Effect of Anti-Rotational Abutment Features and Novel Computerized Fabrication Techniques on the Marginal Fit of Implant-Supported Metal Copings.

PURPOSE: An in vitro study to compare the marginal fit of cobalt-chromium (Co-Cr) metal copings fabricated with selective laser melting (SLM), computer-aided design and computer-aided manufacturing (CAD/CAM) milling, and lost-wax (LW) techniques, on abutments with two different antirotational features. MATERIALS AND METHODS: A total of 60 stainless steel abutments with the same length and convergence angles were fabricated using a numerical control machining. Half of the abutments had one flat plane, while the other half had three grooves as an antirotation feature. Thirty abutments of each kind were then divided into three subgroups, and metal copings were fabricated with SLM, CAD/CAM milling, or the LW technique (n = 10). The metal copings were cemented with polycarboxylate cement. Marginal gap measurements were performed using a stereomicroscope at a magnification of × 45 and data were analyzed with two-way analysis of variance (ANOVA) tests. RESULTS: The LW (p = 0.002) and CAD/CAM (p < 0.001) techniques exhibited increased marginal gaps on the abutments with a three groove antirotational feature; however, no significant difference was detected with the SLM technique (p = 0.259). The copings fabricated with the SLM technique demonstrated significantly lower gap values in both abutment types (p < 0.001). CONCLUSION: While all marginal gap values were within the clinically acceptable range (<120 µm), abutments with more antirotational grooves exhibited wider marginal gaps with the LW and CAD/CAM techniques.

Efficacy of Diode Laser and Gluma on Post-Preparation Sensitivity: A Randomized Split-Mouth Clinical Study.

OBJECTIVE: This study aimed to compare the efficacy of a 940-nm diode laser and Gluma desensitizer on post-preparation sensitivity of prepared teeth. MATERIALS AND METHODS: Twenty patients with 76 teeth participated in the study. For each patient, prepared molar or premolar in one quadrant were individually irradiated by laser. In the symmetrical quadrant, Gluma was applied onto the prepared teeth. No treatment was performed in the control group. Temporary crowns were placed after preparation. Pain response to tactile stimulus was assessed at one day, one week, and two weeks using visual analog scale (VAS). Intergroup comparisons were made with Kruskal Wallis test (p < 0.05). RESULTS: Mean VAS scores of the control group were statistically higher than laser and Gluma groups (p < 0.017). The difference between VAS scores of the laser and Gluma groups was statistically insignificant (p > 0.05). CONCLUSIONS: A significant reduction in level of sensitivity after both treatments was observed. The reduction of sensitivity with Gluma was not significantly superior to laser. No significant additional reduction occurred in level of sensitivity from the first day to the second week after both treatments. CLINICAL SIGNIFICANCE: The application of Gluma or a 940-nm diode laser may be considered as effective in reducing sensitivity after tooth preparation without superiority of either method. (J Esthet Restor Dent 28:405-411, 2016).

Evaluation of Heat Transfer to the Implant-Bone Interface During Removal of Metal Copings Cemented onto Titanium Abutments.

PURPOSE: The aim of this investigation was to measure the temperature increase due to heat transferred to the implant-bone interface when the abutment screw channel is accessed or a metal-ceramic crown is sectioned buccally with diamond or tungsten carbide bur using an air rotor, with or without irrigation. MATERIALS AND METHODS: Cobalt-chromium copings were cemented onto straight titanium abutments. The temperature changes during removal of the copings were recorded over a period of 1 minute. RESULTS: The sectioning of coping with diamond bur and without water irrigation generated the highest temperature change at the cervical part of the implant. CONCLUSION: Both crown removal methods resulted in an increase in temperature at the implant-bone interface. However, this temperature change did not exceed 47°C, the potentially damaging threshold for bone reported in the literature.

In Vitro Evaluation of Planktonic Growth on Experimental Cement-Retained Titanium Surfaces.

BACKGROUND The purpose of this study was to compare the effects of selected cements, or their combination with titanium, on the growth of two periodontopathic bacteria: Prevotella intermedia (Pi) and Fusobacterium nucleatum (Fn). MATERIAL AND METHODS This study was comprised of several experimental groups: 1) Dental luting cements (glass ionomer cement, methacrylate-based resin cement, zinc-oxide eugenol cement, eugenol-free zinc oxide cement; 2) titanium discs; and 3) titanium combination cement discs. The disks were submerged in bacterial suspensions of either Fn or Pi. Planktonic bacterial growth within the test media was measured by determining the optical density of the cultures (OD600). Mean and standard deviations were calculated for planktonic growth from three separate experiments. RESULTS Intergroup comparison of all experimental groups revealed increased growth of Pi associated with cement-titanium specimens in comparison with cement specimens. Regarding the comparison of all groups for Fn, there was an increased amount of bacterial growth in cement-titanium specimens although the increase was not statistically significant. CONCLUSIONS The combination of cement with titanium may exacerbate the bacterial growth capacity of Pi and Fn in contrast to their sole effect.

Comparison of implant versus tooth-supported zirconia-based single crowns in a split-mouth design: a 4-year clinical follow-up study.

OBJECTIVES: This study aims to evaluate the 4-year clinical performance of tooth versus implant-supported single-unit zirconia crowns (LAVA™) placed on posterior region. MATERIALS AND METHODS: Twenty-four patients (10 men and 14 women) who had received 48 single crowns (24 implant-supported and 24 tooth-supported) from January 2007 to December 2009, were included. California Dental Association (CDA) quality assessment system, plaque and gingival index scores were used to evaluate the performance of the crowns at baseline and at all follow-up examinations. RESULTS: During the follow-up period, no fracture of zirconia coping has occurred. Major complication was chipping in three patients that required a new crown fabrication. Except for the failure ones, all crowns in both groups were rated as satisfactory at the follow-up examinations based on the CDA quality assessment criteria. There were no statistically significant differences between tooth and implant-supported crowns in terms of periodontal parameters. CONCLUSIONS: The present 4-year follow-up clinical study demonstrates that single-unit tooth- and implant-supported zirconia crowns have similar prosthetic and periodontal outcomes. CLINICAL RELEVANCE: Single-unit implant or tooth-supported zirconia crowns may be considered acceptable treatment modalities for restoration of either missing or compromised posterior teeth.

Effect of Opaque Layer Application on the Color of Resin Composites Used to Fill Access Openings of Screw-Retained Implant Restorations.

The purpose of this preliminary in vitro study was to evaluate the effect of an opaque layer and application of resin composite in dual colors on the ΔE values of resin composites used to fill access openings of screw-retained implant restorations. Sixty cylindrical nickel-chromium metal molds with a central channel simulating a posterior screw-retained, implant-supported, porcelain-fused-to-metal crown were cast. Access openings were filled with combinations of opaquer, enamel composite (A2E), dentin composite (A2B and A3B), and resilient composite. ΔE values differed significantly among the groups (P<.01). The combination of opaque layer and dual color resin composites of shades A2E and A3B resulted in significantly lower ΔE values than the other groups (P<.01).

Zirconia-based crowns up to 5 years in function: a retrospective clinical study and evaluation of prosthetic restorations and failures.

PURPOSE: The purpose of this retrospective study was to evaluate the 5-year clinical performance and failure rate of single- or multiple-unit zirconia-based crowns. MATERIALS AND METHODS: A total of 148 patients (39 men and 109 women, mean age: 46.9 ± 10.6 years) treated in university and private practices with 618 single- or multiple-unit zirconia-based (Lava) crowns made on natural teeth from January 2007 to December 2008 were included. Two hundred fifty-nine anterior and 359 posterior crowns were examined. A core and/or veneer fracture that required replacement of the restoration was considered to be a failure. The cumulative survival rate (CSR) was described with Kaplan-Meier survival functions. The crowns replaced for other reasons were deemed lost to follow-up, and esthetic, functional, and biologic complications were rated. RESULTS: At the 5-year follow-up, no zirconia core fractures were observed. Twelve veneer fractures that required crown replacement were detected. The CSR was 98.1%. There was a statistically significant difference between survival of the anterior and posterior restorations (P < .001). In total, 116 crowns experienced biologic and technical complications. The most common complications were smooth veneer fracture (4, 0.6%), loss of retention (7, 1%), staining because of smoking (24, 4%), and gingival recession (48, 8%). CONCLUSIONS: According to the 5-year CSR (98.1%) observed in this study, zirconia-based single or multiple crowns may be considered an acceptable treatment modality for the replacement of anterior and posterior teeth. RESULTS from the current study should be supported by additional randomized clinical trials.

Effects of various denture cleansers on surface roughness of hard permanent reline resins.

The aim of this study was to investigate the influence of denture cleansers on surface roughness (Ra, µm) of two hard permanent reline resins and a conventional acrylic denture base resin. Fifty specimens of each material, measuring 10 mm×2 mm were randomly divided into 1 control and 4 experimental subgroups (n=10). Surface roughness values were measured using profilometer before and after immersion in distilled water and in 4 different denture cleansers for 8 h for 140 days. The Kruskal Wallis and Wilcoxon Signed Ranks tests were used for comparison among groups with a significance level of α=0.05. Immersion in denture cleansers significantly increased the surface roughness of reline resins and the difference among the cleansers was statistically significant (p=0.059). Denture cleansers can cause significant surface roughness alterations on hard permanent reline resins and denture base resin where their effect may differ according to the selected resin material.

Effect of liquid polishing materials on the stainability of bis-acryl interim restorative material in vitro.

STATEMENT OF PROBLEM: The discoloration of interim restorations may negatively affect a patient's perception of treatment. PURPOSE: The purpose of this study was to investigate the effect of liquid polishing materials on the color stability of bis-acryl interim restorative material. MATERIAL AND METHODS: One hundred twenty specimens (10×2 mm) of a bis-acryl interim restorative material were divided into 3 groups. Group CO (control) was not subjected to any liquid polishing material. Groups GC and BC were polished with 2 liquid polishing materials. The specimens were then divided into 4 subgroups (n=10) and stored for 24 hours at 37°C in different staining solutions: coffee, coffee with sugar, cola, and distilled water. The color of the specimens was measured at baseline and after immersion with a spectrophotometer by using the CIE L*a*b* system, and color changes (ΔE) were calculated. The means of color change for each specimen were analyzed by 2-way and 1-way ANOVA tests. Post hoc comparisons were made with the Tukey HSD and Tamhane T2 tests. RESULTS: The application of liquid polishing materials significantly decreased the staining of autopolymerized bis-acryl interim restorative material (P<.01). Coffee with sugar resulted in higher ΔE values than coffee without sugar or cola. CONCLUSIONS: The use of liquid polishing materials significantly decreased staining when compared with bis-acryl specimens without liquid polish. The presence of sugar in coffee increased color change compared with coffee without sugar for all groups evaluated.

Is it safe to reuse dental implant healing abutments sterilized and serviced by dealers of dental implant manufacturers? An in vitro sterility analysis.

PURPOSE: This study was undertaken to investigate the sterility of used healing abutments sterilized and serviced by dealers of dental implant manufacturers. MATERIALS AND METHODS: Sixty used but sterilized healing abutments in sealed sterilization pouches were obtained from 6 manufacturers unaware of the study design and equally grouped from A to F. The sterilization pouches were examined for perforation. The driver slots and screw grooves of healing abutments were examined for calculus and scratches under a ×5 LED magnifying lamp, without opening the pouches. Each abutment was immersed in brain heart infusion broth in test tubes and incubated. RESULTS: Macroscopic observation of 57 healing abutments revealed dirty screw grooves (10.5%) and partially filled driver slots (5.2%). None of the group C, E, and F samples showed turbidity. Penicillium variabile was morphologically identified in 3 abutments of group A. Enterococcus faecalis and E faecium were detected in 1 abutment each of groups B and D, respectively. CONCLUSION: Reuse of healing abutments can be cost effective in dental practice. However, used abutments sterilized and serviced by dental implant dealers might be a source of cross-infection. They should therefore be cleaned and resterilized before reuse as a precaution.

Interdisciplinary treatment of a patient with bilateral cleft lip and palate and congenitally missing and transposed teeth.

The comprehensive treatment of a patient with cleft lip and palate requires an interdisciplinary approach for functional and esthetic outcomes. A 20-year-old woman with bilateral cleft lip and palate had a chief complaint of unesthetic appearance of her teeth and the presence of oronasal fistulae. Her clinical and radiographic evaluation showed a dolichofacial growth pattern, a Class II skeletal relationship with retroclined maxillary central incisors, 5 mm of negative overjet, maxillary constriction, maxillary and mandibular crowding, congenitally missing maxillary right incisors and left lateral incisor, and a transposed maxillary left canine. Her treatment plan included the extraction of 3 premolars, maxillary expansion, segmental maxillary osteotomy, repair of the oronasal fistulae, rhinoplasty, periodontal surgery, and prosthodontic rehabilitation. To obtain a better occlusion and reduce the dimensions of the fistulae, orthognathic surgery comprising linear and rotational movements of the maxillary segments (premaxilla, right and left maxillary alveolar segments) in all 3 axes was planned by performing 3-dimensional virtual surgery on 3-dimensional computerized tomography. At the end of the interdisciplinary treatment, a functional occlusion, a harmonious profile, and patient satisfaction were achieved. Posttreatment records after 1 year showed stable results.

Orthodontic bonding to acid- or laser-etched prebleached enamel.

OBJECTIVE: Bonding forces of brackets to enamel surfaces may be affected by the procedures used for bleaching and enamel etching. The aim of this study was to investigate the bonding strength of orthodontic brackets to laser-etched surfaces of bleached teeth. METHODS: In a nonbleached control group, acid etching (group A) or Er:YAG laser application (group B) was performed prior to bracket bonding (n = 13 in each group). Similar surface treatments were performed at 1 day (groups C and D; n = 13 in each subgroup) or at 3 weeks (groups E and F; n = 13 in each subgroup) after 38% hydrogen peroxide bleaching in another set of teeth. The specimens were debonded after thermocycling. RESULTS: Laser etching of bleached teeth resulted in clinically unacceptable low bonding strength. In the case of acid-etched teeth, waiting for 3 weeks before attachment of brackets to the bleached surfaces resulted in similar, but not identical, bond strength values as those obtained with nonbleached surfaces. However, in the laser-etched groups, the bonding strength after 3 weeks was the same as that for the nonbleached group. CONCLUSIONS: When teeth bleached with 38% hydrogen peroxide are meant to be bonded immediately, acid etching is preferable.

Comparison of 3 luting agents on retention of implant-supported crowns on 2 different abutments.

BACKGROUND: For fixed prostheses, retention is one of the most important factors for clinical success. It is unknown whether grooves that increase surface area of implant abutment while retaining the diameter and wall height provide greater uniaxial retention force. The purpose of this study was to determine the retention of 3 different cements on 2 implant abutments with different surface configurations. MATERIALS AND METHODS: Thirty samples on 2 different abutments (a total of 60 crowns) with different margin and axial walls configuration and surface area were used. Metal crowns were fabricated on the abutment and cemented with 3 different (zinc-phosphate [ZP], glass ionomer [GI], or eugenol-free zinc oxide [ZO]) cements. After cementation, implant-abutment-casting assemblies were thermal cycled 1000 times with 1-minute dwell-time between 5°C and 55°C then subjected to tensile test with universal testing machine until decementation occurred. The mean force required to dislodge castings from abutment was determined. RESULTS: The luting agents influenced retention of castings on implant abutments, whereas different surface configurations and total surface area of the abutments did not influence the uniaxial retention forces. Among the cements tested, ZP exhibited higher values of retention, followed by GI and eugenol-free ZO. CONCLUSIONS: The increase in surface area of abutment did not result in improved retention. The present results suggest using ZP rather than GI and eugenol-free ZO in implant-supported crowns to provide higher retention.

Shear bond strength of brackets bonded to amalgam with different intermediate resins and adhesives.

The aims of this study were to compare, in vitro, the shear bond strength (SBS) of stainless steel orthodontic brackets bonded to silver amalgam with the use of three different intermediate resins and two different adhesives, and to evaluate bond failure mode. Forty-five amalgam specimens were divided into three equal groups. In groups 1 and 2, the brackets were bonded with Unite (3M Unitek) using Reliance Metal Primer (RMP; Reliance Orthodontic Products) and Power Bond OLC (PB OLC; Ortho Organizers Inc.) as intermediate resins, respectively. In group 3, Resinomer and One-Step Plus (OS+; Bisco Inc.) were used. Thirty bovine teeth served as the controls to test bracket bonding to acid-etched enamel with Unite and Resinomer-OS+. After thermocycling from 10 to 50 degrees C 1000 times, all samples were tested for SBS. Bond failure sites were classified using a modified adhesive remnant index (ARI) system. Data were analyzed with one-way analysis of variance, post hoc Tukey multiple comparison and chi-square tests. The results showed that the mean SBS to amalgam surfaces were significantly lower than those to etched bovine enamel (P<0.001). There were no statistically significant differences in mean SBS between the amalgam bonding groups (P>0.05). For the ARI, significant differences were found between the amalgam- and enamel-bonding groups (P<0.001). The mean SBS of stainless steel orthodontic brackets bonded to amalgam surfaces with RMP, PB OLC, OS+ intermediate resins and Unite and Resinomer adhesives was significantly lower than to etched bovine enamel. Bond failure occurred at the amalgam-adhesive interface regardless of the adhesive system and without damage to the amalgam restoration.

Prosthetic rehabilitation of a mandibular gunshot defect with an implant-supported fixed partial denture: a clinical report.

This report describes the clinical evaluation of a patient with a mandibular gunshot defect and the prosthodontic treatment with an implant-supported screw-retained fixed partial denture. Treatment included cemented crowns for 2 maxillary implants and an implant-supported screw-retained fixed partial denture supported by 8 mandibular implants. Despite the implant malposition limitations, the esthetic and functional demands of the patient were fullfilled.