monolithic crowns were higher than those for zirconia hybrid crowns, which was only statistically significant after aging. Artificial aging reduced the fracture load of feldspar and lithium-disilicate crowns both for hybrid and monolithic crowns. The effect was only statistically significant for lithium disilicate hybrid crowns. The fracture load for hybrid and monolithic zirconia crowns was increased by artificial aging without reaching statistical significance. The retention force of lithium-disilicate and zirconia hybrid crowns was not affected by artificial aging. Taking into account retention force and fracture load, lithium-disilicate hybrid crowns showed promising results.
Collapse
|
22
|
Kohal RJ, von Schierholz C, Nold J, Spies BC, Adolfsson E, Vach K, Burkhardt F. Influence of loading and aging on the fracture strength of an injection-molded two-piece zirconia implant restored with a zirconia abutment. Clin Oral Implants Res 2023; 34:105-115. [PMID: 36444693 DOI: 10.1111/clr.14022] [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: 07/05/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the fracture strength and potential phase transformation of an injection-molded two-piece zirconia implant restored with a zirconia abutment after loading and/or aging. METHODS Thirty-two two-piece zirconia implants (4.0 mm diameter) restored with zirconia abutments were embedded according to ISO 14801 and divided into four groups (n = 8/group): Three groups were either exclusively hydrothermally treated (group HT; 85°C), dynamically loaded (group DL; 107 cycles; 98 N), or subjected to both treatments simultaneously (group DL/HT). One group remained untreated (group 0). A sample from each group was cross-sectioned and examined by scanning electron microscopy for possible crystal phase transformation. The remaining samples were then loaded to fracture in a static loading test. A one-way ANOVA was used for statistical analyses. RESULTS During dynamic loading, three implants of group DL and six implants of group DL/HT fractured at a load of 98 N. The fracture strength of group DL/HT (108 ± 141 Ncm) was significantly reduced compared to the other groups (group 0: 342 ± 36 Ncm; HT: 363 ± 49 Ncm; DL: 264 ± 198 Ncm) (p < .05). Fractures from group 0 and HT occurred at both implant and abutment level, whereas implants from group DL and DL/HT fractured only at implant level. A shallow monoclinic transformation zone of approximately 2 μm was observed following hydrothermal treatment. CONCLUSIONS Within the limitations of this study, it can be concluded that dynamic loading and the combination of loading and aging reduced the fracture strength of the implant abutment combination. Hydrothermal treatment caused a shallow transformation zone which had no influence on the fracture strength.
Collapse
Affiliation(s)
- Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christopher von Schierholz
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Julian Nold
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Benedikt C Spies
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | | | - Kirstin Vach
- Faculty of Medicine, Medical Center - University of Freiburg, Institute for Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Felix Burkhardt
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| |
Collapse
|
23
|
Kohal RJ, Vach K, Butz F, Spies BC, Patzelt SBM, Burkhardt F. One-Piece Zirconia Oral Implants for the Support of Three-Unit Fixed Dental Prostheses: Three-Year Results from a Prospective Case Series. J Funct Biomater 2023; 14:jfb14010045. [PMID: 36662092 PMCID: PMC9864364 DOI: 10.3390/jfb14010045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/09/2023] [Accepted: 01/11/2023] [Indexed: 01/15/2023] Open
Abstract
The objective was to investigate the clinical and radiological outcome of one-piece zirconia oral implants to support three-unit fixed dental prostheses (FDP) after three years in function. Twenty-seven patients were treated with a total of 54 implants in a one-stage surgery and immediate provisionalization. Standardized radiographs were taken at implant placement, after one year and after three years, to evaluate peri-implant bone loss. Soft-tissue parameters were also assessed. Linear mixed regression models as well as Wilcoxon Signed Rank tests were used for analyzing differences between groups and time points (p < 0.05). At the three-year evaluation, one implant was lost, resulting in a cumulative survival rate of 98.1%. The mean marginal bone loss amounted to 2.16 mm. An implant success grade I of 52% (bone loss of ≤2 mm) and success grade II of 61% (bone loss of ≤3 mm) were achieved. None of the evaluated baseline parameters affected bone loss. The survival rate of the zirconia implants was comparable to market-available titanium implants. However, an increased marginal bone loss was observed with a high peri-implantitis incidence and a resulting low implant success rate.
Collapse
Affiliation(s)
- Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Correspondence:
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center-University of Freiburg, University of Freiburg, Zinkmattenstr. 6a, 79108 Freiburg, Germany
| | - Frank Butz
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Private Dental Clinic, Belchenstr. 6a, 79189 Bad Krozingen, Germany
| | - Benedikt Christopher Spies
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| | - Sebastian Berthold Maximilian Patzelt
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
- Private Dental Clinic, Am Dorfplatz 3, 78658 Zimmern ob Rottweil, Germany
| | - Felix Burkhardt
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center-University of Freiburg, University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany
| |
Collapse
|
24
|
Ho KN, Chen LW, Kuo TF, Chen KS, Lee SY, Wang SF. Surface modification of zirconia ceramics through cold plasma treatment and the graft polymerization of biomolecules. J Dent Sci 2023; 18:73-80. [PMID: 36643227 PMCID: PMC9831855 DOI: 10.1016/j.jds.2022.06.007] [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: 06/15/2022] [Revised: 06/16/2022] [Indexed: 01/18/2023] Open
Abstract
Background/purpose Although zirconia ceramics were highly versatile as dental implants, their long-term presence in the human body may slow down healing and impede cell growth in the past. To enhance the cytocompatibility of zirconia ceramics, surface activation modification was used to immobilize biopolymers such that a biomimetic environment was created. Materials and methods Hexamethyldisilazane thin films were deposited onto the surface of inorganic zirconia through cold plasma treatment under various power and deposition time settings to form an organosilane interface layer. Next, oxygen plasma treatment was performed to activate the free radicals on the surface. Subsequently, ultraviolet light was employed to graft and polymerize acrylic acid for generating carboxyl groups on the surface. This was followed by a condensation reaction with biopolymers (chitosan, chitosan/poly-γ-glutamic acid, and gelatin). Results Under a 20-min deposition time at 40 W and 150 mTorr, the thin films had a maximum graft density of 2.1 mg/cm2. MG-63 cells (human osteosarcoma cells) were employed to evaluate cell compatibility. Chitosan and chitosan/poly-γ-glutamic acid promoted the compatibility of MG-63 cells (a human osteosarcoma cell line) with zirconia ceramics, whereas gelatin reduced this compatibility. Conclusion The findings confirm that cold plasma treatment and graft polymerization can promote the immobilization of biomolecules and improve the biocompatibility of zirconia ceramics. This approach can be applied to the modification of zirconia ceramic implants.
Collapse
Affiliation(s)
- Kuo-Ning Ho
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Liang-Wei Chen
- Department of Materials and Mineral Resources Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Tzong-Fu Kuo
- School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
| | - Ko-Shao Chen
- Department of Mechanical and Materials Engineering, Tatung University, Taipei, Taiwan
| | - Sheng-Yang Lee
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan,Department of Dentistry, Wan-Fang Medical Center, Taipei Medical University, Taipei, Taiwan,Corresponding author.School of Dentistry, College of Oral Medicine, Taipei Medical University, No. 250, Wu-Hsing Street, Taipei 11031, Taiwan.
| | - Sea-Fue Wang
- Department of Materials and Mineral Resources Engineering, National Taipei University of Technology, Taipei, Taiwan,Corresponding author.Department of Materials and Mineral Resources Engineering, National Taipei University of Technology, No.1, Sec 3., Chung-Hsiao East Rd., Taipei 10617, Taiwan.
| |
Collapse
|
25
|
Pozzi A, Arcuri L, Fabbri G, Singer G, Londono J. Long-term survival and success of zirconia screw-retained implant-supported prostheses for up to 12 years: A retrospective multicenter study. J Prosthet Dent 2023; 129:96-108. [PMID: 34187699 DOI: 10.1016/j.prosdent.2021.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 04/20/2021] [Accepted: 04/21/2021] [Indexed: 01/18/2023]
Abstract
STATEMENT OF PROBLEM Despite the broad clinical application of zirconia for fixed implant-supported prostheses, evidence of long-term performance is sparse. PURPOSE The purpose of this retrospective study was to evaluate the long-term clinical and radiographic outcomes of zirconia-based partial and complete screw-retained implant-supported zirconia fixed dental prostheses (ISZFDPs). MATERIAL AND METHODS Records of patients treated with dental implants and ISZFDPs between December 2004 and June 2017 were screened. Eligible study participants, according to inclusion criteria, were contacted and invited to undergo clinical and radiographic examinations. Outcomes were evaluated as implant and prosthetic survival rates, prosthetic success rate, complications, marginal bone level (MBL) change, and soft tissue condition. Along with the effects of zirconia prosthesis type and level, the effects of implant type and connection, type of loading, and follow-up on MBL were tested with a generalized linear effects model (GLEM) (α=.05). RESULTS A total of 118 patients were identified, of whom 20 (16.9%) were not available for clinical examination for various reasons. Ninety-eight participants (mean age 60.7 ±11.7 years) with 337 implants were included, of which 176 (52.2%) had been immediately loaded. A total of 111 ISZFDPs (96 zirconia connection and 15 titanium base) were investigated: 24 complete ISZFDPs with a zirconia connection (12.9 ±0.97 dental units, minimum 12, maximum 14), 72 partial with a zirconia connection (3.11 ±1.12, minimum 2, maximum 7), 15 partial with a titanium base (3.62 ±1.02, minimum 2, maximum 5). Forty ISZFDPs had been in function for ≥10 years (36%), 38 for 5 to 9 years (34.2%), and 33 for 2 to 4 years (22.8%). The mean follow-up time was 7.2 ±3.4 years. No zirconia fractures were identified. Two implants and 2 ISZFDPs failed, with chipping being the most common complication (13.5%). The implant survival rate was 99.4%, and the prosthetic survival rate was 98.2%. The cumulative prosthetic success rate was 91.9%. MBL change was -0.18 ±0.59 mm. Thirteen implants were treated for peri-implantitis (3.8%), and 9 for mucositis (2.7%), but presented healthy peri-implant soft tissues at the follow-up examination. A significant difference was found between the implant-level and abutment-level prostheses (P=.013), with less marginal bone loss observed in ISZFDPs delivered at the implant level. CONCLUSIONS Zirconia-based screw-retained implant-supported prosthesis can be considered a reliable long-term treatment option for partial and complete edentulism. No zirconia fractures were experienced. Stable bone levels and low peri-implantitis rates were reported regardless of the ISZFDP type and level, implant type and connection, and type of loading.
Collapse
Affiliation(s)
- Alessandro Pozzi
- Adjunct Associate Professor, Goldstein Center for Esthetic and Implant Dentistry, Department of Restorative Sciences, The Dental College of Georgia at Augusta University, Augusta, Ga; Private practice, Rome, Italy.
| | - Lorenzo Arcuri
- Assistant Professor, Department of Clinical Sciences and Translational Medicine, University of Tor Vergata, Rome, Italy
| | | | | | - Jimmy Londono
- Associate Professor, Director of Goldstein Center for Esthetic and Implant Dentistry, Department of Restorative Sciences, The Dental College of Georgia at Augusta University, Augusta, Ga
| |
Collapse
|
26
|
Brunello G, Rauch N, Becker K, Hakimi AR, Schwarz F, Becker J. Two-piece zirconia implants in the posterior mandible and maxilla: A cohort study with a follow-up period of 9 years. Clin Oral Implants Res 2022; 33:1233-1244. [PMID: 36184914 DOI: 10.1111/clr.14005] [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: 01/02/2022] [Revised: 08/12/2022] [Accepted: 09/06/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Long-term follow-up observations of zirconia implants are rare. This study aimed at evaluating the clinical performance of two-piece zirconia implants in the posterior jaws over 9 years. MATERIALS AND METHODS Sixty partially edentulous patients were treated with two-piece zirconia implants. In eight no primary stability could be achieved. Fifty-two patients received the final restoration (i.e., cemented fibreglass abutments and all-ceramic crowns). After 2 years, 2 implants failed and 4 dropouts were recorded. The remaining 46 patients with one target implant each were recalled at 9 years. Besides implant survival, clinical parameters at the implant level (plaque index-PI, bleeding on probing-BOP, probing depth-PD, mucosal recession-MR) were recorded and compared with previously collected data. Mechanical and technical complications were assessed. RESULTS Thirty patients responded. The mean observation period was of 111.1 ± 2.2 months. One implant was lost. Data recorded from the remaining 29 implants were analysed. PI values increased overtime. Mean BOP and PD remained unchanged during follow-up. No additional cases of peri-implantitis were recorded over the 10 diagnosed during the first 2 years of follow-up. No significant changes in mean MR values were detected over time, with 65% of the all included implants exhibiting no recession at 9 years and all the others, but one, a maximum MR of 1 mm. Three technical and 6 mechanical complications occurred in 7 patients between 2- and 9-years (6.9% and 20.7%, respectively, at patient level). CONCLUSION Within the limitations of the present study, a high survival rate was registered. Albeit frequent mechanical and technical complications, two-piece zirconia implants could represent a valid solution for the replacement of single teeth in the posterior jaws.
Collapse
Affiliation(s)
- Giulia Brunello
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.,Department of Neurosciences, Dentistry Section, University of Padova, Padova, Italy
| | - Nicole Rauch
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Kathrin Becker
- Department of Orthodontics, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Ahmad R Hakimi
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany.,Private Practice, Berlin, Germany
| | - Frank Schwarz
- Department of Oral Surgery and Implantology, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Jürgen Becker
- Department of Oral Surgery, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| |
Collapse
|
27
|
Madeira S, Buciumeanu M, Nobre D, Carvalho O, Silva FS. Development of a novel hybrid Ti6Al4V-ZrO 2 surface with high wear resistance by laser and hot pressing techniques for dental implants. J Mech Behav Biomed Mater 2022; 136:105508. [PMID: 36265278 DOI: 10.1016/j.jmbbm.2022.105508] [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: 07/12/2022] [Revised: 09/27/2022] [Accepted: 10/02/2022] [Indexed: 11/06/2022]
Abstract
The development of implant metal-free surfaces has gained attention since non-benefic results have been reported related to the metallic ions released from metal implants to the human body. Ceramic coatings have been proposed as a possible solution however, the detachment of these coatings, during implantation or even in function, can compromise its function. In order to overcome this problem, this work proposes a novel hybrid Ti6Al4V-ZrO2 surface, starting with laser texturing of the Ti6Al4V substrate by Laser Nd:YV04, followed by the allocation of the zirconia (ZrO2) powder and its subsequent sintering by hot pressing process. Results revealed that zirconia strongly adheres to titanium textured surfaces since no detachment was found under tribological and adhesion scratch tests. Moreover, the tribological results showed that the incorporation of zirconia into textured titanium surface reduces significantly the wear rate of titanium (≈93%), which is a good indicator of low metallic particles/ions released to the body. These results suggest that this novel surface with good aesthetic properties and improved wear resistance (given by zirconia) and mechanical resistance (from titanium) can be a promising solution for dental implants, especially for implant/abutment or abutment/ceramic contact zones, and thus have a huge impact on the long-term performance of implants.
Collapse
Affiliation(s)
- S Madeira
- Center for Micro-Electro Mechanical Systems (CMEMS-UMinho), University of Minho, Campus de Azurém, 4800-058, Guimarães, Portugal; LABBELS -Associate Laboratory, Braga, Guimarães, Portugal.
| | - M Buciumeanu
- Faculty of Engineering, "Dunărea de Jos" University of Galaţi, Domnească 47, 800008, Galati, Romania
| | - D Nobre
- Center for Micro-Electro Mechanical Systems (CMEMS-UMinho), University of Minho, Campus de Azurém, 4800-058, Guimarães, Portugal
| | - O Carvalho
- Center for Micro-Electro Mechanical Systems (CMEMS-UMinho), University of Minho, Campus de Azurém, 4800-058, Guimarães, Portugal; LABBELS -Associate Laboratory, Braga, Guimarães, Portugal
| | - F S Silva
- Center for Micro-Electro Mechanical Systems (CMEMS-UMinho), University of Minho, Campus de Azurém, 4800-058, Guimarães, Portugal; LABBELS -Associate Laboratory, Braga, Guimarães, Portugal
| |
Collapse
|
28
|
Spitznagel FA, Hoppe JS, Bonfante EA, Campos TMB, Langner R, Gierthmuehlen PC. Failure Load and Fatigue Behavior of Monolithic and Bi-Layer Zirconia Fixed Dental Prostheses Bonded to One-Piece Zirconia Implants. MATERIALS (BASEL, SWITZERLAND) 2022; 15:8465. [PMID: 36499960 PMCID: PMC9740162 DOI: 10.3390/ma15238465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 11/19/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
No evidence-based prosthetic treatment concept for 3-unit fixed-dental-prostheses (FDPs) on ceramic implants is currently available. Therefore, the aim of this in vitro study was to investigate the failure load and fatigue behavior of monolithic and bi-layer zirconia FDPs supported by one-piece ceramic implants. Eighty 3-unit FDPs supported by 160 zirconia-implants (ceramic.implant; vitaclinical) were divided into 4 groups (n = 20 each): Group Z-HT: 3Y-TZP monolithic-zirconia (Vita-YZ-HT); Group Z-ST: 4Y-TZP monolithic-zirconia (Vita-YZ-ST); Group FL: 3Y-TZP zirconia (Vita-YZ-HT) with facial-veneer (Vita-VM9); Group RL (Rapid-layer): PICN “table-top” (Vita-Enamic), 3Y-TZP-framework (Vita-YZ-HT). Half of the test samples (n = 10/group) were fatigued in a mouth-motion chewing-simulator (F = 98 N, 1.2 million-cycles) with simultaneous thermocycling (5−55 °C). All specimens (fatigued and non-fatigued) were afterwards exposed to single-load-to-failure-testing (Z010, Zwick). Statistical analysis was performed using ANOVA, Tukey’s post-hoc tests and two-sample t-tests (p < 0.05, Bonferroni-corrected where appropriate). All specimens withstood fatigue application. While the effect of fatigue was not significant in any group (p = 0.714), the choice of material had a significant effect (p < 0.001). Material FL recorded the highest failure loads, followed by Z-ST, Z-HT and RL, both with and without fatigue application. Taken together, all tested FDP material combinations survived chewing forces that exceeded physiological levels. Bi-Layer FL and monolithic Z-ST showed the highest resilience and might serve as reliable prosthetic reconstruction concepts for 3-unit FDPs on ceramic implants.
Collapse
Affiliation(s)
- Frank A. Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Johanna S. Hoppe
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Estevam A. Bonfante
- Department of Prosthodontics and Periodontology; Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-230, SP, Brazil
| | - Tiago M. B. Campos
- Department of Prosthodontics and Periodontology; Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-230, SP, Brazil
| | - Robert Langner
- Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany
- Institute of Neuroscience and Medicine, Brain and Behavior (INM-7), Research Center Jülich, 52425 Jülich, Germany
| | - Petra C. Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
| |
Collapse
|
29
|
Alves L, Rodrigues C, Vardhaman S, Saunders C, Schneider J, Lawn B, Zhang Y. Exploring Ductility in Dental Ceramics. J Dent Res 2022; 101:1467-1473. [PMID: 35689403 PMCID: PMC9608091 DOI: 10.1177/00220345221100409] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Two damage regimes-"brittle" and "ductile"-have been identified in the literature on ceramic grinding, machining, grit blasting, and wear. In the brittle regime, the damage mechanism is essentially crack formation, while in the ductile region, it is quasiplasticity. Onset of the brittle mode poses the greater threat to strength, so it becomes important to understand the mechanics of ductile-brittle thresholds in these materials. Controlled microcontact tests with a sharp indenter are employed to establish such thresholds for a suite of contemporary computer-aided design/computer-aided manufacturing dental ceramics. Plots of flexural strength S versus indentation load P show a steep decline beyond the threshold, consistent with well-established contact mechanics relations. Threshold dimensions occur on a scale of order 1 µm and contact load of order 1 N, values pertinent to practical grit finishing protocols. The ductile side of ceramic shaping is accessed by reducing grit sizes, applied loads, and depths of cut below critical levels. It is advocated that critical conditions for ductile shaping may be most readily quantified on analogous S(P) plots, but with appropriate machining variable (grit size, depths of cut, infeed rate) replacing load P. Working in the ductile region offers the promise of compelling time and cost economies in prosthesis fabrication and preparation.
Collapse
Affiliation(s)
- L.M.M. Alves
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University, São José dos Campos, SP, Brazil
| | - C.S. Rodrigues
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA
- Department of Dental Materials and Prosthodontics, Institute of Science and Technology, São Paulo State University, São José dos Campos, SP, Brazil
| | - S. Vardhaman
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA
- Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - C. Saunders
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA
| | - J.M. Schneider
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA
| | - B.R. Lawn
- Material Measurement Laboratory, National Institute of Standards and Technology, Gaithersburg, MD, USA
| | - Y. Zhang
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA
- Department of Preventive and Restorative Sciences, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
30
|
Zhang F, Monzavi M, Li M, Čokić S, Manesh A, Nowzari H, Vleugels J, Van Meerbeek B. Fracture analysis of one/two-piece clinically failed zirconia dental implants. Dent Mater 2022; 38:1633-1647. [PMID: 36064469 DOI: 10.1016/j.dental.2022.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Analyzing factors that may have led to fracture of zirconia implants by macro/micro-fractography. METHODS Six one-piece and ten two-piece full-ceramic zirconia implants from two manufacturers, Z-Systems and CeraRoot, were retrieved after clinical failure. The time-to-failure ranged from 3 to 49 months. Optical and scanning electron microscopy (SEM) were used to analyze the fracture planes at the macro- and microscopic level. Treatment planning, surgical protocol, fracture-origin location and characteristic fracture features were assessed. RESULTS The fracture of all implants seemed to have been primarily due to overload in bending mode, while the fracture-initiation sites varied for the one- and two-piece implants. The fracture of all one-piece implants originated in the constriction region between two threads in the endosseous implant part. For two-piece implants, the abutment neck, internal abutment-implant connections and inner threads were found to be the main fracture-initiation sites. Surface defects at the root area for one-piece implants and damages at the abutment surface for two-piece implants were connected to the fracture origins. Importantly, the clinical failures of implants were often found to result from combined effects related to patient aspects, treatment planning/protocols, a high bending moment at the weakest link, implant-surface conditions and specific implant designs. SIGNIFICANCE This study provided information to be considered for future optimization of treatment planning and the surgical protocol for zirconia implants. Optimization of the surface conditions and the zirconia-starting powder were also suggested.
Collapse
Affiliation(s)
- Fei Zhang
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, B-3001 Leuven, Belgium`; KU Leuven, Department of Oral Health Sciences, BIOMAT - Biomaterials Research Group & UZ Leuven (University Hospitals Leuven), Dentistry, Kapucijnenvoer 7 block a, B-3000 Leuven, Belgium.
| | - Mona Monzavi
- Periodontics and Ceramic Implantology (private Practice), 1401N Tustin Ave Suite #345, Santa Ana, CA 92705, USA
| | - Maoyin Li
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, B-3001 Leuven, Belgium`
| | - Stevan Čokić
- KU Leuven, Department of Oral Health Sciences, BIOMAT - Biomaterials Research Group & UZ Leuven (University Hospitals Leuven), Dentistry, Kapucijnenvoer 7 block a, B-3000 Leuven, Belgium
| | - Al Manesh
- Mission Dental Implant Center (private Practice), 26800 Crown Valley Pkwy Ste 425, Mission Viejo, CA 92691, USA
| | - Hessam Nowzari
- Periodontics and Implant Dentistry (private practice), 120 S Spalding Dr #201, Beverlyhills, CA 90210, USA
| | - Jef Vleugels
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, B-3001 Leuven, Belgium`
| | - Bart Van Meerbeek
- KU Leuven, Department of Oral Health Sciences, BIOMAT - Biomaterials Research Group & UZ Leuven (University Hospitals Leuven), Dentistry, Kapucijnenvoer 7 block a, B-3000 Leuven, Belgium
| |
Collapse
|
31
|
Balmer M, Fischer C, Pirc M, Hämmerle CHF, Jung RE. Results at the 1-Year Follow-Up of a Prospective Cohort Study with Short, Zirconia Implants. MATERIALS (BASEL, SWITZERLAND) 2022; 15:5584. [PMID: 36013728 PMCID: PMC9416786 DOI: 10.3390/ma15165584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 08/08/2022] [Accepted: 08/10/2022] [Indexed: 06/15/2023]
Abstract
The objective of this study was to clinically and radiologically evaluate the performance of a short (8 mm), 1-piece, zirconia implant after an observation period of 1 year in function. A total of 47 patients with 1 missing tooth in the position of a premolar or molar were recruited. Short (8 mm), 1-piece, zirconia implants were placed and loaded after a healing period of 2 to 4 months with monolithic crowns made of 3 different materials. Implants were followed up for one year and clinically and radiologically assessed. A total of 46 implants were placed. One was excluded since no primary stability was achieved at implant placement. At the 1-year follow-up, mean marginal bone loss 1 year after loading was 0.05 ± 0.47 mm. None of the implants showed marginal bone loss greater than 1 mm or clinical signs of peri-implantitis. A total of 2 implants were lost during the healing phase and another after loading, resulting in a survival rate of 93% after 1 year. All lost implants showed a sudden increased mobility with no previous signs of marginal bone loss or peri-implant infection. The short, 8 mm, zirconia implants showed stable marginal bone levels over the short observation period of 1 year. Although they revealed slightly lower survival rates, they can be suggested for the use in sites with reduced vertical bone. Scientific data are very limited, and long-term data are not yet available, and therefore, they are needed.
Collapse
|
32
|
Zirconia versus Titanium Implants: 8-Year Follow-Up in a Patient Cohort Contrasted with Histological Evidence from a Preclinical Animal Model. MATERIALS 2022; 15:ma15155322. [PMID: 35955254 PMCID: PMC9369473 DOI: 10.3390/ma15155322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/18/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
Zirconia ceramic (ZC) implants are becoming more common, but comparisons between preclinical histology and long-term clinical trials are rare. This investigation comprised (1) 8-year clinical follow-up of one-piece ZC or titanium (Ti) implants supporting full overdentures and (2) histomorphometric analysis of the same implants in an animal model, comparing implants with various surface treatments. Methods: (1) Clinical trial: 24 completely edentulous participants (2 groups of N = 12) received 7 implants (one-piece ball-abutment ZC or Ti; maxilla N = 4, mandible N = 3) restored with implant overdentures. Outcomes after 8-years included survival, peri-implant bone levels, soft-tissue responses, and prosthodontic issues. (2) Preclinical trial: 10 New Zealand sheep received 4 implants bilaterally in the femoral condyle: Southern Implants ZC or Ti one-piece implants, identical to the clinical trial, and controls: Southern ITC® two-piece implants with the same surface or Nobel (NBC) anodised (TiUnite™) surface. %Bone-implant contact (%BIC) was measured after 12 weeks of unloaded healing. Results: 8 of 24 participants (33%) of an average age of 75 ± 8 years were recalled; 21% of original participants had died, and 46% could not be contacted. 80.4% of implants survived; excluding palatal sites, 87.5% of Ti and 79% of ZC implants survived. All failed implants were in the maxilla. Three ZC implants had fractured. Bone loss was similar for Ti vs. ZC; pocket depths (p = 0.04) and attachment levels (p = 0.02) were greater for Ti than ZC implants. (1.7 ± 1.6 mm vs. 1.6 ± 1.3 mm). All implants in sheep femurs survived. %BIC was not statistically different for one-piece blasted surface Ti (80 ± 19%) versus ZC (76 ± 20%) or ITC® (75 ± 16 mm); NBC had significantly higher %BIC than ITC (84 ± 17%, p = 0.4). Conclusion: Short-term preclinical results for ZC and Ti one-piece implants showed excellent bone-implant contact in unloaded femoral sites. This differed from the long-term clinical results in older-aged, edentulous participants. While ZC and Ti implants showed equivalent performance, the risks of peri-implantitis and implant loss in older, completely edentulous patients remain a significant factor.
Collapse
|
33
|
Atalay P, Öztaş DD. Fatigue resistance and fracture strength of narrow-diameter one-piece zirconia implants with angled abutments. J ESTHET RESTOR DENT 2022; 34:1060-1067. [PMID: 35855644 DOI: 10.1111/jerd.12944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 07/05/2022] [Accepted: 07/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Zirconia implants are assumed to satisfy the esthetic requirements that titanium implants cannot meet, however, there are not enough studies in the literature about narrow-diameter and angled zirconia implants that can be preferred especially in the anterior region. This in vitro study aimed to evaluate the fatigue resistance and fracture strength of narrow-diameter zirconia implants with angled abutments. MATERIALS AND METHODS Forty-eight one-piece experimental zirconia implants and monolithic zirconia crowns were produced from 3-YTZP blanks. The implant diameters (3.0 or 3.7 mm) and the restoration types were determined according to three intraoral regions (upper central incisors, lower central incisors, and upper canine), and abutments were designed as straight or 15° angled. The samples were subjected to chewing simulation corresponding to 5 years of clinical performance and then the static loading test. The survival rates of groups were measured by the Kaplan-Meier log-rank test, and the fracture load values were estimated by using Kruskal-Wallis and Mann-Whitney U tests (p < 0.05). RESULTS All 3.0 mm diameter implants failed the fatigue test. The fatigue resistance of the implants with angled abutments was significantly lower than the straight abutments, and different crown designs were found to affect survival rates significantly. The fracture strengths of the surviving groups were above the maximum physiological chewing forces, and the differences were not significant. CONCLUSIONS The implant diameter, abutment angle, and restoration type have a significant effect on the fatigue behavior of zirconia implants. CLINICAL SIGNIFICANCE The fracture strengths of the one-piece zirconia implants with a 3.7 mm diameter and a 15° abutment angle are above the chewing forces for the anterior intraoral region.
Collapse
Affiliation(s)
- Pelin Atalay
- Department of Prosthodontics, Faculty of Dentistry, University of Niğde Ömer Halisdemir, Niğde, Turkey
| | - Doğan Derya Öztaş
- Department of Prosthodontics, Faculty of Dentistry, Ankara University, Ankara, Turkey
| |
Collapse
|
34
|
Tchinda A, Chézeau L, Pierson G, Kouitat-Njiwa R, Rihn BH, Bravetti P. Biocompatibility of ZrO2 vs. Y-TZP Alloys: Influence of Their Composition and Surface Topography. MATERIALS 2022; 15:ma15134655. [PMID: 35806779 PMCID: PMC9267226 DOI: 10.3390/ma15134655] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 06/21/2022] [Accepted: 06/29/2022] [Indexed: 12/04/2022]
Abstract
The osseointegration of implants is defined as the direct anatomical and functional connection between neoformed living bone and the surface of a supporting implant. The biological compatibility of implants depends on various parameters, such as the nature of the material, chemical composition, surface topography, chemistry and loading, surface treatment, and physical and mechanical properties. In this context, the objective of this study is to evaluate the biocompatibility of rough (Ra = 1 µm) and smooth (Ra = 0 µm) surface conditions of yttria–zirconia (Y-TZP) discs compared to pure zirconia (ZrO2) discs by combining a classical toxicological test, morphological observations by SEM, and a transcriptomic analysis on an in vitro model of human Saos-2 bone cells. Similar cell proliferation rates were observed between ZrO2 and Y-TZP discs and control cells, regardless of the surface topography, at up to 96 h of exposure. Dense cell matting was similarly observed on the surfaces of both materials. Interestingly, only 110 transcripts were differentially expressed across the human transcriptome, consistent with the excellent biocompatibility of Y-TZP reported in the literature. These deregulated transcripts are mainly involved in two pathways, the first being related to “mineral uptake” and the second being the “immune response”. These observations suggest that Y-TZP is an interesting candidate for application in implantology.
Collapse
|
35
|
Chopra D, Jayasree A, Guo T, Gulati K, Ivanovski S. Advancing dental implants: Bioactive and therapeutic modifications of zirconia. Bioact Mater 2022; 13:161-178. [PMID: 35224299 PMCID: PMC8843948 DOI: 10.1016/j.bioactmat.2021.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/22/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022] Open
Abstract
Zirconium-based implants have gained popularity in the dental implant field owing to their corrosion resistance and biocompatibility, attributed to the formation of a native zirconia (ZrO2) film. However, enhanced bioactivity and local therapy from such implants are desirable to enable the earlier establishment and improved long-term maintenance of implant integration, especially in compromised patient conditions. As a result, surface modification of zirconium-based implants have been performed using various physical, chemical and biological techniques at the macro-, micro-, and nano-scales. In this extensive review, we discuss and detail the development of Zr implants covering the spectrum from past and present advancements to future perspectives, arriving at the next generation of highly bioactive and therapeutic nano-engineered Zr-based implants. The review provides in-depth knowledge of the bioactive/therapeutic value of surface modification of Zr implants in dental implant applications focusing on clinical translation.
Collapse
Affiliation(s)
| | | | | | - Karan Gulati
- Corresponding authors. School of Dentistry, University of Queensland, 288 Herston Road, Herston QLD, 4006, Australia.
| | - Sašo Ivanovski
- Corresponding authors. School of Dentistry, University of Queensland, 288 Herston Road, Herston QLD, 4006, Australia.
| |
Collapse
|
36
|
Full Digital Workflow in the Esthetic Dental Restoration. Case Rep Dent 2022; 2022:8836068. [PMID: 35762014 PMCID: PMC9233610 DOI: 10.1155/2022/8836068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/31/2022] [Accepted: 06/04/2022] [Indexed: 12/23/2022] Open
Abstract
This case report presented a fully digital workflow in esthetic dental restoration. A 51-year-old female patient was referred to BDMS Wellness Clinic due to a fracture of the maxillary left central incisor. An immediate dental implant was planned to restore tooth 21 with esthetic crown lengthening of upper front teeth and new zirconia crowns for teeth 11, 12, 13, 21, 22, and 23. Digital impression was made using a digital scanner (PRIMESCAN®, Dentsply Sirona, Bensheim, Germany); surgical guide (Cerec Guide 3, Dentsply Sirona, Bensheim, Germany) was designed by using a designing software (Galileos Software, Dentsply Sirona, Bensheim, Germany) and was milled by using a milling machine (MCXL milling machine, Dentsply Sirona, Bensheim, Germany) to create a precise surgical guide. 3D smile design was done by using the Digital Smile Design (DSD) program, the crown lengthening guide was designed according to DSD designed by using a designing software (Inlab 19 Software, Dentsply Sirona, Bensheim, Germany), and the guide was fabricated by a 3D printer (FormLabs Form 2, Formlab, MA, USA). Provisional crowns (splinted) for teeth 11, 12, 13, 21, 22, and 23 were milled by using polymer (VIPI BLOCK TRILUX®, VIPI Industria, Pirassununga, SP, Brazil) using a milling machine (MCX5, Dentsply Sirona, Bensheim, Germany). The zirconia crowns were designed by using software (Inlab19 Software, Dentsply Sirona, Bensheim, Germany) and milled using the same milling machine. At the implant position, Ti-base is cemented by using an abutment (Multilink Hybrid Abutment, Ivoclar Vivadent, Schaan, Lichtenstein, Germany) with zirconia coping (Cercon base white shade, Dentsply Sirona, Bensheim, Germany) utilized as the abutment. The zirconia crowns (Cercon Xt, Dentsply Sirona, Bensheim, Germany) were sintered and characterized and then cemented. The patient was satisfied with the esthetic outcome of the treatment.
Collapse
|
37
|
Wen C, Muhetaer HJ, Gao Z, Wu J. Dual response of fibroblasts viability and
Porphyromonas gingivalis
adhesion on nanostructured zirconia abutment surfaces. J Biomed Mater Res A 2022; 110:1645-1654. [PMID: 35676876 DOI: 10.1002/jbm.a.37414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Cheng Wen
- Department of Stomatology The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People's Hospital Shenzhen Guangdong China
| | - Huo Jia Muhetaer
- Department of Stomatology The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People's Hospital Shenzhen Guangdong China
| | - Zhengyang Gao
- Department of Stomatology The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People's Hospital Shenzhen Guangdong China
| | - Jincheng Wu
- Department of Stomatology The Third Affiliated Hospital of Shenzhen University, Shenzhen Luohu Hospital Group Luohu People's Hospital Shenzhen Guangdong China
| |
Collapse
|
38
|
Surface Structure of Zirconia Implants: An Integrative Review Comparing Clinical Results with Preclinical and In Vitro Data. MATERIALS 2022; 15:ma15103664. [PMID: 35629692 PMCID: PMC9143528 DOI: 10.3390/ma15103664] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/13/2022] [Accepted: 05/19/2022] [Indexed: 01/27/2023]
Abstract
Background: The purpose of this review was to analyze and correlate the findings for zirconia implants in clinical, preclinical and in vitro cell studies in relation to surface structure. Methods: Electronic searches were conducted to identify clinical, preclinical and in vitro cell studies on zirconia implant surfaces. The primary outcomes were mean bone loss (MBL) for clinical studies, bone-to-implant contact (BIC) and removal torque (RT) for preclinical studies and cell spreading, cell proliferation and gene expression for cell studies. The secondary outcomes included comparisons of data found for those surfaces that were investigated in all three study types. Results: From 986 screened titles, 40 studies were included for data extraction. In clinical studies, only micro-structured surfaces were investigated. The lowest MBL was reported for sandblasted and subsequently etched surfaces, followed by a sinter and slurry treatment and sandblasted surfaces. For BIC, no clear preference of one surface structure was observable, while RT was slightly higher for micro-structured than smooth surfaces. All cell studies showed that cell spreading and cytoskeletal formation were enhanced on smooth compared with micro-structured surfaces. Conclusions: No correlation was observed for the effect of surface structure of zirconia implants within the results of clinical, preclinical and in vitro cell studies, underlining the need for standardized procedures for human, animal and in vitro studies.
Collapse
|
39
|
Alqutaibi AY, Ghulam O, Krsoum M, Binmahmoud S, Taher H, Elmalky W, Zafar MS. Revolution of Current Dental Zirconia: A Comprehensive Review. Molecules 2022; 27:1699. [PMID: 35268800 PMCID: PMC8911694 DOI: 10.3390/molecules27051699] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/16/2022] [Accepted: 03/02/2022] [Indexed: 01/27/2023] Open
Abstract
The aim of this article is to comprehensively review the revolution of dental zirconia (Zir), including its types, properties, applications, and cementation procedures. A comprehensive search of PubMed and Embase was conducted. The search was limited to manuscripts published in English. The final search was conducted in October 2021. Newly developed monolithic Zir ceramics have substantially enhanced esthetics and translucency. However, this material must be further studied in vitro and in vivo to determine its long-term ability to maintain its exceptional properties. According to the literature, monolithic translucent Zir has had promising results and a high survival rate. Thus, the utilization of this material is indicated when strength and esthetics are needed. Both the materials and methods used for cementation of monolithic Zir have significantly improved, encouraging dentists to use this material, especially when a conservative approach is required. Zir restorations showed promising outcomes, particularly for monolithic Zir crowns supported with implant and fixed dental prostheses.
Collapse
Affiliation(s)
- Ahmed Yaseen Alqutaibi
- Department of Prosthodontics, College of Dentistry, Taibah University, Al Madinah 41311, Saudi Arabia;
- Department of Prosthodontics, College of Dentistry, Ibb University, Ibb 70270, Yemen
| | - Omar Ghulam
- Dental Department, Prince Mohammad bin Abdulaziz Hospital (Ministry of National Guard-Health Affairs), Madinah 42324, Saudi Arabia; (O.G.); (M.K.); (H.T.)
| | - Majid Krsoum
- Dental Department, Prince Mohammad bin Abdulaziz Hospital (Ministry of National Guard-Health Affairs), Madinah 42324, Saudi Arabia; (O.G.); (M.K.); (H.T.)
| | - Suhail Binmahmoud
- Dental Department, Prince Sultan Armed Forces Hospital, Madinah 42375, Saudi Arabia;
| | - Hasan Taher
- Dental Department, Prince Mohammad bin Abdulaziz Hospital (Ministry of National Guard-Health Affairs), Madinah 42324, Saudi Arabia; (O.G.); (M.K.); (H.T.)
| | - Wael Elmalky
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah 41311, Saudi Arabia;
| | - Muhammad Sohail Zafar
- Department of Restorative Dentistry, College of Dentistry, Taibah University, Al Madinah 41311, Saudi Arabia;
- Department of Dental Materials, Islamic International Dental College, Riphah International University, Islamabad 44000, Pakistan
| |
Collapse
|
40
|
Jaeggi M, Gyr S, Astasov-Frauenhoffer M, Zitzmann NU, Fischer J, Rohr N. Influence of different zirconia surface treatments on biofilm formation in vitro and in situ. Clin Oral Implants Res 2022; 33:424-432. [PMID: 35137461 PMCID: PMC9304171 DOI: 10.1111/clr.13902] [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: 08/23/2021] [Revised: 01/10/2022] [Accepted: 01/30/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine if the surface treatment of zirconia affects biofilm formation in an in vitro three-species biofilm model and in situ. MATERIAL AND METHODS Zirconia surfaces considered for the transmucosal portion of a zirconia implant were compared with polished pure titanium grade 4 (Tp). Discs 13 mm in diameter of either polished (Zp), polished and heat-treated (Zpt), machined (Zm), machined and heat-treated (Zmt) and sandblasted, etched and heat-treated (Z14) zirconia were fabricated. Surface roughness and wettability of specimens was measured. Biofilm formation was evaluated by safranin staining and scanning electron microscopy (SEM) using a three-species model, and intraorally with 16 volunteers carrying oral splints in two independent experiments. Relative biofilm formation was compared with Kruskal-Wallis followed by Bonferroni post-hoc test (α=0.05). RESULTS In vitro biofilm formation with optical density values on Zp (0.14±0.01), Zpt (0.14±0.02), Zm (0.13±0.01) and Zmt (0.13±0.01) was significantly lower than on Tp (0.21±0.05) and Z14 (0.20±0.04) (p<0.05). In situ biofilm formation was significantly higher on Z14 (0.56±0.45) (p<0.05), while no significant differences in optical density were observed among Zp (0.25±0.20), Zm (0.36±0.34) and Tp (0.28±0.22). SEM analysis supported quantitative findings. CONCLUSIONS In the in vitro three-species biofilm model differences in material and surface roughness affected biofilm formation. In situ biofilm formation was mainly affected by the surface roughness of the specimens. Polishing of zirconia is recommended to reduce biofilm formation while heat-treatment has no significant effect.
Collapse
Affiliation(s)
- Marco Jaeggi
- Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Sharon Gyr
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Monika Astasov-Frauenhoffer
- Department of Research, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Nicola U Zitzmann
- Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Jens Fischer
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| | - Nadja Rohr
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland.,Department of Research, University Center for Dental Medicine Basel, University of Basel, Basel, Switzerland
| |
Collapse
|
41
|
Moreira A, Madeira S, Buciumeanu M, Fialho J, Carvalho A, Silva F, Monteiro FJ, Caramês J. Design and surface characterization of micropatterned silica coatings for zirconia dental implants. J Mech Behav Biomed Mater 2022; 126:105060. [PMID: 34974323 DOI: 10.1016/j.jmbbm.2021.105060] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022]
Abstract
The use of zirconia as an alternative biomaterial for titanium implants has been increasing due to its biocompatibility, favorable aesthetic features, less potential for early plaque accumulation and mechanical properties. Despite the developed efforts, strategies to promote an effective osseointegration are still enough. In this sense and combining the silica properties to improve bone formation with the micropatterning guidance characteristics, silica coatings with micropatterns were designed and evaluated regarding their hydrophilicity and integrity through resistance to scratch and friction tests against femoral bone plates (simulating implant insertion). A combined sol-gel and soft-lithography techniques were used to produce silica coatings onto zirconia substrates and different techniques were used to characterize the micropatterned silica coatings. The results revealed that the production of lines and pillars micropatterns increases the surface roughness (Ra values) and improves the surface strength adhesion. Through the scratch test, it was possible to verify that the integrity and topography characteristics of all micropatterned coatings were not significantly affected after the friction test meaning that their function is not compromised after implant insertion. Additionally, the lines micropattern was the one that presented the highest hydrophilicity for distilled water, thus being a promising surface to promote improved osseointegration. The combined use of different surface micropatterns could potentially be used to guide bone apposition and avoiding peri-implantitis.
Collapse
Affiliation(s)
- André Moreira
- Department of Oral Surgery and Implant Dentistry, Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277, Lisboa, Portugal.
| | - Sara Madeira
- Center for Micro-Electro Mechanical Systems (CMEMS-UMinho), Universidade do Minho, Campus de Azurém, 4800-058, Guimarães, Portugal
| | - Mihaela Buciumeanu
- Faculty of Engineering, "Dunărea de Jos" University of Galaţi, Domnească 47, 800008, Galati, Romania
| | - Joana Fialho
- Escola Superior de Tecnologia e Gestão de Viseu, CI&DEI, Instituto Politécnico de Viseu, 3504-510 Viseu, Portugal
| | - Angela Carvalho
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal; INEB, Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal
| | - Filipe Silva
- Center for Micro-Electro Mechanical Systems (CMEMS-UMinho), Universidade do Minho, Campus de Azurém, 4800-058, Guimarães, Portugal
| | - Fernando J Monteiro
- i3S, Instituto de Investigação e Inovação em Saúde, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal; INEB, Instituto de Engenharia Biomédica, Universidade do Porto, Rua Alfredo Allen 208, 4200-135, Porto, Portugal; Faculdade de Engenharia, Departamento de Engenharia Metalúrgica e Materiais, Universidade do Porto, Rua Dr Roberto Frias, s/n, 4200-465, Porto, Portugal
| | - João Caramês
- Department of Oral Surgery and Implant Dentistry, Faculdade de Medicina Dentária, Universidade de Lisboa, 1600-277, Lisboa, Portugal
| |
Collapse
|
42
|
Borgonovo AE, Ferrario S, Maiorana C, Vavassori V, Censi R, Re D. A Clinical and Radiographic Evaluation of Zirconia Dental Implants: 10-Year Follow-Up. Int J Dent 2021; 2021:7534607. [PMID: 35003263 PMCID: PMC8739170 DOI: 10.1155/2021/7534607] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 12/17/2021] [Indexed: 12/02/2022] Open
Abstract
PURPOSE The aim is to evaluate the survival and success rates, as well as the marginal bone loss (MBL) and periodontal indexes, of zirconia implants with 10-year follow-up. MATERIALS AND METHODS 10 patients were selected and 26 one-piece zirconia implants were used for the rehabilitation of single tooth or partially edentulous ridge. After 10 years, a clinical-radiographic evaluation was performed in order to estimate peri-implant tissue health and marginal bone loss. RESULTS The survival and success rates were 100%. The average marginal bone loss from baseline to 120 months after surgery was 0.92 ± 0.97 mm. CONCLUSION One-piece zirconia dental implants are characterised by high biocompatibility, low plaque adhesion, and absence of microgap that can be related to the clinical success of these implants.
Collapse
Affiliation(s)
- Andrea Enrico Borgonovo
- Department of Esthetic Dentistry, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
| | - Susanna Ferrario
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, University of Milan, Via Della Commenda 10, Milan 20122, Italy
| | - Carlo Maiorana
- Head Department of Implant Center for Edentulism and Jawbone Atrophies, Maxillofacial Surgery and Odontostomatology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Via Della Commenda 10, Milan 20122, Italy
| | - Virna Vavassori
- Department of Esthetic Dentistry, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
| | - Rachele Censi
- Department of Esthetic Dentistry, Istituto Stomatologico Italiano, University of Milan, Milan, Italy
| | - Dino Re
- Head Department of Esthetic Dentistry, Istituto Stomatologico Italiano, Milan 20122, Italy
| |
Collapse
|
43
|
WANG D, ZHANG X, ZHANG C, JIANG L, DENG C, ZHAO B. Clinical assessment of food impaction after implant restoration: a retrospective analysis. FOOD SCIENCE AND TECHNOLOGY 2021. [DOI: 10.1590/fst.56320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
|
44
|
Spitznagel FA, Balmer M, Wiedemeier DB, Jung RE, Gierthmuehlen PC. Clinical outcomes of all-ceramic single crowns and fixed dental prostheses supported by ceramic implants: A systematic review and meta-analyses. Clin Oral Implants Res 2021; 33:1-20. [PMID: 34665900 PMCID: PMC9297865 DOI: 10.1111/clr.13871] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/17/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
Objective To analyze the clinical outcomes of all‐ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants. Materials and Methods Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all‐ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient‐related outcome measurements. Meta‐analyses were performed after 1, 2, and 5 years using random‐effect meta‐analyses. Results Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement‐retained reconstructions (mean observation: 12.0–61.0 months). Meta‐analyses estimated a 5‐year survival rate of 94% (95% confidence interval [CI]: 82%–100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%–100%); veneered zirconia SCs, 89% (95%CI: 62%–100%); and veneered zirconia FDPs 94% (95%CI: 81%–100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%–11%); veneered zirconia SCs, 38% (95%CI: 24%–54%); and veneered zirconia FDPs, 57% (95%CI: 38%–76%). Further outcomes were summarized descriptively. Conclusions Due to the limited data available, only tendencies could be identified. All‐ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid‐term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants.
Collapse
Affiliation(s)
- Frank Akito Spitznagel
- Department of Prosthodontics, School of Dentistry, Heinrich-Heine-University, Düsseldorf, Germany
| | - Marc Balmer
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel B Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | | |
Collapse
|
45
|
Stavropoulos A, Bertl K, Winning L, Polyzois I. What is the influence of implant surface characteristics and/or implant material on the incidence and progression of peri-implantitis? A systematic literature review. Clin Oral Implants Res 2021; 32 Suppl 21:203-229. [PMID: 34642989 DOI: 10.1111/clr.13859] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/06/2021] [Accepted: 04/27/2021] [Indexed: 12/09/2022]
Abstract
OBJECTIVES To answer the focused question, 'In animals or patients with dental implants, does implant surface characteristics and/or implant material have an effect on incidence and progression of peri-implantitis?' MATERIAL AND METHODS Pre-clinical in vivo experiments on experimental peri-implantitis and clinical trials with any aim and design, and ≥5 years follow-up, where the effect of ≥2 different type of implant material and/or surface characteristics on peri-implantitis incidence or severity, and/or progression, implant survival or losses due to peri-implantitis, and/or marginal bone levels/loss was assessed. RESULTS Meta-analyses based on data of pre-clinical experiments, using the ligature induced peri-implantitis model in the dog, indicated that after the spontaneous progression phase implants with a modified surface showed significantly greater radiographic bone loss (effect size 0.44 mm; 95%CI 0.10-0.79; p = .012; 8 publications) and area of infiltrated connective tissue (effect size 0.75 mm2 ; 95%CI 0.15-1.34; p = .014; 5 publications) compared to non-modified surfaces. However, in 9 out of the 18 included experiments, reported in 25 publications, no significant differences were shown among the different implant surface types assessed. Clinical and/or radiographic data from 7605 patients with 26,188 implants, reported in 31 publications (20 RCTs, 3 CTs, 4 prospective cohort, and 4 retrospective studies; 12 with follow-up ≥10 years), overall did not show significant differences in the incidence of peri-implantitis, when this was reported or could be inferred, among the various implant surfaces. In general, high survival rates (90-100%) up to 30 years and no clinically relevant differences in marginal bone loss/levels, merely compatible with crestal remodelling, were presented for the various implant types. CONCLUSION Pre-clinical in vivo experiments indicate that surface characteristics of modified implants may have a significant negative impact on peri-implantitis progression, while clinical studies do not support the notion that there is a difference in peri-implantitis incidence among the various types of implant surfaces. No assumptions can be made regarding the possible impact of implant material on incidence and/or peri-implantitis progression due to limited information.
Collapse
Affiliation(s)
- Andreas Stavropoulos
- Division of Regenerative Dental Medicine and Periodontology, University Clinics of Dental Medicine (CUMD), University of Geneva, Geneva, Switzerland.,Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden
| | - Kristina Bertl
- Department of Periodontology, Faculty of Odontology, University of Malmö, Malmö, Sweden.,Division of Oral Surgery, University Clinic of Dentistry, Medical University of Vienna, Vienna, Austria
| | - Lewis Winning
- Department of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| | - Ioannis Polyzois
- Department of Restorative Dentistry and Periodontology, Dublin Dental University Hospital, Trinity College, Dublin, Ireland
| |
Collapse
|
46
|
Qu Y, Liu L. Zirconia Materials for Dental Implants: A Literature Review. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.687983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Titanium is currently the most commonly used material for manufacturing dental implants. However, its potential toxic effects and the gray color have resulted in increasing requests for metal-free treatment options. Zirconia is a type of ceramic materials that has been extensively used in medicine field, such as implant abutments and various joint replacement appliances. Amounts of clinical evaluations have indicated good biocompatibility for zirconia products. Besides, its toothlike color, low affinity for plaque and outstanding mechanical and chemical properties have made it an ideal candidate for dental implants. The aim of this study is to review the laboratory and clinical papers about several kinds of zirconia materials and zirconia surface modification techniques. Although there are plenty of literatures on these topics, most of the researches focused on the mechanical properties of the materials or based on cell and animal experiments. Randomized clinical trials on zirconia materials are still urgently needed to validate their application as dental implants.
Collapse
|
47
|
Burkhardt F, Spies BC, Riemer L, Adolfsson E, Doerken S, Kohal RJ. Fracture resistance and crystal phase transformation of a one- and a two-piece zirconia implant with and without simultaneous loading and aging-An in vitro study. Clin Oral Implants Res 2021; 32:1288-1298. [PMID: 34352139 DOI: 10.1111/clr.13825] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the influence of artificial aging on the transformation propagation and fracture resistance of zirconia implants. METHODS One-piece (with integrated implant abutment, 1P; regular diameter [4.1mm]; n = 16) and two-piece (with separate implant abutment, 2P; wide diameter [5 mm]; n = 16) zirconia implants were embedded according to ISO 14801. A two-piece titanium-zirconium implant (Ti-Zr; 4.1 mm diameter) served as a control (n = 16). One subgroup (n = 8) of each system was simultaneously dynamically loaded (107 cycles; 98N) and hydrothermally aged (85°C, 58 days), while the other subgroup (n = 8) remained untreated. Finally, specimens were statically loaded to fracture. Potential crystal phase transformation was examined at cross sections using scanning electron microscopy (SEM). A multivariate linear regression model was applied for statistical analyses. RESULTS The fracture resistance of 1P (1,117 [SD = 38] N; loaded/aged: 1,009 [60] N), 2P (850 [36] N; loaded/aged: 799 [84] N), and Ti-Zr implants (1,338 [205] N; loaded/aged: 1,319 [247] N) was not affected significantly by loading/aging (p = .171). However, when comparing the systems, they revealed significant differences independent of loading/aging (p ≤ .001). Regarding the crystal structure, a transformation zone was observed in SEM images of 1P only after aging, while 2P showed a transformation zone even before aging. After hydrothermal treatment, an increase of this monoclinic layer was observed in both systems. CONCLUSIONS The Ti-Zr control implant showed higher fracture resistance compared to both zirconia implants. Loading/aging had no significant impact on the fracture resistance of both zirconia implants. The wide-body 2P zirconia implant was weaker than the regular body 1P implant.
Collapse
Affiliation(s)
- Felix Burkhardt
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
| | - Benedikt C Spies
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
| | - Lennart Riemer
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
| | | | - Sam Doerken
- Medical Center - University of Freiburg, Institute for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
| |
Collapse
|
48
|
In Vitro Investigations in a Biomimetic Approach to Restore One-Piece Zirconia Implants. MATERIALS 2021; 14:ma14164361. [PMID: 34442883 PMCID: PMC8400740 DOI: 10.3390/ma14164361] [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: 06/30/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 11/21/2022]
Abstract
The objective of this study was to evaluate the fracture load and retention force of different bonding systems while restoring one-piece zirconia implants with a novel cementation approach using a mesostructure. Polymer-infiltrated ceramic mesostructures (n = 112) were therefore designed as caps on the implant abutment, and a molar feldspathic ceramic crown was constructed on top of it as a suprastructure. For cementation, different bonding systems were used. Fracture load and retention force were measured immediately after storage in water at 37 °C for 24 h (n = 8) as well as after artificial aging in a chewing simulator and subsequent thermal cycling (n = 8). Combined restorations showed higher fracture load compared to monolithic restorations of polymer-infiltrated ceramic (n = 8) or feldspathic ceramic (n = 8) identical in shape. However, the fracture load of the combined restorations was significantly affected by aging, independent of the primers and cements used. Restorations cemented with primers containing methyl methacrylate and 10-methacryloyloxydecyl dihydrogen phosphate exhibited the highest retention force values. Aging did not affect the retention force significantly. Similar fracture load values can be expected from combination restorations when compared with monolithic crowns.
Collapse
|
49
|
Abstract
This review aims to discuss the advantages and disadvantages of zirconia implants compared with titanium implants. Moreover, it intends to review the relevant available long-term literature of these two materials regarding osteointegration, soft-tissue, microbiota, and peri-implantitis, focusing on clinical results. Briefly, titanium implants are a reliable alternative for missing teeth; however, they are not incapable of failure. In an attempt to provide an alternative implant material, implants made from ceramic-derivate products were developed. Owing to its optimal osseointegration competence, biocompatibility, and esthetic proprieties, zirconium dioxide (ZrO2), also known as zirconia, has gained popularity among researchers and clinicians, being a metal-free alternative for titanium implants with its main use in the anterior esthetic zones. This type of implant may present similar osseointegration as those noted on titanium implants with a greater soft-tissue response. Furthermore, this material does not show corrosion as its titanium analog, and it is less susceptible to bacterial adhesion. Lastly, even presenting a similar inflammatory response to titanium, zirconia implants offer less biofilm formation, suggesting less susceptibility to peri-implantitis. However, it is a relatively new material that has been commercially available for a decade; consequently, the literature still lacks studies with long follow-up periods.
Collapse
|
50
|
Dordunoo D, Anaman-Torgbor J, Smith C, Shaik A, Hass M, Gordon C, An M, Aviles-G ML, Weinzierl M. Hypersensitivity in patients receiving metal implants: a scoping review protocol. JBI Evid Synth 2021; 19:1404-1411. [PMID: 33278266 DOI: 10.11124/jbies-20-00171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The objective of this scoping review is to gather the available evidence on metal hypersensitivity to determine the extent of the problem and identify gaps in the evidence about screening practices. INTRODUCTION Hypersensitivity to metal was first reported in 1966. Since this time, the use of metal in prosthetic devices has increased with an associated rise in reported hypersensitivity reaction to other metals. Symptoms of metal hypersensitivity can be subtle, and it is unclear whether clinicians are aware of or routinely ask patients about metal hypersensitivity when documenting allergies. This can lead to a delay in diagnosis, which puts patients at risk of poor outcomes. Hence, there is a need to map the available evidence on hypersensitivity reaction in people who receive metallic device implantation. INCLUSION CRITERIA The review will consider studies that include patients who undergo procedures involving metal implantation. The concept to be explored is hypersensitivity following a procedure that involves the implementation of a device with metal components. Implementation is defined as permanent integration of a foreign (non-biological) object into the human body to restore function. METHODS The proposed scoping review will be conducted in accordance with JBI methodology for scoping reviews. Searches will be generated in multiple databases and updated as needed. Gray literature and organizational websites will also be searched. Titles, abstracts, and full articles will be screened according to the inclusion criteria. Studies published in English from 1960 to the present will be included. Data will be extracted and findings will be presented in tabular form with a narrative summary.
Collapse
Affiliation(s)
- Dzifa Dordunoo
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada.,The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Health (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
| | - Judith Anaman-Torgbor
- School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Catherine Smith
- Faculty of Health Sciences, University of the Fraser Valley, Chilliwack, BC, Canada
| | - Ajijoon Shaik
- School of Nursing, Camosun College, Victoria, BC, Canada
| | | | - Carol Gordon
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada.,The University of Victoria (UVic) Centre for Evidence-Informed Nursing and Health (CEiNHC): A JBI Affiliated Group, Victoria, BC, Canada
| | - Minjeong An
- College of Nursing, Chonnam National University, Chonnam, South Korea
| | - Martha L Aviles-G
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada
| | - Miriam Weinzierl
- School of Nursing/Human and Social Development, University of Victoria, Victoria, BC, Canada
| |
Collapse
|