Plaque Ruptures Are Related to High Plaque Stress and Strain Conditions: Direct Verification by Using In Vivo OCT Rupture Data and FSI Models.

BACKGROUND: While it has been hypothesized that high plaque stress and strain may be related to plaque rupture, its direct verification using in vivo coronary plaque rupture data and full 3-dimensional fluid-structure interaction models is lacking in the current literature due to difficulty in obtaining in vivo plaque rupture imaging data from patients with acute coronary syndrome. This case-control study aims to use high-resolution optical coherence tomography-verified in vivo plaque rupture data and 3-dimensional fluid-structure interaction models to seek direct evidence for the high plaque stress/strain hypothesis. METHODS: In vivo coronary plaque optical coherence tomography data (5 ruptured plaques, 5 no-rupture plaques) were acquired from patients using a protocol approved by the local institutional review board with informed consent obtained. The ruptured caps were reconstructed to their prerupture morphology using neighboring plaque cap and vessel geometries. Optical coherence tomography-based 3-dimensional fluid-structure interaction models were constructed to obtain plaque stress, strain, and flow shear stress data for comparative analysis. The rank-sum test in the nonparametric test was used for statistical analysis. RESULTS: Our results showed that the average maximum cap stress and strain values of ruptured plaques were 142% (457.70 versus 189.22 kPa; P=0.0278) and 48% (0.2267 versus 0.1527 kPa; P=0.0476) higher than that for no-rupture plaques, respectively. The mean values of maximum flow shear stresses for ruptured and no-rupture plaques were 145.02 dyn/cm2 and 81.92 dyn/cm2 (P=0.1111), respectively. However, the flow shear stress difference was not statistically significant. CONCLUSIONS: This preliminary case-control study showed that the ruptured plaque group had higher mean maximum stress and strain values. Due to our small study size, larger scale studies are needed to further validate our findings.

Three-dimensional finite element analysis of the impact of access cavity preparation on first molar fracture resistance: A scoping review.

Access cavity preparation represents the initial step in root canal treatment. Minimally invasive approaches have gained increasing attention and involve advancements in the traditional access cavity preparation. Simultaneously, the development of three-dimensional finite element analysis (3D-FEA) has provided a theoretical foundation for evaluating the merits and drawbacks of various access cavity preparations. Studies using static loading 3D-FEA have suggested that conservative access cavity preparation reduces the concentration of stress in the cervical region, thereby strengthening fracture resistance. However, the lack of support from clinical data raises concerns about the validity of this suggestion. Conversely, studies involving cyclic loading 3D-FEA and dynamic loading 3D-FEA have challenged the prevailing perspectives by taking into account additional factors such as filling materials, thus providing a more comprehensive understanding of the impact of access cavity preparation on fracture resistance. Existing research lacks a comprehensive comparison of the different 3D-FEA methods, and this review fills this gap by providing a systematic assessment of different 3D-FEA methods and their applications in access cavity preparation.

Effect of attachment configuration and trim line design on the force system of orthodontic aligners: A finite element study on the upper central incisor.

OBJECTIVES: To use the finite element method (FEM) to investigate the effect of various attachment configurations and trimming line designs of orthodontic aligners on their biomechanical performance. METHOD: A 3D upper jaw model was imported into 3D design software. The upper right central incisor tooth (Tooth 11) was made mobile, and its periodontal ligament (PDL) and bone structures were designed. Aligners were modelled with three distinct attachment configurations: No attachment, rectangular horizontal, rectangular vertical, and two trimming line designs; scalloped and straight extended, with a homogeneous thickness of 0.6 mm. These models were then imported into an FE software. Simulations were conducted for three different movements, including facial translation, distalization, and extrusion. RESULTS: Forces were recorded at 1.3-2.6 N during facial translation, 1.4-5.9 N in distalization, and 0.0-2.0 N in extrusion. The straight extended trimming line consistently generated higher forces than the scalloped design. Attachments had no significant impact on force components during facial translation but were more effective in distalization and extrusion. The combination of a straight extended trimming line with horizontal attachments exhibited the least stresses at the apical third during distalization, and the highest stresses during extrusion, suggesting superior retention. CONCLUSIONS: Rectangular attachments offer limited benefits in facial translation, but horizontal rectangular attachments can intensify load in distalization and are crucial for force generation in extrusion. Horizontal attachments are preferred over vertical options. Additionally, the straight extended trim line enhances control of tooth movement and can replace attachments in certain cases. CLINICAL RELEVANCE: These findings provide biomechanical evidence and an optimal protocol to guide clinical practice in planning diverse teeth movements. The emphasis is on the influence of attachment utilization and the specific design of aligner trimming lines to enhance control over tooth movement.

Effect of material composition and thickness of orthodontic aligners on the transmission and distribution of forces: an in vitro study.

OBJECTIVES: To investigate the effects of material type and thickness on force generation and distribution by aligners. MATERIALS AND METHODS: Sixty aligners were divided into six groups (n = 10): one group with a thickness of 0.89 mm using Zendura Viva (Multi-layer), four groups with a thickness of 0.75 mm using Zendura FLX (Multi-layer), CA Pro (Multi-layer), Zendura (Single-layer), and Duran (Single-layer) sheets, and one group with a thickness of 0.50 mm using Duran sheets. Force measurements were conducted using Fuji® pressure-sensitive films. RESULTS: The lowest force values, both active and passive, were recorded for the multi-layered sheets: CA Pro (83.1 N, 50.5 N), Zendura FLX (88.9 N, 60.7 N), and Zendura Viva (92.5 N, 68.5 N). Conversely, the highest values were recorded for the single-layered sheets: Duran (131.9 N, 71.8 N) and Zendura (149.7 N, 89.8 N). The highest force was recorded at the middle third of the aligner, followed by the incisal third, and then the cervical third. The net force between the incisal and cervical thirds (FI-FC) showed insignificant difference across different materials. However, when comparing the incisal and middle thirds, the net force (FI-FM) was higher with single-layered materials. Both overall force and net force (FI-FM) were significantly higher with 0.75 mm compared to those with a thickness of 0.50 mm. CONCLUSIONS: Multi-layered aligner materials exert lower forces compared to their single-layered counterparts. Additionally, increased thickness in aligners results in enhanced retention and greater force generation. For effective bodily tooth movement, thicker and single-layered rigid materials are preferred. CLINICAL RELEVANCE: This research provides valuable insights into the biomechanics of orthodontic aligners, which could have significant clinical implications for orthodontists. Orthodontists might use this information to more effectively tailor aligner treatments, considering the specific tooth movement required for each individual patient. In light of these findings, an exchangeable protocol for aligner treatment is suggested, which however needs to be proven clinically. This protocol proposes alternating between multi-layered and single-layered materials within the same treatment phase. This strategy is suggested to optimize treatment outcomes, particularly when planning for a bodily tooth movement.

Design and Analysis of a Hand-Held Surgical Forceps with a Force-Holding Function.

Physiological hand tremors, twitching, and the nonlinear characteristics of the relationship between surgical forceps clamping force and operating force seriously affect the clamping accuracy of surgical instruments. To address this problem, a new type of surgical forceps with a force-holding function was developed to replace traditional forceps, which was studied in terms of structural design, statics, and dynamics. The overall structure of the surgical forceps was designed based on the lever principle, the kinematic model of the clamping part of the surgical forceps was established by the geometrical method, and the correctness of the kinematic model was verified by ADAMS. To address the clamping accuracy of the surgical forceps, a stress analysis was performed, its dynamics model was established, a finite element simulation was performed, the modal of the forceps was optimized using the Box-Behnken method, and, finally, an experimental platform was built to perform the accuracy test. The results demonstrate that the designed surgical forceps exhibit high clamping accuracy and fulfill the design specifications for surgical operations.

High-Precision Visual Servoing for the Neutron Diffractometer STRESS-SPEC at MLZ.

With neutron diffraction, the local stress and texture of metallic components can be analyzed non-destructively. For both, highly accurate positioning of the sample is essential, requiring the measurement at the same sample location from different directions. Current sample-positioning systems in neutron diffraction instruments combine XYZ tables and Eulerian cradles to enable the accurate six-degree-of-freedom (6DoF) handling of samples. However, these systems are not flexible enough. The choice of the rotation center and their range of motion are limited. Industrial six-axis robots have the necessary flexibility, but they lack the required absolute accuracy. This paper proposes a visual servoing system consisting of an industrial six-axis robot enhanced with a high-precision multi-camera tracking system. Its goal is to achieve an absolute positioning accuracy of better than 50µm. A digital twin integrates various data sources from the instrument and the sample in order to enable a fully automatic measurement procedure. This system is also highly relevant for other kinds of processes that require the accurate and flexible handling of objects and tools, e.g., robotic surgery or industrial printing on 3D surfaces.

Assessment of Surgeons' Stress Levels with Digital Sensors during Robot-Assisted Surgery: An Experimental Study.

Robot-Assisted Minimally Invasive Surgery (RAMIS) marks a paradigm shift in surgical procedures, enhancing precision and ergonomics. Concurrently it introduces complex stress dynamics and ergonomic challenges regarding the human-robot interface and interaction. This study explores the stress-related aspects of RAMIS, using the da Vinci XI Surgical System and the Sea Spikes model as a standard skill training phantom to establish a link between technological advancement and human factors in RAMIS environments. By employing different physiological and kinematic sensors for heart rate variability, hand movement tracking, and posture analysis, this research aims to develop a framework for quantifying the stress and ergonomic loads applied to surgeons. Preliminary findings reveal significant correlations between stress levels and several of the skill-related metrics measured by external sensors or the SURG-TLX questionnaire. Furthermore, early analysis of this preliminary dataset suggests the potential benefits of applying machine learning for surgeon skill classification and stress analysis. This paper presents the initial findings, identified correlations, and the lessons learned from the clinical setup, aiming to lay down the cornerstones for wider studies in the fields of clinical situation awareness and attention computing.

Effect of two esthetic digitally produced materials used in fabrication of extracoronal attachments on the stresses Induced in removable partial dentures.

BACKGROUND: Preservation of the remaining structures while maintaining an esthetic appearance is a major objective in removable partial prosthodontics. So, the aim of the current study was to compare the stresses induced on the supporting structures by two digitally produced esthetic core materials; Zirconia and Polyetheretherketone when used as an extracoronal attachment in distal extension removable partial dentures using strain gauge analysis. METHODS: A mandibular Kennedy class II stone cast with the necessary abutments' preparations was scanned. The mandibular left canine and first premolar teeth were virtually removed. An acrylic mandibular left canine and first premolar teeth were prepared with heavy chamfer finish line and scanned. Virtual superimposition of the acrylic teeth in their corresponding positions was done. Two strain gauge slots were designed: distal to the terminal abutment and in the residual ridge. Two models and two sets of scanned teeth were digitally printed. The printed teeth were then placed in their corresponding sockets in each model and scanned. The attachment design was selected from the software library and milled out of Zirconia in the model ZR and Polyetheretherketone in the model PE. Five removable partial dentures were constructed for each model. The strain gauges were installed in their grooves. A Universal testing machine was used for unilateral load application of 100 N (N). For each removable partial denture, five measurements were made. The data followed normal distribution and were statistically analyzed by using unpaired t test. P value < 0.05 was considered to be statistically significant. RESULTS: During unilateral loading unpaired t test showed statistically significant difference (p = 0.0001) in the microstrain values recorded distal to the abutment between the models ZR (-1001.6 µÎµ ± 24.56) and PE (-682.6 µÎµ ± 22.18). However, non statistically significant difference (p = 0.3122) was observed in the residual ridge between them; ZR (16.2 µÎµ ± 4.53) and PE (15 µÎµ ± 3.74). CONCLUSIONS: In removable partial dentures, Polyetheretherketone extracoronal attachment induces less stress on the supporting abutments compared to the zirconia one with no difference in the stresses induced by them on the residual ridge.

Effect of different framework materials on stresses induced in distal extension removable partial dentures: A strain gauge analysis.

PURPOSE: Evaluation of the strain transmitted to the abutments and residual ridge by polyetherketoneketone material compared to the cobalt-chromium one in distal extension removable partial dentures (RPDs) to fulfill the objective of preservation of the supporting structures. MATERIALS AND METHODS: A virtual model simulating a Kennedy class I partially edentulous mandibular arch was designed. Two models, one for each group, were printed. Five RPDs were made in each group. In group CR, the framework was milled from a cobalt-chromium alloy. While in group PK, it was milled from a polyetherketoneketone blank. Strain gauge rosettes were bonded distal to the last abutment and posteriorly in the distal end of the residual ridge. Unilateral vertical and oblique loadings were applied. Mann-Whitney U test was used for inter-group comparisons while the Friedman test was used for intra-group comparisons and corrected by Wilcoxon Signed-Rank Sum. The significance level was set at p ≤ 0.05. RESULTS: During unilateral vertical load application, a statistically significant difference was found between both groups distal to the abutment in the loaded and unloaded sides as well as the residual ridge on the unloaded side. During oblique load application, a statistically significant difference was found between both groups in all slots. CONCLUSION: Polyetherketoneketone material induces less stress on the abutments and more stress on the residual ridges compared to the cobalt-chromium ones. Therefore, it may be recommended for weak abutments supporting RPDs.

Effect of preparation design and endodontic access on fracture resistance of zirconia overlays in mandibular molars: An in vitro study.

PURPOSE: To evaluate the fracture resistance of zirconia overlays, considering various preparation designs and the presence of endodontic access. MATERIALS AND METHODS: Ninety translucent zirconia (5Y-PSZ) overlay restorations were divided into six groups (n = 15/group) based on different preparation designs, with and without endodontic access: chamfer margin 4 mm above the gingival level without (group 1) and with endodontic access (group 2); margin 2 mm above the gingival level without (group 3) and with endodontic access (group 4); overlay with no chamfer margin without (group 5) and with endodontic access (group 6). Restorations were bonded to mandibular first molar resin dies, and the groups with endodontic access were sealed with flowable resin composite. All restorations underwent 100,000 cycles of thermal cycling between 5°C and 55°C, followed by loading until fracture. Maximum load and fracture resistance were recorded. ANOVA with Tukey post-hoc tests were used for statistical comparison (α < 0.05). RESULTS: Fracture resistance significantly varied among overlay designs with and without endodontic access (p < 0.001), except for the no-margin overlays (groups 5 and 6). Overlays with a 2 mm margin above the gingival margin with endodontic access (group 4) exhibited significantly higher fracture resistance compared to both the 4-mm supragingival (group 2) and no-margin (group 6) designs, even when compared to their respective intact groups (groups 1 and 5). There were no significant differences between the no-margin and 4-mm supragingival overlays. CONCLUSION: The more extensive zirconia overlay for mandibular molars is the first choice since the 2 mm margin above the gingival level design withstood considerable loads even after undergoing endodontic access. A no-margin overlay is preferred over the 4-mm supragingival design as it preserves more tooth structure and there was no outcome difference, irrespective of endodontic access. Caution is warranted in interpreting these findings due to the in vitro nature of the study.

Hot isostatic pressing as an alternative thermo-mechanical treatment for metallic full-arch implant-supported frameworks obtained by additive and subtractive manufacturing technology: Vertical and horizontal fit, screw removal torque, and stress analysis.

PURPOSE: To assess vertical and horizontal fit, screw removal torque, and stress analysis (considered biomechanical aspects) of full-arch implant frameworks manufactured in Ti-6Al-4V through milling, and additive manufacturing Direct Metal Laser Sintering (DMLS) and Electron Beam Melting (EBM), and the effect of the thermo-mechanical treatment Hot Isostatic Pressing (HIP) as a post-treatment after manufacturing. MATERIAL AND METHODS: Maxillary full-arch implant frameworks were made by milling, DMLS, and EBM. The biomechanical assessments were screw removal torque, strain-gauge analyses, and vertical and horizontal marginal fits. The vertical fit was assessed by the single-screw test and with all screws tightened. All frameworks were submitted to a standardized HIP cycle (920°C, 1000 bar pressure, 2 h), and the tests were repeated (α = 0.05). RESULTS: At the initial time, milled frameworks presented higher screw removal torque values, and DMLS and EBM frameworks presented lower levels of strain. Using the single-screw test, milled and DMLS frameworks presented higher vertical fit values, and with all screws tightened and horizontally, higher fit values were found for milled frameworks, followed by DMLS and EBM. After HIP, milling and EBM frameworks presented higher screw removal torque values; the lowest strain values were found for EBM. Using the single-screw test, milled and DMLS frameworks presented higher vertical fit values, and with all screws tightened and horizontally no differences were found. CONCLUSIONS: DMLS and EBM full-arch frameworks presented adequate values of screw removal torque, strain, and marginal fit, although the worst values of marginal fit were found for EBM frameworks. The HIP cycle enhanced the screw removal torque of milled and EBM frameworks and reduced the strain values of milled frameworks. The HIP represents a reliable post-treatment for Ti-6Al-4V dental prostheses produced by milling and EBM technologies.

Occlusal Loading Effect on Stress Distribution of Endodontically Treated Teeth: Finite Element Analysis Study.

AIM: Evaluate the influence of occlusal loading on the stress distribution of endodontically treated teeth after root canal preparation with different file's sizes and tapers by means of finite element analysis. METHODOLOGY: Seven three-dimensional models of a single-rooted, single-canal lower second premolar were established, one healthy control and six endodontically treated and restored models. The shape of root canal preparations followed file configurations 30/.05, 30/.09, 35/.04, 35/.06, 40/.04, and 40/.06. Von- Mises equivalent stresses were calculated by applying 30 N, 90 N and 270 N loads to the buccal cusp tip, each one at 90º, 45º and 20º angles from the occlusal plane simulating occlusion, dental interference and laterality, respectively. RESULTS: 45º loading was more prone to formation of higher stress values. The simulation of occlusion and laterality resulted in maximum stress areas located at the inner side of the root curvature, while under occlusal interference they were on the lingual surface over the tooth's long axis. CONCLUSIONS: The angulation of occlusal loading and magnitude were determinants for stress distribution on dental structure. Both variations of size and taper were not determinants for the increase in the maximum stress areas.

Comparing the influence of cuspal angulation, occlusal loading, and connector widths between tooth- and implant-supported zirconia fixed dental prosthesis.

Background: Few studies have established the relationship between connector widths, cuspal angulation, loading forces, and supporting structures of zirconia fixed dental prosthesis (FDP). The objective of the study was to compare the stress distribution in implant- and tooth-supported zirconia FDP with different connector designs, and cuspal angulations of replaced teeth under diverse angulations of forces. Methods: Finite element (FE) analysis was done by simulating a 3-unit implant- and tooth-supported FDP. FE models with varying cuspal angulations 0°, 20°, and 33° and connector designs 2 mm, 2.5 mm, and 3 mm was generated. The simulated models were loaded with 100 N of forces under different axial and non-axial angulations. The graphical and numerical stresses were observed, recorded, and statistically analyzed. Results: Higher stress of 245.55 MPa in implant-supported FDP and lower stress value of 28.22 MPa in tooth-supported FDP was observed at 0-cuspal inclination for 3 mm connector width. The data were statistically analyzed with unpaired t test to eliminate the differences. The inter-group, intra-group tests, p and t values for various connector, and tooth angulations of tooth- and implant-supported FDP were statistically insignificant. (p > 0.05). Conclusion: There was no statistically significant difference in stress was observed between tooth- and implant-supported FDP for different connector widths, cuspal inclination, and diverse angulation of forces.

Xenon Difluoride Dry Etching for the Microfabrication of Solid Microneedles as a Potential Strategy in Transdermal Drug Delivery.

Although hypodermic needles are a "gold standard" for transdermal drug delivery (TDD), microneedle (MN)-mediated TDD denotes an unconventional approach in which drug compounds are delivered via micron-size needles. Herein, an isotropic XeF2 dry etching process is explored to fabricate silicon-based solid MNs. A photolithographic process, including mask writing, UV exposure, and dry etching with XeF2 is employed, and the MN fabrication is successfully customized by modifying the CAD designs, photolithographic process, and etching conditions. This study enables fabrication of a very dense MNs (up to 1452 MNs cm-2 ) with height varying between 80 and 300 µm. Geometrical features are also assessed using scanning electron microscopy (SEM) and 3D laser scanning microscope. Roughness of the MNs are improved from 0.71 to 0.35 µm after titanium and chromium coating. Mechanical failure test is conducted using dynamic mechanical analyzer to determine displacement and stress/strain values. The coated MNs are subjected to less displacement (≈15 µm) upon the applied force. COMSOL Multiphysics analysis indicates that MNs are safe to use in real-life applications with no fracture. This technique also enables the production of MNs with distinct shape and dimensions. The optimized process provides a wide range of solid MN types to be utilized for epidermis targeting.

Stress analysis of self-tightness metal sealing against ultrahigh pressure medium.

Stress is one of the most important factors in metal-to-metal sealing. In this paper, two methods (theoretical and empirical) were adopted to calculate the normal stress of the brass sealing surfaces against different ultrahigh pressure liquid. The theoretical formula was derived in terms of force balance, and the empirical formula was obtained by polynomial curve fitting, which the fitted data were from simulated results; besides, the results calculated using the empirical formula agree well with the results by theoretical formula. Meanwhile, the equivalent stresses of the brass seal, normal stress and contact stress on the brass seal surfaces were simulated by finite element method, and the simulated results indicated these stresses are increased with the increase of liquid pressure, and the maximum stresses always appear on the tip of the brass seal.

Effect of glass-ceramic coating versus alumina air-abrasion on the bond strength and residual stress of zirconia.

OBJECTIVES: To assess the effect of glass-ceramic coated zirconia versus alumina air-abraded zirconia on the shear bond strength (SBS) of resin cement and investigate the residual stresses present on both mechanically pre-treated surfaces. MATERIALS AND METHODS: A total of 180 zirconia disks, with diameters of 10 mm and 5 mm, were divided into two groups: DCMhotbond glass-ceramic coated, followed by hydrofluoric acid etching (DCM), and alumina air-abraded (AB). All mechanically pre-treated disks were conditioned with G-Multi Primer and bonded using G-Cem Linkforce Cement. Ninety specimens were immersed in distilled water for 24 h and subsequently allocated into three groups based on aging conditions (n = 15/subgroups): immediate testing, 5000 thermal cycles, and 10,000 thermal cycles. Then, the shear bond strength was assessed, and the obtained data were subjected to analysis using a two-way ANOVA, followed by a one-way ANOVA and Tukey's HSD post hoc test (α = 0.05). The residual stresses present on both mechanically pre-treated surfaces were examined using X-ray diffraction analysis. RESULTS: The mean SBS values of the DCM and AB groups showed no significant difference under each aging condition. The SBS of DCM groups was not affected by thermal cycles, whereas the SBS of AB groups exhibited a significant decrease following thermal cycles. Glass-ceramic coated surfaces exhibited higher compressive stresses than alumina air-abrasion. CONCLUSIONS: The DCMhotbond glass-ceramic coated zirconia showed comparable bond strength to the alumina air-abrasion technique. CLINICAL RELEVANCE: The DCMhotbond glass-ceramic coating technique is a promising alternative for zirconia surface pre-treatment. However, further investigations are needed before suggesting its clinical use.

Multimodal Assessment of Cognitive Workload Using Neural, Subjective and Behavioural Measures in Smart Factory Settings.

Collaborative robots (cobots) have largely replaced conventional industrial robots in today's workplaces, particularly in manufacturing setups, due to their improved performance and intelligent design. In the framework of Industry 5.0, humans are working alongside cobots to accomplish the required level of automation. However, human-robot interaction has brought up concerns regarding human factors (HF) and ergonomics. A human worker may experience cognitive stress as a result of cobots' irresponsive nature in unpredictably occurring situations, which adversely affects productivity. Therefore, there is a necessity to measure stress to enhance a human worker's performance in a human-robot collaborative environment. In this study, factory workers' mental workload was assessed using physiological, behavioural, and subjective measures. Electroencephalography (EEG) and functional near-infrared spectroscopy (fNIRS) signals were collected to acquire brain signals and track hemodynamic activity, respectively. The effect of task complexity, cobot movement speed, and cobot payload capacity on the mental stress of a human worker were observed for a task designed in the context of a smart factory. Task complexity and cobot speed proved to be more impactful. As physiological measures are unbiased and more authentic means to estimate stress, eventually they may replace the other conventional measures if they prove to correlate with the results of traditional ones. Here, regression and artificial neural networks (ANN) were utilised to determine the correlation between physiological data and subjective and behavioural measures. Regression performed better for most of the targets and the best correlation (rsq-adj = 0.654146) was achieved for predicting missed beeps, a behavioural measure, using a combination of multiple EEG and fNIRS predictors. The k-nearest neighbours (KNN) algorithm was used to evaluate the accuracy of correlation between traditional measures and physiological variables, with the highest accuracy of 77.8% achieved for missed beeps as the target. Results show that physiological measures can be more insightful and have the tendency to replace other biased parameters.

Strains in the implant collars supporting a cantilevered cross-arch bar prosthesis. An in vitro study.

PURPOSE: To examine the strains in the collar area of implants supporting a cantilevered cross-arch bar prosthesis during vertical load application. MATERIALS AND METHODS: A milled cross-arch metal framework supported by four implants in a trapezoidal design was supported in polymethylmethacrylate. T-strain gage rosettes were attached to the crestal areas of the implants with two grids, one recording circumference strain of the crestal area of the implant and the second recording vertical strain, torquing strains of the implant. The framework was subject to vertical loading from an MTS 810 mechanical system. Loading sites were directly on anterior and posterior implants, and on a cantilever at 7.5, 15, 22.5, and 30 mm (0.5, 1.0, 1.5, and 2.0 of the anterior-posterior spread) distal from the posterior implant on the right side. The anterior-posterior (A-P) spread from anterior to posterior implants was 15 mm. Sites were loaded individually with 50 and 100 N. The data from the rosettes were transferred to a desktop computer and processed using StrainSmart 5000 software. RESULTS: Means and standard deviations were calculated for the 10 trials at each of the loading sites. Two-way ANOVAs were done separately for each dependent variable, the vertical grid, and the circumferential grid. The independent variables were the load magnitude and the load site. Tukey's test was used to compare groups post hoc. When directly loading the implants, loading the anterior implant resulted initially in compression followed by increasing tensile strain with 100 N loads. Loading the implant adjacent to cantilever (the posterior implant) resulted in greater strain at the collar than that observed with anterior implant with minimal bending strains. When loading the cantilever, anterior implant showed increasing bending strain at greater cantilever length, whereas the circumferential strains were greater for the supporting implant adjacent to the cantilever, particularly at 100 N loads, p ≤ 0.001. CONCLUSIONS: Limiting cantilever lengths to A-P spread ratios of 0.5 are preferred. Ratios greater than 1.0 should be avoided as flexing of the collar may occur. The dimensions of the implant, particularly wall thickness, adjacent to the cantilever should be carefully considered when planning the cantilevered implant-supported prosthesis.

Effect of non-rigid connector on the stress distribution of tooth-implant supported fixed prostheses using different implant length and diameter: A comparative 3D finite element study.

PURPOSE: To investigate the significance of the connector type on stress dissemination within the tooth-implant-supported fixed dental prostheses in the mandibular posterior region with different combinations of implant diameter and length by means of finite element analysis (FEA). MATERIALS AND METHODS: Six models of different designs for tooth-implant fixed dental prosthesis (FDPs) were simulated and divided into two main groups. Implant lengths were 10, 11.5, and 13 mm while implant diameters were 3.7, 4.7, and 5.7 mm. The main difference between the groups was the connector type. Models were evaluated using 3D FEA (Solidworks Premium 2018 × 64 Edition). Group A tooth-implant FDPs (5.7 mm × 10 mm) had a mesial and distal rigid connector while group B tooth-implant FDPs (3.7 mm × 10 mm, 3.7 mm × 11.5 mm, 3.7 mm × 13 mm, 4.7 mm × 10 mm and 5.7 mm × 10 mm) had a mesial non-rigid connector in their design between the pontic and the tooth. Models were analyzed to determine the magnitude of von Misses Stresses at six specific zones (fixed dental prosthesis, bone around distal implant, bone around tooth, cementum, periodontal ligament, implant) under vertical occlusal loading of 100 N after meshing and assigning the material properties. RESULTS: Stress values around the supporting bone were significantly higher in Group B (tooth-implant FDP with non-rigid connection) when compared to Group A (tooth-implant FDP with rigid connection). Also, the stresses measured at the FDP level showed that the rigid connection group (5.7 mm × 10 mm) exhibited 26% lower stress values when compared to the non-rigid group (5.7 mm × 10 mm). CONCLUSIONS: Implant-tooth FDPs with rigid connector design using the combination of implant diameter and length (5.7 mm × 10 mm) demonstrated a better design modality thus predicting a higher success rate and more longevity than using the non-rigid connection option.

Double veneering, low-temperature porcelain, and total glaze application methods to overcome failures of zirconia-based restorations.

OBJECTIVES: The purpose of this in vitro study was to evaluate the efficacy of double veneering, low-temperature porcelain, and total glaze application methods to overcome failures of zirconia-based restorations. MATERIALS AND METHODS: Ninety yttrium-stabilized tetragonal zirconia materials with 1.2 × 5 × 24 mm dimensions were cut from pre-sintered blocks. According to the fabrication process of the samples, 3 main groups were formed in the beginning. Low-temperature porcelain and press-on ceramic were used for veneering. First, the samples were divided into 9 sub-groups. Then they were arranged to form triple groups. Triple groups were arranged according to the sample preparation and applied test methods, respectively. After three-point bending tests, marked samples were oriented for stereomicroscope and scanning electron microscope to evaluate and identify the fracture types. Data were statistically analyzed (p < 0.05). RESULTS: Delamination counts were higher than the chipping counts at all the samples with press layer. Chipping count was higher than the delamination count at low-temperature porcelain-veneered triple group. Delamination count was the highest at double-layered triple group. Scatter sample count was the least at ceramic-veneered triple group. Standard triple group was found to be more fracture-resistant. Accelerated aging increased delamination and/or scatter counts at all sub-groups and significantly (p = 0.01 < 0.05) degreased the mean fracture strength values. Total glaze application significantly (p = 0.01 < 0.05) improved the fracture strength values. CONCLUSION: All-round thinking is very important considering fracture strength, fracture type, delamination, chipping, normal fracture, and scattering. Applying low-temperature porcelain on zirconia substructure is more efficient than a transition material. Press-on material alone as a superstructure is not sufficient for successful restoration. Double veneering method is highly questionable. CLINICAL RELEVANCE: Zirconia-based all-ceramic restorations meet many criteria, especially durability and esthetics, which are necessary for a successful restoration. However, the harmony/integrity of substructure and superstructure is still an issue. Therefore, choosing of the veneering and/or protective method used during the fabrication of the restoration is very determinative for long-term success.