Wear Resistance, Color Stability and Displacement Resistance of Milled PEEK Crowns Compared to Zirconia Crowns under Stimulated Chewing and High-Performance Aging

Effects of combined modification of sulfonation, oxygen plasma and silane on the bond strength of PEEK to resin

OBJECTIVE

This study aimed to evaluate the combined effects of sulfonation, non-thermal oxygen plasma and silane on the shear bond strength (SBS) of PEEK to resin materials.

MATERIALS AND METHODS

Two hundred and eighty specimens were randomly divided into four groups: (A) untreated; (B) sulfonation for 60 s; (C) oxygen plasma for 20 min; (D) sulfonation for 60 s and oxygen plasma for 20 min. According to the instructions, 120 samples (N = 30) were coated with silane, adhesive, and resin composites. Each group of bonding specimens was divided into two subgroups (n = 15) to measure immediate and post-aging SBS. The surface morphology and the interface between the samples and adhesive were analyzed through SEM. Physicochemical characteristics of the surface and mechanical properties were determined through XPS, FTIR, light interferometry, contact angle measurement, and three-point bending tests.

RESULTS

Sulfonation produced a porous layer of approximately 20 µm thickness on the surface, and the oxygen plasma increased the O/C ratio and oxygen-containing groups of the sample surface. After coating with silane, the SBS values of sulfonated PEEK and plasma-treated PEEK increased (9.96 and 10.72 MPa, respectively), and dual-modified PEEK exhibited the highest SBS value (20.99 MPa), which was significantly higher than that of blank group (p > 0.01). After 10,000 thermal cycles, the dual-modified PEEK still displayed a favorable SBS (18.68 MPa).

SIGNIFICANCE

Sulfonation strengthened the mechanical interlocking between PEEK and the resin while oxygen plasma established a chemical bonding between silane and PEEK. This dual modification of the surface microstructure and chemical state synergistically improved the bond strength of PEEK to resin and resulted in considerable long-term effects.

How could mouthwashes affect the color stability and translucency of various types of monolithic zirconia? An in-vitro study

OBJECTIVES

This study aimed to evaluate the color stability and translucency of various types of monolithic zirconia after immersion in chlorhexidine and Listerine mouthwashes.

MATERIALS AND METHODS

This experimental study was performed on 36 disk-shaped specimens fabricated from low-translucent, high-translucent, and multilayered monolithic zirconia (n = 12 per group). Each group was equally divided and immersed in either 2% chlorhexidine (CHX) or Listerine mouthwash for 2 min daily over 7 days. Changes in color (ΔE) and the translucency parameter (ΔTP) were evaluated and compared. The data were analyzed with one-way ANOVA followed by Tukey's post-hoc tests (α = 0.05).

RESULTS

Chlorhexidine caused a significantly lower ΔE and a significantly higher ΔTP in multilayered zirconia compared to the low-translucency (ΔE: P = 0.0027, ΔTP: P<0.001) and the high-translucency zirconia group (ΔE: P<0.001, ΔTP: P = 0.022). Listerine caused a significantly higher ΔE in the high-translucency zirconia group compared to the multilayered zirconia group (P = 0.0165). It also resulted in a significantly higher mean ΔTP in the multilayered zirconia group compared to the low-translucency (P = 0.0003) and high-translucency zirconia groups (P = 0.019).

CONCLUSIONS

In both mouthwashes, multilayered monolithic zirconia exhibited the highest color stability among the tested materials; albeit with the most pronounced changes in translucency. Meanwhile, high-translucency monolithic zirconia was more prone to discoloration when exposed to both mouthwashes.

A Comparison of Failure Loads for Polycrystalline Zirconia Ceramics with Varying Amounts of Yttria, Glass-Ceramics and Polymers in Two Different Test Conditions

It is unclear how zirconia dental crowns with different yttria compositions will perform clinically, and how they will compare with crowns made of glass-ceramics and polymers. The present objective was to determine failure loads of crowns and discs made of glass ceramics or polymers as compared to yttria-partially stabilized zirconia (Y-PSZ) crowns and discs with varying yttria concentrations. Crowns of zirconia (Cercon XT, Katana UTML, BruxZir Anterior), glass ceramic (Celtra press, IPS e.max press, Lisi press), and polymeric materials (Trilor, Juvora, Pekkton) were fabricated and cemented to epoxy abutments. The total number of specimens was 135 for crowns and 135 for discs (n = 15 specimens per material type and design). A universal testing machine was used to perform compressive loading of crowns/discs to failure with a steel piston along the longitudinal axis of the abutments. Energy dispersive spectroscopy (EDS) was used to identify the yttria concentration for each zirconia brand. The data were analyzed using generalized linear models and regression analyses. The results revealed significant differences (p < 0.05) in mean failure loads for different crown materials: Trilor (6811 ± 960 N) > Juvora (5215 ± 151 N) > Cercon (4260 ± 520 N) = BruxZir (4186 ± 269 N) = e.max (3981 ± 384 N) > Katana (3195 ± 350 N) = Lisi (3173 ± 234 N) = Pekkton (3105 ± 398 N) > Celtra (2696 ± 393 N). The general linear model revealed significant differences (p < 0.05) in mean failure loads when comparing the different materials for the discs, i.e., Trilor (5456 ± 1748 N) > Juvora (4274 ± 869 N) > Pekkton (3771 ± 294 N) > Katana (2859 ± 527 N) > Cercon (2319 ± 342 N) = BuxZir (2250 ± 515 N) = e.max (2303 ± 721 N) = Lisi (2333 ± 535 N) > Celtra (1965 ± 659 N). EDS showed that the zirconia materials contained yttria at different concentrations (BruxZir = 5Y-PSZ, Cercon = 4Y-PSZ, Katana = 3Y-PSZ). The yttria concentration had a significant effect on the failure load of the Katana (3Y-PSZ) crowns, which revealed lower failure loads than the Cercon (4Y-PSZ) and BruxZir (5Y-PSZ) crowns, whose failure loads were comparable or higher than e.max glass ceramic. The failure load of the trilayer disc specimens did not correlate with the failure load of the respective crown specimens for the zirconia, glass-ceramic and polymeric materials.

Zinc and Silver-Infused Calcium Silicate Cement: Unveiling Physicochemical Properties and In Vitro Biocompatibility

INTRODUCTION

Calcium silicate-based types of cement have gained recognition in various dental applications due to their exceptional sealing capabilities, bioactivity, and minimal adaptability. However, these materials have certain shortcomings that can lead to mechanical failures and premature degradation. The inclusion of metal ions into their structure is expected to promote their biological activity. This article focuses on the preparation and characterization of calcium silicate cement to enhance its fundamental material properties, by introducing zinc and silver while retaining its biomaterial characteristics.

AIM

This study aims to evaluate the biomedical potential of zinc and silver-impregnated bioactive calcium silicate cement.

MATERIALS AND METHODS

The calcium silicate powder was synthesized via the sol-gel method. Tetraethyl orthosilicate, calcium nitrate, silver nitrate, and zinc nitrate were sequentially added to create the bioactive calcium silicate material. The synthesized particles underwent physicochemical characterization using techniques such as scanning electron microscopy, X-ray diffraction, Raman spectroscopy, and biological characterization through in vitro hemocompatibility assays.

RESULTS

The study's results revealed the presence of multiple crystalline phases (Ag6Si2O7, Zn2SiO4, CaCO3) as indicated by X-ray diffraction. Raman spectra displayed vibrations associated with Si-O-Si and Zn-O bonding in the zinc and silver-infused bioactive calcium silicate. Scanning electron microscopy confirmed a mixture of spherical and sheet-like morphologies, while energy dispersive spectra confirmed the presence of elements Ca, Si, Zn, Ag, O, and C. In vitro hemocompatibility testing affirmed the material's biocompatible nature.

CONCLUSION

In conclusion, the zinc and silver-infused calcium silicate cement was successfully synthesized through an in-house procedure and demonstrated biocompatibility. The inclusion of zinc and silver, known for their osteogenic and antimicrobial properties, is anticipated to enhance the cement's biological properties and broaden its utility in dentistry. Further in vitro and in vivo investigations are imperative to validate its clinical applications and elucidate the molecular mechanisms underlying its efficacy.

New biomaterials for modern dentistry

Whilst the appropriate assessment criteria for dental biomaterials is debated, there has been an increasing interest in the use of dental biomaterials for oral rehabilitation. Consequently, a variety of new biomaterials have been introduced in dentistry. To address this issue, BMC Oral Health has launched a Collection on "New biomaterials for modern dentistry".

Surface Texture Designs to Improve the Core-Veneer Bond Strength of Zirconia Restorations Using Digital Light Processing

Veneered zirconia ceramics are widely used for dental restorations. However, the relatively poor bonding strength between the ceramic core and veneer porcelain remains a common problem in clinical applications. To address this issue, this study focused on enhancing the core-veneer bond strength of zirconia restorations through the implementation of surface textures using digital light processing (DLP) technology. The light intensity was precisely tuned to optimize mechanical strength and minimize light scattering. Subsequently, hexagonal or square grids were printed on the surface of the zirconia ceramic core. Following veneering procedures, the shear bond strength (SBS) test was conducted using a universal testing machine. Dates were compared using analysis of variance (ANOVA) and the least significant difference (LSD) test. Furthermore, optical microscopy and scanning electron microscopy (SEM) were used to examine the failure modes and observe the cross-sectional structures, respectively. The results indicated that the presence of a 0.09 mm high hexagon grid led to a significant 21% increase in the SBS value. However, grids with heights of 0.2 and 0.3 mm showed less improvement, owing to the formation of large defects at the interface during the fusion process. This study demonstrated the potential of DLP technology in preparing zirconia ceramics with complex structures and high mechanical strength, thereby offering promising solutions for overcoming challenges associated with dental applications.

Impact of Contracted Endodontic Access Cavities on the Fracture Resistance of Endodontically Treated Teeth After Mechanical Aging by Simulated Chewing Forces

INTRODUCTION

This in vitro study aimed to comparatively evaluate the fracture resistance of contracted endodontic cavities (CECs) versus traditional endodontic cavities (TECs) in mandibular molars after subjecting the samples to a chewing simulator.

METHODS

A total of 24 freshly extracted human mandibular molars were included in the study. Teeth with intact crowns and mature root apices that were devoid of caries, attrition, restorations, and cracks were selected and randomly assigned to 3 groups (n = 8) as follows: Group 1: TECs, Group 2: CECs, and Group 3: intact teeth (control group). After endodontic treatment, the teeth were restored with EverX bulk-fill composite and layered occlusally with nanohybrid composite SolareX and subjected to a chewing simulator where 240,000 masticatory cycles were simulated, which translates to 1 year of clinical function. The teeth were then subjected to static loading in a universal testing machine and the maximum load to fracture and the pattern of failure (restorable/unrestorable) were recorded. Data were evaluated with analysis of variance and the Tukey post hoc test for multiple comparisons.

RESULTS

The CEC group had higher fracture resistance when compared with the TEC group; however, the difference was not statistically significant. The fracture resistance of the samples in the control group was statistically higher than those in the experimental groups (P < .005).

CONCLUSIONS

There was no difference observed in the fracture resistance of mandibular molars with TECs and CECs subjected to masticatory loading.

Evaluation of Physical-Chemical Properties of Contemporary CAD/CAM Materials with Chromatic Transition "Multicolor"

The use of materials for computer-aided design/computer-aided manufacturing (CAD/CAM) has been rapidly increasing in daily practice. However, one of the main issues regarding modern CAD/CAM materials is their aging in the oral environment, which may lead to significant changes in their overall properties. The aim of this study was to compare the flexural strength, water sorption, cross-link density (softening ratio%), surface roughness, and SEM analysis of three modern CAD/CAM "multicolor" composites. Grandio (Grandio disc multicolor-VOCO GmbH, Cuxhaven, Germany), Shofu (Shofu Block HC-Shofu Inc., Kyoto, Japan), and Vita (Vita Enamic multiColor-Vita Zahnfabrik, Bad Sackingen, Germany) were tested in this study. They were prepared in stick-shaped specimens and submitted to different tests after several aging protocols, such as thermocycling and mechanical cycle loading challenge. Further disc-shaped specimens were also created and tested for water sorption, cross-link density, surface roughness, and SEM ultramorphology, before and after storage in an ethanol-based solution. For flexural strength and ultimate tensile strength, Grandio showed the greatest values both at baseline and after aging (p < 0.05). Grandio and Vita Enamic presented the highest modulus of elasticity and the lowest water sorption (p < 0.05). A significant reduction (p < 0.05) in microhardness after ethanol storage (softening ratio%) was observed especially in Shofu. Grandio had the lowest roughness parameters compared to the other tested CAD/CAM materials, while ethanol storage significantly increased the Ra and RSm values in Shofu (p < 0.05). Despite the comparable modulus of elasticity of Vita and Grandio, this latter showed greater flexural strength and ultimate tensile strength both at baseline and after aging. Hence, Grandio and Vita Enamic may be employed for the anterior teeth and for those restorations requiring load-bearing capacity. Conversely, aging seems to affect several properties of Shofu, so its use for permanent restorations should be well-pondered based on the clinical situation.

Dental Luting Cements: An Updated Comprehensive Review

The cementation of indirect restoration is one of the most important steps in prosthetic and restorative dentistry. Cementation aims to bond the prosthetic restoration to the prepared enamel or enamel and dentine. Successful cementation protocols prevent biofilm formation at the margin between tooth and restoration and minimize mechanical and biological complications. With the advancements in dental cements, they have been modified to be versatile in terms of handling, curing, and bond strengths. This review presents updates on dental cements, focusing on the composition, properties, advantages, limitations, and indications of the various cements available. Currently, dental restorations are made from various biomaterials, and depending on each clinical case, an appropriate luting material will be selected. There is no luting material that can be universally used. Therefore, it is important to distinguish the physical, mechanical, and biological properties of luting materials in order to identify the best options for each case. Nowadays, the most commonly used dental cements are glass-ionomer and resin cement. The type, shade, thickness of resin cement and the shade of the ceramic, all together, have a tangible influence on the final restoration color. Surface treatments of the restoration increase the microtensile bond strength. Hence, the proper surface treatment protocol of both the substrate and restoration surfaces is needed before cementation. Additionally, the manufacturer's instructions for the thin cement-layer thickness are important for the long-term success of the restoration.

Comparison of Regular and Speed Sintering on Low-Temperature Degradation and Fatigue Resistance of Translucent Zirconia Crowns for Implants: An In Vitro Study

BACKGROUND

Although there are a few studies which compare fast and slow sintering in normal zirconia crowns, it is essential to compare the cracks and load-bearing capacity in zirconia screw-retained implant crowns between regular and speed sintering protocols. This research aimed to compare the surface structure, cracks, and load-bearing capacity in zirconia screw-retained implant crowns between regular sintering (RS) and speed sintering (SS) protocol with and without cyclic loading (fatigue).

METHODS

A total of 60 screw-retained crowns were fabricated from zirconia (Katana STML Block) by the CAD/CAM system. Then, 30 crowns were subjected to the RS protocol and 30 crowns were subjected to the SS protocol. Cyclic loading was done in half zirconia crowns (15 crowns in each group) using a chewing simulator CS-4.8/CS-4.4 at room temperature. The loading force was applied on the middle of the crowns by a metal stylus underwater at room temperature with a chewing simulator at an axial 50 N load for 240,000 cycles and lateral movement at 2 mm. Scanning electron microscopy was done to study the surface of the crowns and the cracks in the crowns of the regular and speed sintering protocols, with and without fatigue.

RESULTS

For the speed sintering group, the surface looks more uniform, and the crack lines are present at a short distance compared to regular sintering. The sintering protocol with a larger Weibull module and durability increases the reliability. It showed that the Speed group showed the maximum fracture load, followed by the regular, speed fatigue, and regular fatigue groups. The fracture load in various groups showed significant differences.

CONCLUSIONS

It was found that the speed group showed the maximum fracture load followed by the regular, speed fatigue, and regular fatigue. The crack lines ran from occlusal to bottoms (gingiva) and the arrest lines were perpendicular to the crack propagations.

Synthetic materials in craniofacial regenerative medicine: A comprehensive overview

The state-of-the-art approach to regenerating different tissues and organs is tissue engineering which includes the three parts of stem cells (SCs), scaffolds, and growth factors. Cellular behaviors such as propagation, differentiation, and assembling the extracellular matrix (ECM) are influenced by the cell's microenvironment. Imitating the cell's natural environment, such as scaffolds, is vital to create appropriate tissue. Craniofacial tissue engineering refers to regenerating tissues found in the brain and the face parts such as bone, muscle, and artery. More biocompatible and biodegradable scaffolds are more commensurate with tissue remodeling and more appropriate for cell culture, signaling, and adhesion. Synthetic materials play significant roles and have become more prevalent in medical applications. They have also been used in different forms for producing a microenvironment as ECM for cells. Synthetic scaffolds may be comprised of polymers, bioceramics, or hybrids of natural/synthetic materials. Synthetic scaffolds have produced ECM-like materials that can properly mimic and regulate the tissue microenvironment's physical, mechanical, chemical, and biological properties, manage adherence of biomolecules and adjust the material's degradability. The present review article is focused on synthetic materials used in craniofacial tissue engineering in recent decades.

Clinical Applications of Polyetheretherketone in Removable Dental Prostheses: Accuracy, Characteristics, and Performance

The high-performance thermoplastic polyetheretherketone (PEEK) has excellent mechanical properties, biocompatibility, chemical stability, and radiolucency. The present article comprehensively reviews various applications of PEEK in removable dental prostheses, including in removable partial dentures (RPDs) (frameworks and clasps), double-crown RPDs, and obturators. The clinical performance of PEEK in removable dental prostheses is shown to be satisfactory and promising based on the short-term clinical evidence and technical complications are scarce. Moreover, the accuracy of RPDs is a vital factor for their long-term success rate. PEEK in removable dental prostheses is fabricated using the conventional lost-wax technique and CAD/CAM milling, which produces a good fit. Furthermore, fused deposition modeling is considered to be one of the most practical additive techniques. PEEK in removable prostheses produced by this technique exhibits good results in terms of the framework fit. However, in light of the paucity of evidence regarding other additive techniques, these manufacturers cannot yet be endorsed. Surface roughness, bacterial retention, color stability, and wear resistance should also be considered when attempting to increase the survival rates of PEEK removable prostheses. In addition, pastes represent an effective method for PEEK polishing to obtain a reduced surface roughness, which facilitates lower bacterial retention. As compared to other composite materials, PEEK is less likely to become discolored or deteriorate due to wear abrasion.

Influence of Aging on the Fracture Characteristics of Polyetheretherketone Dental Crowns: A Preliminary Study

Although polyetheretherketone (PEEK) is becoming more widely used in dentistry applications, little is known about how aging will affect this material. Therefore, this study aimed to investigate the influence of an aging treatment on fracture characteristics of PEEK dental crowns. Additionally, the impact of the addition of titanium dioxide (TiO₂) into PEEK was examined. Two types of commercial PEEK discs were used in this study, including TiO₂-free and 20% TiO₂-containing PEEK. The PEEK dental crowns were fabricated and aging-treated at 134 °C and 0.2 MPa for 5 h in accordance with the ISO 13356 specification before being cemented on artificial tooth abutments. The fracture loads of all crown samples were measured under compression tests. Results demonstrated that adding TiO₂ enhanced the fracture load of PEEK crowns compared to TiO₂-free PEEK crowns before the aging treatment. However, the aging treatment decreased the fracture load of TiO₂-containing PEEK crowns while increasing the fracture load of TiO₂-free PEEK crowns. The fracture morphology of TiO₂-containing PEEK crowns revealed finer feather shapes than that of the TiO₂-free PEEK crowns. We concluded that adding TiO₂ increased the fracture load of PEEK crowns without aging treatment. Still, the aging treatment influenced the fracture load and microscopic fracture morphology of PEEK crowns, depending on the addition of TiO₂.

Effect of Nanosilica Incorporation on Flexural Strength, Shear Bond Strength, and Color of Veneering Porcelain after Thermocycling

AIM: The focus of this research was to see how silica nanoparticles changed veneering porcelain over a zirconia core affected flexure strength, shear bond strength, and color. METHODS: A total number of 30 zirconia core veneer samples were constructed and classified according to silica nanoparticles modification of veneering porcelain into two groups: Group 1 (control group) veneering porcelain without any modification (n = 15) and Group 2 (modified group) veneering porcelain modified by silica nanoparticles (n = 15). Silica nanoparticles were added to the veneering porcelain powder at a rate of 5% by weight. Silica nanoparticles powder and veneering porcelain powder were manually crushed for about 10 min using a pestle and mortar then the mixed powder was combined with the porcelain moldings liquid to make a paste. After thermal cycling, each group was examined for flexural strength, shear bond strength, and color measurement (n = 5). Universal testing equipment was used to determine flexural and shear bond strength. The color shift was measured using a spectrophotometer. RESULTS: Flexural strength levels in the modified group (280.9 ± 29.85 Mpa) were substantially higher than in the control group (431.78 ± 22.73 Mpa). Shear bond strength values in the modified group (34.31 ± 5.6) were significantly higher than in the control group (26.97 ± 4.03). Color change was within the clinical acceptable range (1.71 ± 0.32). CONCLUSIONS: The addition of silica nanoparticles to veneering porcelain improved the flexural and shear bond strength, as well as, color change was within the clinical acceptable limits.

Effect of Speed Sintering on Low Temperature Degradation and Biaxial Flexural Strength of 5Y-TZP Zirconia

Translucent zirconia is becoming the material of choice for the esthetic restorative material. We aimed to evaluate the surface structure, phase determination, translucency, and flexural strength of 5Y-TZP Zirconia (Katana STML Block and Disc) between the regular sintering and the speed sintering with and without low-temperature degradation (LTD). A total of 60 zirconia discs (30 per group; regular sintering and speed sintering) were used in this study. A CAM machine was used to mill cylinders out of the zirconia blanks and then cut into smaller discs. For the speed sintering, the zirconia blocks were milled into smaller discs. The zirconia discs were subjected to regular and speed sintering with and without LTD. Scanning electron microscopy was used to characterize the zirconia specimens and the zirconia grain size. Furthermore, the zirconia specimens were analyzed for elemental analysis using energy dispersive spectroscopy and phase identification using X-ray diffraction. The zirconia specimens were subjected to translucency measurements and biaxial flexural strength testing. The results of the zirconia specimens were compared among the groups. Statistical analysis was completed using SPSS version 20.0 to detect the statistically significant differences (p value = 0.05). A one-way ANOVA with multiple comparisons was performed using Scheffe analysis among the groups. The speed sintering presented smaller grain sizes. The zirconia specimens with and without LTD in regular and speed sintering presented a similar surface structure. Regular sintering showed more translucency compared to speed sintering. Multiple comparisons of the translucency parameter were a significant difference (p value < 0.05) between the various groups except for the comparison between speed sintering and speed sintering LTD. The regular sintering showed bigger gain sizes and slightly more translucency compared to speed sintering. The speed sintering showed higher biaxial flexural strengths compared to regular sintering. This shows that speed sintering can be considered a suitable method of sintering zirconia.

Treatment methods toward improving the anti-infection ability of poly(etheretherketone) implants for medical applications

Due to its favorable chemical stability, biocompatibility, and mechanical properties, Poly(etheretherketone) (PEEK) is a promising material for repairing bone and dental hard tissue defects. However, there are critical disadvantages: PEEK is biologically and chemically inert, which influences osseointegration of implants and bonding strength of prostheses, and its mechanical properties still cannot meet the requirements for some medical applications. Furthermore, bacterial infections and inflammatory reactions often accompany bone defects caused by trauma or inflammation or teeth loss caused by periodontitis. Previous studies mainly focused on enhancing PEEK's bioactivity and mechanical performance, but PEEK also lacks effective anti-infection ability. Thus, it is necessary to improve its anti-infection ability, and this is considered in this paper from two aspects. The first is to inhibit the attachment and growth of bacteria on the material, and the second is to endow the material with immunoregulatory ability, which means mobilizing the host immune system to protect tissue from inflammation. In this review, we analyze and discuss the existing treatment methods to improve the antibacterial and immunomodulatory abilities of PEEK addressing their limitations, relevant future challenges, and required research efforts.

Effect of Erosive Agents on Surface Characteristics of Nano-Fluorapatite Ceramic: An In-Vitro Study

Erosive beverages cause dissolution of natural teeth and intra-oral restorations, resulting in surface characteristic changes, particularly roughness and degradation. The purpose of this study was to evaluate the surface roughness and topography of a dental ceramic following immersion in locally available erosive solutions. A total of 160 disc specimens of a nano-fluorapatite type ceramic (12 mm diameter and 2 mm thickness) were fabricated and equally distributed into two groups (n = 80) and then evenly distributed among the following five testing groups (n = 16): lemon juice, citrate buffer solution, 4% acetic acid, soft cola drink, and distilled water which served as a control. The surface roughness (Ra) and topography were evaluated using a profilometer and scanning electron microscope at baseline, 24 h, 96 h, and 168 h respectively. Data were analyzed using ANOVA and Tukey’s multiple comparisons (p ≤ 0.05). Surface changes were observed upon exposure to all acidic beverages except distilled water. Amongst all immersion media, 4% acetic acid produced the most severe surface roughness across all time periods (i.e., baseline, 24 h, 96 h, and 168 h). A statistically significant difference in the surface roughness values between all immersion media and across all four time intervals was observed. Erosive agents had a negative effect on the surface roughness and topography of the tested ceramic. The surface roughness increased with increased storage time intervals.

Contemporary Concepts in Osseointegration of Dental Implants: A Review

In a society highly conscious of esthetics, prosthetic rehabilitation of lost teeth with tissue-integrated implants has gained wide acceptance and demand by patients and clinicians. The backbone of these tissue-integrated implants is the biotechnical process of osseointegration. Although the concept has been introduced and discussed for ages, the deepening knowledge about its cellular and molecular mechanisms has led the researchers to borrow further into the factors influencing the process of osseointegration. This has aided in the hastening and improving the process of osseointegration by exploiting several, even the minutest, details and events taking place in this natural process. Recently, due to the high esthetic expectations of the patients, the implants are being loaded immediately, which demands a high degree of implant stability. Implant stability, especially secondary stability, largely depends on bone formation and integration of implants to the osseous tissues. Various factors that influence the rate and success of osseointegration can either be categorized as those related to implant characteristics like the physical and chemical macro- and microdesign of implants or the bone characteristics like the amount and quality of bone and the local and systemic host conditions, or the time or protocol followed for the functional loading of the dental implant. To address the shortcomings in osseointegration due to any of the factors, it is mandatory that continuous and reliable monitoring of the status of osseointegration is done. This review attempts to encompass the mechanisms, factors affecting, and methods to assess osseointegration, followed by a discussion on the recent advances and future perspectives in dental implantology to enhance the process of osseointegration. The review was aimed at igniting the inquisitive minds to usher further the development of technology that enhances osseointegration.

Bioactive Coatings in Dentistry—What Is the Future?

Bioactive coatings are widely used and understood materials in engineering [...]

PEEK in Fixed Dental Prostheses: Application and Adhesion Improvement

Polyetheretherketone (PEEK) has been widely applied in fixed dental prostheses, comprising crowns, fixed partial dentures, and post-and-core. PEEK’s excellent mechanical properties facilitate better stress distribution than conventional materials, protecting the abutment teeth. However, the stiffness of PEEK is not sufficient, which can be improved via fiber reinforcement. PEEK is biocompatible. It is nonmutagenic, noncytotoxic, and nonallergenic. However, the chemical stability of PEEK is a double-edged sword. On the one hand, PEEK is nondegradable and intraoral corrosion is minimized. On the other hand, the inert surface makes adhesive bonding difficult. Numerous strategies for improving the adhesive properties of PEEK have been explored, including acid etching, plasma treatment, airborne particle abrasion, laser treatment, and adhesive systems.

Improved Mechanical Properties and Bioactivity of Silicate Based Bioceramics Reinforced Poly(ether-ether-ketone) Nanocomposites for Prosthetic Dental Implantology

Polyether-ether-ketone (PEEK) biomaterial has been increasingly employed for orthopedic, trauma, spinal, and dental implants due to its biocompatibility and in vivo stability. However, a lack of bioactivity and binding ability to natural bone tissue has significantly limited PEEK for many challenging dental implant applications. In this work, nanocomposites based on PEEK reinforced with bioactive silicate-based bioceramics (forsterite or bioglass) as nanofillers were prepared using high energy ball milling followed by melt blending and compression molding. The influence of nanofillers type and content (10, 20 and 30 wt.%) on the crystalline structure, morphology, surface roughness, hydrophilicity, microhardness, elastic compression modulus, and flexural strength of the nanocomposites was investigated. The scanning electron microscopy images of the nanocomposites with low nanofillers content showed a homogenous surface with uniform dispersion within the PEEK matrix with no agglomerates. All nanocomposites showed an increased surface roughness compared to pristine PEEK. It was found that the incorporation of 20 wt.% forsterite was the most effective in the nanocomposite formulation compared with bioglass-based nanocomposites; it has significantly improved the elastic modulus, flexural strength, and microhardness. In vitro bioactivity evaluation, which used biomimetic simulated body fluid indicated the ability of PEEK nanocomposites loaded with forsterite or bioglass nanofillers to precipitate calcium and phosphate bone minerals on its surface. These nanocomposites are expected to be used in long-term load-bearing implant applications and could be recommended as a promising alternative to titanium and zirconia when used as a dental implant material.

PEEK Biomaterial in Long-Term Provisional Implant Restorations: A Review

Polyetheretherketone (PEEK) has become a useful polymeric biomaterial due to its superior properties and has been increasingly used in dentistry, especially in prosthetic dentistry and dental implantology. Promising applications of PEEK in dentistry are dental implants, temporary abutment, implant-supported provisional crowns, fixed prosthesis, removable denture framework, and finger prosthesis. PEEK as a long-term provisional implant restoration has not been studied much. Hence, this review article aims to review PEEK as a long-term provisional implant restoration for applications focusing on implant dentistry. Articles published in English on PEEK biomaterial for long-term provisional implant restoration were searched in Google Scholar, ScienceDirect, PubMed/MEDLINE, and Scopus. Then, relevant articles were selected and included in this literature review. PEEK presents suitable properties for various implant components in implant dentistry, including temporary and long-term provisional restorations. The modifications of PEEK result in wider applications in clinical dentistry. The PEEK reinforced by 30-50% carbon fibers can be a suitable material for the various implant components in dentistry.

Strength of Polyether Ether Ketone Composite as a Major Connector Material for Removable Partial Dentures

PEEK composite was tested mechanically as a maxillary removable partial denture (RPD) framework material instead of cast cobalt chromium alloy. Methods: Partial edentulous upper jaw cast was scanned using structured-light 3D scanner, palatal strap (PS) designs for RPD were designed by a designing dental laboratory software. CAD/CAM machine fabricated PSs patterns using their designs’ STL software files. PSs were made from poly-ether-ether ketone (PEEK) reinforced by ceramic fillers using thermal injection press technique and Co-Cr alloy using centrifugal casting, each material group was subdivided into two subgroups according to storage conditions (stored and non-stored subgroups), storage took place in deionized water for about 180 days at 37.5 ± 2 o C. All specimens were subjected to fracture resistance test using universal testing machine then maximum compression load (MCL) result values were subjected to statistical analysis. PEEK composite specimens were scanned by field emission microscope (FEM) and energy dispersive spectroscopy. Storage water of PEEK composite was analyzed using atomic absorption spectroscopy (AAS). Results: In either stored or non-stored subgroups of PEEK composite straps they showed significant lower mean MCL values than corresponding alloy subgroups (p=0.0001). FEM scanning showed fillers agglomerations in non-stored PEEK composite and their nearly absence from stored PEEK composite specimens. AAS detected Al element in PEEK composite storage water. Conclusion: Mechanically thermally injected ceramic reinforced PEEK composite could not replace cast Co-Cr alloy as PSs material for maxillary RPD. Biocompatibility concerns raised in this study due to suspected Al leaching and ceramic fillers dissolution from PEEK composite matrix.

Applications and Clinical Behavior of BioHPP in Prosthetic Dentistry: A Short Review

(1) Background: BioHPP® (Bredent, UK) is a partially crystalline poly ether ether ketone (PEEK) that is strengthened using ceramic. PEEK and its various formulations represent a very interesting alternative, and has been in-depth with its literature in recent years; (2) Methods: A PubMed and Scopus search for the term “BioHPP” yielded 73 results and 42 articles which were included in this short review. Considering the scarce literature on the subject, each article was considered in this review; (3) Results: the articles analyzed are very recent, all published in the last 5 years. Their clinical evaluation of BioHPP® highlights many positive aspects, and few articles have highlighted critical issues in its multiple clinical applications; (4) Conclusions: this material is not only extremely interesting for the future, but possesses characteristics suitable for clinical application today, for endocrowns, small adhesive bridges, temporary prostheses and for immediate loads on implant restorations. The excellent aesthetics and the possibility of simple reprocessing of the restorations made with this material invite its clinical application.

Thermal Change Affects Flexural and Thermal Properties of Fused Deposition Modeling Poly(Lactic Acid) and Compression Molding Poly(Methyl Methacrylate)

OBJECTIVE

 Polylactic acid (PLA) is one of the most widely used materials in three-dimensional (3D) printing technology due to its multiple advantages such as biocompatibility and biodegradable. However, there is still a lack of study on 3D printing PLA for use as a denture base material. The goal of this study was to compare 3D printing PLA to traditional poly(methyl methacrylate) (PMMA) as a denture basis.

MATERIALS AND METHODS

 The PMMA (M) and PLA (L) specimens were fabricated by compression molding, and fuse deposition modeling technique, respectively. Each specimen group was divided into three different temperature groups of 25°C (25), 37°C (37), and 55°C (55). The glass transition temperature (T_g) of raw materials and specimen was investigated using differential scanning calorimetry. The heat deflection temperature (HDT) of each material was also observed.

STATISTICAL ANALYSIS

 The data of flexural strength and flexural modulus were analyzed with two-way analysis of variance, and Tukey honestly significant difference. The T_g and HDT data, on the other hand, were descriptively analyzed.

RESULTS

 The results showed that PLA had lower flexural strength than PMMA in all temperature conditions, while the PMMA 25°C (M25) and PMMA 37°C (M37) obtained the highest mean values. PLA 25°C (L25) and PLA 37°C (L37) had significant higher flexural modulus than the other groups. However, the flexural properties of L55 could not be observed, which may be explained by T_g and HDT of PLA.

CONCLUSION

 PLA only meets the flexural modulus requirement, although it was greater than flexural modulus of PMMA. On the other hand, PMMA can meet both good flexural strength and modulus requirement. However, increase in temperature could reduce flexural strength and flexural modulus of PMMA and PLA.

Bending Fracture of Different Zirconia-Based Bioceramics for Dental Applications: A Comparative Study

The fabrication of fixed dental prostheses using aesthetic materials has become routine in today’s dentistry. In the present study, three-unit full zirconia fixed prosthetic restorations obtained by computer-aided design/computer-aided manufacturing (CAD/CAM) technology were tested by bending trials. The prostheses were intended to replace the first mandibular left molar and were manufactured from four different types of zirconia bioceramics (KatanaTM Zirconia HTML and KatanaTM Zirconia STML/Kuraray Noritake Dental Inc.; NOVAZir^® Fusion float^® ml/NOVADENT/Dentaltechnik; and 3D PRO Zirconia/Bloomden Bioceramics). In total, sixteen samples were manufactured—four samples per zirconia material. Additionally, the morphology, grain size area distribution, and elemental composition were analyzed in parallelepiped samples made from the selected types of zirconia in three different areas, noted as the upper, middle, and lower areas. The scanning electron microscope (SEM) analysis highlighted that the grain size area varies with respect to the researched area and the type of material. Defects such as microcracks and pores were also noted to a smaller extent. In terms of grain size area, it was observed that most of the particles in all samples were under 0.5 μm², while the chemical composition of the investigated materials did not vary significantly. The results obtained after performing the bending tests showed that a zirconia material with fewer structural defects and an increased percentage of grain size area under 0.5 µm², ranging from ~44% in the upper area to ~74% in the lower area, exhibited enhanced mechanical behavior. Overall, the resulting values of all investigated parameters confirm that the tested materials are suitable for clinical use.