Effect of surface treatments on wear and surface properties of different CAD-CAM materials and their enamel antagonists

STATEMENT OF PROBLEM

Which surface treatment provides optimal surface roughness, microhardness, and wear behavior for computer-aided design and computer-aided manufacturing (CAD-CAM) materials and their enamel antagonists is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of surface treatment on the surface roughness, microhardness, and 2-body wear of different CAD-CAM materials and their enamel antagonists.

MATERIAL AND METHODS

Monolithic zirconia, polymer-infiltrated ceramic network, lithium disilicate, leucite-reinforced ceramic, zirconia-reinforced lithium silicate, and feldspathic ceramic specimens were sliced into 2-mm-thick rectangular plates and divided into polished or glazed subgroups (n=6). After surface roughness and microhardness measurements, the specimens were loaded at 49 N for 250 000 cycles and simultaneously thermocycled (5 °C and 55 °C). All specimens were scanned before and after the wear test by using a scanner. The volumetric loss and wear depth of the materials and the volumetric and height loss of the enamel were calculated, and scanning electron microscope images of the specimens were made. Multiple 2-way ANOVAs and Tukey honestly significant difference tests were used to assess the effect of material and surface treatment on surface roughness, microhardness, and wear behavior of materials and enamel (α=.05).

RESULTS

Material and surface treatment interactions affected the surface roughness (P<.001), microhardness (P<.001), volumetric loss of materials (P=.044), and height loss of enamel (P<.001).

CONCLUSIONS

Polishing resulted in higher surface roughness and microhardness than glazing. Volumetric loss depended on the material, which affected the height loss of the antagonists. Glazing and polishing had similar effects on the volumetric loss of materials and antagonists. No correlation was found between the wear of materials and the antagonists, nor between the surface roughness of materials and the volumetric loss of materials or antagonists.

Effect of computer-aided design and computer-aided manufacturing technique on the accuracy of fixed partial denture patterns used for casting or pressing

OBJECTIVES

To evaluate the effect of additive and subtractive manufacturing on the accuracy (trueness and precision) of fixed partial denture patterns (FPDPs) used for casting or pressing.

MATERIALS AND METHODS

A 3-unit complete coverage FPD on mandibular right first premolar and first molar teeth was virtually designed. Using the design data, FPD patterns were fabricated from an additively manufactured resin (PR, ProArt Print Wax) and 2 CAD-CAM wax discs (YW, ProArt CAD Wax Yellow and BW, ProArt CAD Wax Blue) (n = 10). Each pattern was then digitized with a scanner (CEREC Primescan) and evaluated for 3D surface deviation at 4 different surfaces (overall, external, marginal, and intaglio surfaces) by using a 3D analysis software (Medit Link). Root mean square (RMS) values were automatically calculated. Data were analyzed by using Kruskal-Wallis and Dunn's post hoc tests for trueness and precision (α= 0.05).

RESULTS

Significant differences were found among the RMS values for overall (P<.001) and each surface (P≤.040) evaluated. PR had the highest overall (P≤.011) and intaglio surface (P≤.01) deviations, while the difference between YW and BW was not significant (P≥.199). PR had the highest (P≤.027) and BW had the lowest (P≤.042) external surface mean RMS values. BW had higher mean marginal RMS value than YW (P=.047). For precision, significant differences were observed among test groups only for marginal RMS values (P=.002). PR had lower precision than BW (P=.002).

CONCLUSIONS

BW and YW FPDPs mostly had higher trueness compared with PR FPDPs. However, considering relatively smaller deviations at marginal and intaglio surfaces and the fact that patterns mostly had similar precision, clinical fit of FPDs fabricated by using tested patterns may be similar.

CLINICAL SIGNIFICANCE

Definitive 3-unit fixed partial dentures fabricated by using tested patterns may be similar. However, FPDs fabricated with tested additively manufactured resin patterns might result in more chairside adjustments than those fabricated with tested subtractively manufactured wax patterns.

Effect of coffee thermocycling on the surface roughness and stainability of nanographene-reinforced polymethyl methacrylate used for fixed definitive prostheses

STATEMENT OF PROBLEM

A nanographene-reinforced polymethyl methacrylate (PMMA) has been introduced for definitive prostheses. However, knowledge on the surface roughness and stainability of this material is lacking.

PURPOSE

The purpose of this in vitro study was to compare the surface roughness and stainability of nanographene-reinforced PMMA with those of a prepolymerized PMMA and a reinforced composite resin after coffee thermocycling.

MATERIAL AND METHODS

Disk-shaped specimens (Ø10×1.5-mm) were prepared from 3 different A1-shade millable resins (prepolymerized PMMA [M-PM; PMMA]; nanographene-reinforced PMMA [G-CAM; G-PMMA]; reinforced composite resin [Brilliant Crios; RCR]). Surface roughness (R_a) values were measured before and after conventional polishing by using a noncontact profilometer. Initial color coordinates were measured over a gray background with a spectrophotometer after polishing. Specimens were then thermocycled in coffee for 5000 cycles. Measurements were repeated after coffee thermocycling, and color differences (ΔE₀₀) were calculated. R_a values among different time intervals were analyzed by using either the Friedman and Dunn tests (RCR) or repeated measures analysis of variance (ANOVA) and Bonferroni corrected paired samples t tests (PMMA and G-PMMA), while R_a values within a time interval were analyzed by using either the Kruskal-Wallis and Dunn tests (before polishing) or 1-way ANOVA and Tukey HSD (after polishing) or Tamhane T2 tests (after coffee thermocycling). ΔE₀₀ values were analyzed by using 1-way ANOVA and Tukey HSD tests, while color coordinates of the specimens after polishing and after coffee thermocycling were compared by using paired samples t tests (α=.05).

RESULTS

All materials had their highest R_a values before polishing (P≤.011), while differences after polishing and after coffee thermocycling values were nonsignificant (P≥.140). PMMA had higher R_a than RCR before polishing (P=.002), and RCR had higher values than G-PMMA after polishing and after coffee thermocycling (P≤.023). RCR had the highest ΔE₀₀ (P<.001). Polishing increased the b∗ values of PMMA, and coffee thermocycling increased the a∗ values of G-PMMA and all values of RCR (P≤.012).

CONCLUSIONS

The tested materials had similar and acceptable surface roughness after polishing. The surface roughness of materials was not affected by coffee thermocycling. Considering the reported color thresholds, all materials had acceptable color change, but the computer-aided design and computer-aided manufacturing composite resin had perceptible color change after coffee thermocycling.

PRELIMINARY FINDINGS OF TLR2 AND TLR4 EXPRESSION IN PRETERM NEONATES WITH NECROTIZING ENTEROCOLITIS

Necrotizing enterocolitis (NEC) is a leading cause of morbidity and mortality in preterm infants. Despite significant advances made in the prevention and treatment of disease so far, there has not been much change in the rate of mortality and morbidity associated with NEC. Although the factors affecting the development of necrotizing enterocolitis are not yet known precisely, prematurity is thought to be the most important risk factor for the development of NEC. This study aims to determine toll-like receptor (TLR) 2 and TLR4 expression levels in preterm neonates. A total of 50 preterm infants (patient: 42, control: 8) were included in the study. TLR2 and TLR4 expression levels were analysed by the RT-qPCR method. While there was no difference in infants' birth weight (g), gestational age (months), mother's age (years), father's age (years), and WBC (109/L); HGB (g/dL) and RBC (1012/L) were found to be significantly higher in the group with NEC (p<0.05). When TLR2 and TLR4 relative gene expression levels of neonates were evaluated (log2), it was determined that there was a significant difference between the two groups (below 1500 g) (p<0.001). TLR4 relative expression (2^-ddCt, above 1500 g) was higher in the NEC group than in the healthy group, while TLR2 relative expression (2^-ddCt, above 1500 g) was higher in the healthy group. TLR2 and TLR4 have been shown to have prominent roles in the development of NEC in experimental animal models and it would be significant to support this with human studies/animal models for a better understanding of the disease. Thus, it is recommended that future studies be carried out on experimental models that better replicate the human body, and dietary factors should be examined in detail.

Effect of intraoral scanner and fixed partial denture situation on the scan accuracy of multiple implants: An in vitro study

BACKGROUND

Accuracy of intraoral implant scans may be affected by the region of the implant and the type of the intraoral scanner (IOSs). However, there is limited knowledge on the scan accuracy of multiple implants placed for an implant-supported fixed partial denture (FPD) in different partially edentulous situations when digitized by using different IOSs.

PURPOSE

To investigate the effect of IOS and FPD situation on the scan accuracy of two implants when partial-arch scans were performed.

MATERIALS AND METHODS

Tissue level implants were placed in 3 maxillary models with implant spaces either at right first premolar and right first molar sites (Model 1, 3-unit FPD), at right canine and right first molar sites (Model 2, 4-unit FPD), or at lateral incisor sites (Model 3, 4-unit FPD). Reference standard tessellation language (STL) files of the models were generated by using an optical scanner (ATOS Capsule 200MV120). Two IOSs (CEREC Primescan [CP] and TRIOS 3 [TR]) were used to perform partial-arch scans (test-scans) of each model (n = 14), which were exported in STL format. A metrology-grade analysis software (GOM Inspect 2018) was used to superimpose test-scan STLs over the reference STL to calculate 3D distance, inter-implant distance, and angular (mesiodistal and buccopalatal) deviations. Trueness and precision analyses were performed by using bootstrap analysis of variance followed by Welch tests with Holm correction (α = 0.05).

RESULTS

Trueness of the scans was affected by IOS and FPD situation when 3D distance deviations were considered, while inter-implant distance, mesiodistal angular, and buccopalatal angular deviations were only affected by the FPD situation (p < 0.001). Scan precision was affected by the interaction between the IOSs and the FPD situation when 3D distance and buccopalatal angular deviations were concerned, while IOSs and FPD situation were effective when all deviations were concerned (p≤ 0.001). When 3D distance deviations were considered, CP scans had higher accuracy TR scans in Models 1 and 3 (p ≤ 0.002), and the Model 1 scans had the highest accuracy (p < 0.001). When inter-implant distance deviations were considered, Model 1 scans had the highest accuracy with CP and higher accuracy than Model 2 when TR was used (p ≤ 0.030). When mesiodistal angular deviations were considered, Model 1 scans had the highest accuracy (p ≤ 0.040). When buccopalatal angular deviations were considered, Model 1 scans had the highest accuracy among models when CP was used (p ≤ 0.020).

CONCLUSIONS

Posterior 3-unit fixed partial denture implant scans, CP scans, and combination of these two factors had accuracy either similar to or better than their tested counterparts.

Effect of material type, torque value, and sterilization on linear displacements of a scan body: An in vitro study

BACKGROUND

There is limited knowledge on the effect of scan body (SB) material type, torque value, and sterilization on linear displacements of implant SBs.

PURPOSE

To evaluate the effect of material type, torque value, and sterilization on linear displacements of SBs during screw tightening by using digital image correlation (DIC) analysis.

MATERIALS AND METHODS

One polyetheretherketone (PEEK, Zfx Intraoral Scan Body) and one titanium SB (Ti, MPS Zimmer Scanbody R1410) were tightened with 5 Ncm torque on two implants (Zimmer TSV ⌀4.7 mm) by using a digital torque limiting device. SBs' initial spatial positions relative to the implants were recorded by using 3D DIC technique. Measurements were repeated after initially increasing torque value to 10 Ncm and then to 15 Ncm, and these steps were repeated for a total of 10 PEEK and 10 Ti SBs on both implants (n = 20). All SBs were then sterilized 25 times by using an autoclave (STATIM 5000 S G4) according to manufacturer's recommendations and all measurements were repeated. Linear displacements on three axes were calculated for each SB with increasing torque values (from 5 to 10 Ncm and from 10 to 15 Ncm) before and after sterilization. SB displacements within each torque value-sterilization pair were compared by using Mann-Whitney U test, whereas Wilcoxon signed-rank test was used to compare SB displacements within each material-torque value pair between conditions and within each material-sterilization pair between torque values (α = 0.05).

RESULTS

On x-axis, PEEK SBs had higher displacements than Ti SBs (p < 0.001), whereas sterilization (p ≤ 0.028) and 15 Ncm torque application (p ≤ 0.006) led to higher displacements of PEEK SBs. On y-axis, PEEK SBs had higher displacements than Ti SBs with 15 Ncm torque application (p ≤ 0.033). A total of 15 Ncm torque-applied PEEK SBs and 10 Ncm torque-applied Ti SBs had higher displacements after sterilization (p ≤ 0.028). Application of 15 Ncm torque led to higher displacements regardless of the material (p ≤ 0.002). On z-axis, PEEK SBs had higher displacements (p ≤ 0.015), except for 10 Ncm torque-applied sterilized SBs (p = 0.102). With 10 Ncm torque application, sterilization decreased the displacement values of PEEK SBs (p = 0.044). Greater displacements were observed with 10 Ncm torque-applied Ti SBs before sterilization and 15 Ncm torque-applied PEEK SBs after sterilization (p ≤ 0.033).

CONCLUSIONS

Axial displacement of SBs was affected by material type, torque value, and sterilization. Ti SBs mostly had lower displacements than PEEK SBs. Application of 15 Ncm torque to tested PEEK SBs should be refrained from and a calibrated tightening tool may enable the application of 10 Ncm or lower torque values for lower displacements. Sterilization generally increased PEEK SB displacements.

Influence of drilling sequence and guide-hole design on the accuracy of static computer-assisted implant surgery in extraction sockets and healed sites-An in vitro investigation

OBJECTIVES

To evaluate the effect of drilling sequence, guide-hole design, and alveolar ridge morphology on the accuracy of implant placement via static computer-assisted implant surgery (sCAIS).

MATERIALS AND METHODS

Standardized maxillary bone models including single-tooth gaps with fresh extraction sockets or healed alveolar ridge morphologies were evaluated in this study. Implants were placed using different drilling sequences (i.e., complete [CDS] or minimum [MDS]), and guide-hole designs (i.e., manufacturer's sleeve [MS] or sleeveless [SL] guide-hole designs). The time for implant placement via sCAIS procedures was also recorded. The angular, crestal, and apical three-dimensional deviations between planned and final implant positions were digitally obtained. Statistical analyses were conducted by a non-parametric three-way ANOVA (α = .05).

RESULTS

Based on a sample size analysis, a total of 72 implants were included in this study. Significantly higher implant position accuracy was found at healed sites compared to extraction sockets and in SL compared to MS guide-hole design in angular, crestal, and apical 3D deviations (p ≤ .048). A tendency for higher accuracy was observed for the CDS compared to the MDS, although the effect was not statistically significant (p = .09). The MDS required significantly shorter preparation times compared with CDS (p < .0001).

CONCLUSION

Implant placement via sCAIS resulted in higher accuracy in healed sites than extraction sockets, when using SL compared to MS guides, and tended to be more accurate when using CDS compared to MDS. Therefore, even though surgery time was shorter with MDS, its use should be limited to strictly selected cases.

Interim rehabilitation of an edentulous situation with an overdenture retained by short implants during a staged vertical and horizontal ridge augmentation: a dental technique

Interim rehabilitation of edentulous patients is essential in implant prosthodontics. However, surgical augmentation may be required for patients with reduced bone density, which complicates the use of an interim prosthesis. This report describes the rehabilitation of an edentulous patient with an interim maxillary overdenture retained by short implants with individual attachments during the healing period of vertical and horizontal ridge augmentation. This technique increased the stability of the interim prosthesis even with shortened flanges to eliminate any pressure on the surgical site. This technique could also be used when immediate loading is not possible due to lack of primary stability of the implants placed for definitive fixed prostheses.

Prosthetic complications with monolithic or micro-veneered implant-supported zirconia single-unit, multiple-unit, and complete-arch prostheses on titanium base abutments: A single center retrospective study with mean follow-up period of 72.35 months

BACKGROUND

The influence of prosthetic design on prosthetic complications when monolithic or micro-veneered zirconia prostheses are supported with titanium base (ti-base) abutments is not well-known.

PURPOSE

The purpose of this single center, retrospective study was to assess the prevalence of prosthetic complications with monolithic or micro-veneered single-unit, multi-unit, and complete-arch zirconia prostheses supported with ti-base abutments (implant level or multi-unit abutment level).

MATERIAL AND METHODS

This study retrospectively evaluated the electronic health record (EHR) of participants who received either monolithic or micro-veneered implant-supported single-unit, multi-unit, and/or complete-arch prostheses supported by ti-base or zirconia-ti-base hybrid abutments delivered between the years 2010 and 2021. Data were analyzed by using logistic regression and Exact Mantel-Haenszel chi-square test (α = 0.05) to assess the clinical performance of prostheses and complications including crown decementation, feldspathic porcelain chipping, prosthesis fracture, zirconia-ti-base hybrid abutment decementation, abutment screw loosening, screw fracture, abutment fracture, implant loss, and prosthesis remake.

RESULTS

The study included 94 participants (50 female, 44 male) with a mean age of 59.5 years (range: 24-101 years of age). The retrospective EHR evaluation yielded 82 single-unit, 51 multi-unit, and 20 complete-arch prostheses on 325 implants. Among 153 prostheses delivered, 108 were micro-veneered (47 single-unit, 41 multi-unit, and 20 complete-arch prostheses) and 45 were monolithic. The average duration was 72.35 months (6.02 years) with a follow-up period of 5-132 months. From the time of insertion to the time of EHR review, of 153 prostheses, 78.43% did not exhibit any prosthetic complication. However, 33 prostheses (21.57%) from 29 participants (30.85%) had at least one prosthetic complication. Only four patients (4.25%) experienced two or more prosthetic complications. Prosthetic design affected the probability of having a complication (p = 0.005); complete-arch prostheses had higher probability (p ≤ 0.028). Single-unit prostheses had lower probability of complication than multi-unit prostheses (p = 0.005). The most commonly observed complication was fracture of veneering material (5.88%) followed by prosthetic screw loosening (4.57%) and decementation between the zirconia and the ti-base abutment (2.61%). Micro-veneered complete-arch prostheses had higher probability of having chipping than that of not having (p < 0.001), and other micro-veneered prosthetic designs had similar probability of chipping with that of complete-arch prostheses (p ≥ 0.082). Frequency of chipping was affected by veneering (p < 0.001). Monolithic prostheses had lower probability of chipping than micro-veneered prostheses, regardless of the prosthetic design (p < 0.001).

CONCLUSIONS

The frequency of prosthetic complications varied depending on prosthetic design. Complete-arch prostheses had the highest probability of complications while the single-unit prostheses had the lowest. Micro-veneered prostheses had higher probability for chipping than monolithic prostheses. Probability of chipping was similar for micro-veneered single-unit, multi-unit, and complete-arch zirconia prostheses.

Prevention of peri-implant disease in edentulous patients with fixed implant rehabilitations

OBJECTIVES

To provide an overview about the current approaches to prevent peri-implant diseases in edentulous patients with complete-arch implant-supported prostheses, and to review the clinical applications of the latest digital technologies for implant prosthodontics.

METHODS

A review of the guidelines to prevent peri-implant diseases in patient's receiving complete-arch implant-supported prostheses including facially driven treatment planning procedures using either conventional or digital methods, computer-aided implant planning procedures, and prosthodontic design variables including the optimal number and distribution of dental implants, implant to abutment connection type, implant or abutment level design, screw- or cement-retained alternatives, prostheses contours, and material selection is provided. Furthermore, an outline of the current therapeutic management approaches to address peri-implant diseases is reviewed.

CONCLUSIONS

Clinicians should understand and know different planning and design-related variables that can affect biological and mechanical complication rates of complete-arch implant-supported prostheses. Maintenance protocols are fundamental for minimizing biological and mechanical complications.

Error analysis of stages involved in CBCT-guided implant placement with surgical guides when different printing technologies are used

STATEMENT OF PROBLEM

Digital light processing (DLP), continuous liquid interface printing (CLIP), and stereolithography (SLA) technologies enable 3-dimensional (3D) printing of surgical guides. However, how their accuracy compares and how accuracy may affect subsequent steps in guided surgery is unclear.

PURPOSE

The purpose of this in vitro study was to investigate the fabrication and seating accuracy of surgical guides printed by using DLP, SLA, and CLIP technologies and evaluate the positional deviation of the osteotomy site and placed implant compared with the digital implant plan.

MATERIAL AND METHODS

Twenty-one polyurethane models were divided into 3 groups and used to plan implants and design surgical guides. The guides were fabricated by using DLP, SLA, or CLIP 3D printers (n=7) and scanned, and the scan file was compared with the digital design file to analyze the fabrication accuracy at the intaglio and overall external surfaces using root mean square (RMS) values. The triple scan protocol was used to evaluate the seating accuracy of the guides on their respective models. Osteotomies were prepared on models by using the guides followed by a microcomputed tomography image of each osteotomy. The implants were placed through the guides, the scan bodies were tightened to implants, and the models were scanned to obtain the images of placed implant position. Osteotomy and placed implant images were used to calculate the entry point, apex, and long axis deviations from the planned implant position with a software program. A 2-way repeated-measures ANOVA of the RMS data was used to analyze printing and seating trueness, and homogeneity of variance analyses were used at each surface for precision. A 3-way repeated-measures ANOVA was used to analyze distance deviations over the stages (osteotomy and final implant) and locations studied, and a 2-way repeated-measures ANOVA was used for angular deviations. Homogeneity of variance analyses were performed for precision (α=.05).

RESULTS

The 3D printer type significantly affected the trueness of the guide at the intaglio surface (P<.001). SLA guides had the lowest mean RMS (59.04 μm) for intaglio surface, while CLIP had the highest mean RMS (117.14 μm). Guides from all 3D printers had low variability among measured deviations and therefore were similarly precise. The seating accuracy of SLA and DLP guides was not significantly different, but both had lower mean RMS values than CLIP (P=.003 for SLA, P=.014 for DLP). There were no significant interactions between the stage of surgery, the printer type, or the location of implant deviation (P=.734). Only the location of deviation (cervical versus apical) had a significant effect on distance deviations (P<.001). The printer type, stage of surgery, and their interaction did not significantly affect angular deviations (P=.41).

CONCLUSIONS

The 3D printing technology affected printing trueness. The intaglio surface trueness was higher with SLA and overall trueness was higher with the CLIP printer. The precision of all guides was similarly high. Guides from SLA and DLP printers had more accurate seating than those from CLIP. Higher deviations were observed at the apex; however, osteotomy and final implant position did not significantly differ from the digitally planned position.

Differences in maxillomandibular relationship recorded at centric relation when using a conventional method, four intraoral scanners, and a jaw tracking system: A clinical study

STATEMENT OF PROBLEM

Digital systems including intraoral scanners (IOSs) and optical jaw tracking systems can be used to acquire the maxillomandibular relationship at the centric relation (CR). However, the discrepancy of the maxillomandibular relationship recorded at the CR position when using digital methods remains uncertain.

PURPOSE

The purpose of this clinical study was to compare the accuracy of the maxillomandibular relationship recorded at the CR position using a conventional procedure, 4 different IOSs, and an optical jaw tracking system.

MATERIAL AND METHODS

A completely dentate volunteer was selected. A Kois deprogrammer (KD) was fabricated. Six groups were created based on the technique used to obtain diagnostic casts and record the maxillomandibular relationship at the CR position: conventional procedures (CNV group), 4 IOS groups: TRIOS4 (TRIOS4 group), iTero Element 5D (iTero group), i700 wireless (i700 group), Primescan (Primescan group), and a jaw tracking system (Modjaw) (Modjaw group) (n=10). In the CNV group, conventional diagnostic stone casts were obtained. A facebow record was used to mount the maxillary cast on an articulator (Panadent). The KD was used to obtain a CR record for mounting the mandibular cast, and the mounted casts were digitized by using a scanner (T710) to acquire the reference scans. In the TRIOS group, intraoral scans were obtained and duplicated 10 times. The KD was used to obtain a bilateral virtual occlusal record at the CR position. To acquire the specimens of the iTero, i700, and Primescan groups, the procedures in the TRIOS4 group were followed, but with the corresponding IOS. In the Modjaw group, the KD was used to record and export the maxillomandibular relationship at the CR position. Articulated virtual casts of each group were exported. Thirty-six interlandmark linear measurements were computed on both the reference and experimental scans. The distances obtained on the reference scan were used to calculate the discrepancies with the distances obtained on each experimental scan. The data were analyzed by using 1-way ANOVA followed by the pairwise comparison Tukey tests (α=.05).

RESULTS

The trueness and precision of the maxillomandibular relationship record were significantly affected by the technique used (P<.001). The maxillomandibular relationship trueness values from high to low were iTero (0.14 ±0.09 mm), followed by the Modjaw (0.20 ±0.04 mm) and the TRIOS4 (0.22 ±0.09 mm) groups. However, the iTero, Modjaw, and TRIOS4 groups were not significantly different from each other (P>.05). The i700 group obtained the lowest trueness and precision values (0.40 ±0.22 mm) of all groups tested, followed by the Primescan grop (0.26±0.13 mm); however, the i700 and Primescan groups had significantly lower trueness and precision than only the iTero group (P<.05).

CONCLUSIONS

The trueness and precision of the maxillomandibular relationship recorded at the CR position were influenced by the different digital techniques tested.

Effect of Abutment Cooling on Reverse Torque Values of Abutment Screws: An In Vitro Study

Purpose: To evaluate the effect of cooling on the reverse torque values of different abutments in bone-level and tissue-level implants. The null hypothesis was that there would be no difference in reverse torque values of abutment screws when cooled and uncooled implant abutments were compared. Materials and Methods: Bone-level and tissue-level implants (Straumann, each n = 36) were placed in synthetic bone blocks and subdivided into three groups (each n = 12) based on the abutment type (titanium base, cementable abutment, abutment for screw-retained restorations). All abutment screws were tightened to 35 Ncm torque. In half of the implants, a dry ice rod was applied on the abutments close to the implant-abutment connection for 60 seconds before untightening the abutment screw. The remaining implant-abutment pairs were not cooled. The maximum reverse torque values were recorded using a digital torque meter. The tightening and untightening procedure was repeated three times for each implant including cooling for the test groups, resulting in 18 reverse torque values per group. Two-way analysis of variance (ANOVA) was used to analyze the effect of cooling and abutment type on the measurements. Post hoc t tests were used to make group comparisons (α = .05). The P values of post hoc tests were corrected for multiple testing using the Bonferroni-Holm method. Results: The null hypothesis was rejected. Cooling and abutment type significantly affected the reverse torque values in bone-level implants (P = .004) but not in tissue-level implants (P = .051). The reverse torque values of bone-level implants significantly decreased after cooling (20.31 ± 2.55 Ncm vs 17.61 ± 2.49 Ncm). Overall mean reverse torque values were significantly higher in bone-level implants compared to tissue-level implants (18.96 ± 2.84 Ncm vs 16.13 ± 3.17 Ncm; P < .001). Conclusion: Cooling of the implant abutment led to a significant decrease in reverse torque values in bone-level implants and may therefore be recommended as a pretreatment before the application of procedures to remove a stuck implant part.

Influence of Cyclic Loading on Load to Failure of Different Ceramic CAD/CAM Implant-Supported Single Crowns

PURPOSE

To compare the load to failure values of different ceramic CAD/CAM implant crown materials with drilled screw access holes with and without cyclic loading applied.

MATERIALS AND METHODS

Forty zirconia abutments with a titanium base were pre-loaded onto implants to support maxillary right first premolar crowns that were milled from four different CAD/CAM ceramic materials (zirconia reinforced lithium silicate, hybrid ceramic, lithium disilicate, and zirconia; n = 10 each). After cementing the crowns, screw access channels were prepared by drilling through occlusal surfaces. Half of the specimens were subjected to cyclic loading for 5 million cycles at 2 Hz (n = 5/material). After cyclic loading, vertical loads were applied to failure, and the load to failure values of all crowns were recorded and statistically analyzed. Two-way analysis of variance was used with restricted maximum likelihood estimation and Tukey-Kramer adjustments (α = .05).

RESULTS

During cyclic loading, the zirconia abutment in one lithium disilicate specimen cracked at 2 million cycles, as well as a zirconia-reinforced lithium silicate crown. Results for the load to failure test series showed statistical differences between the materials. Zirconia resulted in significantly higher failure loads when compared to the other materials (P < .001). Cyclic loading did not significantly affect the load to failure values.

CONCLUSION

Cyclic loading did not significantly influence the load to failure of any of the materials tested. Zirconia crowns with drilled screw access channels cemented on zirconia abutments with a titanium base had higher load to failure values compared to the other ceramic crown materials.

Influence of digital implant analog design on the positional trueness of an analog in additively manufactured models: An in-vitro study

BACKGROUND

Limited evidence exists regarding the accuracy of implant analog position in printed models, particularly when implant analogs with varying designs are used.

PURPOSE

To evaluate the effect of digital implant analog (DIA) design on the trueness of their position in additively manufactured digital implant models (DIMs) and to compare with that of a conventional implant analog in a stone cast.

MATERIALS AND METHODS

A dentate maxillary model with a conventional implant analog (Nobel Biocare Implant Replica 4.3 mm CC RP) at left second premolar site was digitized by using a laboratory scanner (3Shape D2000) and a (SB) scan body to generate the master standard tessellation language (STL) file (M0). 12 custom trays were fabricated on M0 file and conventional polyvinylsiloxane impressions of the model were made. All impressions were poured after inserting conventional implant analogs (Nobel RP Implant Replica) (Group A). Model was then digitized with an intraoral scanner (TRIOS 3) and the same SB, and DIMs with three different DIA designs (Nobel Biocare [Group B], Elos [Group C], and NT-trading [Group D]) were generated (Dental System-Model Builder). 12 DIMs of each design were additively manufactured and corresponding DIAs were inserted. All models were digitized by using the same laboratory scanner and SB, and these STLs were transferred to a 3D analysis software (Geomagic Control X), where the STL files of the models were superimposed over M0. Linear and 3D deviations at three selected points on SB (implant-abutment connection, most cervical point on SB, and most coronal point on SB) as well as angular deviations on two planes (buccolingual and mesiodistal) were calculated. Analysis of variance (ANOVA) and Bonferroni corrected t-tests were used to analyze the trueness of implant analog positions (α = 0.05).

RESULTS

The interaction of main effects significantly affected linear (p < 0.001) and angular deviations (p = 0.020). At point 1, group D had higher deviations than groups A and B (p ≤ 0.015). In addition, groups A and D had higher deviations than group B at point 4 (p < 0.001). While group C had similar linear deviations to those of other groups at point 1 and point 4 (p ≥ 0.192), the differences among test groups at point 2 were nonsignificant (p ≥ 0.276). Group B had lower angular deviations than groups C (p = 0.039) and D (p = 0.006) on buccolingual plane.

CONCLUSIONS

Analog design affected the trueness of analog position as proprietary, pressure/friction fit DIA (group B) had higher linear trueness than screw-retained DIA (Group D) and conventional implant analog (group A). In addition, pressure/friction fit DIA had the highest angular trueness among tested DIAs.

Effect of thermal cycling on the flexural strength and hardness of new-generation denture base materials

PURPOSE

To evaluate the flexural strength and Vickers microhardness of different CAD-CAM denture base materials.

MATERIALS AND METHODS

Sixty rectangular specimens (64×10×3.3 ±0.2 mm) were fabricated from 3 different denture base materials (G-CAM, Graphene-reinforced polymethylmethacrylate, GC), Ivotion Base (Prepolymerized polymethylmethacrylate, IV), and Denturetec (3D-printed resin, DT) either by using additive (DT) or subtractive manufacturing (IV and GC). Specimens of each group were divided into 2 subgroups (thermal cycled or non-thermal cycled, n = 10/group). Non-thermal cycled specimens were stored in distilled water at 37°C for 24 hours and subjected to 3-point flexural strength test with a universal testing machine. Thermal cycled specimens were initially evaluated for Vickers microhardness and subjected to thermal cycling (10000 cycles at 5-55°C). Vickers microhardness values were re-measured, and the specimens were subjected to 3-point flexural strength test. Data were analyzed by using 2-way analysis of variance and Bonferroni-corrected Tukey honestly significant difference tests (α = .05).

RESULTS

Material type and condition significantly affected flexural strength (P≤.004), whereas their interaction was nonsignificant (P = .778). Overall flexural strength of the materials in decreasing order was GC, IV, and DT (P<.001), regardless of the condition. Material had a higher effect on flexural strength (ηp² = .731) than thermal cycling (ηp² = .142). The effect of the interaction between the material type and thermal cycling on Vickers microhardness was significant (P<.001). GC had the highest microhardness before and after thermal cycling (P<.001). IV had higher microhardness than DT before thermal cycling (P<.001). However, DT and IV showed similar microhardness after thermal cycling (P = .665). Thermal cycling decreased the microhardness of GC and IV (P≤.022), whereas its effect on DT's microhardness was nonsignificant (P = .538). Material type had the highest effect on microhardness (ηp² = .864) followed by the interaction between the main factors (ηp² = .258).

CONCLUSIONS

Graphene-reinforced polymethylmethacrylate had the highest flexural strength and Vickers microhardness values, regardless of thermal cycling. Thermal cycling reduced the flexural strength of all resins. Thermal cycling reduced the microhardness of milled polymethylmethacrylate, but not that of 3D-printed resin. This article is protected by copyright. All rights reserved.

Marginal discrepancy and fracture load of thermomechanically fatigued crowns fabricated with different CAD-CAM techniques

PURPOSE

To assess the effect of CAD-CAM technique (monolithic, CAD-on, or CAD-on cemented) and thermomechanical fatigue on the marginal discrepancy and fracture load of ceramic crowns.

MATERIAL AND METHODS

A total of 90 brass master dies were fabricated to investigate marginal adaptation and fracture load. A mandibular first molar crown's median measurements were loaded into CAD software and divided into 2 crown design groups: Monolithic (M)(IPS e.max zirCAD)(n = 30) or CAD-on core (IPS e.max zirCAD) and lithium disilicate veneer (IPS e.max CAD) (n = 60). The crowns and cores were milled, seated on their respective dies, and marginal discrepancy values were measured by using microcomputed tomography. After veneers were milled, the cores in veneer groups were divided into 2 groups; veneers bonded with fusion glass-ceramic (IPS e.max CAD Crystal) in CAD-on group (CO) and CAD-on cemented group (CO-C) where veneers were cemented (RelyX U200) onto cores (CO-C). The marginal discrepancy measurements were remade and the crowns were subjected to thermomechanical fatigue (TMF) by using a chewing simulator and thermocycling (5-55°C, 1,200,000 cycles). Marginal discrepancy measurements were repeated and the crowns were subjected to fracture load test by using a universal test device. Data were analyzed statistically by analysis of variance (ANOVA) and Tukey's honestly significant difference test (α = 0.05).

RESULTS

All crown groups had similar marginal discrepancy before veneering. Veneering and cementation on die increased the marginal discrepancy of crowns in cemented CAD-on group. Thermomechanical fatigue increased the marginal discrepancy of both CAD-on groups. Monolithic crown group had the lowest marginal discrepancy after thermomechanical fatigue (P<0.001), and the highest fracture load (P<0.001) CONCLUSIONS: Fabrication technique affected the marginal fit and fracture load of CAD-CAM crowns after thermomechanical fatigue. All crowns survived the thermomechanical fatigue test without dislodgement or fracture. Monolithic crowns had the best fit and highest fracture load after fatigue testing. The CAD-on systems had similar marginal discrepancies, and static loading reproduced veneer chipping. This article is protected by copyright. All rights reserved.

Pellicle modification with natural bioproducts: Influence on tooth color under erosive conditions

Salivary pellicle was modified with bioproducts and we assessed the change in tooth color and the protection of enamel to erosion. Human enamel specimens were assigned to one of three solutions: grape seed extract or black tea (bioproducts), or deionized water (negative control); after which one half the specimens underwent erosive challenges. The specimens underwent 15 cycles involving salivary pellicle formation (10 min, 37°C), incubation in solution (2 min, 25°C), subsequent pellicle formation (90 min, 37°C). Half of the specimens was kept in a humid chamber and the other half was submitted to erosion (2 min, 1% citric acid). After 15 such cycles, the pellicle was removed. Tooth color and the surface reflection intensity were assessed after every five cycles and after pellicle removal. For non-eroded specimens, the exposure to bioproducts promoted significantly greater color change than the deionized water, with increases in yellow appearance. After pellicle removal, the color was similar in all non-eroded specimens. The bioproducts increased the surface reflection intensity over cycles. For the erosion-exposed specimens, erosion itself resulted in color change. Black tea and deionized water resulted in increased yellow appearance. Exposure to the bioproducts resulted in higher relative surface reflection intensity values over time, but only grape seed extract resulted in higher relative surface reflection intensity value at the time of pellicle removal. The bioproducts caused transient staining effect, which was reduced after pellicle removal. For enamel submitted to erosion, grape seed extract resulted in less color change and better protection of enamel against erosion than black tea or water.

Surface Roughness and Color Stability of 3D-Printed Denture Base Materials after Simulated Brushing and Thermocycling

Three-dimensional (3D) printing is increasingly used to fabricate denture base materials. However, information on the effect of simulated brushing and thermocycling on the surface roughness and color stability of 3D-printed denture base materials is lacking. The aim of this study was to evaluate the effect of brushing and thermocycling on the surface roughness and color stability of 3D-printed denture base materials and to compare with those of milled and heat-polymerized denture base resins. Disk-shaped specimens (Ø 10 mm × 2 mm) were prepared from 4 different denture base resins (NextDent Denture 3D+ (ND); Denturetec (SC); Polident d.o.o (PD); Promolux (CNV)) (n = 10). Surface roughness (R_a) values were measured before and after polishing with a profilometer. Initial color coordinates were measured by using a spectrophotometer after polishing. Specimens were then consecutively subjected to simulated brushing (10,000 cycles), thermocycling (10,000 cycles), and brushing (10,000 cycles) again. R_a and color coordinates were measured after each interval. Color differences (ΔE₀₀) between each interval were calculated and these values were further evaluated considering previously reported perceptibility (1.72 units) and acceptability (4.08 units) thresholds. Data were analyzed with Friedman, Kruskal-Wallis, and Mann-Whitney U tests (α = 0.05). R_a (p ≥ 0.051) and ΔE₀₀ (p ≥ 0.061) values among different time intervals within each material were similar. Within each time interval, significant differences in R_a (p ≤ 0.002) and ΔE₀₀ values (p ≤ 0.001) were observed among materials. Polishing, brushing, and thermocycling resulted in acceptable surface roughness for all materials that were either similar to or below 0.2 µm. Color of ND printed resin was affected by brushing and thermocycling. All materials had acceptable color stability when reported thresholds are considered.

Influences of Toothbrushing and Different Toothpastes on the Surface Roughness and Color Stability of Interim Prosthodontic Materials

The surface properties and color stability of interim crown materials may vary depending on the toothbrushing procedure. This study aimed to investigate the effects of toothbrushing and different toothpastes on the surface roughness (Ra) and color stability of different interim crown materials. Disc-shaped specimens were prepared from four interim crown materials (Tab 2000 (ChPM), Imident (LaPM), Protemp 4 (ChDM), and Telio-CAD (CadPM)). Specimens were divided into four subgroups for the control group (Cnt) and for simulated toothbrushing with distilled water (Dw) or with two different toothpastes (whitening toothpaste (WTp), activated charcoal toothpaste (ACTp)). The specimens’ Ra values were measured before and after 10,000 cycles of toothbrushing. The color parameters were measured and the color differences (ΔE00) were calculated. Data were statistically analyzed by two-way analysis of variance (ANOVA) and Tukey’s HSD tests. A significant increase in the Ra values was observed after toothbrushing, except for the LaPM_Dw, ChDM_Dw, and all the CadPM specimens (p < 0.05). Toothbrushing with toothpastes increased the ΔE00 values of all ChPM and ChDM interim materials (p < 0.05). Before and after all toothbrushing procedures, the CadPM specimens had smoother and ChPM specimens had rougher surfaces than the other interim materials. The two tested toothpastes had similar effects on the Ra of all interim materials. Non-perceivable color changes were seen only with the CadPM_Dw group.

Surface roughness and stainability of CAD-CAM denture base materials after simulated brushing and coffee thermocycling

STATEMENT OF PROBLEM

Denture bases machined from prepolymerized materials have become popular. However, information on the effect of simulated brushing and coffee thermocycling (CTC) on their surface roughness and stainability is lacking.

PURPOSE

The purpose of this in vitro study was to compare the effect of simulated brushing and CTC on the surface roughness (Ra) and stainability of computer-aided design and computer-aided manufacturing (CAD-CAM) denture base materials and a heat-polymerized denture base material.

MATERIAL AND METHODS

Forty disk-shaped specimens were prepared from 3 CAD-CAM denture base resins (AvaDent, AV; Merz M-PM, M-PM; and Polident d.o.o, Poli) and a heat-polymerized polymethylmethacrylate resin (Promolux, CV) (n=10). Ra values of the specimens were measured by using a noncontact profilometer after conventional polishing. The color coordinates were also measured over a gray background with a spectrophotometer. Specimens were then consecutively subjected to simulated brushing for 20 000 cycles, CTC for 5000 cycles, and another 10 000 brushing cycles. Ra and color coordinates were measured after each interval. Color differences (ΔE00) were calculated by using the CIEDE2000 formula, and the data were analyzed by using 2-way analysis of variance and Tukey honestly significant difference tests (α=0.05).

RESULTS

The time interval had a significant effect on Ra (P<.001) as brushing cycles resulted in higher values than those at baseline and after CTC (P<.001). However, the differences between brushing cycles (P=.143) and between the baseline and after CTC (P=.994) were not significant. The interaction between the material type and time interval was significant for ΔE00 (P=.016). The only significant difference in ΔE00 values was observed between M-PM and CV after all treatments were completed (P=.029).

CONCLUSIONS

Brushing increased the Ra of all materials when compared with the baseline. All materials showed similar stainability throughout the brushing and CTC processes. However, M-PM CAD-CAM denture base resin underwent a greater color change after all treatments were completed than conventional denture base resin. All color changes can be considered clinically small, considering reported perceptibility and acceptability thresholds.

Peri-Implant Bone Loss and Overload: A Systematic Review Focusing on Occlusal Analysis through Digital and Analogic Methods

The present review aimed to assess the possible relationship between occlusal overload and peri-implant bone loss. In accordance with the PRISMA guidelines, the MEDLINE, Scopus, and Cochrane databases were searched from January 1985 up to and including December 2021. The search strategy applied was: (dental OR oral) AND implants AND (overload OR excessive load OR occlusal wear) AND (bone loss OR peri-implantitis OR failure). Clinical studies that reported quantitative analysis of occlusal loads through digital contacts and/or occlusal wear were included. The studies were screened for eligibility by two independent reviewers. The quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. In total, 492 studies were identified in the search during the initial screening. Of those, 84 were subjected to full-text evaluation, and 7 fulfilled the inclusion criteria (4 cohort studies, 2 cross-sectional, and 1 case-control). Only one study used a digital device to assess excessive occlusal forces. Four out of seven studies reported a positive correlation between the overload and the crestal bone loss. All of the included studies had moderate to serious overall risk of bias, according to the ROBINS-I tool. In conclusion, the reported data relating the occlusal analysis to the peri-implant bone level seem to reveal an association, which must be further investigated using new digital tools that can help to standardize the methodology.