1
|
Zamora GP, Molina-González JM, Martínez-Marco JF, Ruiz AJO, Mardas N, Garcia-Sanchez R. Aesthetic outcomes of different materials for delayed, single-tooth restorations for immediately placed implants. A randomized controlled clinical trial. J Dent 2024; 146:105067. [PMID: 38763385 DOI: 10.1016/j.jdent.2024.105067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 05/09/2024] [Accepted: 05/10/2024] [Indexed: 05/21/2024] Open
Abstract
OBJECTIVES The aim of this study is to compare the aesthetic outcomes of metal porcelain (C), lithium disilicate (T1) and porcelain-layered zirconium (T2) immediate implant-supported single crowns in the anterior maxilla. MATERIALS AND METHODS Forty-five immediate dental implants were provided for 45 patients that required the extraction of a single tooth in the anterior maxilla. A temporary prosthesis was provided at 8 weeks after placement followed by the final prosthesis at 24 weeks post-implantation. The patients were randomly allocated into 3 groups: 15 patients in the control group (C) received a metal-porcelain restoration, 15 patients (T1) received a lithium disilicate (LD) restoration and 15 patients (T2) received a porcelain-layered, zirconium (Z) restoration. Pink (PES) and White (WES) esthetic scores, radiographic bone levels, periodontal parameters and patient's esthetic satisfaction using a visual analogue scale (VAS) were evaluated at the time of final restoration placement (t0) and at 12-months post-loading (t12). RESULTS No implants were lost during the duration of this study. Statistically significant higher WES and VAS scores (p < 0.05) were recorded in T1 vs C and T1 vs T2 groups respectively. Similar radiographic bone levels and periodontal parameters were recorded in all groups. CONCLUSION Within the limitations of this study, it was concluded that T1 restorations provided better WES outcomes when compared to C restorations and better VAS scores when compared to T2 restorations at 12 months post-loading. Besides, different material interphases did not have an impact in PES, bone levels or periodontal parameters. CLINICAL RELEVANCE There is limited data comparing aesthetic outcomes of implant supported single crowns made of different ceramic materials based on accepted and comparable indexes and the evaluation of the patient's perspective regarding these aesthetic outcomes.
Collapse
Affiliation(s)
| | | | | | | | - Nikos Mardas
- QMUL, Barts & The London School of Dentistry, London, United Kingdom
| | - Ruben Garcia-Sanchez
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom; King's College London, London, United Kingdom.
| |
Collapse
|
2
|
Strasding M, Marchand L, Merino E, Zarauz C, Pitta J. Material and abutment selection for CAD/CAM implant-supported fixed dental prostheses in partially edentulous patients - A narrative review. Clin Oral Implants Res 2024. [PMID: 38864592 DOI: 10.1111/clr.14315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
Restorative material selection has become increasingly challenging due to the speed of new developments in the field of dental material science. The present narrative review gives an overview of the current indications for implant abutments and restoration materials for provisional and definitive implant-supported fixed dental prostheses in partially edentulous patients. For single implant restorations, titanium base abutments for crowns are suggested as an alternative to the conventional stock- and customized abutments made out of metal or zirconia. They combine the mechanical stability of a metallic connection with the esthetic potential of ceramics. For multiple-unit restorations, conical titanium bases especially designed for bridges are recommended, to compensate for deviating implant insertion axes and angulations. Even though titanium base abutments with different geometries and heights are available, certain clinical scenarios still benefit from customized titanium abutments. Indications for the definitive material in fixed implant restorations depend on the region of tooth replacement. In the posterior (not esthetically critical) zone, ceramics such as zirconia (3-5-Ymol%) and lithium-disilicate are recommended to be used in a monolithic fashion. In the anterior sector, ceramic restorations may be buccally micro-veneered for an optimal esthetic appearance. Lithium-disilicate is only recommended for single-crowns, while zirconia (3-5-Ymol%) is also recommended for multiple-unit and cantilever restorations. Attention must be given to the specific mechanical properties of different types of zirconia, as some feature reduced mechanical strengths and are therefore not indicated for all regions and restoration span lengths. Metal-ceramics remain an option, especially for cantilever restorations.
Collapse
Affiliation(s)
- Malin Strasding
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Marchand
- Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Elizabeth Merino
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Cristina Zarauz
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - João Pitta
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
3
|
Goldstein G, Goodacre C, Brown MS, Tarnow DP. Proposal regarding potential causes related to certain complications with dental implants and adjacent natural teeth: Physics applied to prosthodontics. J Prosthodont 2024. [PMID: 38512996 DOI: 10.1111/jopr.13843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 03/03/2024] [Indexed: 03/23/2024] Open
Abstract
PURPOSE Complications can and do occur with implants and their restorations with causes having been proposed for some single implant complications but not for others. METHODS A review of pertinent literature was conducted. A PubMed search of vibration, movement, and dentistry had 175 citations, while stress waves, movement, and dentistry had zero citations as did stress waves, movement. This paper discusses the physics of vibration, elastic and inelastic collision, and stress waves as potentially causative factors related to clinical complications. RESULTS Multiple potential causes for interproximal contact loss have been presented, but it has not been fully understood. Likewise, theories have been suggested regarding the intrusion of natural teeth when they are connected to an implant as part of a fixed partial denture as well as intrusion when a tooth is located between adjacent implants, but the process of intrusion, and resultant extrusion, is not fully understood. A third complication with single implants and their crowns is abutment screw loosening with several of the clinical characteristics having been discussed but without determining the underlying process(es). CONCLUSIONS Interproximal contact loss, natural tooth intrusion, and abutment screw loosening are common complications that occur with implant retained restorations. Occlusion is a significant confounding variable. The hypothesis is that vibration, or possibly stress waves, generated from occlusal impact forces on implant crowns and transmitted to adjacent teeth, are the causative factors in these events. Since occlusion appears to play a role in these complications, it is recommended that occlusal contacts provide centralized stability on implant crowns and not be located on any inclined surfaces that transmit lateral forces that could be transmitted to an adjacent tooth and cause interproximal contact loss or intrusion. The intensity, form, and location of proximal contacts between a natural tooth located between adjacent single implant crowns seem to play a role in the intrusion of the natural tooth. Currently, there is a lack of information about the underlying mechanisms related to these occurrences and research is needed to define any confounding variables.
Collapse
Affiliation(s)
- Gary Goldstein
- Department of Prosthodontics, New York University College of Dentistry, New York, New York, USA
| | - Charles Goodacre
- Advanced Education Program in Implant Dentistry, Loma Linda University School of Dentistry, Loma Linda, California, USA
| | | | - Dennis P Tarnow
- Columbia University College of Dental Medicine, New York, New York, USA
| |
Collapse
|
4
|
Tekpınar L, Yiğit V. Cost-Effectiveness Analysis of Implant-Supported Single Crown and Tooth-Supported Fixed Dental Prostheses in Türkiye. Value Health Reg Issues 2024; 42:11-17. [PMID: 38340673 DOI: 10.1016/j.vhri.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 12/19/2023] [Accepted: 01/08/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES The most cost-effective option for replacing lost teeth is not evident because there is a dearth of evidence-based information on implant-supported single crowns versus tooth-supported fixed dental prostheses. This study conducted the analysis of cost-effectiveness of implant-supported single crown and tooth-supported fixed dental prostheses from a social perspective in Türkiye. METHODS Costs were calculated in the analysis from a social perspective for 2021. Costs and quality-adjusted prosthesis year (QAPY) values were computed over a 20-year period in the study using the Markov model. The computed values were discounted by 5%. The results are presented as the incremental cost-effectiveness ratio. To assess the impact of uncertainty on cost-effectiveness analyses, a tornado diagram and Monte Carlo simulations were created. RESULTS Throughout the 20-year time horizon, tooth-supported fixed dental prostheses cost $985.58 cumulatively, whereas implant-supported single crown cost $2161.64 (US $1 = 9.22 ₺ as of 15 October 2021). The calculated incremental cost-effectiveness ratio is 1.333 per QAPY. Compared with the implant-supported single crown tooth-supported fixed dental prostheses, it offers a QAPY of 0.882 over a 20-year period, while costing an additional $1176.06. CONCLUSIONS These results suggest that the implant-supported single crown provided higher QAPY value but was costlier. When the research's findings are compared with the literature, it becomes clear that Türkiye has lower dental care expenses than most other nations.
Collapse
Affiliation(s)
- Lütfiye Tekpınar
- Department of Health Economics, Nezahat Keleşoğlu Faculty of Health Sciences, Necmettin Erbakan University, Konya, Türkiye; Department of Health Management, Nezahat Keleşoğlu Faculty of Health Sciences, Necmettin Erbakan University, Konya, Türkiye.
| | - Vahit Yiğit
- Department of Hospital Management, Faculty of Economics and Administrative Sciences, Süleyman Demirel University, Isparta, Türkiye; Department of Health Management, Faculty of Economics and Administrative Sciences, Süleyman Demirel University, Isparta, Türkiye
| |
Collapse
|
5
|
Nokar K, Atri F, Nokar S. Comparative Evaluation of the Effect of Implant Crown Materials on Implant Components and Bone Stress Distribution: A 3D Finite Element Analysis. Int J Dent 2023; 2023:1896475. [PMID: 38130700 PMCID: PMC10735729 DOI: 10.1155/2023/1896475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 11/06/2023] [Accepted: 11/23/2023] [Indexed: 12/23/2023] Open
Abstract
Background Choosing implant crown materials for restoration remains challenging in clinical practice. This study assesses the impact of all-ceramic restoration instead of porcelain-fused-to-metal (PFM) restoration on the stress distribution within implant components and the surrounding bone. Methods Four 3D models of a mandibular second premolar were meticulously prepared. The study groups comprised zirconia, lithium disilicate, and zirconia lithium silicate monolithic ceramic crowns cemented onto a zirconia hybrid abutment. A PFM crown cemented onto a cementable abutment was chosen as the control group. A total vertical load of 583 N was applied to the occlusal contact areas. Stress distribution within the crown and implant components was analyzed using von Mises stress analysis. Principal stress analyses were employed to assess stress distribution in the peripheral bone. Results The PFM model exhibited the highest von Mises stress values for both the implant (428.7 MPa) and crown (79.7 MPa) compared to the other models. The all-ceramic models displayed the highest maximum von Mises stress within the abutment, approximately 335 MPa, compared to the PFM model. von Mises stresses of the abutment and implant in the all-ceramic models were 69% higher and 20% lower, respectively, than those in the PFM model. Screw stresses were relatively consistent across all groups. Principal stresses in spongy bone and minimum principal stress in cortical bone were consistent across all models. Conclusions All-ceramic restoration with a hybrid abutment, as opposed to traditional PFM restoration with a cementable abutment, does not adversely affect the implant and abutment screw and reduces crown stresses. Stresses within hybrid abutments were notably higher than those within cementable abutments. Spongy bone stresses remained unaffected by the type of crown or abutment.
Collapse
Affiliation(s)
- Kimia Nokar
- School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Faezeh Atri
- Department of Prosthodontics, School of Dentistry, Craniomaxillofacial Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saied Nokar
- Department of Prosthodontics, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
6
|
Gadzo N, Ioannidis A, Naenni N, Hüsler J, Jung RE, Thoma DS. Survival and complication rates of two dental implant systems supporting fixed restorations: 10-year data of a randomized controlled clinical study. Clin Oral Investig 2023; 27:7327-7336. [PMID: 37906305 PMCID: PMC10713755 DOI: 10.1007/s00784-023-05323-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 10/10/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVES To compare clinical, radiographic, biological and technical long-term outcomes of two types of dental implants over a period of 10 years. MATERIALS AND METHODS Ninety-eight implants were placed in 64 patients, randomly allocated to one of two manufacturers (AST and STM). All implants were loaded with fixed restorations. Outcome measures were assessed at implant insertion (Ti), at baseline examination (TL), at 1, 3, 5, 8 and 10 (T10) years. Data analysis included survival, bone level changes, complications and clinical measures. RESULTS Re-examination was performed in 43 patients (23 AST and 20 STM) at 10 years. The implant level analysis was based on 37 (AST) and 32 (STM) implants. Survival rates of 100% were obtained for both groups. The median changes of the marginal bone levels between baseline and T10 (the primary endpoint) amounted to a loss of 0.07 mm for group AST and a gain of 0.37 mm for group STM (intergroup p = 0.008). Technical complications occurred in 27.0% of the implants in group AST and in 15.6% in group STM. The prevalence of peri-implant mucositis was 29.7% (AST) and 50.1% (STM). The prevalence of peri-implantitis amounted to 0% (AST) and 6.3% (STM). CONCLUSIONS Irrespective of the implant system used, the survival rates after 10 years were high. Minimal bone level changes were observed, statistically significant but clinically negligible in favor of STM. Technical complications were more frequently encountered in group AST, while group STM had a higher prevalence of peri-implant mucositis.
Collapse
Affiliation(s)
- Naida Gadzo
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, 8032, Zurich, CH, Switzerland
| | - Alexis Ioannidis
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, 8032, Zurich, CH, Switzerland
| | - Nadja Naenni
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, 8032, Zurich, CH, Switzerland
| | - Jürg Hüsler
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, 8032, Zurich, CH, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, 8032, Zurich, CH, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, 8032, Zurich, CH, Switzerland.
- Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea.
| |
Collapse
|
7
|
Zhang Y, Wei D, Tian J, Zhao Y, Lin Y, Di P. Clinical evaluation and quantitative occlusal change analysis of posterior implant-supported all-ceramic crowns: A 3-year randomized controlled clinical trial. Clin Oral Implants Res 2023; 34:1188-1197. [PMID: 37526213 DOI: 10.1111/clr.14151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 07/12/2023] [Accepted: 07/18/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES To compare the survival and complication rates of posterior screw-retained monolithic lithium disilicate (LS2 )/veneered zirconia (ZrO2 ) single implant crowns (SICs), as well as analyze the occlusal changes observed during a 3-year follow-up period. MATERIALS AND METHODS Thirty-three patients were included and randomly divided into two groups. The test group consisted of 17 patients who received monolithic-LS2 -SIC, while the control group consisted of 16 patients who received veneered-ZrO2 -SIC. Implant/prosthesis survival rates, technical complications, peri-implant soft tissue conditions, and quantitative occlusal changes of SIC (obtained by the intra-oral scanner and analyzed in reverse software Geomagic Control 2015) were assessed at 1- and 3-year follow-ups. Bone loss and Functional Implant Prosthodontic Score (FIPS) were evaluated at a 3-year follow-up. RESULTS After a 3-year follow-up period, one patient dropped out of the follow-up. No implant loss was observed. One crown was fractured, resulting in prosthesis survival rates of 93.75% for the monolithic group and 100% for the veneered group. A technical complication rate of 25% (4/16) was observed in the veneered group (p = .333). No significant differences in the marginal bone loss were observed at the 3-year follow-up (0.00 (-0.22, 0.17) mm versus 0.00 (-0.12, 0.12) mm, p = .956). The total FIPS scores for the test group were 9.0 (9.0, 9.0), while the control group received scores of 9.0 (8.0, 10.0) (p = .953). The changes in mean occlusal clearance were 0.022 ± 0.083 mm for the test and 0.034 ± 0.077 mm for the control group (at 3 years, p = .497). The changes in occlusal contact area were 1.075 ± 2.575 mm2 for the test and 1.676 ± 2.551 mm2 for the control group (at 3 years, p = .873). CONCLUSION After a 3-year follow-up, screw-retained monolithic LS2 and veneered ZrO2 SIC demonstrated similar survival rates. The occlusal performance of implant prostheses needs to be closely examined during follow-up, and appropriate occlusal adjustments need to be considered.
Collapse
Affiliation(s)
- Yifan Zhang
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Donghao Wei
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Jiehua Tian
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Yijiao Zhao
- Center of Digital Dentistry, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ye Lin
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| | - Ping Di
- Department of Oral Implantology, Peking University School and Hospital of Stomatology & National Clinical Research Center for Oral Disease & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology, Beijing, China
| |
Collapse
|
8
|
Pjetursson BE, Sailer I, Merino-Higuera E, Spies BC, Burkhardt F, Karasan D. Systematic review evaluating the influence of the prosthetic material and prosthetic design on the clinical outcomes of implant-supported multi-unit fixed dental prosthesis in the posterior area. Clin Oral Implants Res 2023; 34 Suppl 26:86-103. [PMID: 37750526 DOI: 10.1111/clr.14103] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Revised: 04/24/2023] [Accepted: 04/30/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVE The objectives of the study were to assess the survival, failure, and technical complication rates of implant-supported fixed dental prosthesis (iFDPs) with pontic or splinted crown (iSp C) designs in the posterior area and compare the influence of prosthetic materials and prosthetic design on the outcomes. METHODS Electronic and manual searches were performed to identify randomized-, prospective-, and retrospective clinical trials with follow-up time of ≥12 months, evaluating the clinical outcomes of posterior iFDPs with pontic or iSp Cs. Survival and complication rates were analyzed using robust Poisson's regression models. RESULTS Thirty-two studies reporting on 42 study arms were included in the present systematic review. The meta-analysis of the included studies indicated estimated 3-year survival rates of 98.3% (95%CI: 95.6-99.3%) for porcelain-fused-to-metal (PFM) iFDPs, 97.5% (95%CI: 95.5-98.7%) for veneered zirconia (Zr) iFDPs with pontic, 98.9% (95%CI: 96.8-99.6%) for monolithic or micro-veneered zirconia iFDPs with pontic, and 97.0% (95%CI: 84.8-99.9%) for lithium disilicate iFDPs with pontics. The survival rates for different material combination showed no statistically significant differences. Veneered restorations, overall, showed significantly (p < .01) higher ceramic fracture and chipping rates compared with monolithic restorations. Furthermore, there was no significant difference in survival rates (98.3% [95%CI: 95.6-99.3%] vs. 99.1% [95%CI: 97.6-99.7%]) and overall complication rates between PFM iFDPs with pontic and PFM iSp Cs. CONCLUSIONS Based on the data identified by this systematic review, PFM, veneered Zr, and monolithic Zr iFDPs with pontic and iSp Cs showed similarly high short-term survival rates in the posterior area. Veneered restorations exhibit ceramic chipping more often than monolithic restorations, with the highest fracture rate reported for veneered Zr iFDPs.
Collapse
Affiliation(s)
- Bjarni E Pjetursson
- Department of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Elizabeth Merino-Higuera
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
- Department of Prosthodontics, University Center of Health Sciences, University of Guadalajara, Guadalajara, Mexico
| | - Benedikt Christopher Spies
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Felix Burkhardt
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
9
|
Roehling S, Gahlert M, Bacevic M, Woelfler H, Laleman I. Clinical and radiographic outcomes of zirconia dental implants-A systematic review and meta-analysis. Clin Oral Implants Res 2023; 34 Suppl 26:112-124. [PMID: 37750521 DOI: 10.1111/clr.14133] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 09/27/2023]
Abstract
OBJECTIVES For the present review, the following focused question was addressed: In patients with root-analog dental implants, what is the effect of implants made of other materials than titanium (alloy) on implant survival, marginal bone loss (MBL), and technical and biological complications after at least 5 years. MATERIALS AND METHODS An electronic (Medline, Embase, Web of Science) search was performed to identify observational clinical studies published from January 2000 investigating a minimum of 20 commercially available zirconia implants with a mean follow-up of at least 60 months. Primary outcome was implant survival, secondary outcomes included peri-implant MBL, probing depths (PDs), and technical and biological complications. Meta-analyses were performed to evaluate implant survival, MBL, and PD. RESULTS From 5129 titles, 580 abstracts were selected, and 111 full-text articles were screened. Finally, 4 prospective and 2 retrospective observational clinical cohort studies were included for data extraction. Meta-analyses estimated after 5 years of loading mean values of 97.2% (95% CI 94.7-99.1) for survival (277 implants, 221 patients), 1.1 mm (95% CI: 0.9-1.3) for MBL (229 implants, 173 patients), and 3.0 mm (95% CI 2.5-3.4) for PDs (231 implants, 175 patients). CONCLUSIONS After 5 years, commercially available zirconia implants showed reliable clinical performance based on survival rates, MBL, and PD values. However, more well-designed prospective clinical studies and randomized clinical trials investigating titanium and zirconia implants are needed to confirm the presently evaluated promising outcomes.
Collapse
Affiliation(s)
- S Roehling
- Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Clinic for Oral and Cranio-Maxillofacial Surgery, Kantonsspital Aarau, Aarau, Switzerland
- Private Dental Clinic PD Dr. Gahlert & PD Dr. Roehling, Munich, Germany
| | - M Gahlert
- Clinic for Oral and Cranio-Maxillofacial Surgery, Hightech Research Center, University Hospital Basel, University of Basel, Basel, Switzerland
- Private Dental Clinic PD Dr. Gahlert & PD Dr. Roehling, Munich, Germany
- Sigmund Freud Private University, Vienna, Austria
| | - M Bacevic
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
- Centre for Oral Clinical Research, Institute of Dentistry, London, UK
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | | | - I Laleman
- Department of Periodontology and Oral Surgery, Faculty of Medicine, University of Liège, Liège, Belgium
- Dental Biomaterials Research Unit (d-BRU), Faculty of Medicine, University of Liège, Liège, Belgium
| |
Collapse
|
10
|
Benalcázar-Jalkh EB, de Carvalho LF, Alves LMM, Campos TMB, Sousa EDO, Bergamo ETP, Coelho PG, Gierthmuehlen PC, Spitznagel FA, Zahoui A, Bonfante EA. Reliability and Failure Mode of Ti-Base Abutments Supported by Narrow/Wide Implant Systems. Dent J (Basel) 2023; 11:207. [PMID: 37754327 PMCID: PMC10529977 DOI: 10.3390/dj11090207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 09/28/2023] Open
Abstract
To assess the reliability and failure modes of Ti-base abutments supported by narrow and wide-diameter implant systems. Narrow (Ø3.5 × 10 mm) and wide (Ø5 × 10 mm) implant systems of two different manufacturers with internal conical connections (16°) and their respective Ti-base abutments (3.5 and 4.5 mm) were evaluated. Ti-base abutments were torqued to the implants, standardized metallic maxillary incisor crowns were cemented, and step stress accelerated life testing of eighteen assemblies per group was performed in three loading profiles: mild, moderate, and aggressive until fracture or suspension. Reliability for missions of 100,000 cycles at 100 and 150 N was calculated, and fractographic analysis was performed. For missions at 100 N for 100,000 cycles, both narrow and wide implant systems exhibited a high probability of survival (≥99%, CI: 94-100%) without significant differences. At 150 N, wide-diameter implants presented higher reliability (≥99%, CI: 99-100%) compared to narrow implants (86%, CI: 61-95%), with no significant differences among manufacturers. Failure mode predominantly involved Ti-base abutment fractures at the abutment platform. Ti-base abutments supported by narrow and wide implant systems presented high reliability for physiologic masticatory forces, whereas for high load-bearing applications, wide-diameter implants presented increased reliability. Failures were confined to abutment fractures.
Collapse
Affiliation(s)
- Ernesto B. Benalcázar-Jalkh
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Laura F. de Carvalho
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Larissa M. M. Alves
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Tiago M. B. Campos
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Edisa de Oliveira Sousa
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Edmara T. P. Bergamo
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Paulo G. Coelho
- Department of Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Petra C. Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Frank A. Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Abbas Zahoui
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| | - Estevam A. Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru 17012-980, Brazil
| |
Collapse
|
11
|
Tajti P, Solyom E, Czumbel LM, Szabó B, Fazekas R, Németh O, Hermann P, Gerber G, Hegyi P, Mikulás K. Monolithic zirconia as a valid alternative to metal-ceramic for implant-supported single crowns in the posterior region: A systematic review and meta-analysis of randomized controlled trials. J Prosthet Dent 2023:S0022-3913(23)00336-0. [PMID: 37349158 DOI: 10.1016/j.prosdent.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/24/2023]
Abstract
STATEMENT OF PROBLEM Technical complication rates of standard metal-ceramic implant-supported posterior restorations are relatively high. Whether monolithic zirconia crowns represent a more successful alternative is unclear. PURPOSE The purpose of this systematic review and meta-analysis was to compare the clinical outcomes of posterior monolithic zirconia and metal-ceramic implant-supported single crowns. MATERIAL AND METHODS A search was conducted in MEDLINE, Scopus, Embase, Web of Science, and CENTRAL databases for randomized controlled trials up to April 2023 with a follow-up time of at least 1 year. Restoration and implant survival and failure rates, marginal bone loss (MBL), bleeding on probing (BOP), and technical complications were analyzed by 2 reviewers. Statistical analyses were conducted using the R-statistics software program. The risk of bias was assessed by the Cochrane Risk of Bias Tool 2 (RoB 2), and the certainty of evidence by the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. RESULTS A total of 11 out of 2030 records were identified by title and abstract, and 4 records were included after full-text analysis. The statistical analysis revealed no significant difference in MBL (MD -0.11, 95% CI: [-0.25; 0.03]), BOP (OR 0.66, 95% CI: [0.25; 1.77]), or implant failure (OR 1.30, 95% CI: [0.24; 7.08]). Monolithic zirconia presented significantly less chipping over 1 year (OR 0.17, 95% CI: [0.03; 0.99]). The chipping rate was 0% for monolithic zirconia and 7.61% for metal-ceramic. Based on a narrative review, the restoration survival rate was 97.5% in the monolithic zirconia group and 99.1% in the metal-ceramic group. CONCLUSIONS Monolithic zirconia showed favorable short-term survival rates and had significantly less chipping over 1 year. Regarding MBL, BOP, and failure rates, both restoration types presented similar results at the 1-year follow-up.
Collapse
Affiliation(s)
- Péter Tajti
- Resident, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; PhD student, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Eleonora Solyom
- Clinical Specialist, Department of Periodontology, Semmelweis University, Budapest, Hungary; PhD student, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - László Márk Czumbel
- Resident, Department of Periodontology, Semmelweis University, Budapest, Hungary; Scientific Methodology Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Bence Szabó
- Biostatistician, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Réka Fazekas
- Assistant Professor, Department of Conservative Dentistry, Semmelweis University, Budapest, Hungary; Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Orsolya Németh
- Director, Associate Professor, Department of Community Dentistry, Semmelweis University, Budapest, Hungary; Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hermann
- Director, Full Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Gábor Gerber
- Associate Professor, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary; Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Strategic Director, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary; Strategic Director, Institute for Translational Medicine, Medical School, University of Pécs, Pécs, Hungary
| | - Krisztina Mikulás
- Assistant Professor, Department of Prosthodontics, Semmelweis University, Budapest, Hungary; Supervisor, Centre for Translational Medicine, Semmelweis University, Budapest, Hungary.
| |
Collapse
|
12
|
Strasding M, Hicklin SP, Todorovic A, Fehmer V, Mojon P, Sailer I. A multicenter randomized controlled clinical pilot study of buccally micro-veneered lithium-disilicate and zirconia crowns supported by titanium base abutments: 1-year outcomes. Clin Oral Implants Res 2023; 34:56-65. [PMID: 36321877 PMCID: PMC10098475 DOI: 10.1111/clr.14018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 09/07/2022] [Accepted: 10/08/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To investigate survival rates, technical and biologic outcomes of buccally micro-veneered all-ceramic single implant crowns. MATERIAL AND METHODS Sixty subjects randomly received immediately or early placed implants. Crowns out of lithium-disilicate (n = 30) and zirconia-ceramic (n = 30) were bonded to titanium-base-abutments. Restorations were inspected at baseline (BL) and during follow-up visits (6, 12 months). Technical and biologic parameters were recorded. Data were analysed descriptively. Differences between groups were tested with Student's t-test. Paired T-test was used when comparing data from the same implant or tooth over time. Linear model repeated measures were used to test differences between materials over time. Differences in counts were evaluated using Pearson Chi-square test. The level of significance was at p < .05. RESULTS After a mean observation time of 13.2 ± 2.4 months, 54 restorations were re-examined. The implant survival rate was 98.3%, and the restoration survival rate was 100%. One early implant failure occurred. Two minor chippings occurred in lithium-disilicate restorations. No chippings or fractures occurred in any zirconia restorations at 1 year (0%). The technical complication rate was 3.7%, with 7.7% complications among the lithium-disilicate restorations and no differences between the two materials (p = .558). At 1-year follow-up, mean Bleeding on Probing (BOP) was higher at implants (0.27 ± 0.3) than adjacent teeth (0.17 ± 0.18) (p = .046) with no differences between materials (p = .36). Differences in pocket probing depth (PPD) between implants and adjacent teeth were significant (p < .01). Jemt Index improved significantly from BL to 1-y-follow-up (p < .001). CONCLUSIONS Preliminary results were good, suggesting that the ceramic type does not impact technical and biologic parameters.
Collapse
Affiliation(s)
- Malin Strasding
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva 4, Switzerland
| | - Stefan Paul Hicklin
- Clinic of Preventive Dentistry, Periodontology and Cariology, and Clinic of General, Special Care and Geriatric Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ana Todorovic
- Division of Prosthodontics, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Vincent Fehmer
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva 4, Switzerland
| | - Philippe Mojon
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva 4, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinic of Dental Medicine, University of Geneva, Geneva 4, Switzerland
| |
Collapse
|
13
|
Bonfante EA, Calamita M, Bergamo ETP. Indirect restorative systems-A narrative review. J ESTHET RESTOR DENT 2023; 35:84-104. [PMID: 36688803 DOI: 10.1111/jerd.13016] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 01/03/2023] [Accepted: 01/04/2023] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The background and clinical understanding of the properties of currently available indirect restorative systems and fabrication methods is, along with manufacturer and evidence-based literature, an important starting point to guide the clinical selection of materials for tooth and/or implant supported reconstructions. Therefore, this review explores most indirect restorative systems available in the market, especially all-ceramic, along with aspects of manufacturing process, clinical survival rates, and esthetic outcomes. OVERVIEW Progressive incorporation of new technologies in the dental field and advancements in materials science have enabled the development/improvement of indirect restorative systems and treatment concepts in oral rehabilitation, resulting in reliable and predictable workflows and successful esthetic and functional outcomes. Indirect restorative systems have evolved from metal ceramics and polymers to glass ceramics, polycrystalline ceramics, and resin-matrix ceramics, aiming to improve not only biological and mechanical properties, but especially the optical properties and esthetic quality of the reconstructions, in attempt to mimic natural teeth. CONCLUSIONS Based on several clinical research, materials, and patient-related parameters, a decision tree for the selection of indirect restorative materials was suggested to guide clinicians in the rehabilitation process. CLINICAL SIGNIFICANCE The pace of materials development is faster than that of clinical research aimed to support their use. Since no single material provides an ideal solution to every case, professionals must continuously seek information from well designed, long-term clinical trials in order to incorporate or not new materials and technological advancements.
Collapse
Affiliation(s)
- Estevam A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
| | - Marcelo Calamita
- Department of Restorative Dental Sciences at the University of Florida, Gainesville, Florida, USA
| | - Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
| |
Collapse
|
14
|
Scanning Electron Microscopy Analyses of Dental Implant Abutments Debonded from Monolithic Zirconia Restorations Using Heat Treatment: An In Vitro Study. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4030041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aim: The aim of this in vitro study is to present a debonding protocol developed to remove a screw-retained, monolithic, zirconia restoration from its titanium-base abutment, and to microscopically evaluate the abutment integrity at both the prosthetic and connection levels. Materials and Methods: A total of 30 samples were tested. Each sample consisted of a monolithic zirconia restoration bonded on a titanium link abutment. Five different shapes were designed and fabricated. Randomly, one-third of the Ti-link abutments were subjected to an anodizing process. Then, all the zirconia samples were bonded to the Ti-link abutments according to a pre-established protocol. Forty-eight hours later, the samples were debonded according to the experimental protocol. The outcomes were evaluated by a visual inspection with an optical microscope, scanning electron microscopy (SEM), and chemical composition analysis. Results: Thirty samples were collected and visually analyzed. Seven samples were randomly evaluated via scanning electron microscopy. In all the examinations, no relevant changes were reported. Chemical composition analysis also relieved no changes in the chemical structure of the titanium. Conclusions: The titanium-base abutments do not alter the structure and properties of the material, not creating phase changes or the birth of oxides such as to induce fragility. Further clinical studies with longer follow-up periods are needed to confirm these preliminary results.
Collapse
|
15
|
Hjerppe J, Jung RE, Hämmerle CH, Özcan M, Mühlemann S. Mechanical stability of fully personalized, abutment-free zirconia implant crowns on a novel implant-crown interface. J Dent 2022; 121:104121. [PMID: 35395344 DOI: 10.1016/j.jdent.2022.104121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 03/24/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To test the failure load and failure mode of a novel implant-crown interface specifically designed for the fabrication of fully personalized, abutment-free monolithic zirconia CAD-CAM crowns compared to conventional implant-abutment interfaces involving prefabricated or centrally manufactured abutments for zirconia CAD-CAM crowns. METHODS Implants (N=48) were divided into groups (n=12) according to different implant-abutment interface designs: (1) internal implant connection with personalized, abutment-free CAD-CAM crowns (Abut-Free-Zr), (2) internal conical connection with customized, centrally manufactured zirconia CAD-CAM abutments (Cen-Abut-Zr), (3) prefabricated titanium base abutments from manufacturer 1 (Ti-Base-1), (4) additional prefabricated titanium base abutments from manufacturer 2 (Ti-Base-2). All specimens were restored with a screw-retained monolithic zirconia CAD-CAM molar crown and subjected to thermomechanical aging (1.200.000 cycles, 49 N, 1.67 Hz, 30° angulation, thermocycling 5-50°C). Static load until failure was applied in a universal testing machine. Failure modes were analyzed descriptively under digital microscope. Mean failure load values were statistically analyzed at a significance level of p<0.05. RESULTS All specimens survived thermomechanical aging. The mean failure loads varied between 1332 N (Abut-Free-Zr) and 1601 N (Ti-Base-2), difference being significant between these groups (p<0.05). No differences between the other groups were seen. The predominant failure mode per group was crown fracture above implant connection (Abut-Free-Zr, 75%), abutment fracture below implant neck (Cen-Abut-Zr, 83%), crown fracture leaving an intact abutment (Ti-Base-1/Ti-Base-2 100%). CONCLUSIONS Implant-crown interface with fully personalized, abutment-free monolithic CAD-CAM zirconia crowns exhibited similar failure loads as conventional implant-abutment interfaces (except group Ti-Base-2) involving CAD-CAM crowns with prefabricated or centrally manufactured abutment. CLINICAL SIGNIFICANCE The new implant connection simplifies the digital workflow for all-ceramic implant reconstructions. The specific design of the implant-crown interface allows the fabrication of fully personalized, abutment-free zirconia implant crowns both in-house and in-laboratory without the need of a prefabricated abutment or central manufacturing.
Collapse
Affiliation(s)
- Jenni Hjerppe
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland.
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Christoph Hf Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Mutlu Özcan
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| |
Collapse
|
16
|
Sailer I, Barbato L, Mojon P, Pagliaro U, Serni L, Karasan D, Cairo F. Single and partial tooth replacement with fixed dental prostheses supported by dental implants: a systematic review of outcomes and outcome measures used in clinical trials in the last 10 years. Clin Oral Implants Res 2022; 34 Suppl 25:22-37. [PMID: 35332952 DOI: 10.1111/clr.13926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/01/2022] [Accepted: 02/20/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To evaluate outcome measures, methods of assessment and analysis in clinical studies on fixed single- and multiple- unit implant restorations. METHODS Three independent electronic database searches (MEDLINE, EMBASE, COCHRANE) were done to identify prospective and retrospective clinical studies published from January 2011 up to June 2021 with ≥20 patients and minimum 1 year follow-up period on technical and clinical outcomes of implant-supported single crowns (SCs) and partial fixed dental prostheses (P-FDPs). An entire data extraction was performed to identify primarily the most reported outcome measures and later to define the choice of assessment methods of those outcome measures. The outcomes were analysed descriptively, and the strength of association was evaluated using Pearson Chi-square test (p≤0.05). RESULTS In total 531 studies, 368 on SCs (69.3%), 70 on P-FDPs (13.1%), and 93 on both restoration types (17.5%) were included. 56.3% of all studies did not clearly define a primary outcome. The most frequent primary outcome was marginal bone-level (MBL) (55.2%) followed by implant survival (5.3%), professional esthetic evaluation (3.4%) and technical complications (2.1%). Peri-implant indices were the most reported secondary outcome (55.1%) followed by implant survival (39.9%), MBL (36%) and implant success (26.4%). Prosthetic failure (7 studies - 3.9%) was one of the least reported outcome measures CONCLUSIONS: Outcome measures and their assessment methods exhibited high heterogeneity among studies. Primary outcomes were not often defined clearly, and the most frequently selected primary outcome was marginal bone loss. Prosthetic outcomes, implant survival and patient related outcomes remained infrequently reported.
Collapse
Affiliation(s)
- Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Philippe Mojon
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Umberto Pagliaro
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Lapo Serni
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| |
Collapse
|
17
|
Li R, Wan L, Zhang X, Liu W, Rong M, Li X, Lu H. Effect of a neodymium-doped yttrium aluminium garnet laser on the physicochemical properties of contaminated titanium surfaces and macrophage polarization. J Periodontal Res 2022; 57:533-544. [PMID: 35266182 DOI: 10.1111/jre.12982] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/10/2021] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
AIM(S) The objective of this study was to evaluate the changes in the physical and chemical properties of titanium surfaces contaminated by a Nd:YAG laser with different levels of energy and the regulation of macrophage polarization. MATERIALS AND METHODS The titanium specimens were divided into four groups. The blank control group consisted of the above-mentioned contaminated titanium specimens, and the conditioned control group consisted of sandblasted and acid-etched (SLA) titanium surfaces. The blank control and condition control groups were sealed and preserved in a sterile dark box. There were two experimental groups treated with the Nd:YAG laser-one with 0.5 W and the second with 1.0 W. Surface characteristics were evaluated using scanning electron microscopy, surface profilometry, and contact angle assays. The macrophage viability and proliferation of mouse RAW246.7 were analysed, and the macrophage surface markers, macrophage cytokines, and inflammatory and anti-inflammatory genes were expressed. RESULTS The Nd:YAG laser increased the hydrophilicity and roughness of the titanium surface after decontamination. Fewer RAW264.7 cells were observed on the titanium surface after Nd:YAG decontamination than on the contaminated titanium surface expressing the M1-type macrophage marker CCR7, whereas more cells were observed after decontamination than on the contaminated titanium surface expressing the M2-type macrophage marker CD206. Following Nd:YAG laser treatment, the secretion of the inflammatory cytokines IL-1β and TNF-α by RAW264.7 cells on the titanium surface was decreased, whereas the secretion of the anti-inflammatory cytokines IL-4 and IL-10 was increased. RAW264.7 cells cultured for 3 days on the titanium surface after Nd:YAG decontamination treatment expressed significantly reduced levels of the inflammation-related genes IL-1β, TNF-α, IL-6 and iNOS. The expression of the anti-inflammatory genes Arg-1, IL-4, IL-10 and TGF-β by RAW264.7 cells was significantly up-regulated after 3 days of incubation on the titanium surface after Nd:YAG decontamination treatment. CONCLUSION(S) The Nd:YAG laser increased the hydrophilicity and roughness of the titanium surface after decontamination, and this change inhibited M1-type macrophage polarization and promoted M2-type macrophage polarization.
Collapse
Affiliation(s)
- Ruiqi Li
- Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Lei Wan
- Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Xueyang Zhang
- Stomatological Hospital, Southern Medical University, Guangzhou, China.,Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, China
| | - Wenjing Liu
- Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Mingdeng Rong
- Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoling Li
- Stomatological Hospital, Southern Medical University, Guangzhou, China
| | - Haibin Lu
- Stomatological Hospital, Southern Medical University, Guangzhou, China.,Shunde Hospital, Southern Medical University (The First People's Hospital of Shunde), Foshan, China
| |
Collapse
|
18
|
Sailer I, Barbato L, Mojon P, Pagliaro U, Serni L, Karasan D, Cairo F. Single and partial tooth replacement with fixed dental prostheses supported by dental implants: A systematic review of outcomes and outcome measures used in clinical trials in the last 10 years. J Clin Periodontol 2022; 50 Suppl 25:22-37. [PMID: 35246885 DOI: 10.1111/jcpe.13612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/01/2022] [Accepted: 02/20/2022] [Indexed: 11/30/2022]
Abstract
AIM To evaluate outcome measures, methods of assessment, and analysis in clinical studies on fixed single- and multiple-unit implant restorations. MATERIALS AND METHODS Three independent electronic database searches (MEDLINE, EMBASE, and Cochrane) were done to identify prospective and retrospective clinical studies published from January 2011 up to June 2021 with ≥20 patients and minimum 1-year follow-up period on technical and clinical outcomes of implant-supported single crowns (SCs) and partial fixed dental prostheses (P-FDPs). An entire data extraction was performed to identify primarily the most reported outcome measures and later to define the choice of assessment methods of those outcome measures. The outcomes were analysed descriptively, and the strength of association was evaluated using the Pearson chi-square test (p ≤ .05). RESULTS In a total 531 studies, 368 on SCs (69.3%), 70 on P-FDPs (13.1%), and 93 on both restoration types (17.5%) were included; 56.3% of all studies did not clearly define a primary outcome. The most frequent primary outcome was marginal bone level (MBL) (55.2%) followed by implant survival (5.3%), professional aesthetic evaluation (3.4%), and technical complications (2.1%). Peri-implant indices were the most reported secondary outcome (55.1%), followed by implant survival (39.9%), MBL (36%), and implant success (26.4%). Prosthetic failure (seven studies [3.9%]) was one of the least reported outcome measures. CONCLUSIONS Outcome measures and their assessment methods showed high heterogeneity among studies. Primary outcomes were not often defined clearly, and the most frequently selected primary outcome was marginal bone loss. Prosthetic outcomes, implant survival, and patient-related outcomes were only infrequently reported.
Collapse
Affiliation(s)
- Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Luigi Barbato
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Philippe Mojon
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Umberto Pagliaro
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Lapo Serni
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics of Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Francesco Cairo
- Research Unit in Periodontology and Periodontal Medicine, University of Florence, Florence, Italy
| |
Collapse
|
19
|
Kraus RD, Espuelas C, Hämmerle CHF, Jung RE, Sailer I, Thoma DS. Five-year randomized controlled clinical study comparing cemented and screw-retained zirconia-based implant-supported single crowns. Clin Oral Implants Res 2022; 33:537-547. [PMID: 35224774 PMCID: PMC9313572 DOI: 10.1111/clr.13913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/17/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
Objectives To compare screw‐retained and cemented all‐ceramic implant‐supported single crowns regarding biological and technical outcomes over a 5‐year observation period. Materials and methods In 44 patients, 44 two‐piece dental implants were placed in single‐tooth gaps in the esthetic zone. Patients randomly received a screw‐retained (SR) or cemented (CR) all‐ceramic single crown and were then re‐examined annually up to 5 years. Outcome measures included: clinical, biological, technical, and radiographic parameters. Data were statistically analyzed with Wilcoxon–Mann–Whitney, Wilcoxon, and Fisher's exact tests. Results During the observation period, three patients (6.8%) were loss to follow‐up. Eight restorations (18.2%, CI (8.2%, 32.7%)) were lost due to technical (6 patients, 13.6% (CI (5.2%, 27.4%)), 2 CR and 4 SR group, intergroup p = .673; implants still present) or biological complications (2 patients, 4.5% (CI (0.6%, 16.5%)), only CR group, intergroup p = .201, both implants lost). This resulted in a survival rate of 81.2% (CI (65.9%, 90.1%)) on the restorative level (18 SR; 15 CR, 3 lost to follow‐up). At the 5‐year follow‐up, the median marginal bone levels were located slightly apical relative to the implant shoulder with 0.4 mm (0.5; 0.3) (SR) and 0.4 mm (0.8; 0.3) (CR) (intergroup p = .582). Cemented restorations demonstrated a significantly higher biological complication rate (36.8%, SR: 0.0%; intergroup p = .0022), as well as a significantly higher overall complication rate (68.4%, SR: 22.7%, intergroup p = .0049). All other outcomes did not differ significantly between the two groups (p > .05). Conclusions All‐ceramic single‐tooth restorations on two‐piece dental implants resulted in a relatively low survival rate. Cemented restorations were associated with a higher biological and overall complication rate than screw‐retained restorations.
Collapse
Affiliation(s)
- Riccardo D Kraus
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Catharina Espuelas
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| |
Collapse
|
20
|
Sailer I, Karasan D, Todorovic A, Ligoutsikou M, Pjetursson BE. Prosthetic failures in dental implant therapy. Periodontol 2000 2022; 88:130-144. [PMID: 35103329 PMCID: PMC9305548 DOI: 10.1111/prd.12416] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Both fixed and removable implant‐supported prostheses are well‐established methods for replacing missing teeth in partially or fully edentulous patients. Numerous systematic reviews have been performed in recent years to evaluate the survival and complication rates of implant‐retained fixed dental prostheses and implant‐retained overdentures, displaying high 5‐year survival rates ranging from 97.1% for fixed dental prostheses to 95%‐100% for implant‐retained overdentures. However, the survival rates only represent the prostheses remaining in use for a defined follow‐up time, and do not account for the potential prosthetic complications that may have arisen and influence the general success of the implant treatment. The most common technical complications of fixed implant‐retained single crowns are crown fracture, fractures of ceramic implant abutments, and esthetic problems. The predominant technical complication at multiple‐unit, implant‐retained fixed dental prostheses is fracture/chipping of the veneering ceramic. Reported technical complications for implant‐retained overdentures are overdenture fracture or chipping of the veneer materials, whereas mechanical complications include implant fracture, attachment failure, and attachment housing or insert complications. To reduce the risk of such failures, a comprehensive pretreatment diagnostic work‐up is essential, including defining the prosthetic goal with the aid of a wax‐up or set‐up and the associated ideal, prosthetically oriented three‐dimensional implant position. Furthermore, selection of the ideal type of prosthesis, including the respective implant components and materials, is important for clinical long‐term treatment success.
Collapse
Affiliation(s)
- Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Ana Todorovic
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Division of Prosthodontics, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Maria Ligoutsikou
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Bjarni Elvar Pjetursson
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland
| |
Collapse
|
21
|
Zhang CN, Zhu Y, Zhang YJ, Jiang YH. Clinical esthetic comparison between monolithic high-translucency multilayer zirconia and traditional veneered zirconia for single implant restoration in maxillary esthetic areas: Prosthetic and patient-centered outcomes. J Dent Sci 2022; 17:1151-1159. [PMID: 35784115 PMCID: PMC9236935 DOI: 10.1016/j.jds.2022.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/14/2022] [Indexed: 11/19/2022] Open
Abstract
Background/purpose Clinical esthetic evidence for the performance of monolithic high-translucency multilayer zirconia is lacking. The aim of this study was to compare monolithic high-translucency multilayer zirconia with traditional veneered zirconia in clinical situation. Material and methods A total of 30 participants who were provided with both monolithic zirconia crowns (Group 1) and traditional veneered crowns (Group 2) for single implant restoration in maxillary esthetic areas were enrolled. Patients' subjective outcome (Visual Analog Scale, VAS) were recorded. Photos were taken and then evaluated by 9 evaluators with Pink and White Esthetic Score (WES). Wilcoxon signed rank test was used for comparison between Group 1 and Group 2 in VAS, WES and five variables in WES. Kendall's coefficient of concordance test was used to calculate inter-rater reliability of WES variables. Spearman correlation was used to analyze association between patients' outcome and evaluators' scores. Results There was no significant difference in patients' subjective outcome between monolithic zirconia and traditional veneered crowns: overall VAS were 9.0 (8.0–9.0) and 9.0 (8.5–9.5), respectively (P > 0.05). However, in professional view, significant difference between Group 1 and Group 2 in WES was observed: 7.5 (6.0–8.0) and 8.0 (6.5–8.5), respectively (P < 0.05). Kendall's test showed, among WES variables, translucency demonstrated the highest agreement. Professionally reported evaluations did not correlate with patient-reported outcomes (Spearman correlation were 0.246 and 0.224 for Group 1 and Group 2, respectively). Conclusion Within the limitation of this study, it can be concluded that monolithic high-translucency multilayer zirconia restoration might be a treatment modality.
Collapse
Affiliation(s)
- Chu-Nan Zhang
- Department of Implant Dentistry, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yu Zhu
- Department of Implant Dentistry, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yi-Jie Zhang
- Department of Implant Dentistry, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yin-Hua Jiang
- Department of Oral and Maxillofacial Implantology, Lishui People’s Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, China
- Corresponding author. Department of Oral and Maxillofacial Implantology, Lishui People's Hospital, The Sixth Affiliated Hospital of Wenzhou Medical University, No. 15 Dazhong Road, Lishui, 323000, China. Fax: +86 0578 2187120.
| |
Collapse
|
22
|
Nawafleh N, Elshiyab S, Öchsner A, George R. In Vitro Fatigue and Fracture Load of Monolithic Ceramic Crowns Supported by Hybrid Abutment. Open Dent J 2021. [DOI: 10.2174/1874210602115010664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective:
This study evaluated the performance of zirconia and lithium disilicate crowns supported by implants or cemented to epoxy resin dies.
Methods:
Eigthy zirconia and lithium disilicate crowns each were prepared and assigned in four groups according to the crown material and supporting structure combinations (implant-supported zirconia, die-supported zirconia, implant-supported lithium disilicate, and die-supported lithium disilicate). Ten crowns in each group acted as control while the rest (n=10) underwent thermocycling and fatigue with 100 N loading force for 1.5 million cycles. Specimens were then loaded to fracture in a universal testing machine. Data were analysed using one-way ANOVA and Tukey multiple comparison test with a 95% level of significance.
Results:
No implants or crown failure occurred during fatigue. The mean fracture load values (control, fatigued) in newton were as follows: (4054, 3344) for implant-supported zirconia, (3783, 3477) for die-supported zirconia, (2506, 2207) for implant-supported lithium disilicate, and (2159, 1806) for die-supported lithium disilicate. Comparing the control with the corresponding fatigued subgroup showed a significantly higher fracture load mean of the control group in all cases. Zirconia showed a significantly higher fracture load mean than lithium disilicate (P=0.001, P<0.001). However, comparing crowns made from the same material according to the supporting structure showed no significant difference (P=0.923, P=0.337).
Conclusion:
Zirconia and lithium disilicate posterior crowns have adequate fatigue and fracture resistance required for posterior crowns. However, when heavy fatigue forces are expected, zirconia material is preferable over lithium disilicate. Zirconia and lithium disilicate implant-supported crowns cemented to hybrid abutments should have satisfactory clinical performance.
Collapse
|
23
|
Mechanical Stability of Screw-Retained Monolithic and Bi-layer Posterior Hybrid Abutment Crowns after Thermomechanical Loading: An In Vitro Study. MATERIALS 2021; 14:ma14247539. [PMID: 34947134 PMCID: PMC8706390 DOI: 10.3390/ma14247539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
To evaluate the failure-load and survival-rate of screw-retained monolithic and bi-layered crowns bonded to titanium-bases before and after mouth-motion fatigue, 72 titanium-implants (SICvantage-max, SIC-invent-AG) were restored with three groups (n = 24) of screw-retained CAD/CAM implant-supported-single-crowns (ISSC) bonded to titanium-bases: porcelain-fused-to-metal (PFM-control), porcelain-fused-to-zirconia (PFZ-test) and monolithic LDS (LDS-test). Half of the specimens (n = 12/group) were subjected to fatigue in a chewing-simulator (1.2 million cycles, 198 N, 1.67 Hz, thermocycling 5–55 °C). All samples were exposed to single-load-to-failure without (PFM0, PFZ0, LDS0) or with fatigue (PFM1, PFZ1, LDS1). Comparisons were statistically analyzed with t-tests and regression-models and corrected for multiple-testing using the Student–Neuman–Keuls method. All PFM and LDS crowns survived fatigue exposure, whereas 16.7% of PFZ showed chipping failures. The mean failure-loads (±SD) were: PFM0: 2633 ± 389 N, PFM1: 2349 ± 578 N, PFZ0: 2152 ± 572 N, PFZ1: 1686 ± 691 N, LDS0: 2981 ± 798 N, LDS1: 2722 ± 497 N. Fatigue did not influence load to failure of any group. PFZ ISSC showed significantly lower failure-loads than monolithic-LDS regardless of artificial aging (p < 0.05). PFM ISSC showed significantly higher failure loads after fatigue than PFZ (p = 0.032). All ISSC failed in a range above physiological chewing forces. Premature chipping fractures might occur in PFZ ISSC. Monolithic-LDS ISSC showed high reliability as an all-ceramic material for screw-retained posterior hybrid-abutment-crowns.
Collapse
|
24
|
Fardin VP, Bergamo ETP, Bordin D, Hirata R, Bonfante EA, Bonfante G, Coelho PG. Effect of different tightening protocols on the probability of survival of screw-retained implant-supported crowns. J Mech Behav Biomed Mater 2021; 126:105019. [PMID: 34875501 DOI: 10.1016/j.jmbbm.2021.105019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/24/2021] [Accepted: 11/28/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE This study evaluated the effect of different tightening protocols on the probability of survival of screw-retained implant-supported anterior crowns. MATERIALS AND METHODS Seventy-two implants with internal conical connections (4.0 × 10mm, Ti-6Al-4V, Colosso, Emfils) were divided into four groups (n = 18 each): 1) Manufacturer's recommendations torque (25 N.cm for abutment's screw and 30 N.cm for crown's screw) (MaT); 2) Retightening after 10 min (ReT); 3) Torque 16% below recommended to simulate an uncalibrated wrench (AgT), and; 4) Temporary crown simulation (TeT), where crowns were torqued to 13 N.cm to simulate manual tightening, subjected to 11,200 cycles to simulate temporary crown treatment time (190 N), and then retightened to manufacturer torque (TeT). All specimens were subjected to cyclic fatigue in distilled water with a load of 190 N until 250,000 cycles or failure. The probability of survival (reliability) to complete a mission of 50,000 cycles was calculated and plotted using the Weibull 2-Parameter analysis. Weibull modulus and number of cycles at which 62.3% of the specimens would fail were also calculated and plotted. The failure mode was characterized in stereo and scanning electron microscopes (SEM). RESULTS The probability of survival was 69.3% for MaT, 70% for ReT, 54.8% for AgT, and 40.3% for TeT, all with no statistically significant difference. Weibull modulus was approximately 1.0 for all groups. The characteristic number of cycles for failure was 105,000 cycles for MaT, 123,000 for ReT, 82,000 cycles for AgT, and 54,900 cycles for TeT, with no significant difference between groups. The chief failure mode for MaT, ReT, AgT groups was crown screw fracture, whereas abutment screw fracture was the chief failure mode for the TeT group. CONCLUSION Tightening protocol did not influence the probability of survival of the screw-retained anterior crowns supported by internal conical implants (Ti-6Al-4V, Colosso, Emfils).
Collapse
Affiliation(s)
- Vinicius P Fardin
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru College of Dentistry, Bauru, SP, Brazil
| | - Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru College of Dentistry, Bauru, SP, Brazil.
| | - Dimorvan Bordin
- Department of Restorative Dentistry, University Universus Veritas UNG, Guarulhos, SP, Brazil
| | - Ronaldo Hirata
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, USA
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru College of Dentistry, Bauru, SP, Brazil
| | - Gerson Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru College of Dentistry, Bauru, SP, Brazil
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, USA; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, New York, NY, USA; Mechanical and Aerospace Engineering, NYU Tandon School of Engineering, New York University, New York, NY, USA
| |
Collapse
|
25
|
Spitznagel FA, Balmer M, Wiedemeier DB, Jung RE, Gierthmuehlen PC. Clinical outcomes of all-ceramic single crowns and fixed dental prostheses supported by ceramic implants: A systematic review and meta-analyses. Clin Oral Implants Res 2021; 33:1-20. [PMID: 34665900 PMCID: PMC9297865 DOI: 10.1111/clr.13871] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/17/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
Objective To analyze the clinical outcomes of all‐ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants. Materials and Methods Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all‐ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient‐related outcome measurements. Meta‐analyses were performed after 1, 2, and 5 years using random‐effect meta‐analyses. Results Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement‐retained reconstructions (mean observation: 12.0–61.0 months). Meta‐analyses estimated a 5‐year survival rate of 94% (95% confidence interval [CI]: 82%–100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%–100%); veneered zirconia SCs, 89% (95%CI: 62%–100%); and veneered zirconia FDPs 94% (95%CI: 81%–100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%–11%); veneered zirconia SCs, 38% (95%CI: 24%–54%); and veneered zirconia FDPs, 57% (95%CI: 38%–76%). Further outcomes were summarized descriptively. Conclusions Due to the limited data available, only tendencies could be identified. All‐ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid‐term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants.
Collapse
Affiliation(s)
- Frank Akito Spitznagel
- Department of Prosthodontics, School of Dentistry, Heinrich-Heine-University, Düsseldorf, Germany
| | - Marc Balmer
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel B Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | | |
Collapse
|
26
|
Pjetursson BE, Sailer I, Latyshev A, Rabel K, Kohal RJ, Karasan D. A systematic review and meta-analysis evaluating the survival, the failure, and the complication rates of veneered and monolithic all-ceramic implant-supported single crowns. Clin Oral Implants Res 2021; 32 Suppl 21:254-288. [PMID: 34642991 PMCID: PMC9293296 DOI: 10.1111/clr.13863] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
Objective To assess the survival, failure, and complication rates of veneered and monolithic all‐ceramic implant‐supported single crowns (SCs). Methods Literature search was conducted in Medline (PubMed), Embase, and Cochrane Central Register of Controlled Trials until September 2020 for randomized, prospective, and retrospective clinical trials with follow‐up time of at least 1 year, evaluating the outcome of veneered and/or monolithic all‐ceramic SCs supported by titanium dental implants. Survival and complication rates were analyzed using robust Poisson's regression models. Results Forty‐nine RCTs and prospective studies reporting on 57 material cohorts were included. Meta‐analysis of the included studies indicated an estimated 3‐year survival rate of veneered‐reinforced glass‐ceramic implant‐supported SCs of 97.6% (95% CI: 87.0%–99.6%). The estimated 3‐year survival rates were 97.0% (95% CI: 94.0%–98.5%) for monolithic‐reinforced glass‐ceramic implant SCs, 96.9% (95% CI: 93.4%–98.6%) for veneered densely sintered alumina SCs, 96.3% (95% CI: 93.9%–97.7%) for veneered zirconia SCs, 96.1% (95% CI: 93.4%–97.8%) for monolithic zirconia SCs and only 36.3% (95% CI: 0.04%–87.7%) for resin‐matrix‐ceramic (RMC) SCs. With the exception of RMC SCs (p < 0.0001), the differences in survival rates between the materials did not reach statistical significance. Veneered SCs showed significantly (p = 0.017) higher annual ceramic chipping rates (1.65%) compared with monolithic SCs (0.39%). The location of the SCs, anterior vs. posterior, did not influence survival and chipping rates. Conclusions With the exception of RMC SCs, veneered and monolithic implant‐supported ceramic SCs showed favorable short‐term survival and complication rates. Significantly higher rates for ceramic chipping, however, were reported for veneered compared with monolithic ceramic SCs.
Collapse
Affiliation(s)
- Bjarni Elvar Pjetursson
- Department of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland.,Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Andrey Latyshev
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Maxillofacial, Oral and Plastic Surgery, Faculty of Dentistry, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Kerstin Rabel
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
27
|
Dini C, Borges GA, Costa RC, Magno MB, Maia LC, Barão VAR. Peri-implant and esthetic outcomes of cemented and screw-retained crowns using zirconia abutments in single implant-supported restorations-A systematic review and meta-analysis. Clin Oral Implants Res 2021; 32:1143-1158. [PMID: 34352144 DOI: 10.1111/clr.13824] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the peri-implant tissue changes and esthetic outcomes of cemented and screw-retained crowns of single-tooth implants in the esthetic zone using zirconia abutments. MATERIAL AND METHODS An electronic search was performed on nine databases. The risk-of-bias was assessed by the revised Cochrane risk-of-bias tool for randomized (RoB 2) and non-randomized (ROBINS-I) clinical trials. Marginal bone level change, soft tissue thickness, bleeding on probing, probing depth, survival rates of implants and crowns, complications, plaque and papilla indexes, and pink esthetic score data were extracted and analyzed. The certainty of evidence was accessed through the GRADE approach. RESULTS Nine records were included and 7 were used in the meta-analyses. Screw-retained crowns presented greater marginal bone level change (MD -0.04 [-0.08, -0.00] p = 0.04, I2 = 0%) compared to cemented crowns up to 1-year. At 3 and 4 years no significant differences (p > 0.05) were observed. Soft tissue thickness did not differ between groups (p > 0.05). The bleeding on probing was higher in cemented group than in screw-retained crowns at 1-year (MD 0.17 [0.08, 0.27] p = 0.0005, I2 = 0%), at medium-term periods (3 and 4 years) no statistically significant differences (p > 0.05) were observed for this outcome. Probing depth, survival rates of implants and crowns, complications, and plaque index, as well as esthetic analysis using the papilla index and pink esthetic score did not differ statistically (p > 0.05) between both retention systems at short and medium-term periods. CONCLUSION The connection system considering zirconia abutments presented no influence on peri-implant parameters and esthetics evaluation for medium-term periods (3 and 4 years).
Collapse
Affiliation(s)
- Caroline Dini
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP, Piracicaba, Brazil
| | - Guilherme Almeida Borges
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP, Piracicaba, Brazil
| | - Raphael Cavalcante Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP, Piracicaba, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rua Rodolpho Paulo Rocco - Cidade Universitária, Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rua Rodolpho Paulo Rocco - Cidade Universitária, Rio de Janeiro, Brazil
| | - Valentim Adelino Ricardo Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP, Piracicaba, Brazil
| |
Collapse
|
28
|
Nanoscale physico-mechanical properties of an aging resistant ZTA composite. J Mech Behav Biomed Mater 2021; 123:104690. [PMID: 34385065 DOI: 10.1016/j.jmbbm.2021.104690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/26/2021] [Accepted: 07/02/2021] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To characterize the effects of aging on the nanomechanical properties and 3D surface topographical parameters of an experimental Zirconia Toughened Alumina (ZTA) composite compared to its respective individual counterpart materials. METHODS Disk-shaped specimens comprised of three material groups were processed: 1) ZTA 70/30 (70% alumina reinforced with 30% second-generation 3Y-TZP); 2) Zpex (Second-generation 3Y-TZP), and; 3) Al2O3 (High purity Alumina) (n = 10/material, 12 × 1 mm). After synthesis, ceramic powders were pressed, the green-body samples were sintered and polished. Nanoindentation testing was performed to record elastic modulus (E) and hardness (H). Interferometry was utilized to assess 3D surface roughness parameters (Sa, Sq), while X-ray diffraction (XRD) and scanning electron microscope (SEM) assessed the crystalline content and microstructure. All tests were performed before and after simulated aging (134°C, 2.2 bar, 20 h). Statistical analyses were performed using linear mixed-model and least square difference pos-hoc tests (α = 5%). RESULTS XRD spectra indicated increase of monoclinic peaks for Zpex (~18%) relative to ZTA 70/30 (~2.5%) after aging. Additionally, aging did not affect the surface roughness parameters of ZTA 70/30 and Al2O3, although a significant increase in Sa was recorded for Zpex following aging (~90 nm) (p < 0.001). Al2O3 yielded the highest H and E values (H:21 GPa, E: 254 GPa), followed by ZTA 70/30 (H: 13 GPa, E: 214 GPa) and Zpex (H:11 GPa, E: 167 GPa), all significantly different (p < 0.03). CONCLUSION ZTA 70/30 and Al2O3 presented high hydrothermal stability with respect to all evaluated variables, where artificial aging significantly increased the monoclinic content and surface roughness of Zpex.
Collapse
|
29
|
Clinical Evaluation of Resin Composite CAD/CAM Restorations Placed by Undergraduate Students. J Clin Med 2021; 10:jcm10153269. [PMID: 34362055 PMCID: PMC8348683 DOI: 10.3390/jcm10153269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 07/17/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
To evaluate the clinical outcomes of resin composite CAD/CAM restorations in a prospective cohort study, and to assess patient and operator satisfaction after restoration placement, 59 indirect resin composite were placed by supervised undergraduate students, of which 43 restorations were followed over a mean period of 28 months (14–44 months) and evaluated using USPHS criteria. Patient and operator satisfaction levels were assessed using a visual analogue scale (VAS) after restoration placement. A total of 37 patients and 47 restorations were included for further study. Four teeth were extracted—three due to extensive drug-induced secondary caries in the same patient, and one tooth due to large periapical periodontitis after 44 months of service. The overall survival rate was 91.4%, and success rate was 87.2%. Differences between baseline and endpoint scores were significant for marginal discoloration (p < 0.05) and adaptation (p < 0.001). Color match (p < 0.05) and surface texture (p < 0.001) differed significantly, affecting all restoration types. VAS scores for patient and operator satisfaction showed a significant rank correlation (p < 0.01), and pairwise comparison showed significant differences for mean overall patient and operator VAS scores (p < 0.001). Lava Ultimate CAD/CAM may be considered a suitable material for overlays and endocrown restorations when combined with IDS, air abrasion, and MDP-containing adhesive systems. Marginal disintegration may present in inlays and onlays over time.
Collapse
|
30
|
Laumbacher H, Strasser T, Knüttel H, Rosentritt M. Long-term clinical performance and complications of zirconia-based tooth- and implant-supported fixed prosthodontic restorations: A summary of systematic reviews. J Dent 2021; 111:103723. [PMID: 34119611 DOI: 10.1016/j.jdent.2021.103723] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/21/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To present an overview on systematic reviews on prosthodontic zirconia restorations and to discuss long-term complications as well as information on anatomical and functional changes to the masticatory system. DATA/SOURCES MEDLINE, EMBASE, Trip medical, and Cochrane Library databases were searched for systematic reviews up to February 2021. Bias was assessed and clinical survival and complications were analyzed. STUDY SELECTION 38 eligible articles published between 2006 and 2021 were included. The reviews were based on 128 in vivo studies on approximately 10,000 zirconia restorations. 5-year cumulative survival rates varied between 91.2% and 95.9% for tooth-supported (TS) single crowns (SC), 89.4% and 100% for TS multi-unit fixed dental prostheses (FDP), 97.1% and 97.6% for implant-supported (IS) SCs and 93.0% and 100% for IS FDPs. Chipping was the most often technical complication, followed by framework fracture, loss of retention, marginal discrepancies/discoloration, occlusal roughness and abutment/screw loosening. Color mismatch was the only esthetic complication. Biological complications were caries, endodontic complications, tooth fracture, periodontal disease, abrasion/attrition, persisting pain, high sensitivity, peri‑implantitis and soft tissue issues. Patients with bruxism were only examined sporadically. CONCLUSIONS 5-year results for zirconia restorations were satisfactory. The predominant technical problem of veneering fractures could be overcome with adapted design or fabrication and application of monolithic restorations, but reviews of clinical studies on this subject are rare. The impact of zirconia restorations on the masticatory system remains unclear. CLINICAL SIGNIFICANCE Zirconia restorations are experiencing a rapidly increasing use in dental practice. Being highly wear-resistant, hard and durable, it can be assumed that they do not follow natural abrasion and changes in the masticatory system. Possible long-term effects on the stomatognathic system as a whole should therefore be considered.
Collapse
Affiliation(s)
- Harald Laumbacher
- Department of Prosthetic Dentistry, UKR University Hospital Regensburg, 93042 Regensburg, Germany
| | - Thomas Strasser
- Department of Prosthetic Dentistry, UKR University Hospital Regensburg, 93042 Regensburg, Germany
| | - Helge Knüttel
- University Library, University of Regensburg, 93042 Regensburg, Germany
| | - Martin Rosentritt
- Department of Prosthetic Dentistry, UKR University Hospital Regensburg, 93042 Regensburg, Germany.
| |
Collapse
|
31
|
Lemos CAA, Verri FR, Noritomi PY, Souza Batista VE, Cruz RS, de Luna Gomes JM, Limirio Oliveira JPJ, Pellizzer EP. Biomechanical evaluation of different implant-abutment connections, retention systems, and restorative materials in the implant-supported single crowns using 3D finite element. J ORAL IMPLANTOL 2021; 48:194-201. [PMID: 34091686 DOI: 10.1563/aaid-joi-d-20-00328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This is an in silico study aimed to evaluate the biomechanical influence of different implant-abutment interfaces (external hexagon and Morse taper implants), retention systems (cement- and screw-retained), and restorative crowns (metal-ceramic and monolithic) using three-dimensional finite element analysis (3D-FEA). Eight 3D models were simulated for the maxillary first molar area using InVesalius, Rhinoceros, and SolidWorks and processed using the Femap and NEi Nastran softwares. Axial and oblique forces of 200 N and 100 N, respectively, were applied on the occlusal surface of the prostheses. Microstrain and von Mises stress maps were used to evaluate the deformation (cortical bone tissue) and stress (implants/fixation screws/crowns), respectively for each model. For both loadings, Morse taper implants had lower microstrain values than the external hexagon implants. The retention system did not affect microstrain on the cortical bone tissue under both loadings. However, the cemented prosthesis displayed higher stress with the fixation screw than the external hexagon implants. No difference was observed between the metal-ceramic and zirconia monolithic crowns in terms of microstrain and stress distribution on the cortical bone, implants or components. Morse taper implants can be considered as a good alternative for dental implant rehabilitation because they demonstrated better biomechanical behavior for the bone and fixation screw as compared to external hexagon implants. Cement-retained prosthesis increased the stress on the fixation screw of the external hexagon implants, thereby increasing the risk of screw loosening/fracture in the posterior maxillary area. The use of metal-ceramic or monolithic crowns did not affect the biomechanical behavior of the evaluated structures.
Collapse
Affiliation(s)
- Cleidiel Aparecido Araujo Lemos
- Universidade Estadual Paulista Julio de Mesquita Filho Pos-Graduate Student Materiais Odontológicos e Prótese Rua José Bonifácio, 1193 BRAZIL Araçatuba São Paulo 16015267 +5518981425301 Universidade Federal de Juiz de Fora
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Spitznagel FA, Bonfante EA, Vollmer F, Gierthmuehlen PC. Failure Load of Monolithic Lithium Disilicate Implant-Supported Single Crowns Bonded to Ti-base Abutments versus to Customized Ceramic Abutments after Fatigue. J Prosthodont 2021; 31:136-146. [PMID: 33870577 DOI: 10.1111/jopr.13369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This laboratory study analyzed the influence of retention mode (screw- vs cement retained) and fatigue application on the failure load of monolithic lithium-disilicate (LDS) implant-supported single crowns (ISSC). MATERIAL AND METHODS A total of 72 samples of monolithic LDS (*Ivoclar Vivadent) ISSC were divided into three groups (n = 24) according to their type of retention mode: Group Ti-CAD: Titanium base (SICvantage CAD/CAM Abutment red (SIC invent AG), screw-retained milled monolithic LDS (IPS e.max CAD*); Group Ti-P: Titanium base (SICvantage CAD/CAM Abutment red), screw-retained pressed monolithic LDS (IPS e.max Press*) and Group Ti-Cust: Titanium base with cemented press LDS (IPS e.max Press*) crown on a LDS (IPS e.max Press*) custom abutment. A mandibular first molar implant-supported single crown model was investigated (Titanium implant: SICvantage-max, SIC invent AG, diameter: 4.2 mm, length: 11.5 mm). Half of each group (n = 12) were exposed to fatigue with cyclic mechanical loading (F = 198 N, 1.2 million cycles) and simultaneous thermocycling (5-55°C). Single load to failure testing was performed, before (Subgroups Ti-CAD, Ti-P, and Ti-Cust) and after (Subgroups Ti-CAD-F, Ti-P-F, and Ti-Cust-F) fatigue. Weibull distribution was used to determine the characteristic strength and Weibull modulus differences between groups. Probability of survival at 900N load was calculated. RESULTS No samples failed during fatigue. Characteristic strength values were as follow: Ti-CAD: 3259.5N, Ti-CAD-F: 2926N, Ti-P: 2763N, Ti-P-F: 2841N, Ti-Cust: 2789N, Ti-Cust-F: 2194N. Whereas no difference was observed between pressed or milled monolithic crowns cemented to Ti-base, regardless of loading condition, fatigue decreased the characteristic strength of crowns cemented to custom abutments. Probability of survival at 900 N was not significantly different between groups. CONCLUSIONS Screw-retained pressed or milled monolithic LDS ISSC, cemented directly to Ti-base abutments or LDS crowns cemented to custom ceramic abutments resist physiological chewing forces after simulated 5-year aging in the artificial mouth and presented equally high probability of survival. However, a significant decrease in load to failure was observed in LDS crowns cemented to custom ceramic abutments after fatigue. Prospective clinical trials are needed to confirm the results of this laboratory investigation.
Collapse
Affiliation(s)
- F A Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - E A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil
| | - F Vollmer
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.,Private Practice, Tettnang, Germany
| | - P C Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| |
Collapse
|
33
|
Spitznagel FA, Röhrig S, Langner R, Gierthmuehlen PC. Failure Load and Fatigue Behavior of Monolithic Translucent Zirconia, PICN and Rapid-Layer Posterior Single Crowns on Zirconia Implants. MATERIALS 2021; 14:ma14081990. [PMID: 33921126 PMCID: PMC8071484 DOI: 10.3390/ma14081990] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/16/2022]
Abstract
This laboratory study aimed to evaluate the thermo-mechanical fatigue behavior and failure modes of monolithic and rapid-layer posterior single-crowns (SCs) supported by zirconia implants. Methods: 120 all-ceramic crowns supported by one-piece zirconia implants (ceramic.implant; vitaclinical) were divided into five groups (n = 24 each): Group Z-HT: 3Y-TZP monolithic-zirconia (Vita-YZ-HT); Group Z-ST: 4Y-TZP monolithic-zirconia (Vita-YZ-ST); Z-XT: 5Y-TZP monolithic-zirconia (Vita-YZ-XT); Group E: monolithic-polymer-infiltrated ceramic network (PICN,Vita-Enamic); Group RL (rapid layer): PICN-“table-top” (Vita-Enamic), 3Y-TZP-framework (Vita-YZ-HT). Half of the specimens of each group (n = 12) were exposed to fatigue with cyclic mechanical loading (F = 198N, 1.2-million cycles) and simultaneous thermocycling (5–55 °C). Single-load-to-failure testing (Z010, Zwick) was performed for all specimens without/with fatigue application. Data analysis was performed using ANOVA, Tukey’s post-hoc test, two-sample t-test and Bonferroni correction (p < 0.05). Results: All specimens survived fatigue exposure. Significant differences in failure loads were detected among groups (p ≤ 0.004). Materials Z-HT and Z-ST showed the highest failure loads followed by Z-XT, RL and E. The influence of fatigue was only significant for material RL. Conclusions: All types of tested materials exceeded clinically acceptable failure load values higher than 900N and can be recommended for clinical use. Z-HT and Z-ST appear to be highly reliable towards fatigue. Rapid-layer design of PICN and YZ-HT might be an interesting treatment concept for posterior implant SCs.
Collapse
Affiliation(s)
- Frank A. Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (S.R.); (P.C.G.)
- Correspondence: ; Tel.: +49-211-81-04440
| | - Sara Röhrig
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (S.R.); (P.C.G.)
| | - Robert Langner
- Institute of Systems Neuroscience, Medical Faculty, Heinrich-Heine-University, 40225 Düsseldorf, Germany;
- Institute of Neuroscience and Medicine, Brain and Behaviour (INM-7), Research Centre Jülich, 52425 Jülich, Germany
| | - Petra C. Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, 40225 Düsseldorf, Germany; (S.R.); (P.C.G.)
| |
Collapse
|
34
|
Bergamo ETP, Bastos TMC, Lopes ACO, de Araujo Júnior ENS, Coelho PG, Benalcazar Jalkh EB, Zahoui A, Bonfante EA. Physicochemical and mechanical characterization of a fiber-reinforced composite used as frameworks of implant-supported prostheses. Dent Mater 2021; 37:e443-e453. [PMID: 33865619 DOI: 10.1016/j.dental.2021.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 12/31/2020] [Accepted: 03/29/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To characterize the physicochemical and mechanical properties of a milled fiber-reinforced composite (FRC) for implant-supported fixed dental prostheses (FDPs). METHODS For FRC characterization, scanning electron microscopy (SEM), energy dispersive spectroscopy (EDS), X-ray diffraction, Fourier-transformed infrared spectrometry, simultaneous thermogravimetric analysis and differential scanning calorimetry were performed. For fatigue testing, 3-unit FRC frameworks were fabricated with conventional (9 mm2 connector area) and modified designs (12 mm2 connector area and 2.5 mm-height lingual extension). A hybrid resin composite was veneered onto the frameworks. FDPs were subjected to step-stress accelerated-life fatigue testing until fracture or suspension. Use level probability Weibull curves at 300 N were plotted and the reliability for 100,000 cycles at 300, 600 and 800 N was calculated. Fractographic analysis was performed by stereomicroscope and SEM. RESULTS The FRC consisted of an epoxy resin (∼25%) matrix reinforced with inorganic particles and glass fibers (∼75%). Multi-layer continuous regular-geometry fibers were densely arranged in a parallel and bidirectional fashion in the resin matrix. Fatigue analysis demonstrated high probability of survival (99%) for FDPs at 300 N, irrespective of framework design. Conventional FDPs showed a progressive decrease in the reliability at 600 (84%) and 800 N (19%), whereas modified FDPs reliability significantly reduced only at 800 N (75%). The chief failure modes for FRC FDPs were cohesive fracture of the veneering composite on lower loads and adhesive fracture of the veneering composite at higher loads. SIGNIFICANCE Milled epoxy resin matrix reinforced with glass fibers composite resulted in high probability of survival in the implant-supported prosthesis scenario.
Collapse
Affiliation(s)
- Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil.
| | - Tiago M C Bastos
- Department of Physics, Technological Institute of Aeronautics, 50 Marechal Eduardo Gomes, 12228-900, São José dos Campos, SP, Brazil
| | - Adolfo C O Lopes
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Everardo N S de Araujo Júnior
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, Hansjorg Wyss Department of Plastic Surgery, Mechanical and Aerospace Engineering, New York University, 345 24th Street, 10010, New York City, NY, USA
| | - Ernesto B Benalcazar Jalkh
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil; Department of Biomaterials and Biomimetics, Hansjorg Wyss Department of Plastic Surgery, Mechanical and Aerospace Engineering, New York University, 345 24th Street, 10010, New York City, NY, USA
| | - Abbas Zahoui
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| |
Collapse
|
35
|
Bompolaki D, Punj A, Fellows C, Truong C, Ferracane JL. Clinical Performance of CAD/CAM Monolithic Lithium Disilicate Implant-Supported Single Crowns Using Solid or Predrilled Blocks in a Fully Digital Workflow: A Retrospective Cohort Study With Up To 33 Months of Follow Up. J Prosthodont 2021; 31:38-44. [PMID: 33840144 DOI: 10.1111/jopr.13364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2021] [Indexed: 11/29/2022] Open
Abstract
PURPOSE To assess the clinical performance of CAD/CAM monolithic implant-supported restorations manufactured using a fully digital workflow and two different types of ceramic blocks. MATERIALS AND METHODS One hundred and one patients received single-unit implant-supported restorations at a University predoctoral clinic. All restorations were designed and fabricated using either a predrilled LS2 block (group P, n = 59) or a conventional solid LS2 block with an occlusal opening drilled manually prior to crystallization (group M, n = 42). The mean follow-up time after restoration delivery was 18.4 ± 4.8 months (range 12 to 33 months). Patients with less than a 12-month follow-up were excluded. Electronic health records were reviewed to identify number and type of complications during the follow-up time. Clinical outcomes were classified as success, survival, and failure of the restoration. Chi-square tests were used to identify differences in success and survival rates between the groups. Nonparametric Mann-Whitney U tests were used to identify differences in the number of major and minor complications as well as the total number of complications that were observed among groups. RESULTS Overall success and survival rates were 80.2% and 97%, respectively. Seventy one restorations (70.3%) were complication-free. There were no significant differences between the groups with regards to the number of complications or success and survival rates. CONCLUSIONS Single-unit CAD/CAM monolithic implant-supported restorations that are fabricated in a fully digital workflow present relatively high complication rates and moderate short-term clinical outcomes. Clinical studies with longer follow-up times are needed to evaluate long-term outcomes of these restorations.
Collapse
Affiliation(s)
- Despoina Bompolaki
- Department of Restorative Dentistry, Oregon Health & Science University, Portland, OR, United States
| | | | - Christopher Fellows
- Department of Restorative Dentistry, Oregon Health & Science University, Portland, OR, United States
| | - Christina Truong
- Department of Restorative Dentistry, Oregon Health & Science University, Portland, OR, United States
| | - Jack L Ferracane
- Department of Restorative Dentistry, Oregon Health & Science University, Portland, OR, United States
| |
Collapse
|
36
|
Mazza LC, Lemos CAA, Pesqueira AA, Pellizzer EP. Survival and complications of monolithic ceramic for tooth-supported fixed dental prostheses: A systematic review and meta-analysis. J Prosthet Dent 2021; 128:566-574. [PMID: 33745685 DOI: 10.1016/j.prosdent.2021.01.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 01/06/2021] [Accepted: 01/07/2021] [Indexed: 01/11/2023]
Abstract
STATEMENT OF PROBLEM Although recent studies have reported the success of implant-supported monolithic restorations, consensus on the use of monolithic ceramic restorations is lacking. PURPOSE The purpose of this systematic review and meta-analysis was to evaluate the survival and biological and technical complication rates of monolithic single crowns and fixed partial dentures (FPDs). MATERIAL AND METHODS An electronic search was conducted by 2 independent authors on the PubMed/MEDLINE, Scopus, and Cochrane Library databases. The Newcastle-Ottawa scale and Cochrane risk of bias tool were used to assess the quality and risk of bias of the included studies. Meta-analysis was performed by using the R software program. RESULTS The search identified 763 articles, 18 of which met the eligibility criteria. A total of 15 studies evaluated monolithic ceramic single crowns, and 4 studies evaluated FPDs. The studies included 1061 monolithic single crowns (524 lithium disilicate, 461 zirconia, and 76 polymer-infiltrated ceramic network [PICN]) and 104 FPDs (36 lithium disilicate and 68 zirconia). Meta-analysis of single-arm studies indicated the proportion of survival, biological, and technical complication rates of 1% (95% confidence interval [CI]: 0% to 3%), 1% (CI: 0% to 4%), and 2% (CI: 1% to 4%), respectively, for single crowns, independent of ceramic material, and 3% (CI: 0% to 34%), 5% (CI: 1% to 21%), and 5% (CI: 1% to 21%) for FPDs, respectively. Only 5 studies performed a direct comparison between monolithic and veneered ceramic restorations, and no significant difference was observed in terms of survival (risk ratio [RR]: 0.68; CI: 0.25-1.91; P=.96), biological (RR: 0.69; CI: 0.31-1.53; P=.35), and technical complication rates (RR: 0.87; CI: 0.40-1.88; P=.29). CONCLUSIONS The use of monolithic ceramic can be considered a favorable treatment for tooth-supported single crowns and FPDs, with high survival and low complication rates. However, further randomized controlled trials are needed to reassess these clinical performances, mainly by comparing them with the performance of veneered restorations.
Collapse
Affiliation(s)
- Letícia Cerri Mazza
- MSc student, São Paulo State University (UNESP), School of Dentistry, Department of Dental Materials and Prosthodontics, Araçatuba, Sao Paulo, Brazil
| | - Cleidiel Aparecido Araujo Lemos
- Adjunct Professor, Division of Prosthodontics, Department of Dentistry, Federal University of Juiz de Fora (UFJF), Campus Governador Valadares, Governador Valadares, Minas Gerais, Brazil
| | - Aldiéris Alves Pesqueira
- Assistant Professor, São Paulo State University (UNESP), School of Dentistry, Department of Dental Materials and Prosthodontics, Araçatuba, Sao Paulo, Brazil.
| | - Eduardo Piza Pellizzer
- Titular Professor, São Paulo State University (UNESP), School of Dentistry, Department of Dental Materials and Prosthodontics, Araçatuba, Sao Paulo, Brazil
| |
Collapse
|
37
|
Pieralli S, Spies BC, Schweppe F, Preissner S, Nelson K, Heiland M, Nahles S. Retrospective long-term clinical evaluation of implant-prosthetic rehabilitations after head and neck cancer therapy. Clin Oral Implants Res 2021; 32:470-486. [PMID: 33501694 DOI: 10.1111/clr.13716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 12/24/2020] [Accepted: 01/19/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To assess clinical and patient-reported outcomes of implant-prosthetic rehabilitations in patients with a history of head-neck cancer (HNC), treated with tumor resection without (TR) or with adjuvant radiotherapy (TR/RT). A healthy cohort rehabilitated with the same reconstructive protocols served as control group (C). MATERIALS AND METHODS A total of 28 women and 29 men were considered in the present retrospective study. Participants received 322 implants, finally supporting 79 prosthetic reconstructions. Primary outcome was the assessment of implant and prosthetic survival rates. Furthermore peri-implant soft tissue parameters (attached peri-implant mucosa, AM; modified bleeding and plaque indices, mBI/mPI; probing depth, PD) and prosthetic technical complications were documented. Patient-reported outcome measures (PROMs) by means of visual analog scales (VAS) and the Oral Health Impact Profile German 14 form (OHIP G14) were collected. For statistical purposes Chi-square and Mann-Whitney-U-Test were adapted. RESULTS After a mean follow-up of 81.2 ± 50.3 months, implant survival rate was 98.1% (HNC-TR), 98.2% (HNC-TR/RT) and 100.0% (C), respectively (four implants failed in the HNC groups). HNC-TR/RT showed significant higher mPI and mBI compared to C. Within HNC-TR/RT, vestibuloplasty significantly reduced mBI and PD values. No failures occurred at the prosthetic level. Overall, higher VAS scores were reported for bar- compared with Locator-retained prostheses. Furthermore, increased OHIP G14 values resulted for HNC-TR/RT. CONCLUSIONS High survival rates on implant and prosthetic level were observed. The use of soft tissue grafts resulted in stabilization of the peri-implant mucosa in irradiated patients. In terms of retention and chewing ability, participants preferred bars over Locator attachments.
Collapse
Affiliation(s)
- Stefano Pieralli
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Benedikt Christopher Spies
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Felix Schweppe
- Department of Oral and Maxillofacial Surgery, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Saskia Preissner
- Department of Oral and Maxillofacial Surgery, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katja Nelson
- Department of Oral and Maxillofacial Surgery, Center for Dental Medicine, Medical Center - University of Freiburg, Faculty of Medicine - University of Freiburg, Freiburg, Germany
| | - Max Heiland
- Department of Oral and Maxillofacial Surgery, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Susanne Nahles
- Department of Oral and Maxillofacial Surgery, Berlin Institute of Health, Corporate Member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| |
Collapse
|
38
|
Bergamo ETP, Yamaguchi S, Coelho PG, Lopes ACO, Lee C, Bonfante G, Benalcázar Jalkh EB, de Araujo-Júnior ENS, Bonfante EA. Survival of implant-supported resin-matrix ceramic crowns: In silico and fatigue analyses. Dent Mater 2021; 37:523-533. [PMID: 33483102 DOI: 10.1016/j.dental.2020.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 10/20/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To evaluate the fatigue survival, failure mode, and maximum principal stress (MP Stress) and strain (MP Strain) of resin-matrix ceramic systems used for implant-supported crowns. METHODS Identical molar crowns were milled using four resin-matrix ceramics (n = 21/material): (i) Shofu Hard, (ii) Cerasmart (iii) Enamic, and (iv) Shofu HC. Crowns were cemented on the abutments, and the assembly underwent step-stress accelerated-life testing. Use level probability Weibull curves at 300 N were plotted and the reliability at 300, 500 and 800 N was calculated for a mission of 50,000 cycles. Fractographic analysis was performed using stereomicroscope and scanning electron microscope. MP Stress and MP Strain were determined by finite element analysis. RESULTS While fatigue dictated failures for Cerasmart (β > 1), material strength controlled Shofu Hard, Enamic, and Shofu HC failures (β < 1). Shofu HC presented lower reliability at 300 N (79%) and 500 N (59%) than other systems (>90%), statistically different at 500 N. Enamic (57%) exhibited a significant reduction in the probability of survival at 800 N, significantly lower than Shofu Hard and Cerasmart; however, higher than Shofu HC (12%). Shofu Hard and Cerasmart (>93%) demonstrated no significant difference for any calculated mission (300-800 N). Failure mode predominantly involved resin-matrix ceramic fracture originated from occlusal cracks, corroborating with the MP Stress and Strain location, propagating through the proximal and cervical margins. SIGNIFICANCE All resin-matrix ceramics crowns demonstrated high probability of survival in a physiological molar load, whereas Shofu Hard and Cerasmart outperformed Enamic and Shofu HC at higher loads. Material fracture comprised the main failure mode.
Collapse
Affiliation(s)
- Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry. 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil.
| | - Satoshi Yamaguchi
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, 565-0871, Suita, Osaka, Japan
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, Hansjorg Wyss Department of Plastic Surgery, Mechanical and Aerospace Engineering, New York University, 345 24th Street, 10010, New York City, NY, USA
| | - Adolfo C O Lopes
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry. 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Chunwoo Lee
- Department of Biomaterials Science, Osaka University Graduate School of Dentistry, 1-8 Yamadaoka, 565-0871, Suita, Osaka, Japan
| | - Gerson Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry. 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Ernesto B Benalcázar Jalkh
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry. 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Everardo N S de Araujo-Júnior
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry. 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry. 9-75, Otávio Pinheiro Brisola, 17012-901, Bauru, SP, Brazil
| |
Collapse
|
39
|
Pitta J, Hjerppe J, Burkhardt F, Fehmer V, Mojon P, Sailer I. Mechanical stability and technical outcomes of monolithic CAD/CAM fabricated abutment-crowns supported by titanium bases: An in vitro study. Clin Oral Implants Res 2020; 32:222-232. [PMID: 33258267 DOI: 10.1111/clr.13693] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/08/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate mechanical stability (survival and complication rates) and bending moments of different all-ceramic monolithic restorations bonded to titanium bases (hybrid abutment-crowns) or to customized titanium abutments compared to porcelain-fused-to-metal crowns (PFM) after thermo-mechanical aging. MATERIAL AND METHODS Sixty conical connection implants (4.3 mm-diameter) were divided in five groups (n = 12): PFM using gold abutment (GAbut-PFM), lithium disilicate crown bonded to customized titanium abutment (TAbut+LDS), lithium disilicate abutment-crown bonded to titanium base (TiBase+LDS), zirconia abutment-crown bonded to titanium base (TiBase+ZR), polymer-infiltrated ceramic-network (PICN) abutment-crown bonded to titanium base (TiBase+PICN). Simultaneous thermocycling (5°-55°C) and chewing simulation (1,200,000-cycles, 49 N, 1.67 Hz) were applied. Catastrophic and non-catastrophic events were evaluated under light microscope, and survival and complication rates were calculated. Specimens that survived aging were loaded until failure and bending moments were calculated. RESULTS Survival rates after aging were 100% (TAbut+LDS, TiBase+LDS), 91.7% (GA-PFM), 66.7% (TiBase+ZR) and 58.3% (TiBase+PICN) and differed among the groups (p = .006). Non-catastrophic events as screw loosening (GA-PFM) and loss of retention or micro-/macro-movement (TiBase groups) were observed. Complication rates varied among the groups (p < .001). TiBase+PICN had lower bending moment than all the other groups (p < .001). CONCLUSIONS Hybrid abutment-crowns made of lithium disilicate can be an alternative to PFM-based restorations, although concerns regarding the bonded interface between the titanium base and abutment-crown can be raised. PICN and zirconia may not be recommended due to its inferior mechanical and bonding outcomes, respectively. Titanium customized abutment with bonded lithium disilicate crown appears to be the most stable combination.
Collapse
Affiliation(s)
- João Pitta
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Jenni Hjerppe
- Departments of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUH), Helsinki, Finland.,Department of Prosthodontics and Stomatognathic physiology, University of Turku, Turku, Finland
| | - Felix Burkhardt
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Vincent Fehmer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Mojon
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| |
Collapse
|
40
|
Bergamo ETP, Cardoso KB, Lino LFO, Campos TMB, Monteiro KN, Cesar PF, Genova LA, Thim GP, Coelho PG, Bonfante EA. Alumina-toughened zirconia for dental applications: Physicochemical, mechanical, optical, and residual stress characterization after artificial aging. J Biomed Mater Res B Appl Biomater 2020; 109:1135-1144. [PMID: 33314536 DOI: 10.1002/jbm.b.34776] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/23/2020] [Accepted: 11/28/2020] [Indexed: 01/01/2023]
Abstract
To characterize the physicomechanical properties of an alumina-toughened zirconia (ATZ). ATZ synthesis consisted of the addition of alumina particles in an yttria-stabilized tetragonal zirconia polycrystals (3Y-TZP) matrix. Specimens were obtained by uniaxial and isostatic pressing ATZ and 3Y-TZP powders and sintering at 1600°C/1 h and 1550°C/1 h, respectively. Crystalline content and residual stress were evaluated using X-ray diffraction (XRD). Microstructure was characterized by scanning electron microscopy (SEM). Optical properties were determined by reflectance test. Mechanical properties were assessed by biaxial flexural strength test. All analyses were performed before and after aging (134°C, 20 h, 2 bar). XRD and SEM revealed a typical ATZ and 3Y-TZP crystalline content, chiefly tetragonal phase, with a dense polycrystalline matrix, though a smaller grain size for ATZ. Aging triggered a similar monoclinic transformation for both systems; however, ATZ exhibited higher residual compressive stresses than 3Y-TZP. While as-processed 3Y-TZP demonstrated significantly higher characteristic strength relative to ATZ, no significant difference was observed after aging (~215 MPa increase in the ATZ strength). ATZ presented significantly higher opacity relative to 3Y-TZP, although aging significantly increased the translucency of both systems (increase difference significantly higher in the 3Y-TZP compared to ATZ). ATZ physicomechanical properties support its applicability in the dental field, with a lower detrimental effect of aging relative to 3Y-TZP.
Collapse
Affiliation(s)
- Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
| | - Karina B Cardoso
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
| | - Lucas F O Lino
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
| | - Tiago M B Campos
- Department of Physics, Aeronautics Technological Institute, São José dos Campos, SP, Brazil
| | - Kelli N Monteiro
- Department of Biomaterials and Oral Biology, University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Paulo F Cesar
- Department of Biomaterials and Oral Biology, University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Luis A Genova
- Center of Materials Science and Technology, Institute of Research in Nuclear Energy, São Paulo, SP, Brazil
| | - Gilmar P Thim
- Department of Physics, Aeronautics Technological Institute, São José dos Campos, SP, Brazil
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, Hansjörg Wyss Department of Plastic Surgery, Mechanical and Aerospace Engineering, New York University, New York City, NY, USA
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of São Paulo, Bauru, SP, Brazil
| |
Collapse
|
41
|
Slagter KW, Raghoebar GM, Hentenaar DFM, Vissink A, Meijer HJA. Immediate placement of single implants with or without immediate provisionalization in the maxillary aesthetic region: A 5-year comparative study. J Clin Periodontol 2020; 48:272-283. [PMID: 33141935 PMCID: PMC7839711 DOI: 10.1111/jcpe.13398] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/03/2020] [Accepted: 10/25/2020] [Indexed: 12/18/2022]
Abstract
Aim To compare marginal bone level changes around immediately placed and immediately provisionalized implants with immediately placed and delayed provisionalized implants in the aesthetic region after five years of function. Materials and Methods Forty patients with a failing tooth in the maxillary anterior region were randomly assigned immediate implant placement with immediate (Group A: n = 20) or delayed (Group B: n = 20) provisionalization. Definitive crown placement occurred three months after provisionalization. The primary outcomes were changes in marginal bone level. In addition, survival rates, buccal bone thickness, soft peri‐implant tissues, aesthetics and patient‐reported outcomes were assessed. Results After 5 years, the mean mesial and distal marginal bone level changes were 0.71 ± 0.68 mm and 0.71 ± 0.71 mm, respectively, in group A and 0.49 ± 0.52 mm and 0.54 ± 0.64 mm, respectively, in group B; the difference between the groups was not significant (p = .305 and p = .477, respectively). Implant and restoration survivals were 100%. No clinically relevant differences in buccal bone thickness or in mid‐facial peri‐implant mucosal level, aesthetic and patient outcomes were observed. Conclusions The mean marginal bone level changes following immediate implant placement and provisionalization were comparable with immediate implant placement and delayed provisionalization. (www.isrctn.com: ISRCTN57251089 and www.trialregister.nl: NL8255).
Collapse
Affiliation(s)
- Kirsten W Slagter
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Gerry M Raghoebar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Diederik F M Hentenaar
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Arjan Vissink
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Henny J A Meijer
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Implant Dentistry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| |
Collapse
|
42
|
Optimizing the esthetic outcome by using screw-retained implant abutment crowns: A 3-year clinical follow-up. J Prosthet Dent 2020; 126:608-615. [PMID: 33160619 DOI: 10.1016/j.prosdent.2020.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 09/14/2020] [Accepted: 09/14/2020] [Indexed: 11/21/2022]
Abstract
This clinical report describes a ceramic complete-mouth rehabilitation with screw-retained implant abutment crowns, optimizing esthetics by combining the properties of ceramic materials. The abutments connected a titanium insert to a computer-aided design and computer-aided manufacturing (CAD-CAM) monolithic zirconia framework, offering improved esthetics and biologic response without negatively affecting the implant abutment interface. Lithium disilicate crowns were cemented extraorally on the abutments, resulting in a screw-retained restoration.
Collapse
|
43
|
Impact of Coping Veneering Techniques on the Survival of Implant-Supported Zirconia-Based-Crowns Cemented to Hybrid-Abutments: An-In-Vitro Study. Bioengineering (Basel) 2020; 7:bioengineering7040117. [PMID: 32992792 PMCID: PMC7712862 DOI: 10.3390/bioengineering7040117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/14/2020] [Accepted: 09/20/2020] [Indexed: 11/17/2022] Open
Abstract
The objective of this study is to investigate the influence of veneering technique (hand-layering vs. milling) on the fracture resistance of bi-layer implant-supported zirconia-based hybrid-abutment crowns. Mandibular molar copings were anatomically designed and milled. Copings were then veneered by hand-layering (HL) (n = 20) and milling using the Cad-On technique (LD) (n = 20). Crowns were cemented to zirconia hybrid-abutments. Ten samples of each group acted as a control while the remaining ten samples were subjected to fatigue in a chewing simulator. Crowns were loaded between 50 and 100 N for 1.2 million cycles under simultaneous temperature fluctuation between 5 and 55 °C. Crowns were then subjected to static load a to fracture test. Data were statistically analysed using the one-way ANOVA. Randomly selected crowns from each group were observed under scanning electron microscopy to view fractured surfaces. Study results indicate that during fatigue, LD crowns had a 100% survival rate; while HL crowns had a 50% failure rate. Fracture resistance of LD crowns was statistically significantly higher than that of HL crowns at the baseline and after fatigue (p ≤ 0.05). However, fatigue did not cause a statistically significant reduction in fracture resistance in both LD and HL groups (p > 0.05). Copings fractured in the LD crowns only and the fracture path was different in both LD and HL groups. According to the results, it was concluded that milled veneer implant-supported hybrid-abutment crowns exhibit significantly higher fracture resistance, and better withstand clinical masticatory loads in the posterior region compared to the hand-layered technique. Also, fatigue application and artificial aging caused no significant strength reduction in both techniques. Clinical significance: Different veneering techniques and materials (hand-layering or milling) act differently to clinical forces and environment and may be prone to early chipping during service. Therefore, practitioners are urged to consider the appropriate veneering protocol for posterior implant-supported hybrid-abutment restorations.
Collapse
|
44
|
Failure Modes and Survival of Anterior Crowns Supported by Narrow Implant Systems. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1057846. [PMID: 32964016 PMCID: PMC7495162 DOI: 10.1155/2020/1057846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 08/12/2020] [Indexed: 11/18/2022]
Abstract
The reduced hardware design of narrow implants increases the risk of fracture not only of the implant itself but also of the prosthetic constituents. Hence, the current study is aimed at estimating the probability of survival of anterior crowns supported by different narrow implant systems. Three different narrow implant systems of internal conical connections were evaluated (Ø3.5 × 10 mm): (i) Active (Nobel Biocare), (ii) Epikut (S.I.N. Implant System), and (iii) BLX (Straumann). Abutments were torqued to the implants, and standardized maxillary incisor crowns were cemented. The assemblies were subjected to step-stress accelerated life testing (SSALT) in water through load application of 30 degrees off-axis lingually at the incisal edge of the crowns using a flat tungsten carbide indenter until fracture or suspension. The use level probability Weibull curves and reliability for completion of a mission of 100,000 cycles at 80 N and 120 N were calculated and plotted. Weibull modulus and characteristic strength were also calculated and plotted. Fractured samples were analyzed in a stereomicroscope. The beta (β) values were 1.6 (0.9-3.1) and 1.4 (0.9-2.2) for BLX and Active implants, respectively, and 0.5 (0.3-0.8) for the Epikut implant, indicating that failures were mainly associated with fatigue damage accumulation in the formers, but more likely associated with material strength in the latter. All narrow implant systems showed high probability of survival (≥95%, CI: 85-100%) at 80 and 120 N, without significant difference between them. Weibull modulus ranged from 6 to 14. The characteristic strength of Active, Epikut, and BLX was 271 (260-282) N, 216 (205-228) N, and 275 (264-285) N, respectively. The failure mode predominantly involved abutment and/or abutment screw fracture, whereas no narrow implant was fractured. Therefore, all narrow implant systems exhibited a high probability of survival for anterior physiologic masticatory forces, and failures were restricted to abutment and abutment screw.
Collapse
|
45
|
T P Bergamo E, Zahoui A, Luri Amorin Ikejiri L, Marun M, Peixoto da Silva K, G Coelho P, Soares S, A Bonfante E. Retention of zirconia crowns to Ti-base abutments: effect of luting protocol, abutment treatment and autoclave sterilization. J Prosthodont Res 2020; 65:171-175. [PMID: 32938879 DOI: 10.2186/jpr.jpor_2019_537] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To evaluate the influence of resin cement type, surface pretreatment and autoclave sterilization on the retention of Y-TZP crowns to Ti-base abutments. METHODS Y-TZP crowns were designed and milled to fit Ti-base abutments. Crowns were cemented using either a conventional resin cement (conventional) with a universal adhesive or a self-adhesive resin cement (self-adhesive), both following no surface pretreatment (No) or Ti-base abutment sandblasting (SB) (n=20/group). Half of the cemented samples were subjected to in-office autoclave sterilization. Pullout testing was performed in a universal testing machine at a speed of 1 mm/min until crown displacement. Data were statistically evaluated through a linear mixed model following post hoc comparisons by LSD test. RESULTS Pullout data as a function of cement type demonstrated higher retention for conventional relative to self-adhesive cement (p < 0.001). Ti-base sandblasting (SB) favored crown retentiveness over No pretreatment (p < 0.001). Sterilized crowns exhibited higher pullout values than non-sterile (p=0.036). All the two- and three-factor interaction analyses corroborated with the superior adhesive strength of conventional compared to self-adhesive cement (all, p < 0.011), as well as, SB relative to No pretreatment (all, p < 0.024). While autoclave sterilization maximized bond strength when self-adhesive cement (data collapsed over surface pretreatment, p < 0.050) and No pretreatment were evaluated (data collapsed over surface pretreatment, p < 0.013), no significant difference was observed for conventional resin cement (p=0.280) and SB (p=0.878) groups. CONCLUSIONS Conventional resin cement and/or Ti-base sandblasting increased Y-TZP crown retentiveness, with no significant influence of autoclave sterilization. Autoclaving increased retentiveness when self-adhesive cement and/or no Ti-base pretreatment were used.
Collapse
Affiliation(s)
- Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP
| | - Abbas Zahoui
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP
| | - Larissa Luri Amorin Ikejiri
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP
| | - Manoela Marun
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP
| | - Kimberly Peixoto da Silva
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP
| | - Paulo G Coelho
- Department of Biomaterials and Biomimetics, Department of Biomedical Engineering, New York University Tandon School of Engineering Brooklyn Hansjörg Wyss Department of Plastic Surgery
| | - Simone Soares
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP
| |
Collapse
|
46
|
de Araújo-Júnior ENS, Bergamo ETP, Campos TMB, Benalcázar Jalkh EB, Lopes ACO, Monteiro KN, Cesar PF, Tognolo FC, Tanaka R, Bonfante EA. Hydrothermal degradation methods affect the properties and phase transformation depth of translucent zirconia. J Mech Behav Biomed Mater 2020; 112:104021. [PMID: 32882676 DOI: 10.1016/j.jmbbm.2020.104021] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/28/2020] [Accepted: 07/31/2020] [Indexed: 02/04/2023]
Abstract
OBJECTIVES To characterize the optical and mechanical properties of a commercial and in-house translucent Y-TZP before and after aging in autoclave or hydrothermal reactor. METHODS In-house experimental discs were obtained through uniaxial and isostatic pressing a translucent Y-TZP powder and sintering at 1,550 °C/1 h. Commercial discs were milled from pre-sintered blocks fabricated with the same powder through uniaxial and isostatic pressing and sintering. Discs were allocated into three groups according to aging condition: immediate, aged via autoclave, or reactor (134 °C, 20 h, 2.2 bar). Crystalline content and microstructure were evaluated using X-ray diffraction (XRD) and scanning electron microscopy (SEM). Residual compressive stress (CS) was determined by Raman spectroscopy. Optical properties were determined by the contrast ratio (CR) and translucency parameter (TP) using reflectance data. Mechanical properties were assessed by Vickers hardness, fracture toughness and biaxial flexural strength tests. RESULTS XRD and SEM revealed a typical Y-TZP crystalline content, chiefly tetragonal phase, and a dense crystalline matrix for both processing protocols. Reactor aging triggered a more pronounced t-m transformation relative to autoclave. In-house and commercial Y-TZPs demonstrated similar CR and TP, with reactor aging significantly increasing their translucency. Similarly, reactor aging influenced Vickers hardness and fracture toughness. In-house processed Y-TZP clearly demonstrated the presence of CS, whereas commercial Y-TZP showed no presence of CS. Non-aged in-house Y-TZP resulted in significantly lower characteristic strength relative to commercial Y-TZP. While aging protocols significantly increased the characteristic strength of in-house Y-TZP, reactor significantly decreased commercial Y-TZP characteristic strength. Both Y-TZP processing protocols demonstrated high reliability at high-stress missions, with no detrimental effect of aging. CONCLUSIONS Laboratory aging methodology significantly influenced optical and mechanical properties of a commercial and in-house translucent Y-TZP.
Collapse
Affiliation(s)
- Everardo N S de Araújo-Júnior
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil.
| | - Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Tiago M B Campos
- Department of Physics, Technological Institute of Aeronautics, São José Dos Campos, SP, Brazil
| | - Ernesto B Benalcázar Jalkh
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Adolfo C O Lopes
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Kelli N Monteiro
- Department of Biomaterials and Oral Biology, University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Paulo F Cesar
- Department of Biomaterials and Oral Biology, University of São Paulo, School of Dentistry, São Paulo, SP, Brazil
| | - Fernanda C Tognolo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Ricardo Tanaka
- TNK Lab, Rua João de Santa Maria, 129 - Jardim da Saúde - São Paulo, SP, Brazil
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| |
Collapse
|
47
|
A Prospective Clinical Cohort Investigation on Zirconia Implants: 5-Year Results. J Clin Med 2020; 9:jcm9082585. [PMID: 32785031 PMCID: PMC7464596 DOI: 10.3390/jcm9082585] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/21/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022] Open
Abstract
Mid-term data on zirconia oral implants is very rare. Therefore, the aim of this prospective clinical investigation was to evaluate the survival rate and the marginal bone loss of a one-piece zirconia implant after five years. Patient-reported outcomes were also recorded. Zirconia implants to support single crowns (SC) or a 3-unit fixed dental prosthesis (FDP) were placed and subsequently restored. After the insertion of the implants, at prosthetic delivery, and after five years, standardized radiographs were taken to evaluate marginal bone loss (MBL). For bone tissue evaluation, linear mixed models with random intercepts were fitted. Twenty-seven patients received one implant for an SC and 13 patients received two implants for a 3-unit FDP. Three patients each lost one implant for an SC before prosthetic delivery. Thirty-five patients were seen after five years, and no further implant was lost. The cumulative five-year implant survival rate was 94.3%. The MBL from implant installation up to five years was 0.81 mm. The MBL from implant installation to prosthetic delivery was statistically significant (p < 0.001). Patients perceived a significant improvement in function, esthetics, sense, speech, and self-esteem from pretreatment up to the five-year follow-up. The present findings substantiate the clinical applicability of this implant system.
Collapse
|
48
|
Granato R, Bergamo ETP, Witek L, Bonfante EA, Marin C, Greenberg M, Kurgansky G, Coelho PG. Clinical, histological, and nanomechanical parameters of implants placed in healthy and metabolically compromised patients. J Dent 2020; 100:103436. [PMID: 32738285 DOI: 10.1016/j.jdent.2020.103436] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 07/04/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the clinical outcomes, histological parameters, and bone nanomechanical properties around implants retrieved from healthy and metabolic syndrome (MS) patients. METHODS Twenty-four patients with edentulous mandibles (12/condition), received four implants between the mental foramina. An additional implant prototype was placed for retrieval histology. The following clinical outcomes were evaluated: insertion torque (IT), implant stability quotient (ISQ) values at baseline and after 60 days of healing, and implant survival. The prototype was retrieved after the healing and histologically processed for bone morphometric evaluation of bone-to-implant contact (%BIC) and bone area fraction occupancy (%BAFO), and bone nanoindentation to determine the elastic modulus (Em) and hardness (H). Descriptive statistical procedures and survival tests were used to analyze the data. RESULTS The final study population was comprised of 10 women and 11 men (∼64 years). A total of 105 implants were placed, 21 retrieved for histology. Implant survival rates were similar between groups (>99 %). Similarly, IT and ISQ analyses showed no significant association with systemic condition (p > 0.216). Histological micrographs depicted similar bone morphology, woven bone, for both conditions. While MS (33 ± 5.3 %) and healthy (39 ± 6.5 %) individuals showed no significant difference for %BIC (p = 0.116), significantly higher %BAFO was observed for healthy (45 ± 4.6 %) relative to MS (30 ± 3.8 %) (p < 0.001). No significant differences on bone nanomechanical properties was observed (p > 0.804). CONCLUSIONS Although no significant influence on clinical parameters and bone nanomechanical properties was observed, MS significantly reduced bone formation in the peri-implant area in the short-term. CLINICAL SIGNIFICANCE A lower amount of bone formation in the peri-implant area was observed in comparison to healthy patients, although the other short-term clinical outcomes were not significantly different. Considering the escalating prevalence of MS patients in need for implant treatment, it becomes crucial to understand bone-to-implant response to determine the ideal loading time in this population.
Collapse
Affiliation(s)
- Rodrigo Granato
- Postgraduate Program in Dentistry, University of Grande Rio, Rio de Janeiro, RJ, Brazil
| | - Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil.
| | - Lukasz Witek
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA; Department of Biomedical Engineering - NYU Tandon School of Engineering, New York University, Brooklyn, NY, USA
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo, Bauru School of Dentistry, Bauru, SP, Brazil
| | - Charles Marin
- Department of Oral Surgery, Federal University of Santa Catarina, Florianopolis, SC, Brazil
| | - Michael Greenberg
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA
| | - Gregory Kurgansky
- Department of Biomaterials and Biomimetics, New York University College of Dentistry, New York, NY, USA
| | - Paulo G Coelho
- Department of Mechanical and Aerospace Engineering - NYU Tandon School of Engineering, Brooklyn, NY, USA; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Health School of Medicine, New York, NY, USA
| |
Collapse
|
49
|
Pieralli S, Spies BC, Hromadnik V, Nicic R, Beuer F, Wesemann C. How Accurate Is Oral Implant Installation Using Surgical Guides Printed from a Degradable and Steam-Sterilized Biopolymer? J Clin Med 2020; 9:jcm9082322. [PMID: 32707759 PMCID: PMC7463912 DOI: 10.3390/jcm9082322] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 01/25/2023] Open
Abstract
3D printed surgical guides are used for prosthetically-driven oral implant placement. When manufacturing these guides, information regarding suitable printing techniques and materials as well as the necessity for additional, non-printed stock parts such as metal sleeves is scarce. The aim of the investigation was to determine the accuracy of a surgical workflow for oral implant placement using guides manufactured by means of fused deposition modeling (FDM) from a biodegradable and sterilizable biopolymer filament. Furthermore, the potential benefit of metal sleeve inserts should be assessed. A surgical guide was designed for the installation of two implants in the region of the second premolar (SP) and second molar (SM) in a mandibular typodont model. For two additive manufacturing techniques (stereolithography [SLA]: reference group, FDM: observational group) n = 10 surgical guides, with (S) and without (NS) metal sleeves, were used. This resulted in 4 groups of 10 samples each (SLA-S/NS, FDM-S/NS). Target and real implant positions were superimposed and compared using a dedicated software. Sagittal, transversal, and vertical discrepancies at the level of the implant shoulder, apex and regarding the main axis were determined. MANOVA with posthoc Tukey tests were performed for statistical analyses. Placed implants showed sagittal and transversal discrepancies of <1 mm, vertical discrepancies of <0.6 mm, and axial deviations of ≤3°. In the vertical dimension, no differences between the four groups were measured (p ≤ 0.054). In the sagittal dimension, SLA groups showed decreased deviations in the implant shoulder region compared to FDM (p ≤ 0.033), whereas no differences in the transversal dimension between the groups were measured (p ≤ 0.054). The use of metal sleeves did not affect axial, vertical, and sagittal accuracy, but resulted in increased transversal deviations (p = 0.001). Regarding accuracy, biopolymer-based surgical guides manufactured by means of FDM present similar accuracy than SLA. Cytotoxicity tests are necessary to confirm their biocompatibility in the oral environment.
Collapse
Affiliation(s)
- Stefano Pieralli
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine—University of Freiburg, 79106 Freiburg, Germany;
| | - Benedikt Christopher Spies
- Department of Prosthetic Dentistry, Center for Dental Medicine, Medical Center—University of Freiburg, Faculty of Medicine—University of Freiburg, 79106 Freiburg, Germany;
- Correspondence: ; Tel.: +49-761-270-49060
| | - Valentin Hromadnik
- Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany; (V.H.); (R.N.); (F.B.); (C.W.)
| | - Robert Nicic
- Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany; (V.H.); (R.N.); (F.B.); (C.W.)
| | - Florian Beuer
- Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany; (V.H.); (R.N.); (F.B.); (C.W.)
| | - Christian Wesemann
- Department of Prosthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Geriatric Dentistry and Craniomandibular Disorders, 14197 Berlin, Germany; (V.H.); (R.N.); (F.B.); (C.W.)
- Department of Orthodontics, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Dentofacial Orthopedics and Pedodontics, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| |
Collapse
|
50
|
Mühlemann S, Lakha T, Jung RE, Hämmerle CHF, Benic GI. Prosthetic outcomes and clinical performance of CAD‐CAM monolithic zirconia versus porcelain‐fused‐to‐metal implant crowns in the molar region: 1‐year results of a RCT. Clin Oral Implants Res 2020; 31:856-864. [DOI: 10.1111/clr.13631] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 06/03/2020] [Accepted: 06/03/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Sven Mühlemann
- Clinic of Reconstructive DentistryCenter of Dental MedicineUniversity of Zurich Zurich Switzerland
| | - Tabrez Lakha
- Clinic of Reconstructive DentistryCenter of Dental MedicineUniversity of Zurich Zurich Switzerland
- Department of Prosthetic DentistryM.A. Rangoonwala College of Dental Sciences & Research Centre Pune India
| | - Ronald E. Jung
- Clinic of Reconstructive DentistryCenter of Dental MedicineUniversity of Zurich Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Reconstructive DentistryCenter of Dental MedicineUniversity of Zurich Zurich Switzerland
| | - Goran I. Benic
- Clinic of Reconstructive DentistryCenter of Dental MedicineUniversity of Zurich Zurich Switzerland
| |
Collapse
|