Patient-reported outcome measures (PROMs) and maintenance events in 2-implant-supported mandibular overdenture patients: A 5-year prospective study.

OBJECTIVE: To prospectively evaluate patient-reported outcome measures (PROMs) and treatment outcomes of mandibular two-implant retained overdentures (IOD) in an edentulous geriatric cohort with history of deficient complete dentures (CD). MATERIALS AND METHODS: A total of 103 patients with deficient CD received new optimal CD. After a period of 3 months, 80 of the patients voluntarily received IOD. Outcomes collected at pre-, post-CD/post-IOD treatment annually up to 5 years, included (a) Clinical outcomes: denture-quality (Woelfel's index), complications, and maintenance events, (b) PROMs: patient complaints (maxillary, mandibular functional complaint scores, generic aesthetic complaint scores, frequency, and intensity of complaints) and patient satisfaction, and (c) Maintenance events: technical complications and adverse events. RESULTS: Five-year data were collected from 67 patients (mean age at initiation = 71.3 years, mean observation = 5.9 years) with cumulative implant survival rate = 98.72%. Multiple comparisons for 8 time points showed significant improvements in denture quality and PROMs after new CD and IOD delivery. Further significant improvements were only after IOD delivery in: mandibular denture-quality, mandibular and generic functional complaints, frequency, intensity of complaints, and overall patient satisfaction score. Thereafter, denture-quality and PROMs remained stable. Maintenance events clustered on 1st year and within a minority of patients. Technical complications and overall maintenance events significantly correlated with overall patient satisfaction score at 1st year. CONCLUSIONS: Mandibular IOD was a beneficial treatment option for seniors with history of deficient CD, improving denture-quality, patient satisfaction, and reducing patient complaints up to 5 years. Maintenance events clustered on 1st year, showing no significant impact on long-term patient satisfaction and other PROMs.

Effect of surface treatment on shear bond strength of zirconia to human dentin.

PURPOSE: The effect of surface treatment using tribochemical silica coating/silane coupling on the shear bond strengths of (1) a glass-infiltrated, zirconia-reinforced alumina (In-Ceram Zirconia) and (2) a yttria-stabilized zirconia ceramic (YZ Zirconia) to human dentin was studied. MATERIALS AND METHODS: Twelve specimens of each ceramic were randomly assigned to one of three surface treatments: (1) no surface treatment (control group); (2) a chairside tribochemical silica coating/silane coupling system (CoJet group); and (3) a laboratory tribochemical silica coating/silane coupling system (Rocatac group). The mode of failure of each specimen was determined under magnification. RESULTS: The shear bond strengths (mean ± SD) of In-Ceram Zirconia of the control, CoJet and Rocatec groups were 5.7 ± 4.3 MPa, 11.4 ± 5.4 MPa, and 6.5 ± 4.8 MPa, respectively. The corresponding figures for YZ Zirconia were 8.2 ± 5.4 MPa, 9.8 ± 5.4 MPa, and 7.8 ± 4.7 MPa. Two-way ANOVA revealed significant differences in bond strength due to the difference in surface treatment (p= 0.02), but the bond strengths between the two ceramics were not significantly different (p= 0.56). Post hoc tests showed that In-Ceram Zirconia treated with CoJet had significantly higher shear bond strengths than those untreated (p < 0.05) or treated with Rocatec (p < 0.05). Surface treatment did not affect the shear bond strength of YZ Zirconia significantly (p > 0.05). CONCLUSION: The bonding of In-Ceram Zirconia can be improved by the chairside surface treatment system.

Strain analysis of maxillary complete denture with three-dimensional finite element method.

STATEMENT OF PROBLEM: The fracture of maxillary complete dentures has been reported as the most common prosthesis failure. PURPOSE: The purpose of this study was to evaluate strain distribution in dentures during application of occlusal load with 3-dimensional (3-D) finite element analysis (FEA). MATERIAL AND METHODS: A maxillary complete denture was converted into a 3-D numerical model by an advanced topometric sensor digitizer (ATOS). The denture surfaces were scanned with fringes. Ten measurements were made for each scan of the denture in top, left, right, back, and front orientations by tilting the scanning table. The individual scans were merged by the digitizing software into a single image. A haptic device with a freeform system (PHANTOM) was used to create the mucosa in contact with the intaglio surface of the denture model. Supporting bone was then constructed from the mucosa model. The posterior teeth were loaded with an occlusal force of 230 N, and the basal bone was constrained for performing FEA. RESULTS: The highest tensile and compressive strains were found at the incisal and labial frenal notches, respectively. Strains on the intaglio surface of the denture were primarily compressive. The buccal flange exhibited tensile strains in the horizontal direction but compressive strains in the vertical direction. The labial flange showed compressive strains in both directions. The posterior border of the denture flexed away from the mucosa during occlusal loading. CONCLUSIONS: Three-dimensional FEA provided different views of strain distribution in the denture and indicated that denture failure was unlikely to occur at the shallow labial frenal notch because the strain is compressive. The high tensile strain concentration at the incisal notch is likely to be the cause of denture fracture during clinical service.

Shear bond strength between nickel-chromium and human dentine using a dual-cure, self-adhesive universal resin luting agent.

The adhesive property of a dual-cure, self-adhesive universal resin luting agent (Rely X Unicem, 3M ESPE) between nickel-chromium (Ni-Cr) and human dentine was compared with three conventional resin luting agents (Calibra, Dentsply; Panavia-F, Kuraray; All-bond 2 C & B cement, Bisco). Ten Ni-Cr rods were bonded to human dentine with each of the four luting agents, and were subjected to shear bond test. Results showed that there was no significant difference in shear bond strengths among the luting agents. A dual-cure, self-adhesive universal resin luting agent was shown to have comparable adhesive property between Ni-Cr and human dentine as three other conventional resin luting agents. Given the simplicity of use of the dual-cure, self-adhesive universal resin luting agent, it appears to be promising in clinical applications.

Accuracy of radiographic measurements for implant planning using cone-beam and helical computer tomography.

AIM: The aim of the present study was to compare the accuracy of radiographic measurements for dental implants planning using cone-beam computed tomography (CBCT) and helical computed tomography (HCT). METHODS: Six pig ribs were wrapped by putty impression material, with radiographic markers placed. Two CBCT and an HCT were taken following the standard protocols. Twenty-five locations were selected, with vertical and horizontal dimensions measured using the default software, as well as on the processed HCT films by a digital caliper. The actual dimensions of the ribs measured by the digital caliper served as the control. Differences between radiographic dimensions and the actual dimensions were tested by two-way analysis of variance. RESULTS: No differences were found between measurements made by CBCT and HCT images using the default software (P > 0.05). However, both measurements were statistically-significantly lower than the control (P < 0.001), and the mean difference was 0.3 mm. Measurements made on HCT films were statistically-significantly greater than the control (P < 0.001), and the mean difference was 0.5 mm. CONCLUSION: The accuracy of CBCT and HCT are similar, and both are reliable tools for implant planning. It is preferable to perform the planning using default software, rather than making direct measurements on films.

Identification of cultivable microorganisms from root canals with apical periodontitis following two-visit endodontic treatment with antibiotics/steroid or calcium hydroxide dressings.

The study was aimed at comparing the efficacy of disinfection of root canals with periapical radiolucencies when treated with either antibiotics/steroid medicaments (Ledermix or Septomixine) or a calcium hydroxide paste (Calasept). Microbiological samples were taken before and after two-visit endodontic treatment from 88 canals with apical periodontitis. All of the canals but one (87 of 88) had cultivable growth before treatment. After dressing with Ledermix, Septomixine, or Calasept, the percentages of canals remained with positive growth were 48% (13 of 27), 31% (8 of 26), and 31% (11 of 35), respectively. The chi(2) tests showed there were no significant differences in the number of canals with positive growth or mean colony forming units counts after instrumentation, irrigation and dressing. In the Ledermix group, 38 strains of bacteria were recovered. The Septomixine group had 25 strains, and the Calasept group had 25 strains. Gram-positive facultative anaerobic cocci (including staphylococci and streptococci) were more prevalent than the Gram-negative obligate anaerobic rods after treatment in all three groups. Similarities in the reduced number of canals with residual growth, and the prevalence of Gram-positive facultative anaerobic cocci suggest that the use of different inter-appointment dressings produced similar microbiological outcomes. However, factors other than the antimicrobial effectiveness of intracanal medicaments may also be responsible for the results observed.

Identification of cultivable microorganisms from primary endodontic infections with exposed and unexposed pulp space.

This study was aimed at comparing the cultivable microorganisms in canals with periapical radiolucencies with exposed and unexposed pulp space. Microbiological samples were taken and analyzed from 45 canals with exposed pulp space, and 43 canals with unexposed pulp space. The canal contents were analyzed by aerobic/anaerobic culture, and conventional identification techniques. There were 211 isolates of bacteria belonging to 28 genera and 55 species recovered from exposed canals. In the unexposed group, 185 isolates of bacteria were recovered, of which 54 species of 28 genera were identified. Among the four most common genera, Prevotella was significantly more common in the exposed group (51/211 in the exposed group versus 30/185 in the unexposed group) (p = 0.049), while there were no differences in prevalence of Actinomyces, Peptostreptococcus, and Campylobacter between two groups of canals. In addition, Fusobacterium nucleatum and Propionibacterium acne were significantly more common in the unexposed canals (p = 0.047 and p = 0.0051, respectively). Similarity in bacterial species in these two groups suggests that pulp space exposure may not be a significant factor in determining the type of bacteria present in infected canals.

Precision surgical template for implant placement: a new systematic approach.

The importance of a precise surgical template for implant placement cannot be overstated. The radiographic template carries both clinical and radiographic information for the planning of fixture angulation and location. This article describes a systematic approach to the fabrication of a dual-purpose radiographic surgical template. The simple steps result in the accurate transfer of radiographic information to the surgical template with no need for complex equipment or maneuvers. key words: dental implants, implant placement, radiographic template, surgical template

Rotational path of insertion for removable partial dentures with an anterior saddle.

The provision of removable partial dentures remains a viable treatment modality for many partially dentate patients. Replacing missing anterior teeth with a removable partial denture using a rotational path of insertion provides improved retention and appearance. The use of a rotational path of insertion also provides additional retention for a removable partial denture restoring combined anterior and posterior bounded saddles. Two case reports demonstrate the use of the rotational path of insertion for partial denture design.

Rehabilitating a patient with bruxism-associated tooth tissue loss: a literature review and case report.

Tooth tissue loss from bruxism has been demonstrated to be associated with various dental problems such as tooth sensitivity, excessive reduction of clinical crown height, and possible changes of occlusal relationship. A literature search revealed a number of treatment modalities, with an emphasis on prevention and rehabilitation with adhesive techniques. Rehabilitating a patient with bruxism-associated tooth tissue loss to an acceptable standard of oral health is clinically demanding and requires careful diagnosis and proper treatment planning. This article describes the management of excessive tooth tissue loss in a 43-year-old woman with a history of bruxism. The occlusal vertical dimension of the patient was re-established with the use of an acrylic maxillary occlusal splint, followed by resin composite build-up. Full-mouth oral rehabilitation ultimately involved constructing multiple porcelain veneers, adhesive gold onlays, ceramo-metal crowns, and fixed partial dentures.

Making porcelain veneers with the Procera AllCeram system: case studies.

Different laboratory techniques are available for making porcelain veneers, and each has its own advantages and limitations. This article describes how high-density alumina core constructed with Computer Assisted Design/Computer Assisted Manufacture (CAD/CAM) technology can be successfully used for making porcelain veneers. Different clinical conditions are also presented to illustrate the use of these bi-layer veneers.

Restorative management of the worn dentition: 4. Generalized toothwear.

This is the final paper of a four part series on the management of worn dentition. The factors affecting the selection of restorative techniques for generalized toothwear, such as pulpal vitality, jaw relationship and occlusal guidance are discussed. The practical steps of oral rehabilitation using fixed prostheses are illustrated with two clinical cases.

Restorative management of the worn dentition: 3. Localized posterior toothwear.

In the management of localized posterior occlusal toothwear, care must be taken not only in determining whether the worn teeth are restorable, but also the desirable occlusal scheme. Assessments of the periodontal, endodontic, and coronal tooth tissues, and the occlusal relationship are necessary for a comprehensive treatment plan for worn posterior teeth.

Restorative management of the worn dentition: I. Aetiology and diagnosis.

In this, the first of a four-part series on the restorative management of the worn dentition, the aetiological factors, diagnosis of toothwear and preventive measures are summarized. Later papers will deal with the management of localized anterior and posterior toothwear, the use of 'Dahl type' appliances as an effective means for the restorations and the various treatment options for the management of the dentition showing generalized wear. The series will discuss the relative merits of the treatment strategies, clinical techniques and dental materials for the restoration of health, function and aesthetics for the dentition.

Restorative management of the worn dentition: 2. Localized anterior toothwear.

This is the second paper in a four-part series detailing the relative merits of the treatment strategies, clinical techniques and dental materials for the restoration of health, function and aesthetics for the dentition. In this paper the management of wear in the anterior dentition is discussed, using three case studies as illustration.

Diagnostic performance of mandibular bone density measurements in assessing osteoporotic status.

PURPOSE: The study evaluated the diagnostic performance of computed tomography (CT) bone density measurements (in Hounsfield units [HU]) in assessing the osteoporotic status of edentulous subjects (21 men, 40 women) scheduled to receive mandibular implant-supported overdentures. MATERIALS AND METHODS: Density (in HU) of 61 left and 61 right mandibular canine sites was measured. Each subject was also subject to body bone mineral density measurements (dual-energy x-ray absorptiometry). Bone density T-score values of total hip, femoral neck, spine (L1 to L4), and total body were assessed. Pearson correlations were conducted between HU of each mandibular bone site and the subject's T-score values. Sensitivity/specificity and receiver operating characteristic curve analyses were used to assess the diagnostic performance of HU in detecting subjects who were, based on each of the four T-scores: (1) "not osteonormal", ie, with a T-score at or below -1.0; or (2) osteoporotic, ie, with a T-score at or below -2.5. RESULTS: HU measurements of mandibular bone sites were found to have modest but significant correlations with each bone density T-score value (total hip, femoral neck, spine, total body). CT mandibular site HU measurement has diagnostic value in detecting a "not osteonormal" condition when total hip, spine, or total body T-scores were used, but not when femoral neck T-score was used. CONCLUSIONS: Based on the limited sample size, optimal HU cutoff values of ~530, ~600, and ~640 HU for total hip, spine, or total body T-scores, respectively, were proposed. CT mandibular site HU measurement had diagnostic value in detecting osteoporosis when spine T-score was used but not when total hip, femoral neck, and total body T-scores were used. An optimal HU cutoff value of ~460 HU for spine T-score was proposed.

Correlation between dental implant insertion torque and mandibular alveolar bone density in osteopenic and osteoporotic subjects.

PURPOSE: Osteoporotic patients require particular attention during implant placement, and insertion torque (IT) has been established as a simple and noninvasive method to assess local bone quality and primary implant stability. This study aimed to test the hypothesis that IT was not significantly correlated with bone density, as assessed with computed tomography, in a group of osteopenic and osteoporotic patients. In addition, the hypothesis that IT was not significantly correlated with implant length was tested. MATERIALS AND METHODS: Fifty-three completely edentulous patients with compromised bone mineral density (osteoporotic or osteopenic) who required treatment with complete maxillary dentures and complete mandibular implantsupported overdentures participated in the study. Each patient received two screw-shaped self-tapping implants (Branemark Mark III TiUnite) at the mandibular canine regions. The IT of each implant during placement was recorded. The Pearson correlation between IT and implant site bone density (Hounsfield unit) obtained from presurgical computed tomographic scans was analyzed. The relationship between IT and implant length was also studied. RESULTS: IT was significantly correlated to implant site bone density but not to implant length. CONCLUSION: IT can be a viable and practical means to assess mandibular bone quality in patients with compromised general bone density.

Contrast ratios and masking ability of three types of ceramic veneers.

STATEMENT OF PROBLEM: Although ceramic veneers have been proven to be clinically successful in longevity studies, there is little information on the contrast ratios and masking ability of the available ceramic systems because dental laboratory technology and expensive experimental equipment are required for the investigation. Moreover, the complexity in understanding how to evaluate translucent ceramic materials may also explain why information in this area is limited. PURPOSE: The purpose of this study was to determine the contrast ratios and masking abilities of 3 types of all-ceramic veneers by measuring their luminance and color difference over white and black backgrounds. MATERIAL AND METHODS: Disk-shaped specimens (8-mm diameter x 0.7-mm thickness) of Shade A2 (Vita Lumin) of 3 types of all-ceramic systems: Procera (n=8), Empress 2 (n=8), and Vitadur Alpha (n=10) were fabricated. The luminance (as Y) and color (as CIE L*a*b*) of the specimens were measured with a colorimeter. The contrast ratio (CR=Yb/Yw), defined as the ratio of illuminance (Y) of the test material when it is placed on the black background (Yb) to the illuminance of the same material when it is placed over a white background (Yw), was determined. The masking ability of a specimen was evaluated by calculating the color difference (DeltaE) of the veneers over white and black backgrounds. Both CR and DeltaE* data were analyzed with 1-way ANOVA and the Tukey HSD test (alpha=.05). RESULTS: The mean contrast ratios (SD) of Procera, Empress 2, and Vitadur Alpha specimens were 0.50 (0.02), 0.46 (0.05), and 0.39 (0.02), respectively. CR values were significantly different among the 3 materials (P<.001). Procera veneers had a significantly higher CR compared to Empress 2 (P=.01) or Vitadur Alpha (P=.01), whereas the CR of Empress 2 was significantly higher than that of Vitadur Alpha (P=.046). Color difference (DeltaE*) (SD) of Procera, Empress 2, and Vitadur Alpha specimens over black and white backgrounds were 24.46 (1.03), 25.80 (1.03), and 31.08 (1.19), respectively. DeltaE* values were statistically different among the 3 materials (P<.001). Vitadur Alpha specimens had significantly higher DeltaE* when compared with Procera (P<.001) or Empress 2 (P<.001), whereas DeltaE* values between Procera and Empress 2 were not significantly different (P=.331). CONCLUSIONS: Vitadur Alpha had significantly lower contrast ratio and poorer masking ability compared to Procera or Empress 2. The clinical application of Vitadur Alpha as a veneer material over discolored teeth is cautioned. Although the contrast ratio of Procera was significantly higher than that of Empress 2, the masking abilities of these materials were not significantly different. The clinical application of these 2 ceramics as a veneer material may still be limited when applied over intense tooth discoloration because neither can fully mask the color of a black background.

Chemical solubility and flexural strength of zirconia-based ceramics.

PURPOSE: This study was undertaken to investigate the chemical solubility and flexural strengths of 3 zirconia-based dental ceramics: In-Ceram Zirconia (IZ), In-Ceram 2000 YZ CUBES (YZ Zirconia) (Vita Zahnfabrik), and Cercon (Dentsply). A pressable lithium disilicate-reinforced glass ceramic (IPS Empress 2, Ivoclar Vivadent) was used as a control. MATERIALS AND METHODS: Ten block specimens (12 x 6 x 4 mm) of each ceramic material were prepared for chemical solubility testing. Each specimen was refluxed in 4% acetic acid solution for 16 hours. The percentage loss of mass and the loss of mass per unit of surface area for each specimen were calculated. Ten bar-shaped (21 x 5 x 2 mm) and 10 disk-shaped (16 mm diameter, 1.2 mm thickness) specimens of each ceramic material were prepared and tested for uniaxial flexural strength (UFS) and biaxial flexural strength (BFS). X-ray diffraction analyses were conducted to determine the relative amount of the monoclinic phase of the as-sintered and fractured surfaces of the zirconia ceramics. RESULTS: There were no significant differences among the ceramics in chemical solubility by percentage mass or mass/surface area. For UFS, YZ Zirconia (899 +/- 109 MPa) > Cercon (458 +/- 95 MPa) IZ (409 +/- 60 MPa) > Empress 2 (252 +/- 36 MPa). For BFS, YZ Zirconia (1,107 +/- 116 MPa) > Cercon (927 +/- 146 MPa) > IZ (523 +/- 51 MPa) > Empress 2 (359 +/- 43 MPa). The fractured YZ Zirconia surface contained approximately 5 times as much monoclinic phase compared to that of its intact surface. The fractured IZ and Cercon surfaces contained approximately twice as much monoclinic phase compared to those of intact surfaces. CONCLUSION: The ceramics tested all satisfied the chemical solubility allowance required of core ceramic material (type I, Class 1 or type II, Class 1) according to the International Organization for Standardization 6872:1995(E) specifications on dental ceramic. The zirconia-based ceramics possessed significantly higher flexural strengths than the control lithium disilicate ceramic. Their clinical application appears sufficiently promising for long-term clinical studies to be undertaken.