Glass fiber-reinforced abutments for dental implants. A pilot study

Different Polymers for the Base of Removable Dentures? Part II: A Narrative Review of the Dynamics of Microbial Plaque Formation on Dentures

This review focuses on the current disparities and gaps in research on the characteristics of the oral ecosystem of denture wearers, making a unique contribution to the literature on this topic. We aimed to synthesize the literature on the state of current knowledge concerning the biological behavior of the different polymers used in prosthetics. Whichever polymer is used in the composition of the prosthetic base (poly methyl methacrylate acrylic (PMMA), polyamide (PA), or polyether ether ketone (PEEK)), the simple presence of a removable prosthesis in the oral cavity can disturb the balance of the oral microbiota. This phenomenon is aggravated by poor oral hygiene, resulting in an increased microbial load coupled with the reduced salivation that is associated with older patients. In 15-70% of patients, this imbalance leads to the appearance of inflammation under the prosthesis (denture stomatitis, DS). DS is dependent on the equilibrium-as well as on the reciprocal, fragile, and constantly dynamic conditions-between the host and the microbiome in the oral cavity. Several local and general parameters contribute to this balance. Locally, the formation of microbial plaque on dentures (DMP) depends on the phenomena of adhesion, aggregation, and accumulation of microorganisms. To limit DMP, apart from oral and lifestyle hygiene, the prosthesis must be polished and regularly immersed in a disinfectant bath. It can also be covered with an insulating coating. In the long term, relining and maintenance of the prosthesis must also be established to control microbial proliferation. On the other hand, several general conditions specific to the host (aging; heredity; allergies; diseases such as diabetes mellitus or cardiovascular, respiratory, or digestive diseases; and immunodeficiencies) can make the management of DS difficult. Thus, the second part of this review addresses the complexity of the management of DMP depending on the polymer used. The methodology followed in this review comprised the formulation of a search strategy, definition of the inclusion and exclusion criteria, and selection of studies for analysis. The PubMed database was searched independently for pertinent studies. A total of 213 titles were retrieved from the electronic databases, and after applying the exclusion criteria, we selected 84 articles on the possible microbial interactions between the prosthesis and the oral environment, with a particular emphasis on Candida albicans.

Ion Bombardment-Induced Nanoarchitectonics on Polyetheretherketone Surfaces for Enhanced Nanoporous Bioactive Implants

In spite of the biocompatible, nontoxic, and radiolucent properties of polyetheretherketone (PEEK), its biologically inert surface compromises its use in dental, orthopedic, and spine fusion industries. Many efforts have been made to improve the biological performance of PEEK implants, from bioactive coatings to composites using titanium alloys or hydroxyapatite and changing the surface properties by chemical and physical methods. Directed plasma nanosynthesis (DPNS) is an atomic-scale nanomanufacturing technique that changes the surface topography and chemistry of solids via low-energy ion bombardment. In this study, PEEK samples were nanopatterned by using argon ion irradiation by DPNS to yield active nanoporous biomaterial surface. PEEK surfaces modified with two doses of low and high fluence, corresponding to 1.0 × 1017 and 1.0 × 1018 ions/cm2, presented pore sizes of 15-25 and 60-90 nm, respectively, leaving exposed PEEK fibers and an increment of roughness of nearly 8 nm. The pores per unit area were closely related for high fluence PEEK and low fluence PEEK surfaces, with 129.11 and 151.72 pore/μm2, respectively. The contact angle significantly decreases in hydrophobicity-hydrophilicity tests for the irradiated PEEK surface to ∼46° from a control PEEK value of ∼74°. These super hydrophilic substrates had 1.6 times lower contact angle compared to the control sample revealing a rough surface of 20.5 nm only at higher fluences when compared to control and low fluences of 12.16 and 14.03 nm, respectively. These super hydrophilic surfaces in both cases reached higher cell viability with ∼13 and 34% increase, respectively, compared to unmodified PEEK, with an increased expression of alkaline phosphatase at 7 days on higher fluences establishing a higher affinity for preosteblasts with increased cellular activity, thus revealing successful and improved integration with the implant material, which can potentially be used in bone tissue engineering.

Evaluation and Assessment of the Colour Stability of Modified Polymethyl Methacrylate Denture Base Materials and Polyether Ether Ketone in a Cast Partial Denture Framework: An In-Vitro Study

Background One of the frequent aesthetic issues patients confront is the loss of colour and lifeless appearance of the dentures of the base materials of their dentures after regular use. This leads to a lack of motivation to use the denture regularly. Due to the drawbacks of conventional PMMA, polyether ether ketone (PEEK) and newer polymethyl methacrylate (PMMA)-based materials have now started being used in cast partial denture frameworks due to their superior physical and biological properties. The lack of long-lasting colour is one of the main reasons for the repeat of dental prostheses. Hence, the need for the study is to help clinicians decide which would be the most suitable denture base material to be used based on colour stability. Aim To assess and compare the colour stability of PEEK, polyan, and biodentaplast denture base materials (DBMs) upon staining with distilled water, tea, coffee, and turmeric solutions after one day, seven days, and 30 days. Methods A total of 20 cuboidal specimens were constructed and immersed in distilled water, tea, coffee, and turmeric (five specimens of each material in each solution, a total of 60 specimens): Group 1: PEEK, Group 2: polyan, Group 3: biodentaplast. All specimens were subjected to colour measurements before exposure to beverage solutions, after 24 hours, on the seventh day and 30th day with a colour reflectance spectrophotometer with computer software. A one-way ANOVA test followed by post hoc Tukey's honestly significant difference (HSD) was performed for comparison of colour stability between the DBMs, revealing a significant difference between PEEK and polyan and PEEK and biodentaplast. Polyan showed the highest delta E values, followed by biodentaplast and PEEK. A two-way ANOVA test, followed by Tukey's HSD post hoc, was done to compare the staining ability of various staining solutions. Turmeric had the highest delta E values, followed by coffee, tea, and distilled water. Data were assessed using Statistical Product and Service Solutions (SPSS, version 23) (IBM SPSS Statistics for Windows, Armonk, NY) software. Results The highest mean delta E value at T1 was seen in biodentaplast immersed in turmeric (12.3900+/-0.442), and the least value at T1 was obtained for PEEK immersed in distilled water (0.4460+/-0.036). The highest mean delta E value at T2 was seen in polyan immersed in turmeric (13.0160+/-0.28962), and the least value at T2 was obtained for PEEK immersed in distilled water (0.5860+/-0.051). At T3, the highest mean delta E value was seen in polyan immersed in turmeric (16.8600+/-0.49845), and the least value at T3 was obtained for PEEK immersed in distilled water (0.700+/-0.037). Conclusion PEEK had the highest colour stability when compared with polyan and biodentaplast.

The Role of Polyether Ether Ketone (Peek) in Dentistry - A Review

This study is aimed to review the applications of Polyether Ether Ketone (PEEK) in dentistry. The increased demand for aesthetics, legislation in some developed countries, few drawbacks with existing materials and clinicians shifting their paradigms towards metal free restorations led space for the metal-free restorations in today's dental practice. An electronic literature search was conducted through Medline via PubMed, Wiley Online library, EBSCOhost, Science Direct, as well as the Google Scholar between January 2010 and March 2018 using the keywords: PEEK, modified PEEK, PEEK and Dental, advantages of PEEK, applications of PEEK in dentistry and PEEK Implants. A total of 103 articles were found in the literature search and out of these, 18 were not related to our study and hence were excluded. Finally, 85 articles were found to be relevant. PEEK has been explained for a number of applications in dental practice. The literature showed that the PEEK material has superior mechanical properties with different uses in various specialties of dentistry.

Osteoblast proliferation and maturation on bioactive fiber-reinforced composite surface

The objective of this study was to evaluate the proliferation and osteogenic potential of bone-marrow derived osteoblast-like cells on fiber-reinforced composite (FRC) substrates with and without bioactive glass surface modification. Three FRC materials were fabricated for the study: (a) grit-blasted FRC, (b) grit-blasted FRC with bidirectional net reinforcement and (c) FRC with bioactive glass (BAG) coating. Rat bone-marrow derived osteoblast-like cells were harvested and cultured on experimental material plates and on cp. titanium plates (control) for 21 days. The materials' surfaces were characterized by roughness testing and scanning electron microscopy. Cell growth and differentiation kinetics were subsequently investigated by evaluating proliferation, alkaline phosphatase (ALP) activity, osteocalcin (OC) and bone sialoprotein (BSP) production. On day 14, the cell proliferation was significantly lower (P<0.05) on FRC-BAG than on titanium and FRC. The proliferation on the other three materials was equal throughout the experiment. The maximal ALP activities on FRC, FRC-Net, and titanium were observed on day 21, whereas FRC-BAG had already reached the maximal level on day 14. Expression of osteoblastic markers (OC, BSP) indicates that the fastest osteogenic differentiation takes place on FRC after 7 days. In contrast, a slower differentiation process was observed on titanium than on any other tested material (P<0.015) at 21 days, as was confirmed by increased mRNA expression of OC and BSP. It can be concluded that the proliferation and maturation of osteoblast-like cells on FRC appears to be comparable to titanium. Presence of BAG enhances cell maturation.

Load bearing capacity of bone anchored fiber-reinforced composite device

The purpose of this study was to evaluate the push-out load-bearing capacity of threaded fiber-reinforced composite (FRC) devices for use as bone-anchored devices. The purpose was also to evaluate the possibility to use bioactive glass (BAG) granules on the experimental FRC devices in terms the mechanical behavior. Three experimental FRC devices (n = 15) were fabricated for the study: (a) threaded device with smooth surface; (b) threaded device with BAG granules (S53P4, Vivoxid Ltd, Turku, Finland) and supplementary retention grooves, and (c) unthreaded device with BAG granules. Threaded titanium devices were used as controls. The FRC devices were prepared from a light-polymerized dimethacrylate resin reinforced with preimpregnated unidirectional and bidirectional E-glass fibers (EverStick, StickTech Ltd, Turku, Finland). Experimental and control devices were embedded into dental plaster to simulate bone before the mechanical push-out test was carried out. ANOVA and Weibull analysis were used for the statistical evaluation. Threaded FRC devices had significantly higher push-out strength than the threaded titanium device (p < .001). The push-out forces exceeding 2,500 N were measured for threaded FRC devices with supplementary grooves and BAG coating. No thread failures were observed in any FRC devices. The unthreaded FRC devices with BAG lost 70% of glass particles during the test, while no BAG particles were lost from threaded FRC devices. It can be concluded that threaded FRC devices can withstand high push-out forces in the dental plaster without a risk of thread failure under physiological load.

Fracture load and marginal fit of shrinkage-free ZrSiO4all-ceramic crowns after chewing simulation

The aim of this in vitro study was to evaluate the fracture load and marginal accuracy of crowns made from a shrinkage-free ZrSiO4 ceramic cemented with glass-ionomer or composite cement after chewing simulation. Thirty-two human mandibular molars were randomly divided into two groups. All teeth were prepared for and restored with shrinkage-free ZrSiO4 ceramic crowns (Everest HPC, KaVo). The crowns of group A (N = 16) were luted to the teeth using KetacCem and group B (N = 16) were adhesively cemented using Panavia21EX. Measurements of the marginal accuracy before and after cementation were made using replicas and an image analysis system. All specimens were exposed to 1.2 million cycles of thermo-mechanical fatigue in a chewing simulator. Surviving specimens were subsequently loaded until fracture in a static testing device. Fracture loads (N) were recorded. All specimens survived chewing simulation. The mean fracture loads (+/-s.d.) were Group A, 1622 N (+/-433); group B, 1957 N (+/-806). There was no significant difference between the two groups (P > 0.05). The marginal gap values before cementation were (mean +/- s.d.): Group A, 32.7 microm (+/-6.8); group B, 33.0 microm (+/-6.7). The mean marginal gap values after cementation were (+/-s.d.): Group A, 44.6 microm (+/-6.7); group B, 46.6 microm (+/-7.7). The marginal openings were significantly higher after cementation for both groups (P < 0.05). All test groups demonstrated fracture load and marginal accuracy values within the range of clinical acceptability.

Effect of cross-sectional design on the modulus of elasticity and toughness of fiber-reinforced composite materials

STATEMENT OF PROBLEM

Many current fabrication protocols for dental fiber-reinforced composites use hand lay-up techniques and technician design input. Little information exists regarding how the manipulation of the cross-sectional design of a prosthesis might affect the modulus of elasticity and toughness.

PURPOSE

The aim of this study was to determine the effect of simple and complex cross-sectional designs on the modulus of elasticity and toughness of fiber-reinforced composite used for dental prostheses.

MATERIAL AND METHODS

Two particulate composites (BelleGlass HP and Targis) were reinforced with ultra-high-molecular-weight polyethylene fiber ribbon (Connect), woven E-glass fibers (Vectris Frame), or unidirectional R-glass fibers (Vectris Pontic). A range of fiber positions, orientations, or geometries were incorporated into the rhombic specimens (2 x 2 x 25 mm(3)) to achieve simple and complex experimental cross-sectional designs. The control specimen did not contain fiber reinforcement. Specimens (n=6) were stored 1 week in distilled water at 37 degrees C prior to 3-point load testing to determine the modulus of elasticity (GPa) and toughness (MPa). The data within each main fiber group were subjected to 1-way analysis of variance and a Tukey post hoc test (alpha=.05). Cross-sections of randomly selected test specimens (n=2) were made for scanning electron microscope (SEM) analysis of the fiber distribution.

RESULTS

The mean modulus of elasticity varied from 8.7 +/- 2.0 GPa (Targis control) to 21.6 +/- 1.4 GPa (2 unidirectional glass fiber reinforcements, 1 each at the tension side and the compression side). Mean toughness varied from 0.07 +/- 0.02 MPa (unidirectional glass fiber positioned at the compression side) as the lowest mean, to 4.53 +/- 0.89 MPa (unidirectional glass fiber positioned at the tension side) as the highest. Significant differences were identified between specimen groups in each main category (all groups P<.001, except modulus of elasticity of the woven E-glass groups, where P=.003). SEM micrographs showed fiber distribution in the cross section of test specimens to correspond with the intended fiber geometry.

CONCLUSION

The modulus of elasticity of the composite specimens increased when 1 or more glass fiber groups were located at the compression side of the specimen. Toughness was most effectively increased when 1 or more fiber groups were located at the tension side of the specimen.

Survival rates of resin-bonded, glass fiber–reinforced composite fixed partial dentures with a mean follow-up of 42 months: A pilot study

STATEMENT OF PROBLEM

Although short-term clinical data exist for resin-bonded, glass fiber-reinforced composite fixed partial dentures (FPDs), long-term data are needed.

PURPOSE

The survival rates of 29 resin-bonded, glass fiber-reinforced composite fixed partial dentures were evaluated in this clinical study for periods of up to 42 months.

MATERIAL AND METHODS

FPDs were fabricated to replace 1 to 3 missing maxillary or mandibular teeth of 29 patients not able to be treated with conventional FPDs. Originally, there were 37 patients (the drop-out rate was 22%). The FPDs were retained with wings, inlays, complete coverage crowns, or combinations of these that were bonded to tooth structure. The FPD frameworks were made of continuous unidirectional E-glass fibers with a multiphase polymer matrix and light-polymerized particulate composite veneer. The patients were recalled for examinations, where a general dental examination was performed, 1 to 3 times per year for up to 63 months (minimum 24 months, mean 42 months). Partial or complete total debonding of the FPD or the framework fracture was considered a treatment failure. The data were analyzed with the Kaplan-Meier survival test (alpha=.05).

RESULTS

Two resin frameworks fractured, and 3 frameworks were debonded. Kaplan-Meier survival probability at 63 months was 75%. Three of the failed FPDs were rebonded or repaired in situ, producing a functional survival rate of 93% after rebonding or repairing (mean survival time was 55 months).

CONCLUSION

The results of this clinical study of 29 prostheses suggest that glass fiber-reinforced FPDs may be a possible alternative to cast metal resin-bonded FPDs. These restorations were successfully used as multiple-unit prostheses that employed a variety of abutment tooth preparation designs.

Effects of two preparation designs and pontic distance on bending and fracture strength of fiber-reinforced composite inlay fixed partial dentures

STATEMENT OF PROBLEM

Joint fractures observed in Targis/Vectris inlay adhesive fixed restorations may be related to the preparation design.

PURPOSE

This in vitro study investigated the effects of the proximal tooth preparation design and the pontic distance on the fracture strength and the amount of bending of fiber-reinforced inlay adhesive fixed partial dentures.

MATERIALS AND METHODS

Forty extracted premolars and 40 molars were embedded in a PMMA resin to represent a premolar and molar mesiodistal separation distance of 7 mm and 11 mm, respectively. Two preparation designs were used (proximal box and tub-shaped). The sample size was 10 for each group. Fiber-reinforced inlay adhesive fixed partial dentures were fabricated by use of the Targis/Vectris system and luted adhesively to the teeth with Variolink luting agent. A vertical force was loaded to the center of the fixed partial dentures at a crosshead speed of 1 mm/min. The initial bending (mm) prior to fracture was evaluated by measuring the distance the test rod moved from a 10 N preload to fracture. The differences in the mean fracture strength and the average amount of bending as a function of the preparation designs and pontic distances were compared by use of a 2-way analysis of variance (alpha=.05). The specimens were examined optically for the type of failure with a stereomicroscope. The fracture surface of the specimens was examined by scanning electron microscopy, and radiography was used to investigate the surface morphological features at the failure sites and to determine the fracture mode. A chi-square test was used to identify the differences in the debonding rates between the types of preparation designs and the pontic distance (alpha=.05).

RESULTS

The mean fracture strength and the standard deviation of the fiber-reinforced inlay retained adhesive fixed partial denture group was 1368+/-212 N for the 7-mm tub group, 885+/-109 N for the 11-mm tub group, 1779+/-317 N for the 7-mm box group, and 1336+/-281 N for the 11-mm box group. The fracture strength was significantly higher in the 7-mm pontic distance (P<.001) and for the box-shaped tooth preparation (P<.001). The amount of bending was significantly greater in the 7-mm pontic distance (P=.025) and the box-shaped tooth preparation (P=.002). Debonding was observed only in premolar teeth and tub-shaped design groups.

CONCLUSION

The box-shaped tooth preparation may be considered for restoration of a missing single posterior tooth with fiber-reinforced inlay adhesive fixed partial dentures.

Bond strength of fibre-reinforced composite to the metal surface

The aim of this study was to measure push-out bond strength of gold alloy and pure titanium bars to dimethacrylate polymer-glass fibre composite. Metal bars were either left untreated, or sandblasted with 110 microm grain size aluminium oxide, pyrolytically silica-coated (Silicoater, Heraeus Kulzer) and silanized, tribochemically silica-coated, silanized (Rocatec, 3M-ESPE) and heat treated (100 degrees C/10 min), or tribochemically silica-coated and left unsilanized. Light-polymerizable opaque was applied on the metal surface and unidirectional glass fibres with Bis-GMA-PMMA monomer-polymer gel matrix was placed in contact to the bars and polymerized. Push-out test was performed for dry specimens and for those thermocycled (12.000 x55-5 degrees C). For titanium and gold alloy silica-coatings with the silane treatments resulted in the highest bond strengths. Values for titanium were somewhat higher than those for gold alloy. Silica-coating without silane treatment gave lower bond strengths but higher than that obtained with aluminium oxide sandblasting. The control specimens showed the lowest bond strength values. anova showed differences between the groups (P < 0.0001) whereas no significant differences between dry and thermocycled specimens were found. The results suggest that pyrolytical silica-coating with silane application resulted in highest bond strengths of dimethacrylate based fibre-reinforced composite to pure titanium and gold alloy.