Evaluation of removal forces of implant-supported zirconia copings depending on abutment geometry, luting agent and cleaning method during re-cementation

Evaluation of the effect of surface roughness and modification of implant abutment axial wall on the retention of zirconium oxide copings before and after thermocycling

Background

The purpose of this study was to determine the effect of one-wall elimination of the abutment and also the surface treatment of the abutment on the retention of cement-retained, implant-supported zirconium oxide copings.

Material and Methods

In this experimental study, four straight abutments were connected to four implant analogs (DIO, UF, Busan, Korea) with 35 Ncm torque. They are mounted vertically in resin blocks. Abutments were prepared as following groups: A) abutment was used in its intact standard form as a control group. B) 4 mm of the flat wall was removed to produce an abutment with 3 walls. C) The abutment surface was abraded with 50 µm AL2O3 powder. D) 4 mm of a flat wall of the abutment was removed, then the abutment surface was abraded with 50 µm AL2O3 airborne particle.10 zirconium oxide copings were made. Samples were cemented with temp bond NE to abutments. The retention of copings was measured before and after incubation using the universal testing machine. T-test, one-way ANOVA, and Post Hoc Tukey Test were used for statistical analysis of data.

Results

In all groups, retention was decreased after thermocycling (P ≤0.001). 3 wall abutments had less retention than the control group before thermocycling. A significant difference was detected between 3 wall abutments and 4 walls of sandblasted abutments before thermocycling. After thermocycling, no difference in retention was seen between groups.

Conclusions

Thermocycling significantly reduces the retention of implant-supported ceramic copings. Sandblasting abutments with 50 µm AL2O3 air-borne particles did not increase the retention of ziconium oxide copings which were cemented with temp bond NE. One wall elimination of abutment decreased the retention of zirconia copings. Key words:Retention, crown, abutment, zirconia coping, sandblasting.

The effect of different methods of cleansing temporary cement (with and without eugenol) on the final bond strength of implant-supported zirconia copings after final cementation: An in vitro study

Background

The temporary cement remaining inside the dental prosthesis can act as a source of microbial colonization and contamination and decrease the final cement retention. Consequently, complete removal of temporary cement before permanent cementation is suggested. This study aimed to assess the effect of different cleaning methods for removing temporary cement on the tensile bond force (TBF) of permanently cemented implant-supported zirconia copings.

Materials and Methods

In this in vitro study fifty titanium abutments were screwed onto 50 analogs with 30 Ncm torque into in acrylic resin blocks. Each abutment was scanned separately, and 50 zirconia copings were designed and milled. Permanent resin cement was used to cement copings of control group (N = 10). Copings were divided into two temporary cementation types that in each group, two cleansing methods were used: Temp-S (temporary cement with eugenol and sandblasted after debonding), Samples of the control group were placed in the universal testing machine, and the TBF values were recorded. Samples of the test groups after debonding and cleaning the abutments were subjected to cement with permanent resin cement, aging, and removing. Levene test, two-way analysis of variance (ANOVA), and Tamhane post hoc tests were applied. α = 0.05.

Results

The highest and lowest TBF values were found for the TempNE-SU (554.7 ± 31.5 N) and Temp-S (492.2 ± 48 N) groups, respectively. The two groups of isopropyl alcohol baths in ultrasonics in combination with sandblasting showed statistically higher TBF values than the other two groups that used only sandblasting (P < 0.001) and had similar values compared to the control group.

Conclusion

Sandblasting combined with immersion in an ultrasonic bath containing isopropyl alcohol resulted in statistically similar values to the values of cementation with resin cement from the beginning. However, cleaning the inside of the copings only by sandblasting method reduced the values of the final retention force in comparison to cement with permanent resin cement from the beginning.

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

Background

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

Methods

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

Results

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

Conclusions

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

Retention of different temporary cements tested on zirconia crowns and titanium abutments in vitro

Purpose

The aim of the present study was to examine the retention force of monolithic zirconia copings cemented with various temporary cements on implant abutments in vitro.

Methods

Sixty exercise implants with pre-screwed implant abutments were embedded in resin. Subsequently, 60 CAD/CAM manufactured zirconia copings were divided into three main groups [Harvard Implant Semi-permanent (HAV), implantlink semi Forte (IMP), Temp Bond NE (TBNE)]. The zirconia copings were cemented on the implant abutments and loaded with 35 N. Specimens were stored in distilled water (37 °C) for 24 h. Half of the test specimens of each group were subjected to a thermocycling (TC) process. Retention force was measured in a universal testing machine. Using magnifying glasses, the fracture mode was determined. Statistical analysis was performed applying the Kruskal-Wallis test, the post hoc test according to Dunn-Bonferroni and a chi-square test of independence.

Results

Without TC, IMP showed the highest retention of the three temporary luting agents (100.5 ± 39.14 N). The measured retention forces of IMP were higher than those of HAV (45.78 ± 15.66 N) and TBNE (61.16 ± 20.19 N). After TC, retention was reduced. IMP showed the greatest retentive strength (21.69 ± 13.61 N, three fail outs). HAV and TBNE showed pull-off forces of similar magnitude (17.38 ± 12.77 N and 16.97 ± 12.36 N, two fail outs). The fracture mode analysis showed different results regarding the tested cements before and after TC (facture type before/after TC): IMP (III+II/III), HAV (I/II) and TBNE (III/III). There were clear differences of the fracture modes regarding the examination before and after TC.

Conclusions

Within the limits of this study, IMP showed the highest pull-off forces under the chosen test conditions. All three temporary luting agents showed lower retention forces after TC. Retention values in the individual cement classes were very heterogeneous. Easy cement removal in the crown lumen favours the dominance of adhesive cement fractures on the abutment and adhesive/cohesive cement fractures on the abutment with HAV appears advantageous in case of recementation of the superstructure.

Effect of Abutment Geometry and Luting Agents on the Vertical Marginal Discrepancy of Cast Copings on Implant Abutments: An In Vitro Study

Aim

Vertical marginal discrepancy (VMD) influences the success of implant-supported restorations. However, there is little literature that has investigated the influence of geometry and cementing agent on changes in VMD of metal copings on implant abutments. The objective was to evaluate the effect of the geometry of the abutment and cementing agents on VMD.

Methods

Cast copings were cemented on implant abutments customized cylindrical (4, 5.5, and 7 mm) and on hexagonal implant abutments (4 mm) cemented or uncemented molded copings were placed (n = 4, totally 64 samples) with different luting agents. The VMD of the copings were measured in the coping-abutment interface at three reference points using a stereomicroscope. The independent Student's t test was used for comparison between the two different abutment walls. The post hoc statistical analysis was performed by the Tukey test.

Results

There was a significant VMD increase between noncemented and cemented cast copings using different luting agents. Abutment geometry and luting agents significantly influenced the VMD (p ≤ 0.05). Cylindrical abutment at 7 mm in height cemented with different luting agent tested showed significantly higher VMD values than cylindrical abutments of 4 mm (p=0.019). Hexagonal abutments with a 4 mm height showed significantly higher VMD values than cylindrical 4 mm abutments using zinc oxide noneugenol and glass ionomer cements (p=0.032).

Conclusions

Abutment geometry and luting agents influence the VMD of cast copings cemented on implant abutment. The higher the cylindrical abutment, the greater the VMD, and hexagonal wall abutments promote greater marginal gap.

Influence of abutment height and convergence angle on the retrievability of cement-retained implant prostheses with a lingual slot

PURPOSE

Cement-retained implant prostheses can lack proper retrievability during repair, and residual cement can cause peri-implantitis. The purpose of this in vitro study was to evaluate the influence of abutment height and convergence angle on the retrievability of cement-retained implant prostheses with lingual slots, known as retrievable cement-type slots (RCS).

MATERIALS AND METHODS

We fabricated six types of titanium abutments (10 of each type) with two different heights (4 mm and 6 mm), three different convergence angles (8°, 10°, and 12°), a sloped shoulder margin (0.6 mm depth), a rectangular shape (6 mm × 6.5 mm) with rounded edges, and a rectangular ledge (2 mm × 1 mm) for the RCS. One monolithic zirconia crown was fabricated for each abutment using a dental computer-aided design/computer-aided manufacturing system. The abutments and crowns were permanently cemented together with dual-curing resin cement, followed by 24 hours in demineralized water at room temperature. Using a custom-made device with a slot driver and torque gauge, we recorded the torque (N·cm) required to remove the crowns. Statistical analysis was conducted using multiple regression analysis and Mann-Whitney U tests (α=.05).

RESULTS

Removal torques significantly decreased as convergence angles increased. Multiple regression analysis showed no significant interaction between the abutment height and the convergence angle (Durbin-Watson ratio: 2.186).

CONCLUSION

Within the limitations of this in vitro study, we suggest that the retrievability of cement-retained implant prostheses with RCS can be maintained by adjusting the abutment height and convergence angle, even when they are permanently cemented together.

Influence of Luting Materials on the Retention of Cemented Implant-Supported Crowns: An In Vitro Study

The retention force of cemented crowns on implant abutments with various luting materials was evaluated. Cobalt⁻chromium crowns were cemented onto tapered titanium abutments (Camlog) with eugenol-free temporary cement (RelyX TempBond NE), composite-based temporary cement (Bifix Temp), zinc phosphate cement (Harvard Cement), glass-ionomer cements (Meron, Fuji I), and resin-modified glass-ionomer cements (Fuji II, Fuji Plus, Ketac Cem Plus). Specimen aging via hydrostress was performed in artificial saliva at 37 °C for 14 days (S1), followed by hydrothermal stress with thermocycling (S2). The crowns were removed, and the force was recorded (T1). Subsequently, the crowns were recemented, aged, and removed, and the force was recorded (T2, T3). The retention forces differences were statistically significant according to the storage conditions at T1 (p = 0.002) and T3 (p = 0.0002). After aging (S1), Ketac Cem Plus had the highest retention force median value difference (T3 versus T1) (-773 N), whereas RelyX TempBond NE had the lowest (-146 N). After aging (S2), Meron had the highest retention force median value difference (-783 N), whereas RelyX TempBond NE had the lowest (-168 N). Recementation decreased the retention force of the implant-supported cobalt⁻chromium crowns cemented and recemented with the same luting materials. Luting materials (at T1) and aging conditions significantly impacted the retention force.

Effects of abutment diameter, luting agent type, and re-cementation on the retention of implant-supported CAD/CAM metal copings over short abutments

PURPOSE

The aim of this study was to evaluate the effects of abutment diameter, cement type, and re-cementation on the retention of implant-supported CAD/CAM metal copings over short abutments.

MATERIALS AND METHODS

Sixty abutments with two different diameters, the height of which was reduced to 3 mm, were vertically mounted in acrylic resin blocks with matching implant analogues. The specimens were divided into 2 diameter groups: 4.5 mm and 5.5 mm (n=30). For each abutment a CAD/CAM metal coping was manufactured, with an occlusal loop. Each group was sub-divided into 3 sub-groups (n=10). In each subgroup, a different cement type was used: resin-modified glass-ionomer, resin cement and zinc-oxide-eugenol. After incubation and thermocycling, the removal force was measured using a universal testing machine at a cross-head speed of 0.5 mm/min. In zinc-oxide-eugenol group, after removal of the coping, the cement remnants were completely cleaned and the copings were re-cemented with resin cement and re-tested. Two-way ANOVA, post hoc Tukey tests, and paired t-test were used to analyze data (α=.05).

RESULTS

The highest pulling force was registered in the resin cement group (414.8 N), followed by the re-cementation group (380.5 N). Increasing the diameter improved the retention significantly (P=.006). The difference in retention between the cemented and recemented copings was not statistically significant (P=.40).

CONCLUSION

Resin cement provided retention almost twice as strong as that of the RMGI. Increasing the abutment diameter improved retention significantly. Re-cementation with resin cement did not exhibit any difference from the initial cementation with resin cement.

Effect of cement type on the color attributes of a zirconia ceramic

PURPOSE

This in vitro study evaluated the effects of four different cements on the color attributes of a zirconia ceramic.

MATERIALS AND METHODS

40 zirconia ceramic disk specimens (0.5 mm thickness, 10 mm diameter, 0.1 mm cement space) were fabricated by a computer-aided design and computer-aided manufacturing system. The specimens were divided into 4 groups of 10 specimens and cemented to composite substrates using four different cements including: Glass Ionomer, Panavia F2.0, Zinc Phosphate, and TempBond. The L^*, a^*, and b^* color attributes of the specimens were measured before and after cementation by a spectrophotometer. Additionally, ΔE values were measured to determine color changes for the groups and then compared with the perceptional threshold of ΔE = 3.3. Repeated Measures ANOVA, Tukey Post Hoc, Bonferroni, One-way ANOVA, and One-sample t-test tests were used to analyze the data. All tests were carried out at the 0.05 level of significance.

RESULTS

Statistically significant differences were detected in the ΔE values for Zinc Phosphate (P<.0001) and TempBond (P<.0001) groups. However, there were no statistically significant differences in this respect for Glass Ionomer (P=.99) and Panavia F2.0 (P=1) groups. The means and standard deviations of the ΔE values for Glass Ionomer, Panavia F2.0, Zinc Phosphate, and Tempbond groups were 2.11±0.66, 0.94±0.39, 5.77±0.83, and 7.50±1.16 Unit, respectively.

CONCLUSION

Within the limitations of this study, it was concluded that Zinc Phosphate and Tempbond cements affected the color attributes of the tested zirconia ceramic beyond the perceptional threshold. However, Glass Ionomer and Panavia F2.0 cements created acceptable color changes.

Clinical evaluation of an improved cementation technique for implant-supported restorations: a randomized controlled trial

BACKGROUND

Cement remnants were frequently associated with peri-implantitis. Recently, a shoulderless abutment was proposed, raising some concern about cement excess removal.

AIM

To compare different cementation techniques for implant-supported restorations assessing the amount of cement remnants in the peri-implant sulcus. Additional aim was to compare the effect of these cementation techniques using two different abutment designs.

MATERIAL & METHODS

Forty-six patients requiring double implant-supported restoration in the posterior maxilla were randomly divided in two groups according to the cementation modality: intraoral and extraoral. According to the abutment finishing line, implants in each patient were randomly assigned to shoulderless or chamfer subgroup. In the intraoral group, crowns were directly seated onto the titanium abutment. In the extraoral group, crowns were firstly seated onto a resin abutment replica and immediately removed, then cleansed of the cement excess and finally seated on the titanium abutment. After cement setting, in both groups, cement excess was carefully tried to remove. Three months later, framework/abutment complexes were disconnected and prepared for microscopic analysis: surface occupied by exposed cement remnants and marginal gaps were measured. Additionally, crown/abutment complexes were grinded, and voids of cement were measured at abutment/crown interface. Related-samples Friedman's two-way analysis of variance by ranks was used to detect differences between groups and subgroups (P ≤ 0.5).

RESULTS

At the end of the study, a mean value of 0.45 mm² (±0.80), 0.38 mm² (±0.84), and 0.065 mm² (±0.13) and 0.07 mm² (±0.15) described surface occupied by cement remnants in shoulderless and chamfer abutment with intraoral cementation and shoulderless and chamfer abutment with extraoral cementation, respectively. A mean value of 0.40 mm² (±0.377), 0.41 mm² (±0.39) and 0.485 mm² (±0.47) and 0.477 mm² (±0.43) described cement voids at the abutment/crown interface; a mean value of 0.062 mm (±0.03), 0.064 mm (±0.35), 0.055 mm (±0.016) and 0.054 mm (±0.024) described marginal gaps. Statistics showed tendency of intraoral cementation to have significantly higher cement remnants compared with abutments with extraoral cementation groups. At the same time, the presence of voids was significantly higher in case of extraoral cementation. No significant differences between groups for the variable "gap".

CONCLUSIONS

Despite the presence of more voids, extraoral cementation reduces cement excess. However, using low adhesivity cement and careful cement removal, a very limited quantity of cement remnants was observed also in the intraoral cementation.