Long-term clinical outcome of three-unit fixed-fixed posterior zirconia ceramic inlay-retained FDPs with a modified design.

OBJECTIVES: To assess the long-term clinical outcome of posterior inlay-retained fixed dental prostheses (IRFDPs) with a modified design made from zirconia ceramic. METHODS: In 30 patients thirty 3-unit IRFDPs were placed to replace 7 premolars (4 in the maxilla, 3 in the mandible), and 23 first molars (15 in the maxilla, 8 in the mandible). Preparations were accomplished in agreement with the general principles for ceramic inlay restorations and modified with a short retainer-wing bevel preparation within the enamel at the buccal and oral sides. The frameworks were milled from 3Y-TZP ceramic, and the pontics were veneered with feldspathic ceramic. All IRFDPs were bonded with a phosphate monomer containing luting resin after air-abrasion of the intaglio surfaces. The patients were recalled 6-12 months after placement, and then annually. Kaplan-Meier analysis was used to calculate the survival and complication rates of the IRFDPs. RESULTS: The mean observation time was 10.6 ± 1.5 years. The 10-year cumulative survival rate was 89% with 4 failures, two of them were due to deep secondary caries with loss of retention, one due to repeated debonding with enamel fractures, and one due to generalized progressive periodontitis. The most common complication was chipping of the veneering ceramic (20.1%). Eighteen IRFDPs were free of any type of complication up to 15.4 years, which corresponds to a 10-year cumulative success rate of 70.4%. CONCLUSION: The long-term clinical performance of modified IRFDPs made of veneered zirconia ceramics was favorable after 10 years, therefore, they represent a treatment alternative to replace posterior single missing teeth. CLINICAL SIGNIFICANCE: Zirconia-based IRFDPs fabricated in the modified design may represent a substance-preserving alternative to conventional posterior FDPs to replace posterior single missing teeth, particularly in cases where implants cannot be placed, and when the adjacent teeth already have small restorations or defects.

Resin-bonded attachments made of monolithic zirconia ceramic: a minimally invasive and esthetic treatment approach.

OBJECTIVE: The aim of this case report was to present a minimally invasive and esthetic treatment approach for the replacement of missing teeth removable partial dentures retained by zirconia ceramic resin-bonded attachments. METHOD AND MATERIALS: The resin-bonded attachments were digitally designed and milled using CAD/CAM technology from monolithic 3Y-TZP zirconia ceramic. The resin-bonded attachments had an optimized attachment design approved for zirconia ceramic. The preparation was based on general preparation guidelines for resin-bonded attachments and resin-bonded fixed dental prostheses (RBFDPs). After placement of rubber dam, the resin-bonded attachments were bonded with a phosphate monomer-containing luting resin. RESULTS: The presented resin-bonded attachment-retained removable partial denture was successful over 30 months of clinical observation without any complications. The patient was satisfied with the minimally invasive treatment procedure. CONCLUSION: Zirconia ceramic resin-bonded attachments fabricated with a special attachment design are an esthetic and minimally invasive treatment approach. However, clinical data on the long-term outcome of zirconia resin-bonded attachments are still needed. (Quintessence Int 2023;54:220-226; doi: 10.3290/j.qi.b3819523).

Forces charging the orbital floor after orbital trauma.

The objectives of this study were (i) to evaluate different fracture mechanisms for orbital floor fractures and (ii) to measure forces and displacement of intraorbital tissue after orbital traumata to predict the necessity of strength for reconstruction materials. Six fresh frozen human heads were used, and orbital floor defects in the right and left orbit were created by a direct impact of 3.0 J onto the globe and infraorbital rim, respectively. Orbital floor defect sizes and displacement were evaluated after a Le Fort I osteotomy. In addition, after reposition of the intraorbital tissue, forces and displacement were measured. The orbital floor defect sizes were 208.3 (SD, 33.4) mm(2) for globe impact and 221.8 (SD, 53.1) mm(2) for infraorbital impact. The intraorbital tissue displacement after the impact and before reposition was 5.6 (SD, 1.0) mm for globe impact and 2.8 (SD, 0.7) mm for infraorbital impact. After reposition, the displacement was 0.8 (SD, 0.5) mm and 1.1 (SD, 0.7) mm, respectively. The measured applied forces were 0.061 (SD, 0.014) N for globe impact and 0.066 (SD, 0.022) N for infraorbital impact. Different fracture-inductive mechanisms are not reflected by the pattern of the fracture. The forces needed after reposition are minimal (~0.07 N), which may explain the success of PDS foils [poly-(p-dioxanone)] and collagen membranes as reconstruction materials.

Sealing Behavior of a New Material Combination in Two-Part Dental Implant Systems: An In Vitro Examination.

PURPOSE: To test a newly introduced implant-abutment material combination against bacterial endotoxin leakage in a human whole blood assay. MATERIALS AND METHODS: Two dental implant systems with internal connections and the following material combinations at the implant-abutment interface (IAI) were used (implant material/abutment material): yttrium-stabilized tetragonal zirconium dioxide (Y-TZP)/polyetherketoneketone (PEKK), and titanium (Ti/Ti). Test implants were inoculated with lipopolysaccharide (LPS) and sealed and submerged in human whole blood. Untreated implants served as the control groups. Changes in gene expression levels of inflammatory markers indicating LPS leakage were assessed after 1, 8, and 24 hours using quantitative real-time polymerase chain reaction. RESULTS: In the Y-TZP/PEKK test group, a significant influence of the implant system (P < .001) on increases in gene expression indicating leakage were detected after 8 hours for TLR-4 and after 24 hours for interleukin 1-ß and nuclear factor kappa-light-chain-enhancer of activated B-cells (NF-κB), indicating microleakage of LPS at the IAI. In the Ti/Ti test group, differences in gene expression were found only for NF-κB after 8 hours. CONCLUSION: The internal hexalobe IAI of two-piece dental implants fabricated from Y-TZP and PEKK do not prevent LPS molecular microleakage.

Forces charging the orbital floor after fractures.

The objective of this study was first to establish a method to measure forces and displacement of the orbital content in defects of the orbital floor in truncated fresh and unfixed heads and second to characterize reconstruction materials with regard to punctuation strength and compression.Orbital floor defects (10 × 20 mm and 15 × 20 mm; 3 mm behind the orbital rim) were prepared after Le Fort I osteotomy. The values of force and displacement were recorded in 6 freshly frozen human heads. In addition, the punctuation strength of 2 reconstruction materials (polydioxanone [PDS] foil and collagen membrane) was evaluated using a Zwick Z010 TN1 universal testing machine. The forces of the orbital content (28.41 [SD, 1.6] g) applied to the defects of 10 × 20 mm and 15 × 20 mm with an intact periorbita were 0.04 (SD, 0.003) N (0.0002 MPa) and 0.07 (SD, 0.02) N (0.0002 MPa), respectively, and with a split periorbita were 0.06 (SD, 0.03) N (0.0003 MPa) and 0.08 (SD, 0.06) N (0.00026 MPa), respectively. The displacement values without reconstruction materials of the 10 × 20-mm and 15 × 20-mm defects were 0.94 (SD, 0.7) mm and 1.2 (SD, 0.5) mm, respectively. The PDS foil could withstand forces of 118.9 (SD, 14.1) N (0.375 MPa), and the collagen membrane could withstand forces of 44.5 (SD, 5.3) N (0.14 MPa). This is the first study to report forces charging the orbital floor. The presented results support the use of PDS foils and collagen membranes as reconstruction materials for orbital floor defects, at least in smaller and medium-sized fractures.

Single-cell adhesion of human osteoblasts on plasma-conditioned titanium implant surfaces in vitro.

OBJECTIVES: This study aimed to demonstrate the effect of treating titanium-implant surfaces with plasma from two different sources on wettability and initial single-cell adhesion of human osteoblasts and to investigate whether aging affects treatment outcomes. METHODS: Titanium disks with sandblasted and acid-etched (SLA) surfaces were treated with atmospheric pressure plasma (APP) and low-pressure plasma (LPP). For wetting behavior of the specimens after plasma treatment, the water contact angle was measured. The single-cell detachment force and amount of work of detachment of human osteoblasts were determined with single-cell force spectroscopy (SCFS). To evaluate the aging effect in APP-treated specimens, SCFS was conducted 10 and 60 min after treatment. RESULTS: Significantly higher hydrophilicity was observed in the APP and LPP treatment groups than in the control group, but no significant difference was observed between the APP and LPP groups. No significant difference in cell-detachment force or work of detachment was observed, and there were no significant differences according to the conditioning mechanisms and storage time. SIGNIFICANCE: Conditioning of the titanium surfaces with APP or LPP was not a significant influencing factor in the initial adhesion of the osteoblasts.

Fifteen-year outcome of three-unit fixed dental prostheses made from monolithic lithium disilicate ceramic.

OBJECTIVES: The purpose of this prospective study was to evaluate the clinical long-term outcome over 15 or more years of crown-retained fixed dental prostheses (FDPs) made from a lithium disilicate ceramic (IPS e.max Press, Ivoclar Vivadent AG). METHODS: Thirty-six three-unit FDPs replacing anterior (16%) and posterior (84%) teeth were inserted in 28 patients. Abutment teeth were prepared following a standardized protocol. The size of the proximal connector of the FDPs was 12 mm² (anterior) or 16 mm² (posterior). FDPs were cemented either conventionally with glass-ionomer cement (n = 19) or adhesively with composite resin (n = 17). The following parameters were evaluated at baseline, 6 months after cementation and then annually (at abutment and contralateral teeth): probing pocket depth, plaque index, bleeding on probing, and tooth vitality. RESULTS: Three FDPs were defined as drop-outs. The mean observation period of the remaining 33 FDPs was 167 months (range: 79-225 months). The survival rate (survival being defined as FDPs remaining in place either with or without complications) according to Kaplan-Meier was 48.6% after 15 years. The success rate (success being defined as free of complications and remaining unchanged) was 30.9% after 15 years. CONCLUSIONS: Fatigue and crack propagation caused by clinical aging in monolithic lithium disilicate ceramics seem to take considerable time, as shown by the presented survival and success rates after 15 years. Further long-term studies are necessary to evaluate the reliability of FDPs made from other all-ceramic materials over a period of 15 or more years.

Fifteen-year outcome of posterior all-ceramic inlay-retained fixed dental prostheses.

OBJECTIVES: To evaluate the long-term clinical outcome of inlay-retained fixed dental prostheses (IRFDPs) made from lithium-disilicate glass-ceramic. MATERIAL AND METHODS: Forty-five IRFDPs were placed in 42 patients (21 women, mean age 36.1 years and 21 men, mean age 42.0 years). The IRFDPs replaced 4 premolars and 19 first molars in the maxilla and 4 premolars and 18 first molars in the mandible. All teeth were prepared following a standardized protocol for ceramic inlay restorations. Five of the 45 FDPs were hybrid-retained restorations, i.e. one abutment tooth with an inlay retainer and one with a full crown retainer. All restorations were fabricated from heat-pressed lithium-disilicate ceramic (IPS e.max Press, Ivoclar Vivadent AG). The minimal size of the proximal connector was 16 mm2 (4 mm × 4 mm in height and width) with a minimum occlusal ceramic thickness of 1.5 mm. Hydrofluoric acid etching (5%) and silane application was used for conditioning the bonding surfaces. Standard adhesive luting techniques were performed using a dentin adhesive and a resin composite. Standardized follow-up reports were performed annually. The survival rates were performed using the Kaplan-Meier analysis. RESULTS: The mean observation period was 100 months (minimum 4, maximum 234 months). Thirty-three FDPs (73%) failed during the observation period and had to be replaced by other restorations. The Kaplan-Meier survival rate for IRFDPs was 57% after 5 years, 38% after 8 years and 22% after 15 years, while for hybrid-retained FDPs it was 100% after 5 years, 60% after 8 years and also 60% after 15 years. CONCLUSION: With the design used in the current, study lithium-disilicate ceramic IRFDP had a high clinical failure rate and cannot be recommended for regular clinical use.

In vitro proinflammatory gene expression changes in human whole blood after contact with plasma-treated implant surfaces.

BACKGROUND: The aim of this in vitro study was to identify changes in gene expression of proinflammatory cytokines in human whole blood after contact with titanium implant surfaces after plasma treatment. MATERIALS AND METHODS: Grade 4 titanium dental implants were conditioned with low-pressure plasma (LPP) and atmospheric-pressure plasma (APP) and submerged in human whole blood in vitro. Unconditioned implants and blood samples without implants served as control and negative control groups, respectively. Sampling was performed at 1, 8, and 24 h. Changes in mRNA expression levels of interleukin 1-beta (IL1-ß) and tumor necrosis factor-alpha (TNF-α) were assessed using RT-qPCR. RESULTS: In the control group, significant increases in IL1-ß and TNF-α expression were observed. Significant decreases in the expression of IL1-ß and TNF-α were identified in blood with implants after plasma treatment. CONCLUSION: Differences in gene expression of proinflammatory cytokines after incubation of plasma-conditioned titanium implants can be assessed using human whole blood. The results of the present study indicate that plasma treatment (APP and LPP) of titanium dental implants leads to downregulation of proinflammatory cytokine gene expression, which might be beneficial in early osseointegration.

Increased intraosseous temperature caused by ultrasonic devices during bone surgery and the influences of working pressure and cooling irrigation.

PURPOSE: The purpose of this study was to investigate the increases in intraosseous temperature generated by a modern ultrasonic device for bone surgery (UDBS) and the influences of working pressure and cooling irrigation on this temperature. MATERIALS AND METHODS: Twenty human mandibular bone specimens (20x15x5 to 7 mm) were used; three vertical cuts were performed for a duration of 12 seconds per cut. Each bone specimen was machined with a different combination of working pressure (1.5, 2.0, 3.0, 4.0, or 6.0 N) and cooling irrigation (0, 30, 60, or 90 mL/min), and intraosseous temperatures were measured. Harmful temperature development was defined as an increase of more than 10°C for the 75th percentile and/or a maximum increase of more than 15°C. Cutting performance was also measured. RESULTS: Harmless intraosseous temperature development was identified for working pressures of 1.5 N and 2.0 N with cooling irrigations of 30, 60, and 90 mL/min and for 3.0 N at 90 mL/min. The maximum temperature observed was 72°C (6.0 N with 60 mL/min). The mean cutting performance values were 0.21±0.02 mm/s for 6.0 N, 0.21±0.06 mm/s for 3.0 N, 0.20±0.01 mm/s for 4.0 N, 0.11±0.05 mm/s for 1.5 N, and 0.08±0.03 mm/s for 2.0 N. CONCLUSIONS: To prevent tissue damage in dental bone surgery, a minimum coolant amount of 30 mL/min is recommended. The working pressure should be chosen with great care because of its significant influence on intraosseous temperature. Doubling of the working pressure from 1.5 to 3.0 N requires a tripling of the coolant (30 to 90 mL/min) to prevent tissue damage. A working pressure above 3.0 N did not result in improved cutting performance.

Changes in human mandibular bone morphology after heat application.

PURPOSE: Intraosseous heat development is always a problem during bone surgery performed using rotary burs and ultrasound devices. However, only few data exist regarding the morphological effects of applied heat on bone surfaces. METHODS: We used 24 human mandibular bone specimens of the mental region from six body donators. Three body donators were fixed in ethanol and the others were stored frozen. Heat application to the bone surfaces at temperatures of 40 degrees C, 50 degrees C, 60 degrees C and 100 degrees C for 1 min respectively, was performed under controlled conditions using an iron heater, and followed by examination using (i) scanning electron microscopy (SEM), (ii) demineralized paraffin sections, and (iii) cryostat sections (both HE staining). RESULTS: There was no difference in the morphology or histology between fixed or unfixed bone specimens. The bone surface was smooth in both groups at 40 degrees C and 50 degrees C of heat application. Applications of 60 degrees C and 100 degrees C induced a rough-textured surface with small cavities visible with SEM and demineralized HE staining. The bone appeared to be unaffected at lower planes. The frozen HE histology could not be evaluated. Although useful in other studies, here the sections were broken and displaced on the glass slide. Therefore, this technique is not recommended by the authors. CONCLUSION: Our findings suggest the applicability of SEM for bone surface morphology and demineralized paraffin sections (HE staining) for frontal plane evaluation. Fixed and non-fixed bone specimens seem to be equal in their morphology and can both be used in these kinds of studies.