Effect of toothbrushing with conventional and whitening dentifrices on monolithic zirconia after finishing procedures.

PURPOSE: To evaluate the effect of toothbrushing with conventional and whitening dentifrices on the color difference (ΔE00), gloss (Δgloss), and surface roughness (SR) of stained stabilized zirconia with 5 mol% of yttrium oxide (5Y-TZP) after polishing or glazing. METHODS: Specimens were divided into four groups (n=20): C (control), S (staining), SG (staining and glazing) and SP (staining and polishing). 50,000 toothbrushing cycles were performed with conventional (n=10) and whitening (n= 10) dentifrice slurries. The ΔE00 and Δgloss were measured using a spectrophotometer and CIEDE2000 system while SR was measured by laser confocal microscope. The ΔE00 and Δgloss data were analyzed using 2-way ANOVA, and SR data were analyzed using the linear repeated measures model, with Bonferroni's complementary test (α= 0.05). RESULTS: The ΔE00 values were beyond the acceptability threshold and no differences were found among the groups. There was no difference among groups to Δgloss after toothbrushing with conventional dentifrice while SP presented the highest values of Δgloss after toothbrushing with whitening dentifrice. Conventional dentifrice decreased the SR of stained groups and whitening dentifrice decreased SR of S and SG. The toothbrushing with conventional and whitening dentifrices promoted color difference, but did not impair gloss and surface roughness of stained 5Y-TZP. CLINICAL SIGNIFICANCE: Monolithic zirconia has been routinely used for esthetic restorations, however the type of finishing procedures that is carried out on it must be taken into consideration, in addition to the fact that brushing can influence the color difference of the material as well as interfere with surface roughness and gloss.

Effect of different grinding protocols on surface characteristics and fatigue behavior of yttria-stabilized zirconia polycrystalline: An in vitro study.

STATEMENT OF PROBLEM: Zirconia frameworks milled by computer-aided design and computer-aided manufacturing (CAD-CAM) often require clinical adjustments. In addition, zirconia prefabricated abutments can also require customization to achieve an adequate emergence profile. However, the influence of grinding adjustment on the surface characteristics and mechanical behavior of yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) and the best grinding protocol is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of different grinding protocols on the surface characteristics, phase transformation, and mechanical behavior of Y-TZP for frameworks and implant abutments. MATERIAL AND METHODS: Bar-shaped specimens were fabricated according to ISO 6872-2016 and divided into 3 groups: GC (control, untreated), GA (grinding and finishing with medium and fine diamond rotary instruments using high-speed handpiece under constant water cooling), and GB (grinding and finishing with coarse and medium diamond rotary instruments, respectively, using slow-speed handpiece without water cooling). After specimen grinding, the topography and surface roughness were evaluated by using a laser confocal microscope, the Young modulus was measured by the impulse excitation technique, and crystallographic phase transformation was analyzed by X-ray diffraction. Specimens were then submitted to step-stress accelerated life testing (n=18). The surface roughness and Young modulus results were analyzed by 1-way ANOVA and the Tukey honestly significant difference test (α=.05). The data of step-stress accelerated life testing were analyzed by the survival probability considering the number of cycles and force until fracture. RESULTS: Statistically significant differences were found among groups considering surface roughness (GA>GB>GC) (P<.05) and Young modulus (GB>GA=GC) (P=.003). X-ray diffraction showed that grinding leads to phase transformation, GC showed only tetragonal phase, while GA and GB showed tetragonal and monoclinic phases. No statistically significant difference (P<.05) was found among groups submitted to the same loading profile when the survival probability was compared, but significant difference was found between the light and moderate loading (P=.002) and light and severe loading (P=.014) of GB when different loading profiles in each group were compared. CONCLUSIONS: Although grinding protocols affected surface characteristics and promoted phase transformation, the mechanical behavior of Y-TZP was not impaired. Therefore, both the grinding protocols tested can be safely used based on the evaluated properties.

A 3-year longitudinal prospective study assessing microbial profile and clinical outcomes of single-unit cement-retained implant restorations: Zirconia versus titanium abutments.

PURPOSE: The aim of this study was to assess the microbiological and clinical outcomes of implant-supported restorations on zirconia or titanium abutments after 3 years in function. MATERIALS AND METHODS: Twenty two-part dental implants were placed in 20 healthy individuals in need of single-tooth replacement. Ceramic-based reconstructions were cemented in either zirconia or titanium abutments. Clinical, radiographic, and microbiological outcomes were examined at implant loading and then yearly up to 3 years post-loading. RESULTS: Cumulative survival/success implant rates were 95% after 3 years. Mean total marginal bone loss was 0.76 ± 0.21 mm for zirconia and 0.99 ± 0.41 mm for titanium, with no significant differences (P > .05). Overall, titanium and zirconia abutments presented similar values of probing depth, gingival recession, and bleeding on probing over time (P < .05). Microbial profile of implants restored with titanium or zirconia is quite similar to that found in the remaining teeth. CONCLUSIONS: Zirconia and titanium presented different microbial profile and genome counts. Clinical findings for both zirconia and titanium abutments were similar and consistent with a healthy condition, reflecting a high survival rate and low bone loss. Microbiota did not impact the clinical outcomes after 3 years of function.

A Digital Image Correlation Analysis of Strain Generated by 3-Unit Implant-Supported Fixed Dental Prosthesis: An In Vitro Study.

OBJECTIVE: To evaluate the influence of different veneering materials (porcelain and resin) and implants (short and conventional) in the strain distribution of implant-supported splinted fixed partial dentures (FPDs) using digital image correlation (DIC). MATERIAL AND METHODS: Four polyurethane models were fabricated with resin replicas (first premolar) and short and/or conventional implants replacing the second premolar and first and second molars, according to the following configurations: G1, 2 conventional (second premolar and first molar) and 1 short (second molar) implant; G2, 1 conventional (second premolar) and 2 short (first and second molar) implants; G3, 3 short implants; G4, 3 conventional implants. Porcelain- and resin-veneered splinted FPDs were screwed to the implant abutments. The DIC system was used to calculate strains during application of occlusal load (250 N). RESULTS: Porcelain- and resin-veneered showed similar strain distribution for all groups (P > 0.05). Concentration of compressive strains was higher in G3P and G3R with maximum compressive strains of -1271.50 and -1026.88 µs, respectively. G4 transferred the best strain distribution (porcelain, -275.14 µs; resin, -254.44 µs), followed by G2 (porcelain, -306.79 µs; resin, -310.63 µs). CONCLUSION: The veneering material used did not influence the strain distribution. In addition, conventional implants generate less strain concentration, although the combination of 2 short and 1 conventional implant seems to be a viable plan.

Photoelastic comparison of as-cast and laser-welded implant frameworks.

STATEMENT OF PROBLEM: A misfit between the implant and metal framework can produce biomechanical problems. PURPOSE: The purpose of this in vitro study was to evaluate the vertical misfit, passivity, and biomechanical behavior of a prosthetic protocol-shaped I-beam framework, varying the number and inclination of implants before and after laser welding. MATERIAL AND METHODS: Two metal models with 4 or 5 implants were used. The I-beam framework for 4 or 5 implants was fabricated with cobalt-chromium alloy. The vertical misfit and passivity were evaluated with a stereomicroscope at ×80 magnification, with frameworks screwed into the respective model. The biomechanical behavior was analyzed with photoelastic studies. These analyses were performed before and after welding to observe the influence of the laser welding. RESULTS: The misfit was not significantly different among the groups studied; laser welding did not influence the vertical misfit. However, when the groups were compared for passivity, the 5 implants before welding group were statistically different (P=.025). CONCLUSIONS: Laser welding generated more passivity, less vertical misfit, and favorable stress distribution to the I-beam framework supported by 4 implants. To the I-beam framework supported by 5 implants laser welding did not influence the misfit or stress distribution, but there was an improvement in passivity.

Experimental titanium alloys for dental applications.

STATEMENT OF PROBLEM: Although the use of titanium has increased, casting difficulties limit routine use. PURPOSE: The purpose of the present study was to compare the mechanical properties and biocompatibility of the experimental titanium alloys titanium-5-zirconium, titanium-5-tantalum, and titanium-5-tantalum-5-zirconium (in wt%) with those of commercially pure titanium. MATERIAL AND METHODS: Specimens of titanium alloys and commercially pure titanium were cast by using plasma. Their modulus of elasticity and ultimate tensile strength were determined in a universal testing machine. Biocompatibility was evaluated with SCC9 cells. In periods of 1, 4, 7, 10, and 14 days, cell proliferation was evaluated by the (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) tetrazolium reduction assay, and cell viability was evaluated in the 7-day period. Cell morphology was evaluated at 2, 12, and 24 hours. Modulus of elasticity, ultimate tensile strength, and cell viability were analyzed by 1-way ANOVA and the Bonferroni test; cell proliferation data were compared by 2-way ANOVA (alloy versus time) and by the Bonferroni test; and the cell morphology data were analyzed by split-plot design. All statistical tests were performed at the 95% confidence level (P<.05). RESULTS: Titanium-5-tantalum presented the lowest modulus of elasticity and ultimate tensile strength, whereas titanium-5-zirconium and titanium-5-tantalum-5-zirconium were statistically similar to commercially pure titanium. Cell proliferation and viability were not affected by any alloy being similar to those observed for commercially pure titanium. No noticeably differences were found in the morphology of cells cultured on any alloy and commercially pure titanium. CONCLUSION: Experimental alloys, especially titanium-5-zirconium and titanium-5-tantalum-5-zirconium, presented promising mechanical results for future studies and clinical applications. In addition, these alloys, evaluated by cell proliferation, viability, and morphology, were found to be biocompatible in vitro.

Effect of surface treatment on the bond strength between yttria partially stabilized zirconia ceramics and resin cement.

STATEMENT OF PROBLEM: No consensus has been reached on the best bonding protocol between a zirconia ceramic surface and the tooth structure. PURPOSE: The purpose of this study was to evaluate the extrusion shear strength between yttria partially stabilized zirconia ceramics and resin cement (Panavia F) after different surface treatments. MATERIAL AND METHODS: The surface treatments evaluated (n=7) included the following: G1-control group (no surface treatment); G2-treated with MDP primer (Alloy Primer); G3-treated with 40% hydrofluoric acid (210 seconds); and G4-treated with 40% hydrofluoric acid (210 seconds) followed by MDP primer. The specimens were bonded to 2.5-mm-thick disks of bovine root dentin, and the extrusion shear tests were performed after they had been stored for 24 hours in distilled water at 37°C. The surface modifications were assessed on 2 specimens that were selected from each group by scanning electron microscopy. Data were analyzed with 1-way ANOVA and the Tukey-Kramer honestly significant difference test (α=.05). RESULTS: G4 (mean 2.84, standard deviation [SD] 0.43 MPa) presented significantly higher (P<.001) extrusion shear strength when compared with the other groups in the study (G1: mean, 1.57; SD 0.28 MPa; G2: mean 1.46, SD 0.28 MPa; G4: mean 1.16, SD 0.41 MPa). No significant differences were found among the other groups in the study. CONCLUSIONS: Yttria partially stabilized zirconia ceramics can be treated with 40% hydrofluoric acid for 210 seconds to increase the bond strength with the resin cement.

Comparison of the correlation of photoelasticity and digital imaging to characterize the load transfer of implant-supported restorations.

STATEMENT OF PROBLEM: Whether splinting or not splinting adjacent implants together can optimize the stress/strain transfer to the supporting structures remains controversial. PURPOSE: The purpose of this study was to compare the photoelasticity and digital image correlation (DIC) in analyzing the stresses/strains transferred by an implant-supported prosthesis. MATERIAL AND METHODS: A polymethylmethacrylate model was made with a combination of acrylic resin replicas of a mandibular first premolar and second molar and threaded implants replacing the second premolar and first molar. Splinted (G1/G3) and nonsplinted (G2/G4) metal-ceramic screw-retained crowns were loaded with (G1/G2) and without (G3/G4) the presence of the second molar. Vertical static loads were applied to the first molar implant-supported crown (50 N-photoelasticity; 250 N-DIC). The resulting isochromatic fringes in the photoelastic models were photographed, and a single-camera 2-dimensional DIC system recorded the deformation at the surface of the resin models. RESULTS: Residual stresses were present in the photoelastic model after screw fixation of the crowns. The following average photoelastic stress results (MPa) were found around the loaded implant: G1 (20.06), G2 (23.49), G3 (30.86), G4 (37.64). Horizontal strains (εxx, %) between the molars averaged over the length of the loaded implant were found by DIC: G1 (0.08 ± 0.09), G2 (0.13 ± 0.10), G3 (0.13 ± 0.11), G4 (0.16 ± 0.11). Splinted crowns transferred lower stresses to the supporting bone when the second molar was absent. The second molar optimized the stress distribution between the supporting structures even for nonsplinted restorations. CONCLUSIONS: Both methods presented similar results and seemed capable of indicating where issues associated with stress/strain concentrations might arise. However, DIC, while apparently less sensitive than photoelasticity, is not restricted to the use of light-polarizing materials.

The use of a mandibular repositioning device for obstructive sleep apnea.

The objective of this study was to verify the effect of a mandibular repositioning device (MRD) on polysomnographic parameters and on the mean electromyographic activity of the masseter and temporal muscles in individuals with obstructive sleep apnea syndrome (OSAS). This is a prospective cohort study conducted at multidisciplinary OSAS center in a tertiary referral center. Nineteen individuals with mild or moderate OSAS associated with Mallampati 3-4 were treated with an MRD during sleep. The subjects underwent diurnal electromyography (EM) and nocturnal polysomnography (PSG) examinations both prior and after initial treatment (3 months with MRD for PSG and 6 and 12 months of treatment for EM). The examinations performed at different times were compared. Comparison of the initial and final polysomnography examination revealed a significant mean reduction of apnea-hypopnea index (AHI) from 13.8 to 7.8. The successful treatment rate with the MRD was 52.6%, and the improved treatment rate was 68.4%. Patients with lower pre-treatment AHI presented higher rates of cure. There was no statistically significant change in electromyography examination among different times. The MRD reduced the apnea-hypopnea index in individuals with enlarged base of tongue and mild and moderate OSAS without damaging the function of the masseter and temporal muscles as determined by electromyography.

Screw loosening of different UCLA-type abutments after mechanical cycling

AIM: To evaluate the loss of applied torque (detorque) values in cast and pre-machined abutments for external hex abutment/implant interface of single implant-supported prostheses subjected to mechanical cycling. METHODS: Ten metal crowns were fabricated using two types of UCLA abutments: cast and pre-machined with metal base in NiCrTi alloy and tightened to regular external hex implants with a titanium alloy screw, with an insertion torque of 32 N.cm, measured with a digital torque gauge. Samples were embedded with autopolymerizing acrylic resin in a stainless steel cylindrical matrix, and positioned in an electromechanical machine. Dynamic oblique loading of 120 N was applied during 5 x 10(5) cycles. Then, each sample was removed from the resin and detorque values were measured using the same digital torque gauge. The difference of the initial (torque) and final (detorque) measurement was registered and the results were expressed as percentage of initial torque. The results of torque loss were expressed as percentage of the initial torque and subjected to statistical analysis by the Student's t-test (p<0.05) for comparisons between the test groups. RESULTS: Statistical analysis demonstrated that mechanical cycling reduced the torque of abutments without significant difference between cast or pre-machined UCLA abutments (p=0.908). CONCLUSIONS: Within the limitations of this in vitro study, it may be concluded that the mechanical cycling, corresponding to one-year use, reduced the torque of the samples regardless if cast or pre-machined UCLA abutments were used.

Validation of finite element models for strain analysis of implant-supported prostheses using digital image correlation.

OBJECTIVES: A validated numerical model for stress/strain predictions is essential in understanding the biomechanical behavior of implant-supported dental prostheses. The digital image correlation (DIC) method for full-field strain measurement was compared with finite element analysis (FEA) in assessing bone strain induced by implants. METHODS: An epoxy resin model simulating the lower arch was made for the experimental test with acrylic resin replicas of the first premolar and second molar and threaded implants replacing the second premolar and first molar. Splinted (G1/G3) and non-splinted (G2/G4) metal-ceramic screw-retained crowns were fabricated and loaded with (G1/G2) or without (G3/G4) the second molar that provided proximal contact. A single-camera, two-dimensional DIC system was used to record deformation of the resin model surface under a load of 250N. Three-dimensional finite element (FE) models were constructed for the physical models using computer-aided design (CAD) software. Surface strains were used for comparison between the two methods, while internal strains at the implant/resin block interface were calculated using FEA. RESULTS: Both methods found similar strain distributions over the simulant bone block surface, which indicated possible benefits of having splinted crowns and proximal contact in reducing bone strains. Internal strains predicted by FEA at the implant-resin interface were 8 times higher than those on the surface of the model, and they confirmed the results deduced from the surface strains. FEA gave higher strain values than experiments, probably due to incorrect material properties being used. SIGNIFICANCE: DIC is a useful tool for validating FE models used for the biomechanical analysis of dental prosthesis.

Abutment rotational freedom evaluation of external hexagon single-implant restorations after mechanical cycling.

PURPOSE: The purpose of this study was to evaluate the rotational freedom between implant and abutment counterpart of two abutments types over external hexagon implants submitted to mechanical cycling. MATERIALS AND METHODS: Ten implants with external hexagon (3.75 mm × 13 mm), five cast abutments, and five premachined abutments both with 4.1 mm plataform size were used in this study. Ten metallic crowns were fabricated using the two types of abutments and were fixed to each implant using titanium screws (Ti6Al4V). Rotational freedom measurements were made before and after the cast procedure and after the mechanical cycling. Groups were classified according to the rotational misfit register using University of California, Los Angeles abutment and implants as new (group 1 = G1); using crowns and implants after crown casting (group 2 = G2); and using crowns and implants after mechanical cycling (group 3 = G3). Oblique loading of 120N at 1.8 Hz and 5 × 10(5) cycles was applied on specimen. RESULTS: Statistical analysis (p < .05) showed that no significant difference was observed when cast abutment was compared with premachined abutment after casting (p = .390) and mechanical cycling (p = .439); however, significant difference was noted before the casting (p = .005) with higher values for the cast abutments. CONCLUSIONS: Within the limitations of this in vitro study, it could be concluded that the abutment type used do not influenced the rotational freedom after casting and the amount of applied cycles (500,000 cycles) was not sufficient to significantly alter the values of rotational freedom at the implant/abutment joint.

Digital image correlation analysis of the load transfer by implant-supported restorations.

This study compared splinted and non-splinted implant-supported prosthesis with and without a distal proximal contact using a digital image correlation method. An epoxy resin model was made with acrylic resin replicas of a mandibular first premolar and second molar and with threaded implants replacing the second premolar and first molar. Splinted and non-splinted metal-ceramic screw-retained crowns were fabricated and loaded with and without the presence of the second molar. A single-camera measuring system was used to record the in-plane deformation on the model surface at a frequency of 1.0Hz under a load from 0 to 250N. The images were then analyzed with specialist software to determine the direct (horizontal) and shear strains along the model. Not splinting the crowns resulted in higher stress transfer to the supporting implants when the second molar replica was absent. The presence of a second molar and an effective interproximal contact contributed to lower stress transfer to the supporting structures even for non-splinted restorations. Shear strains were higher in the region between the molars when the second molar was absent, regardless of splinting. The opposite was found for the region between the implants, which had higher shear strain values when the second molar was present. When an effective distal contact is absent, non-splinted implant-supported restorations introduce higher direct strains to the supporting structures under loading. Shear strains appear to be dependent also on the region within the model, with different regions showing different trends in strain changes in the absence of an effective distal contact.

In vitro cytotoxicity of dental alloys and cpTi obtained by casting.

BACKGROUND: This study aimed to compare the cytotoxicity of base-metal dental alloys and to evaluate if the casting method could influence their cytotoxicity. METHODS: Disks of base-metal dental alloys were cast by two methods: plasma, under argon atmosphere, injected by vacuum-pressure; and oxygen-gas flame, injected by centrifugation, except Ti-6Al-4V and commercially pure titanium (cpTi), cast only by plasma. SCC9 cells were cultured in culture media D-MEM/Ham's F12 supplemented, at 37 degrees C in a humidified atmosphere of 5% carbon dioxide and 95% air, on the previously prepared disks. At subconfluence in wells without disks (control), cell number and viability were evaluated. RESULTS: In plasma method, cpTi and Ti-6Al-4V were similar to control and presented higher number of cells than all other alloys, followed by Ni-Cr. In oxygen-gas flame method, all alloys presented fewer cells than control. Ni-Cr presented more cells than any other alloy, followed by Co-Cr-Mo-W which presented more cells than Ni-Cr-Ti, Co-Cr-Mo, and Ni-Cr-Be. There were no significant differences between casting methods related to cell number. Cell viability was not affected by either chemical composition or casting methods. CONCLUSION: cpTi and Ti-6Al-4V were not cytotoxic while Ni-Cr-Be was the most cytotoxic among tested alloys. The casting method did not affect cytotoxicity of the alloys.

Influence of the interimplant distance on crestal bone resorption and bone density: a histomorphometric study in dogs.

BACKGROUND: The position of gingival soft tissues depends on the position and health of the underlying alveolar bone. The aim of this study was to evaluate the influence of different interimplant distances on crestal bone resorption after prosthetic restoration with a 5-mm distance between the contact point and the bone crest. METHODS: The mandibular bilateral premolars of six dogs were extracted and, after 12 weeks, each dog received eight implants, totaling 48 implants in the experiment. Two pairs, one in each hemiarch, were separated by 2 mm (group 1) and two by 3 mm (group 2). After 12 weeks, the implants received temporary acrylic prostheses. After 4 more weeks, metallic crowns substituted the temporary prostheses. After 4 more weeks, the animals were sacrificed, and their hemimandibles were removed, dissected, and processed. RESULTS: For groups 1 and 2, respectively, the mean of interimplant bone resorption (IIBR) analyzed histologically was 2.03 and 1.98 mm (P >or=0.05), and the mean of the distal extension bone resorption was 2.04 and 1.92 mm for groups 1 and 2, respectively (P >or=0.05). The crestal bone resorption between the implants was 0.13 mm (P >or=0.05) for both groups. The mean of IIBD for groups 1 and 2 was 79% and 80%, respectively. When the IIBD was compared to the distal extension bone density for group 1 (79% and 64%) and group 2 (80% and 62%), statistically significant differences were obtained for both groups (P