Nuevos enfoques en el control de la pérdida ósea marginal periimplantaria / New approaches in the control of peri implant marginal bone loss

La pérdida ósea marginal periimplantaria (MBL) es un proceso de remodelación no infeccioso que ocurre durante el primer año después de la colocación de un implante dental y todavía en la actualidad, sigue siendo un proceso complejo que sigue suscitando dudas. La asociación entre MBL y enfermedades periimplantarias todavía no está clara del todo, sin embargo, algunos autores así lo han establecido. Por este motivo, el control temprano de la MBL puede ser un factor clave en la prevención de la periimplantitis. Se han descrito factores generales y sistémicos del paciente, factores quirúrgicos asociados a la propia colocación del implante o a los tejidos duros y blandos que lo rodean, pero también a factores prostodónticos y de oclusión. El control de la posición del implante y el volumen de los tejidos, de la estabilidad primaria, de la inflamación postoperatoria y tardía, así como el momento de la carga, el tipo de prótesis o la forma y la altura del pilar, son algunos de los factores identificados como clave actualmente. El objetivo de este trabajo es describir desde un punto de vista reflexivo, la implicación de todos estos factores en el control de la MBL. (AU)

Peri-implant marginal bone loss (MBL) is a non-infectious remodelling process that occurs during the first year after the placement of a dental implant and even today, it remains a complex process that continues to raise questions. The association between MBL and peri-implant diseases is still not entirely clear, however, some authors have established it. For this reason, early control of MBL may be a key factor in the prevention of peri-implantitis. General and systemic factors of the patient have been described, surgical factors associated with the actual placement of the implant or the surrounding hard and soft tissues, but also prosthodontic and occlusion factors. The control of the position of the implant and the volume of the tissues, of the primary stability, of the postoperative and late inflammation, as well as the moment of the load, the type of prosthesis or the shape and height of the abutment, are some of the factors currently identified as key. The objective of this work is to describe, from a reflexive point of view, the implication of all these factors in the control of MBL. (AU)

Comparación histológica e inmunohistoquímica de la mucosa periimplantaria localizada alrededor de los pilares rectos estéticos convencionales y de los nuevos pilares slim: ensayo clínico multicéntrico aleatorizado a boca partida / Histological and immunohistochemical comparison of the peri-implant mucosa located around of conventional aesthetic straight abutments and the new slim abutments: clinical trial multicenter randomized split-mouth

Para garantizar el éxito de los implantes dentales, es necesario conseguir la formación de una adecuada mucosa periimplantaria que permita el rápido sellado biológico periimplantario, que es crucial para el éxito del implante, minimizando la capacidad invasiva de microorganismos a través del surco gingival. Por ello, la adhesión del epitelio y el tejido conectivo a la superficie de los pilares protéticos, es muy importante para la viabilidad de un implante dental. En este sentido, en los últimos años se ha modificado la morfología de los pilares protéticos, tanto a nivel del tamaño del cuerpo del pilar (diámetro), como en el cuello de estos, llegando incluso a incorporar surcos para mejorar la salud del tejido periimplantario. Sin embargo, el diseño de pilares estrechos cuyo diámetro a nivel de la conexión es menor que el de la plataforma del implante, comúnmente conocidos como platform switching (PS), parece ser el que mejor sellado mucoso proporcionaría al implante, al reducir el componente vertical del ancho biológico, y crear una mayor distancia horizontal. En la actualidad, el desconocimiento de cómo la modificación del diseño geométrico de un pilar protético, con un cambio en el diámetro del cuello tipo PS, puede influir en la formación de una adecuada mucosa periimplantaria; nos motivó al desarrollo de este proyecto de investigación. En el presente ensayo clínico, pretendemos comparar la composición, distribución y estructura de los tejidos peri-implantarios alrededor de los pilares protésicos intermedios con geometría axial recta (control) y cóncava del tipo PS (test) del fabricante Galimplant® (Galimplant S.L., Sarria, España). El objetivo es estudiar qué diseño de pilares obtiene un mejor sellado biológico desde el punto de vista clínico e histomorfométrico. (AU)

To guarantee the success of dental implants, it is necessary to achieve the formation of an adequate peri-implant mucosa that allows rapid peri-implant biological sealing, which is crucial for the success of the implant, minimizing the invasive capacity of microorganisms through the gingival sulcus. Therefore, the adhesion of the epithelium and connective tissue to the surface of the prosthetic abutments is very important for the viability of a dental implant. In this sense, in recent years the morphology of prosthetic abutments has been modified, both in terms of the size of the abutment body (diameter) and in the neck of these, even incorporating grooves to improve the health of the peri-implant tissue. However, the design of narrow pillars whose diameter at the connection level is less than that of the implant platform, commonly known as platform switching (PS), seems to be the one that would provide the best mucosal seal to the implant, by reducing the vertical component. of the biological width, and create a greater horizontal distance. At present, the lack of knowledge about how the modification of the geometric design of a prosthetic abutment, with a change in the diameter of the PS-type neck, can influence the formation of an adequate peri-implant mucosa; motivated us to develop this research project. In this clinical trial, we intend to compare the composition, distribution and structure of the peri-implant tissues around the intermediate prosthetic posts with straight (control) and concave axial geometry of the PS type (test) from the manufacturer Galimplant® (Galimplant S.L., Sarria, Spain). The objective is to study which abutment design obtains a better biological seal from the clinical and histomorphometric point of view. (AU)

El efecto de la fatiga cíclica sobre los pilares de implantes dentales / The effect of the cyclic fatigue in dental implant abutments

INTRODUCCIÓN: La conexión implante-pilar ha sido sugerida como crucial para el éxito a largo plazo de las restauraciónes sobre implantes oseointegración y para prevenir futuras complicaciónes biológicas y mecánicas. El objetivo de este estudio fué evaluar la influencia del test de fatiga cíclica en el comportamiento de las conexiones internas implante-pilar. MÉTODOS: 36 pilares mutiposición de implantes de titanio de conexión interna fueron divididos en 2 grupos: 18 pilares slim o curvos y 10 pilares rectos con diferentes alturas. Los pilares fueron apretados con una llave de torque a 30 Ncm. Una carga cíclica entre 175 N y 100 N fué aplicada con 30º de inclinación axial al sistema de implantes durante 5 millones de ciclos. RESULTADOS: Los tests biomecánicos muestran una fractura de los implantes y de los tornillos de retención a una carga límite de 100 N de los pilares slim curvos y de 130 N en los pilares rectos. La fracturas aparecieron en la zona de unión entre el cuello y el cuerpo del implante y en los tornillos protéscios. No se han encontrado fracturas en los pilares multiposición. CONCLUSIONES: Este estudio indican que los tests de fatiga cíclica son importantes para analizar la respuesta biomecánica de los diferentes pilares en las conexiones implante-pilar de los sistemas de implantes

INTRODUCTION: The connection implant-abutment has been suggested to be crucial for the long-term success of implant restorations and to prevent future biological and mechanic complications. The aim of this study was to evaluate the influence of fatigue cyclic test in the behavior of internal connection implant-abutments. METHODS: Thirty six titanium abutments of internal connection implants were divided in two groups: 18 slim and 18 right multiunit abutments with different length. Abutments were tightened to 30 Ncm with a torque controller. A cyclic load between 175 N and 100 N according to different implant abutments at a 30-degree angle to the long axis was applied to the implants for a 5 million cycles. RESULTS: Biomechanical testing showed implant and screw retention fracture in a limit load of 100 N of slim implant abutments and 130 N of right implant abutments. Fracture cracks were located in the area between neck and body of implants and screw retention. No abutment fractures were found. CONCLUSIONS: This study indicate that fatigue cyclic test are very important to analize the biomechanical behavior of different abutments in connection implant-abutment of implants systems

La utilización de pilares transmucosos definitivos de colocación inmediata / The use of immediate placement of definitive transmucosal abutments

El uso de pilares de cicatrización transmucosos previos a la colocación del pilar protésico definitivo es una técnica que se ha desarrollado durante muchos años en la implantología clásica. La desconexión y conexión de forma repetida de estos pilares o aditamentos dan lugar a una respuesta ósea negativa que se manifiesta en forma de pérdida de hueso a nivel de la cresta marginal, acompañada por una migración apical de tejidos blandos. Este artículo pretende realizar una revisión de la literatura del estado actual del uso de los pilares transmucosos definitivos con colocación inmediata el día de la inserción de los implantes y el mantenimiento del sellado biológico, minimizando la pérdida ósea periimplantaria y remodelando de forma adecuada los tejidos blandos adyacentes, frente al protocolo tradiciónal del uso de aditamentos que se desconectan en multiples ocasiones produciendo pérdida ósea periimplantaria. La evidencia científica sugiere que los mejores resultados biológicos, estéticos y funciónales se consiguen con el uso del pilar definitivo colocado de forma inmediata a la inserción del implante, especialmente en implantes colocados de forma yuxtacrestal y en implantes postextracción

The use of transmucosal healing abutments before the placement of the definitive prosthetic abutment is a technique that has been developed for many years in classical implantology. Repeated disconnection and connection of theses abutments result in a negative bone response that manifests as bone loss at the marginal ridge level, accompanied by apical soft tissue migration. This article aims to review the current status in the scientific literature of the use of the definitive transepithelial abutments with immediate placement on the day of implant insertion and maintenance of the biological seal, minimizing peri-implant bone loss and adequately remodeling the adjacent soft tissues, compared to the traditional protocol of the use of abutments that are disconnected on multiple occasions producing peri-implant bone loss. Scientific evidence suggests that the best biological, aesthetic, and functional results are achieved with the use of the definitive abutment placed immediately after implant insertion, especially in yuxtacrestal implants and post-extraction implants

Candida albicans biofilms on different materials for manufacturing implant abutments and prostheses

BACKGROUND: Morphological, physical and chemical properties of both implants and prostheses can determine the biofilm formation on their surface and increase the risk of biological complications. The aim of this study was to evaluate the capacity of biofilm formation of Candida albicans on different materials used to manufacture abutments and prostheses. MATERIAL AND METHODS: Biofilm formation was analyzed on cp grade II titanium, cobalt-chromium alloy and zirconia, silicone, acrylic resin (polymethylmethacrylate) and nano-hybrid composite. Some samples were partially covered with lithium disilicate glass ceramic to study specifically the junction areas. C. albicans was incubated in a biofilm reactor at 37 °C with agitation. The biofilm formation was evaluated at 24 and 48 hours. In addition, the morphology of the biofilm was evaluated by scanning electron microscopy. RESULTS: C. albicans developed biofilms on the surface of all materials tested. Cobalt-chromium alloy showed the lowest density of adhered biofilm, followed by zirconia and titanium. Silicone and resin showed up to 20 times higher density of biofilm. A higher biofilm formation was observed when junctions of materials presented micro-pores or imperfections. CONCLUSIONS: The biofilm formed in the three materials used in the manufacture of abutments and prostheses showed no major differences, being far less dense than in the resins. Two clinical recommendations can be made: to avoid the presence of resins in the subgingival area of implant prostheses and to design prostheses placing cobalt-chromium alloy/ceramic or titanium/ceramic junctions as far as possible from implants

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Is the re-use of sterilized implant abutments safe enough? (Implant abutment safety)

Background: The reuse of implant healing abutments is common in dental practice. Effective elimination of bacteria and viruses is accomplished by conventional sterilization. The aim of this work was to explore the eventual survival of microorganisms on sterilized healing abutments and to rule out the presence of transmissible organic material after standard procedures. Material and Methods: A total of 55 healing abutments previously used in patients will be washed and sterilized in a steam autoclave at 121ºC for 15 min. Each healing abutment will be cultured in Brain Heart Infusion broth (BHI) under strict aseptic conditions. Besides, two control groups will be included: one of 3 unused healing abut-ments, and the other of just medium. After 10 days at 37°C under a 5% CO2 100 μl of the broth will be plated on solid media (Brain Infusion Agar, BHIA) and Columbia Blood agar to test for sterility. The remaining volume will be centrifuged, the sediment fixed, and a Gram stain performed to discard the presence of non-cultivable micro-organisms. Moreover, to determine the presence of remaining organic material after the cleaning and sterilizing treatments, the bioburden will be determined by measuring total organic carbon (TOC) in another 10 previously used healing abutments, cleaned and sterilized, that will be submerged in Milli-Q water and sonicated

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Development and viability of biofilms grown on experimental abutments mimicking dental implants: An in vivo model

Background: To determine whether an experimental abutment mimicking the macro- and microstructure of a dental implant is a suitable method for recovering biofilm, and to describe the features of biofilms formed around such abutments on healthy implants. Material and Methods: Experimental abutments were used in 15 patients without peri-implant diseases. After 14 days' absence of dental hygiene in this area, the abutments were retrieved and analyzed through confocal laser scanning microscopy and scanning electron microscopy. The biofilm formation on the surface of the first 5 abut-ments was determined by a fluorescence-staining method using SYTO9 nucleic acid stain. In order to study the biofilm's coverage and vitality, 10 additional abutments were assessed using live & dead bacterial viability. Descriptive and bivariate analyses of the data were performed. Results: A global plaque coverage of the abutments was observed in all cases. The submucosal area of the abutment was mostly covered with biofilm (over 21%). Moreover, significant differences between supra- and subgingival locations were detected. Conclusions: This in vivo experimental model allows detailed observation of the extensive plaque growth found on exposed experimental abutments mimicking dental implants when hygiene measures are absent. The biofilm cover-age is significantly higher in the supragingival zone than in the subgingival portion

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Eficiencia funcional de pacientes rehabilitados con prótesis total implanto retenida comparada con prótesis total convencional / Functional efficiency of patients rehabilitated with implant-retained overdentures compared whit conventional total prosthesis

Introducción: El propósito de este estudio fue determinar la retención y la eficiencia funcional de las prótesis totales retenidas por medio de implantes Ticare Inhex (Mozo-Grau, Valladolid España) y pilares de bola, a través del test de Nakamura, en sujetos adultos mayores. Materiales y método: La muestra incluyo sujetos desdentados totales maxilar y mandibular. Se registró la retención y la actividad electromiográfica, mediante electrodos ubicados bilateralmente en los músculos temporal anterior y masetero superficial, test de Nakamura. Se utilizaron los test de normalidad para comprobar la distribución y el test no paramétrico de Wilcoxon de dos muestras relacionadas, en SPSS 19.0. Resultados: Al medir la retención esta aumentó significativamente, la actividad electromiográfica realizando función masticatoria, se obtuvo una media de 42,19 mv para los Temporales y 33,89 mv para los maseteros con el uso de prótesis convencional, y una media de 56,48 mv y 48,20 mv respectivamente, con el uso de prótesis implanto retenida. Conclusión: en pacientes portadores de prótesis implanto retenidas aumentan la retención y la actividad electromiográfica de los músculos temporal anterior y masetero superficial mejorando su eficiencia masticatoria

Introduction: The purpose of this study was to determine the retention and functional efficiency of total prosthesis when retained by Ticare Inhex implants (Mozo-Grau, Valladolid Spain) and ball attachments, through the Nakamura test, in elderly subjects. Materials and methods: The sample included total maxillary and mandibular edentulous subjects. Retention and electromyographic activity were recorded by electrodes located bilaterally in the anterior temporal and superficial masseter muscles, applying Nakamura test. Normality and Wilcoxon nonparametric tests were used to check the distribution of two related samples, SPSS 19.0. Results: Retention increased significantly, in electromyographic activity during masticatory function, an average of 42.19 mv was obtained for the Temporals and 33.89 mv for the masseters with the use of conventional prosthesis, and an average of 56, 48 mv and 48.20 mv respectively, with the use of implant-retained overdentures. Conclusion: in patients with implant-retained overdentures the retention and electromyographic activity increased for the anterior temporal and superficial masseter muscles improving their masticatory efficiency

Histological differences in the adherence of connective tissue to laser-treated abutments and standard abutments for dental implants. An experimental pilot study in humans

Background: The goal of the current study is to assess the difference in connective tissue adherence to laser microtextured versus machined titanium abutments. Material and Methods: Six patients were selected and each of them received 2 implants, one combined with a laser treated abutment and one with a machined abutment. After three months, the abutments were retrieved together with their surrounding gingival tissue for histological analysis. Qualitative and quantitative evaluation of microscopical images was performed to assess the presence or absence of adherence between the soft tissues and the abutment, and the percentage of soft tissue adhered to the two different surfaces. Results: Intimate adherence between connective tissue and the laser treated abutments, while on machined abutments no adherence was detected. A significant difference was found in the percentage of surface in contact with soft tissue between both implant abutments p=0.03. Conclusions: Within the limitation of the current study, it can be concluded that connective tissues show enhanced adherence to microtextured abutments compared to machined abutments (AU)

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Reconstrucción del diente endodonciado con postes colados o espigas de fibra. Revisión bibliográfica / Reconstruction of tooth endodontic posts with fiber cast or ears

La restauración de los dientes endodonciados mediante postes prefabricados de fibra de vidrio o cuarzo es una práctica frecuente y aceptada, aunque su indicación o no y ventajas frente a otro tipo de postes, es algo aún en lo que no existe una evidencia científica suficiente. Este tipo de poste se puede indicar como una alternativa a los tradicionales postes colados. Existen diferentes tipos de postes prefabricados, aunque en la actualidad han adquirido una gran importancia los compuestos por fibras de vidrio. (1-3). Diferentes estudios muestran la implicación de factores biológicos, mecánicos y estéticos en el éxito de estas restauraciones. Siendo muy importante preservar la mayor cantidad posible de tejido dentario, conseguir un buen efecto ferrule, y una óptima adhesión para el éxito a largo plazo (1,4-6) Se revisarán los niveles de supervivencia de los dientes restaurados con postes colados frente a los restaurados con postes prefabricados. Siendo evidente como los postes de fibra de vidrio han mostrado un buen nivel de éxito a largo plazo en todas las cuestiones analizadas (AU)

The restoration of endodontic teeth with prefabricated fiberglass poles or quartz is a common and accepted practice, although its indication or not and advantages over other posts, is something even as there is insufficient scientific evidence. This type of post can be specified as an alternative to traditional cast posts. There are different types of prefabricated posts, but today have become very important compounds for glass fibers. (1-3). Different studies show the involvement of biological, mechanical and aesthetic in the success of these restorations factors. Being very important to preserve the greatest possible amount of tooth tissue, get a good ferrule effect and optimal adhesion for long-term success (1,4-6) survival rates of teeth restored with cast posts will be reviewed in front of the restored prefabricated posts. It is evident as fiberglass poles have shown a long-term good level of success in all issues discussed (AU)

Pilares de zirconia sobre implantes: comportamiento biomecánico / Zirconia implant abutments: biomechanical behaviour

La cerámica de óxido de aluminio (alúmina) se introdujo en 1993, pero el primer pilar totalmente cerámico fue introducido un año más tarde, en 1994, y consistía en alúmina altamente sinterizada (CerAdapt de Nobel Biocare). Sin embargo, el problema que presentaba este pilar fue su fragilidad. Con la introducción de los pilares de óxido de circonio (zirconia), se mejoraron las propiedades mecánicas y se ofrecieron nuevas oportunidades para las restauraciones. La zirconia desempeña un papel vital dentro de la biotecnología moderna debido a su carácter inerte y a sus excelentes propiedades mecánicas, como resistencia y dureza. Este pilar cerámico se fabrica a partir de zirconia estabilizada con itria (y-TZP), un material que está siendo utilizado en cirugía ortopé- dica desde hace más de 20 años. Sin embargo, la zirconia aún no lleva mucho tiempo en el campo de la odontología, por lo que no hay estudios a largo plazo de su comportamiento mecánico en boca. El objetivo general del trabajo, es estudiar la resistencia estática y a fatiga mediante ensayos in vitro de una muestra de probetas de pilares rectos de zirconia de diámetro estándar sobre implantes, confeccionadas según la normativa uNE-EN ISO 14801. Las conclusiones más destacadas del presente trabajo son las siguientes: todos los pilares fracturan por el cuello; todos los pilares se pueden usar en el sector anterior maxilar incluso a largo plazo; y, por último es necesario, que los estudios sobre aditamentos protésicos, se realicen mediante un protocolo establecido (norma uNE-EN ISO 14801), para que sea más fácil la comparativa entre ellos (AU)

The ceramic of aluminum oxide (Alumina) was first introduced in 1993, however, the first all-ceramic abutment was developed one year later in 1994, this abutment was made of alumina highly synthesized (CerAdapt by Nobel Biocare). however, the problem discovered on these abutments was its fragility. With the introduction of zirconium oxide abutments (zirconium), the mechanical properties were improved and new opportunities for restorations were developed. Zirconium plays an important role within modern biotechnology because of its inertness. In addition, it has excellent mechanical properties, such as strength and hardness. This ceramic abutment is made of yttria stabilized zirconia (yTZP), material that is being used in orthopaedic surgery for over 20 years. however, zirconium hasn´t been tested properly in the field of dentistry, so there is no long-term studies of their mechanical behaviour in the mouth. The aim of this work is to study the static and fatigue strength in vitro of zirconia straight abutments of standard diameter implants, according to uNE-EN ISO 14801. The main results extracted are the following: all abutments fractured by their neck; all abutments can be used in the anterior part of maxilla; and, it is necessary that studies of prosthetic attachments are made using an established protocol (uNE-EN ISO 14801), to make easier the comparison between them (AU)

Mechanical behavior of provisional implant prosthetic abutments

INTRODUCTION: Implant-supported prostheses have to overcome a major difficulty presented by the morphology and esthetics of peri-implant tissues in the anterior sector. Diverse therapeutic techniques are used for managing the mucosa adjacent to the implant and the most noteworthy is immediate/deferred fixed provisionalization. OBJECTIVES: In vitro testing of strength and deformation of implant prosthetic abutments made from different materials(Titanium/PEEK/methacrylate).MATERIAL AND METHODS: Forty Sweden & Martina(R) implant prosthetic abutments (n=40) were divided into five groups: Group MP: methacrylate provisional abutments with machined titanium base; Group PP: Polyether etherketone (PEEK) provisional abutments; Group TP: titanium provisional abutments; Group TAD: titanium antirotational definitive abutments; Group TRD: titanium rotational definitive abutments. Their mechanical behavior under static loading was analyzed. Samples were examined under a microscope to determine the type of fractureproduced. Results and CONCLUSIONS: Definitive anti-rotational titanium abutments and definitive rotational titanium abutments achieved the best mean compression strength, while PEEK resin provisional abutments obtained the lowest. The group that showed the greatest elastic deformation was the group of titanium provisional abutments

Bacterial adhesion efficiency on implant abutments: A comparative study

The attachment of Escherichia coli ATCC 25922 and Staphylococcus aureus ATCC 28213 onto six different materials used to manufacture dental implant abutments was quantitatively determined after 2 and 24 h of contact between the materials and the bacterial cultures. The materials were topographically characterized and their wettability determined, with both parameters subsequently related to bacterial adhesion. Atomic force microscopy, interferometry, and contact angle measurement were used to characterize the materials’ surfaces. The results showed that neither roughness nor nano-roughness greatly influenced bacterial attachment whereas wettability strongly correlated with adhesion. After 2 h the degree of E. coli attachment markedly differed depending on the material whereas similar differences were not observed for S. aureus, which yielded consistently higher counts of adhered cells. Nevertheless, after 24 h the adhesion of the two species to the different test materials no longer significantly differed, although on all surfaces the numbers of finally adhered E. coli were higher than those of S. aureus (AU)

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Factores a tener en cuenta a la hora de la selección del pilar protético: pilares metálicos versus pilares cerámicos / Factors to take into account when selecting prosthetic abutments: metallic abutments versus ceramic abutments

La diversidad de materiales contemporáneos y de métodos disponibles para la fabricación de restauraciones implantosoportadas hace difícil la selección de la modalidad de tratamiento más adecuada. Continuamente se están desarrollando nuevos productos que se incorporan a la amplia gama de alternativas existentes. hasta hace un tiempo, los pilares metálicos han sido considerados una condición necesaria para la longevidad de las prótesis implantológicas. No obstante, los pilares cerámicos nos ofrecen ventajas clínicas innegables. El objetivo de este trabajo es establecer un protocolo a la hora de seleccionar el pilar idóneo, teniendo en cuenta la biocompatibilidad de los mismos con respecto a los tejidos duros y blandos, el comportamiento mecánico y los criterios estéticos. Los hallazgos más destacados en esta revisión fueron los siguientes: En cuanto a la biocompatibilidad, no existe evidencia de que los pilares de titanio tengan mayor capacidad de mantener una estabilidad de los tejidos peri-implantarios al compararlo con la alúmina o el zirconio. En relación a la estética, se ha comprobado que en espesores de 2 mm o menos, los pilares metálicos pueden dar lugar a un aparente cambio de color de la mucosa peri-implantaria. Desde un punto de vista mecánico, las tasas de supervivencia a 5 años, así como la incidencia de complicaciones parecen ser similares tanto en pilares metálicos como cerámicos, sin embargo, el refuerzo basal del zirconio con titanio contribuye al aumento de la resistencia. La incorporación de conceptos como el "platform switching" y "one abutment, one time" ofrecen ventajas tanto a nivel estético como mecánico

The diversity of contemporary materials and methods available for the fabrication of implant-supported restorations make the selection of the most adequate treatment modality difficult. New products are continually being developed that are incorporated to the wide range of existing alternatives. Metallic abutments used to be considered a necessary condition for the longevity of the implanted prosthesis. however, the ceramic abutments offer us undeniable clinical advantages. The purpose of this work is to establish a protocol for selecting the ideal abutment, taking into account its biocompatibility with respect to the hard and soft tissues, the mechanical performance and the aesthetic criteria. The most outstanding findings in this review were the following: As regard biocompatibility, there is no evidence that the titanium abutments have greater capacity of maintaining stability of the peri-implant tissue when compared to aluminium or zirconium. In relation to aesthetics, it was verified that in thicknesses of 2 mm or less, the metallic abutments may lead to an apparent change of colour of the peri-implant mucosa. From the mechanical point of view, the survival rates at five years, as well as the incidence of complications seem to be similar in metallic and ceramic abutments; however, the basal reinforcement of the zirconium with titanium contributes to increasing resistance

Accuracy combining different brands of implants and abutments

Objective: To evaluate the vertical misfit between different brands of dental implants and prosthetic abutments, with or without mechanical torque, and to study their possible combination. Study design: Five different brands of implant were used in the study: Biofit (Castemaggiore, Italy), Bioner S.A.(Barcelona, Spain), 3i Biomet (Palm Beach, U.S.A.), BTI (Alava, Spain) and Nobel Biocare (Göteborg, Sweden), with standard 4.1 mm heads and external hexagons, and their respective machined prosthetic abutments. The implant-toabutmentfit/misfit was evaluated at four points (vestibular, lingual/palatine, mesial and distal) between implants and abutments of the same brand and different brands, with or without mechanical torque, using SEM micrographs at5000X. Image analysis was performed using NIS-Elements software (Nikon Instruments Europe B.V.).Results: Before applying torque, vertical misfit (microgaps) of the different combinations tested varied between1.6 and 5.4 microns and after applying torque, between 0.9 and 5.9 microns, an overall average of 3.46±2.96microns. For manual assembly without the use of mechanical torque, the best results were obtained with the combination of the 3i implant and the BTI abutment. The Nobel implant and Nobel abutment, 3i-3i and BTI-BTI and the combination of 3i implant with BTI or Nobel abutment provided the best vertical fit when mechanical torque was applied. Conclusions: The vertical fits obtained were within the limits considered clinically acceptable. The application of mechanical torque improved outcomes. There is compatibility between implants and abutments of different brand and so their combination is a clinical possibility (AU)

Mechanical resistance of zirconium implant abutments: A review of the literature

The increase of aesthetic demands, together with the successful outcome of current implants, has renewed interestin the search for new materials with enough mechanical properties and better aesthetic qualities than the materials customarily used in implanto-prosthetic rehabilitation. Among these materials, zirconium has been used indifferent types of implants, including prosthetic abutments. The aim of the present review is to analyse current scientific evidence supporting the use of this material for the above mentioned purposes. We carried out the review of the literature published in the last ten years (2000 through 2010) of in vitro trials of dynamic and static loading of zirconium abutments found in the databases of Medline and Cochrane using the keywords zirconium abutment, fracture resistance, fracture strength, cyclic loading. Although we have found a wide variability of values among the different studies, abutments show favourable clinical behaviour for the rehabilitation of single implants in the anterior area. Such variability may be explained by the difficulty to simulate daily mastication under in vitro conditions. The clinical evidence, as found in our study, does not recommend the use of implanto-prosthetic zirconium abutments in the molar area (AU)

Zirconia implant abutments: A review

Objectives: An increasing aesthetic demand within developed populations conducted to the fabrication of metalfree restorations and to a wide use of ceramic materials, due to its excellent characteristics of biocompatibility and aesthetics. With the incessant increase of commercial labels involved in this technological advance, a review is imposed on ceramic abutments, specifically on zirconia. We made a search of articles of peer-reviewed Journalsin PubMed/ Medline, crossing the terms “Dental Abutments”, “Dental Porcelain” and “Zirconia”. The review was divided by subtopics: zirconia physical and mechanical properties, precision fit in the implant-abutment interface,zirconia abutments strength and, finally, bacterial adherence and tissues response. Several studies demonstratethat zirconia abutments offer good results at all the levels but relevant issues need further studies and evaluation.One of the most important is the clinical long term success of zirconia abutments on implants, given that in the literature there are no sufficient in vivo studies that prove it (AU)

CAD / CAM dental systems in implant dentistry: Update

CAD/CAM systems (computer-aided design / computer aided manufacturing) used for decades in restorative dentistry have expanded its application to implant dentistry. This study aimed to look through CAD/CAM systems used in implant dentistry, especially emphasizing implant abutments and surgical templates manufacturing. A search of articles published in English at Medline and Scopus databases at present was conducted, introducing “dental CAD/CAM”, “implants abutments” and “surgical guide CAD/CAM” as key words. These systems consist of three components: 1) data capture using optical systems or laser scanning, 2) CAD for the design of the restoration, and 3) CAM to produce the restoration through the information generated by computer. CAD/CAM abutments present the advantages of being specific to each patient and providing a better fit than the rest of abutments, in addition to being much more tough as they employ materials such as titanium, alumina and zirconium. In order to improve accuracy during implant placement we use stereolithography to manufacture CAD/CAM surgical templates. Using this method, minimally invasive surgery is performed without a flap, and the prosthesis is delivered, achieving immediate functional loading to the implants (AU)

Estudio de la microfiltración en tres sistemas diferentes de elementos sobre implantes / No disponible

Los objetivos de este estudio in vitro son evaluar la presencia de gapsy microfiltración entre pilar e implante en un pilar cementado, pilar mecanizado, pilar colado en titanio, pilar colado en oro y pilar colado con conexión amortiguada, todos ellos excepto el primero, atornillados. Para ello se analizaron al microscopio electrónico, posteriormente se termociclaron y se realizó un análisis de filtración de fluidos. Los pilares cementados no fue posible valorar el gap, en los mecanizados el gap fue inexistente, en los colados en titanio fue de39.26 micras de media, en los colados en oro fue de 9.85 micras, en los colados en titanio amortiguados fue de 22.8 micras. Los pilares cementados, los mecanizados y los colados en titanio amortiguados no mostraron filtración, mientras que los pilares colados en titanio yen oro mostraron filtración de fluidos (AU)

The purpose of this in vitro study is to quantify the gap and microleakage in implants with trasmucosal collar and cemented bolt abutment, implants with screw retained prosthesis with mechanized abutment, implants with screw retained prostheses with abutment casted in titanium, implants with screw retained prostheses with abutment casted in gold and implants with transmucosal collar, resino'ring and titanium casted abutment will be used. All implants were analysed under a scanning electron, later we thermocycled its and evaluate fluid filtration. In mechanised abutments a mean of 0micron gap, in titanium casted abutments a mean of 39 micron gap,in gold casted abutment a mean of 22 micron gap, in casted abutment with o'ring a mean of 9 micron gap, and in cemented abutments the gap was completely filled with cement. Mechanised, cemented abutments and casted abutments with resin o'ring offer better results relating to abutment-implant interface sealing (AU)

Estética de los tejidos blandos periimplantarios / Periimplant soft tissues and aesthetics

Hoy en día, la terapia restauradora mediante implantes dentales constituye un procedimiento más que aceptado por parte de los clínicos. La preocupación de los mismos, por alcanzar la osteointegración y funcionalidad de las restauraciones implantosoportadas, ha dado paso a una nueva etapa, en la cual los pacientes demandan rehabilitaciones que no sólo les devuelvan la función, sino que también sean estéticamente adecuadas. Para lograr estos objetivos cuando realizamos un tratamiento implantológico, debemos tener en cuenta, no solo la forma que van a tener nuestras restauraciones sino también la importancia que tiene el manejo de los tejidos blandos periimplantarios.En este trabajo se describen los conceptos principales de la biología de los tejidos blandos, tanto periodontales como periimplantarios, cuyo conocimiento es imprescindible para una buena manipulación de los mismos. Por otra parte, se enumeran los principios fundamentales para lograr un emplazamiento periimplantario estético (posición de los implantes, importancia de la forma de las restauraciones, aspectos periodontales a tener en cuenta,...). Por último se repasan las técnicas, tanto quirúrgicas como no quirúrgicas, aconsejadas para restaurar la anatomía gingival perdida (AU)

Nowadays, implant therapy has become accepted in dental practice. The clinician’s concerns in terms of osseointegration and function in implant rehabilitation has turned into a new stage in which the patient who decides to undergo implant treatment wants not only a functional prosthesis but also an aesthetically one. To achieve this we have to take into account not only prosthesis of exacting shape and shade but also a dedicated periimplant soft tissue manipulation. This article describes the principal considerations in term of soft tissues biologic, whether periodontal or periiimplant soft tissues. On the other hand, the principles to achieve an aesthetic periimplant location are enumerated (implants placement, restorations shape, periodontal aspects to bear in mind…). Finally, advised surgical and not surgical techniques to restore the lost gingival architecture are revised (AU)