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

Pull-Off Forces on Implant-Supported Single Restorations by Sticky Food: An In Vitro Study

OBJECTIVE

To investigate the pull-off forces on implant-supported restorations caused by sticky food, to understand how much retention force cemented restorations must have to withstand chewing forces without unintentional retention loss. The influence of food type, restoration design, and surface treatment were investigated.

MATERIAL AND METHODS

Monolithic implant-supported CAD/CAM zirconia crowns were fabricated and divided into groups according to their design: no (NC), flat (FC) and high cusps (HC) and subdivided according to surface roughness: rough (r) and smooth (s) (n = 10/group). NC represented the control group. The crowns were fixed in a universal testing machine opposite to each other. Four sticky foods (caramel, fruit jelly, candy strips and licorice) and a resin crown remover were tested. These were heated (36.4°C), placed between the crowns and compressed, then tensile strength tests were performed. The maximum pull-off force was recorded (Newton [N]). Statistical analysis was performed using 3-way ANOVA.

RESULTS

The highest mean pull-off force among food samples was with caramel_HC_r (12.09 ± 1.26 N), whereas the lowest was with licorice_FC_s (3.21 ± 0.15 N). For the resin crown remover, a mean pull-off force of 55.41 ± 3.87 N was measured in the HC_r group. Both food type and crown design showed a significant influence on pull-off force (p < 0.001), whereas no significant effect was reported with different surface roughnesses (p = 0.344).

CONCLUSION

This study reported pull-off forces of up to 20 N between all-ceramic restorations caused by sticky food. The clinical implication of these findings is that a cemented implant-restoration must have a minimum retention force of 20 N to withstand unintentional displacement during function.

Influence of the Composition of Provisional Luting Materials on the Bond Strength of Temporary Single-Tooth Crowns on Titanium Abutments

In addition to zinc oxide-based cements, resin-based materials are also available for temporary cementation. The aim of this in vitro study was to determine the influence of the different material compositions on temporary bonds. In nine test series (n = 30), temporary bis-acrylate single-tooth crowns were bonded onto prefabricated titanium abutments with nine different temporary luting materials. After simulating an initial (24 h, distilled water, 37 °C), a short-term (7 days, distilled water, 37 °C) and a long-term provisional restoration period (12h, distilled water, 37 °C; thermocycling: 5000 cycles) in subgroups (n = 10), the bond strength was examined using a combined tensile-shear test. Statistical analysis was performed by univariate analysis of variance or a non-parametric Kruskal-Wallis test, followed by post hoc tests. Of the three resin-based materials, two showed significantly higher bond strength values compared to all other materials (p < 0.001), regardless of the storage procedure. The resin-based materials were followed by eugenol-free and eugenol-containing zinc oxide materials. Significant intragroup differences were observed between the composite-based materials after all storage periods. This was only observed for some of the zinc oxide-based materials. The results show that under in vitro conditions, not only the composition of the temporary luting materials but also the different storage conditions have a significant influence on temporary bonds.

Comparison of marginal leakage and retentive strength of implant-supported milled zirconia and cobalt-chromium copings cemented with different temporary cements

Background

Few studies assessed the effect of coping material (particularly milled metal copings) on the retentive strength of cements and reported contradictory results. Thus, this study aims to assess the marginal leakage and retentive strength of implant-supported milled zirconia and cobalt-chromium (Co-Cr) copings cemented with different temporary cements.

Materials and Methods

In this in vitro study, Zirconia and Co-Cr copings were fabricated on 100 straight titanium abutments. Each group of copings was divided into five subgroups (n = 10) for the use of different cements: permanent zinc-phosphate (ZP) cement, temporary zinc oxide eugenol cement (temp bond [TB]), calcium hydroxide-based temporary cement (Dycal [DC]), polymer-based eugenol-free acrylic-urethane temporary cement (Dentotemp [DT]), and methacrylate-based temporary cement (Implantlink [IL]). The retentive strength and marginal leakage of restorations were assessed. Data were analyzed by one-way ANOVA, Tukey, and Fisher's exact tests (α = 0.05).

Results

In the Co-Cr group, the retentive strength values (in Newtons) were as follows: ZP (411.40 ± 5.19) >DC (248.80 ± 5.01) >IL (200.10 ± 5.06) >DT (157.90 ± 5.19) >TB (98.50 ± 6.88). This order was as follows in the zirconia group: ZP (388.70 ± 5.35) >DC (226.60 ± 5.08) >IL (179.00 ± 3.71) >DT (136.00 ± 4.88) >TB (78.60 ± 3.50). All pairwise comparisons were statistically significant (P < 0.001). The difference in marginal leakage was not significant among the groups (P = 0.480).

Conclusion

The type of coping material and cement type significantly affected retentive strength, but not marginal leakage, of implant restorations. Milled Co-Cr copings showed higher retentive strength than zirconia copings, and ZP cement followed by DC yielded the highest retention.

An Evaluation of the Effectiveness of Various Luting Cements on the Retention of Implant-Supported Metal Crowns

Background and objective Cement-retained prostheses have replaced screw-retained prostheses as the preferred restoration in recent years in order to overcome the latter's limitations. In this study, four different luting cements were compared to evaluate their efficacy on the retention of cement-based metal crowns to implant abutments. Materials and methods In the right and left first molar regions, four implant analogs (Internal Hex, Adin Dental Implant Systems Ltd., Tel-Aviv, Israel) were screwed into epoxy resin casts (Araldite CY 230-1 IN, India) that were positioned perpendicular to the cast's plane. Four metal copings were created and cemented. Group A: polycarboxylate cement (DUR) (DurelonTM, 3M Espe, St. Paul, MN); Group B: PANAVIA™ F 2.0 dual-cure resin cement (Kuraray America, Inc., New York, NY); Group C: resin-modified glass ionomer (3M™ RelyX™ Luting, 3M Espe); and Group D: non-eugenol temporary resin cement (Kerr-Temp, KaVo Kerr, Brea, CA) were used to cement crowns. To check the retention capacity, samples were put through a pull-out test on an Instron universal testing machine (TSI‑Tecsol, Bengaluru, India) with a crosshead speed of 0.5 mm/min. Each coping's de-cementing load was noted, and average values for every sample were computed and statistically analyzed. Results The findings demonstrated that non-eugenol temporary resin implant cement has the lowest retention value at 138.256 N, followed by resin-modified glass ionomer cement at 342.063 N, polycarboxylate luting cement at 531.362 N, and resin cement at 674.065 N. The average difference in retentive strength across all four groups was statistically very significant (p=0.001). Conclusion Based on our findings, non-eugenol temporary resin implant cement enables simple retrievability of the prosthesis in the event of a future failure and is appropriate for implant restorations with cement retention. Also, cements made of polycarboxylate and resin have the highest retention values.

The effects of provisional resin cements on the color and retentive strength of all-ceramic restorations cemented on customized zirconia abutments

This study aimed to evaluate the effects of two types of provisional resin cements on the color and retentive strength of two different all-ceramic restorations cemented onto customized zirconia abutments. Forty-two crowns were made of monolithic zirconia and lithium disilicate ceramics (n = 21 per group) and cemented on customized zirconia abutments by using two provisional resin cements of TempBond Clear and Implantlink Semi, and TempBond serving as the control (n = 7 per cement subgroup). The specimens’ color was measured before and after cementation and after thermocycling. The color difference was calculated by using CIEDE2000 formula (ΔE₀₀). The tensile force was applied to assess the retentive strength. Kruskal-Wallis, Dunn’s post-hoc, and Mann-Whitney non-parametric tests were used to compare ΔE₀₀(1) and ΔE₀₀(2) and two-way ANOVA followed by one-way ANOVA and Tukey’s HSD post hoc test and T-test were used to compare retentive strength between subgroups. In the lithium disilicate group, ΔE₀₀ of the control subgroup (TempBond) was significantly higher than that of Implantlink Semi cements subgroup (P = 0.001). But, in the monolithic zirconia group, ΔE₀₀ of the control subgroup (TempBond) was significantly higher than that of Implantlink Semi (P = 0.020) and TempBond Clear cements (P = 0.007). In the monolithic zirconia group, the control subgroup (TempBond) was significantly more retentive than TempBond Clear (P = 0.003) and Implantlink Semi cement (P = 0.001). However, in the lithium disilicate group, Implantlink Semi cement was significantly more retentive than TempBond Clear (P = 0.019) and TempBond (control) (P = 0.001). The final color of both restorations was significantly affected by the provisional resin cement type. The retentive strength was influenced by both the type of cement and ceramic.

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.

Restoration of converging implants: Restorative complexity to facilitate retrievability

Implant treatment should be restoratively driven, however at times, ideal implant positioning may be sacrificed for surgical convenience at the expense of restorative complexity. A prosthesis incorporating a novel design was constructed to restore two converging implants placed in close proximity utilizing standard implant impression componentry and simple clinical stages. As the use of angulated screw channel technology was not possible, a customized cast “rest” abutment and overlying telescopic crown was fabricated that facilitated access for oral hygiene and retrievability as required. The complexity of the case design was transferred to the laboratory phases of construction. The case presented a satisfactory clinical outcome for an initially challenging implant presentation and reinforced the need to work closely with the laboratory technician.