Evaluation of Zirconia Surfaces after Strong-Acid Etching and Its Effects on the Shear Bond Strength of Dental Resin Cement.

The present study was intended to investigate changes in the microstructure and phase transformation of zirconia surfaces using etching and airborne-particle abrasion (AB) and the effects of these processes on the shear bond strength of dental resin cements to zirconia. Four groups were classified according to the surface treatment as follows: etching for 15 min (ET15), etching for 30 min (ET30), AB, and etching for 15 min following AB (ABET). These groups were then classified into two subgroups (a total of 8 groups with 11 specimens/group) according to the resin cement used for bonding, namely, Rely-X U200 (3M ESPE, St. Paul, MN, USA) or Panavia F 2.0 (Kuraray, Kurashiki, Okayama, Japan). Shear bond strength testing was performed using a universal testing device. Scanning electron microscopy (SEM) and X-ray diffraction (XRD) were also performed. When using Rely-X U200, ET15 exhibited the highest mean shear bond strength; the strengths of ET15, ABET, and ET30 were significantly higher than that of AB. When using Panavia F 2.0, ABET demonstrated the highest mean shear bond strength; the strengths of ABET and ET15 were significantly higher than those of ET30 and AB. The etched surface of zirconia could be observed using SEM, and the phase transformations resulting from each surface treatment were detected by XRD. Strong-acid etching of zirconia induced significant surface changes that increased the shear bond strength of resin cement, and the resin adhesive strength was higher when zirconia was etched with strong acid vs. AB alone.

Implant fracture failure rate and potential associated risk indicators: An up to 12-year retrospective study of implants in 5,124 patients.

OBJECTIVES: This study investigated fracture rates and risk indicators for fractures in internal connection dental implants. MATERIAL AND METHODS: We performed a retrospective analysis of 19,006 internal connection implants used in fixed restoration in 5,124 patients (4,570 males, 554 females) at the Dental Hospital of Veterans Health Service Medical Center between 2006 and 2015. Patients were followed through June 2018 (0.03-12.39 years post-installation). Clinical factors (age, sex, implant diameter, implant length, placement site, bone graft, fixture material, cervical feature, abutment connection, microthread, and platform switching) were recorded. Kaplan-Meier survival analysis identified risk indicators associated with an implant fracture. Cox regression models elucidated potential fracture risks. RESULTS: One hundred and seventy-four implants fractured in 135 patients, for an incidence rate of 0.92% after an average of 4.95 ± 2.14 years of use. Kaplan-Meier estimates showed that the 3-, 5-, and 10-year survival rates of implants were 99.8%, 99.2%, and 97.7%, respectively. In the multivariable Cox regression model, the diameter, location, history of bone graft, and microthread presence were significantly correlated with implant fractures. Wide-diameter implants had a reduced fracture risk within 90 months, after which the diameter did not correlate with fractures. Implants placed in the anterior mandible had a lower fracture risk within 90 months; mandibular premolar implants corresponded with a lower risk after 90 months. Implants without a history of bone graft or microthreads were more likely to fracture throughout the follow-up time. CONCLUSIONS: These results elucidate risk indicators for implant fractures and facilitate their reduction in clinical practice.

Incidence and pattern of implant fractures: A long-term follow-up multicenter study.

BACKGROUND: Currently, there is incomplete understanding of the fracture patterns in the implant and their association with clinical factors. PURPOSE: The aim of this study was to investigate the incidence and pattern of implant fracture (IF) by using 9-year, long-term multicenter follow-up data. MATERIALS AND METHODS: The association of the incidence and differences in fracture patterns with clinical factors (based on patient variables and implant variables) was assessed for statistical significance using the Chi-square and Fisher exact test, as appropriate. RESULTS: Among a total of 19 087 implants in 8501 patients (7838 male and 663 female) placed over 9 years, fractures were observed in 70 implants (0.4%) in 57 patients (50 male and 7 female). Cases with less than 50% bone loss had a higher incidence of horizontal and vertical IFs limited to the crest module, which are defined as Type I fractures (n = 13, 18.6%). In contrast, cases with ≥50% severe bone loss exhibited a higher incidence of Type II vertical fractures (n = 22, 31.4%), extending beyond the crestal portion (P = .001). Type III fractures (n = 5, 7.1%), defined as a horizontal fracture beyond the crestal module, were also observed. CONCLUSION: Peri-implantitis-induced marginal and vertical bone loss and manufacturing-induced defects were considered to be major factors in IF. Therefore, using clinically verified implant systems and striving to minimize bone loss by preventing and actively treating peri-implantitis is essential to reduce IFs.