Influence of Platform Switching, Abutment Design and Connection Protocols on the Stability of Peri-Implant Tissues. A Systematic Review.

PURPOSE: To appraise the effect of abutment factors namely platform switching, design and connection protocols on the stability of peri-implant tissues. MATERIALS AND METHODS: An electronic and hand search were conducted. Randomized control trials and controlled prospective studies of at least one-year follow-up, published in the last 12 years, were included. RESULTS: Initial electronic database search generated 3054 studies, while individual journal and hand searching resulted in 232 articles. Sixty-three publications were selected for full text analysis based on inclusion and exclusion criteria. Nineteen articles investigated platform switching. Fourteen studies reported positive influence of platform switching while five studies did not find a significant difference in bone loss compared to platform matched abutments. Two articles reported on concave abutments and found no advantage over conventional abutments. Seven studies investigated "one-abutment-one-time protocol", two found comparable results to multiple abutment disconnections while five studies suggested better soft and hard tissue maintenance. The risk of bias was unclear or high in most studies. CONCLUSION: Platform switched abutments may reduce crestal bone loss during the first year. There is insufficient evidence to suggest better clinical outcomes of concave abutment. There is insufficient evidence to indicate the superiority of 'one abutment-one-time protocol'.

A Novel Methodology to Validate the Accuracy of Extraoral Dental Scanners and Digital Articulation Systems.

PURPOSE: The aim of the current study is to develop a novel method to investigate the accuracy of 3D scanners and digital articulation systems. MATERIALS AND METHODS: An upper and a lower poured stone model were created by taking impression of fully dentate male (fifty years old) participant. Titanium spheres were added to the models to allow for an easily recognisable geometric shape for measurement after scanning and digital articulation. Measurements were obtained using a Coordinate Measuring Machine to record volumetric error, articulation error and clinical effect error. Three scanners were compared, including the Imetric 3D iScan d104i, Shining 3D AutoScan-DS100 and 3Shape D800, as well as their respective digital articulation software packages. Stoneglass Industries PDC digital articulation system was also applied to the Imetric scans for comparison with the CMM measurements. RESULTS: All the scans displayed low volumetric error (p⟩0.05), indicating that the scanners themselves had a minor contribution to the articulation and clinical effect errors. The PDC digital articulation system was found to deliver the lowest average errors, with good repeatability of results. CONCLUSION: The new measuring technique in the current study was able to assess the scanning and articulation accuracy of the four systems investigated. The PDC digital articulation system using Imetric scans was recommended as it displayed the lowest articulation error and clinical effect error with good repeatability. The low errors from the PDC system may have been due to its use of a 3D axis for alignment rather than the use of a best fit.

Fluoride release, recharge and mechanical property stability of various fluoride-containing resin composites.

AIM: To determine the fluoride release and recharge of three fluoride-containing resin composites when aged in deionized water (pH 6.5) and lactic acid (pH 4.0) and to assess mechanical properties of these composites following aging. METHODS: Three fluoride-containing resin composites were analyzed in this study; a new giomer material named Beautifil II, Gradia Direct X, and Tetric EvoCeram. A glass ionomer cement, Fuji IX Extra, was also analyzed for comparison. Specimens were fabricated for two test groups: group 1 included 10 disc specimens initially aged 43 days in deionized water (five specimens) and lactic acid (five specimens). The fluoride release from these specimens was measured using a fluoride-specific electrode on nine specific test days during the aging period. Following 49 days of aging, each specimen was recharged in 5000 ppm neutral sodium fluoride solution for 5 minutes. Specimen recharge was then repeated on a weekly basis for 3 weeks. The subsequent fluoride rerelease was measured at 1, 3, and 7 days after each recharge episode. Group 2 included six disc specimens aged for 3 months in deionized water (three specimens) and lactic acid (three specimens). The hardness and elastic modulus of each specimen was measured using nano-indentation at intervals of 24 hours, 1 month, and 3 months after fabrication. Two-way factorial analysis of variance (ANOVA) and post-hoc (Tukey) testing was used to assess the influence of storage media (two levels) and composite type (three levels) on the fluoride release, fluoride rerelease, hardness, and elastic modulus of the assessed materials. The level of significance was set at p=0.05. RESULTS: All three composites demonstrated fluoride release and recharge when aged in both deionized water and lactic acid. The cumulative fluoride released from Beautifil II into both media was substantially greater than the fluoride released from Gradia Direct X and Tetric EvoCeram after 43 days aging and was significantly (p<0.05, ANOVA, Tukey test) greater during several analysis periods. Beautifil II demonstrated the greatest recharge ability of the three composites over the 3-week recharge period in both media. Fuji IX Extra demonstrated a significantly (p<0.05) greater fluoride release and recharge compared with the three resin composites. The elastic modulus and hardness of the three composites did not decrease significantly (p<0.05) with fluoride release or fluid uptake over the 3-month aging period, in either media. CONCLUSION: The three composites in the present study demonstrated fluoride release (Beautiful II > Gradia Direct X > Tetric EvoCeram) and fluoride recharge (Beautiful II > Gradia Direct X > Tetric EvoCeram). This capability raises the possibility of fluoride-containing composites exhibiting a lower incidence of recurrent caries than non fluoride­containing composites. The mechanical properties of each composite did not diminish with aging and fluoride release over the testing period.

Reducing composite restoration polymerization shrinkage stress through resin modified glass-ionomer based adhesives.

BACKGROUND: The aim of this study was to determine whether employing resin modified glass-ionomer based adhesives can reduce polymerization contraction stress generated at the interface of restorative composite adhesive systems. METHODS: Five resin based adhesives (G Bond, Optibond-All-in-One, Optibond-Solo, Optibond-XTR and Scotchbond-Universal) and two resin modified glass-ionomer based adhesives (Riva Bond-LC, Fuji Bond-LC) were analysed. Each adhesive was applied to bond restorative composite Filtek-Z250 to opposing acrylic rods secured within a universal testing machine. Stress developed at the interface of each adhesive-restorative composite system (n = 5) was calculated at 5-minute intervals over 6 hours. RESULTS: The resin based adhesive-restorative composite systems (RBA-RCS) demonstrated similar interface stress profiles over 6 hours; initial rapid contraction stress development (0-300 seconds) followed by continued contraction stress development ≤0.02MPa/s (300 seconds - 6 hours). The interface stress profile of the resin modified glass-ionomer based adhesive-restorative composite systems (RMGIBA-RCS) differed substantially to the RBA-RCS in several ways. Firstly, during 0-300 seconds the rate of contraction stress development at the interface of the RMGIBA-RCS was significantly (p < 0.05) lower than at the interface of the RBA-RCS. Secondly, at 300 seconds and 6 hours the interface contraction stress magnitude of the RMGIBA-RCS was significantly (p < 0.05) lower than the stress of all assessed RBA-RCS. Thirdly, from 300 seconds to 6 hours both the magnitude and rate of interface stress of the RMGIBA-RCS continued to decline over the 6 hours from the 300 seconds peak. CONCLUSIONS: The use of resin modified glass-ionomer based adhesives can significantly reduce the magnitude and rate of polymerization contraction stress developed at the interface of adhesive-restorative composite systems.

Influence of veneering composite composition on the efficacy of fiber-reinforced restorations (FRR).

This study investigated the influence of fiber reinforcement on the flexural properties of four commercial (Artglass, Belleglass HP, Herculite XRV and Solidex) veneering composites (Series A) and two experimental composites (Series B&C). This study investigated how the composition of the veneering composites influenced the enhancement of strength and modulus produced by fiber reinforcement. The formulation of the experimental composites were varied by changing the filler load (Series B) or the resin matrix chemistry (Series C) to assess the effect these changes would have on the degree of reinforcement. In Series A, the commercial veneering composites were reinforced by an Ultra-High-Molecular-Weight Polyethylene fiber (UHMW-PE/Connect) to evaluate flexural properties after 24 hours and six months. In Series B, experimental composites with the same organic matrix but with different filler loads (40% to 80% by weight) were also reinforced by Connect fiber to evaluate flexural properties. In Series C, experimental composites (Systems 1-4) with the same filler load (76.5% by weight) but with different organic matrix compositions were reinforced by Connect fiber to evaluate flexural properties. For Series B and C, flexural properties were evaluated after 24 hours water storage. All the samples were prepared in a mold 2 mm x 2 mm x 25 mm and stored in distilled water at 37 degrees C until they were ready for flexural testing in an Instron Universal Testing Machine using a crosshead speed of 1 mm/minute. The results showed no significant differences in the flexural strength (FS) between any of the commercial reinforced composites in Series A. The flexural modulus (FM) of the fiber-reinforced Belleglass HP group was significantly higher than for Artglass and Solidex. Water storage for six months had no significant (p>0.05) effect on the flexural strength of three of the four reinforced veneering composites. The flexural strength for Artglass was significantly reduced (p<0.05) by six-month water storage. In Series B, however, increasing the amount of filler loading improved the flexural modulus of the reinforced experimental composite but had no effect on its flexural strength. In Series C, changing the organic matrix formulation had no affect on flexural strength but affected the flexural modulus of the reinforced experimental composite.

Influence of bonding agent composition on flexural properties of an Ultra-High Molecular Weight Polyethylene Fiber-Reinforced Composite.

This study evaluated the influence of seven commercially available bonding agents on the flexural properties of an Ultra High Molecular Weight Polyethylene (UHMWPE) Fiber-Reinforced Composite (FRC). Nine groups (n=10 per group) of flexural strength specimens were prepared from an indirect composite reinforced with UHMWPE fiber and cured according to manufacturers' instructions (Groups A to I). Group I was a fiber-reinforced negative control without any bonding agent resination. A tenth group (Group J) was a positive control group prepared using indirect composite alone. The fiber reinforcement material for Groups A to H was resinated with one of the seven different bonding agents. Group H used the same bonding agent as for Group G specimens. However, the fiber was silanized before bonding agent application for Group G specimens. Specimens were stored wet for 24 hours at 37 degrees C before measuring flexural strength and modulus in three-point bend at a crosshead speed of 1 mm/minute. Scanning Electron Microscopy (SEM) was employed to assess the fiber-resin interface of representative samples. The mean (SD) flexural strength of the test groups impregnated by the bonding agents ranged from 169 (37) to 266 (39) MPa. Statistical analysis of the flexural strength data using one-way ANOVA revealed significant (p<0.05) differences between the test groups. There was catastrophic fiber/composite failure in the positive control group that had a mean flexural strength of 75 (8) MPa. Silane pre-treatment of UHMWPE fiber before impregnation with the bonding agent significantly reduced the flexural strength (p<0.05).

Fluoride release, recharge and flexural properties of polymethylmethacrylate containing fluoridated glass fillers.

BACKGROUND: The purpose of this study was to investigate the effect of fluoridated glass fillers on fluoride release, recharge and the flexural properties of modified polymethylmethacrylate (PMMA). METHODS: Specimens of PMMA denture base material with various loading of fluoridated glass fillers (0%, 1%, 2.5%, 5% and 10% by weight) were prepared. Flexural properties were evaluated on rectangular specimens (n = 10) aged in deionized water after 24 hours, 1 and 3 months. Disc specimens (n = 10) were aged for 43 days in deionized water and lactic acid (pH 4.0) and fluoride release was measured at numerous intervals. After ageing, specimens were recharged and fluoride re-release was recorded at 1, 3 and 7 days after recharge. RESULTS: Samples containing 2.5%, 5% and 10% glass fillers showed significantly (p < 0.05) greater levels of fluoride release compared with the control and 1% glass fillers specimens. All experimental specimens exhibited fluoride release in both media. The flexural strength of specimens decreased in proportion to the percentage filler inclusion with the modulus of elasticity values remaining within ISO Standard 1567. CONCLUSIONS: The modified PMMA with fluoridated glass fillers has the ability to release and re-release fluoride ion. Flexural strength decreased as glass filler uploading increased.

Surface characteristics and microbial adherence ability of modified polymethylmethacrylate by fluoridated glass fillers.

BACKGROUND: The current study objectives were to evaluate the influence of fluoridated glass fillers loading on the surface roughness, wettability, and adherence of candida and bacteria with and without saliva presence to a polymethylmethacrylate (PMMA) denture base material surface. METHODS: Four concentrations of fluoridated glass fillers were added to PMMA: 1%, 2.5%, 5% and 10% by weight pre-polymerization and 0% was the control. Discs of each concentration were fabricated (n = 5 for each variable). Surface roughness (Ra ) was measured using atomic force microscopy (AFM). Wettability was assessed by measuring the contact angle of a sessile drop of water. Specimens were incubated with Candida albicans, or Streptococcus mutans with and without saliva coating. Adherence was presented as a percentage of the colonized surface area, counted using an optical microscope at x100 magnification. RESULTS: The 10% group showed significantly greater roughness than the control and 1% groups; however, no significant differences in contact angle values were detected. The microbial adhesion was inversely proportional to the fluoridated glass fillers concentration where 10% concentration significantly decreased candidal and bacterial adhesion compared to others. Saliva coating significantly decreased microbial adhesion. CONCLUSIONS: It was concluded that fluoridated glass fillers could decrease microbial adhesion to acrylic denture base without adversely affecting surface properties.

The effect of repeated fluoride recharge and storage media on bond durability of fluoride rechargeable Giomer bonding agent.

BACKGROUND: For a restorative material or adhesive to exhibit caries inhibitive potential through fluoride release, it must be capable of fluoride recharge. The aim of this study was to evaluate the effect of repeated fluoride recharge and different storage media on dentine bond strength durability. METHODS: Two self-etch adhesive systems (two-step) were evaluated: fluoride-rechargeable Giomer FL-Bond II and non-fluoride-containing UniFil Bond. For each adhesive 32 human dentine specimens were prepared for shear bond strength testing. The specimens were randomly allocated to one of four storage groups: Group 1 - 24-hour water ageing; Group 2 - four-month water ageing; Group 3 - four-month water ageing with weekly fluoride recharge (5000 ppm for 10 minutes); and Group 4 - four-month acid ageing with weekly fluoride recharge. RESULTS: Weekly fluoride recharge over four months ageing did not significantly (p > 0.05) reduce the dentine shear bond strength of FL-Bond II or UniFil Bond. Storage media did not significantly (p > 0.05) affect bond durability. CONCLUSIONS: The adhesion between fluoride rechargeable FL-Bond II and dentine maintained durability despite regular fluoride recharge over the four months ageing. Clinicians prescribing the fluoride recharge regime used in the present study to reduce recurrent caries incidence associated with Giomer FL-Bond II restorations can do so without compromising dentine bond strengths.

Long-term results of 360A° scleral buckling and vitrectomy with silicone oil tamponade for management of gunshot-perforating ocular injury.

PURPOSE: This is a retrospective consecutive study to assess the long-term results of combined scleral buckling and pars plana vitrectomy (PPV) with silicone oil for the management of perforating ocular injury caused by gunshots. METHODS: Data were gathered from medical records of patients who underwent scleral buckling and PPV with silicone oil 2 weeks after primary repair elsewhere, in Magrabi eye center (Tanta, Egypt), from June 2005 to May 2010. RESULTS: The evaluated group consisted of 49 cases, out of which 26 cases presented with gunshot injury. Twenty-two were male (84.62%) and four were female (15.38%), with a mean age of 27.19+12.7 years. The follow-up ranged from 12 to 72 months, with a mean period of 32.04+8.9 months. The t-test was used to determine the visual outcome and main prognostic factors. Visual acuity improved in 22 of 26 eyes (76.92%), was unchanged in 4 eyes (15.38%), and worsened in 2 eyes (6.69%). Ten eyes (38.46%) achieved visual acuity between (20/40) and (20/100), and eight eyes (30.76%) had visual acuity between (20/200) and (20/400). The 18 eyes (69.23%) with visual acuity better than counting fingers (CF) had an attached retina with no signs of active proliferation after removal of the silicone oil. CONCLUSION: POI due to gunshot is usually a terminal event for the eye. Eyes with perforating injury can be saved and may attain useful vision after performance of combined scleral buckling and PPV with silicone oil tamponade. The final visual outcome depends on the macular or the optic nerve involvement and the final retinal stability, and phthisis bulbi can also be prevented.

Influence of implant abutment angulations on the fracture resistance of overlaying CAM-milled zirconia single crowns.

BACKGROUND: An in vitro study was performed to assess the effect of three implant abutment angulations and three core thicknesses on the fracture resistance of overlaying computer-aided manufacturing (CAM) milled zirconia (Cercon(®) system) single crowns. METHODS: Three groups, coded A to C, with different implant abutment angulations (group A/0°, group B/15° and group C/30° angulation) were used to construct 15 crowns for each angulation. Forty-five overlay restorations were milled using the Cercon(®) system with zirconium core thicknesses of 0.4, 0.6 and 0.8 mm using five crowns for each angulation. The final restorations were prepared and stored in distilled water at mouth temperature (37°C) for 24 hours prior to testing. The restorations were cemented using Temp Bond(®) . The load required to break each crown and the mode of failure were recorded. All the results obtained were statistically analysed by the ANOVA test (level of significance p < 0.05). Tested crowns were examined using a stereomicroscope at 40X and selected crowns (five randomly selected from each group were further examined by scanning electron microscopy) to reveal the zirconia-ceramic interface and to determine the fracture origin. RESULTS: Implant abutment angulations significantly (p < 0.05) reduced the fracture resistance of overlaying CAM-milled zirconia single crowns. The fracture loads of Cercon(®) crowns cemented onto abutment preparations with a 30° angulation were the lowest of the groups tested. The core thickness (0.4 to 0.8 mm) did not significantly (p > 0.05) affect the fracture resistance of the CAM-milled zirconia single crowns. SEM showed that the origin of the fracture appeared to be located at the occlusal surfaces of the crowns and the crack propagation tended to radiate from the occlusal surface towards the gingival margin. CONCLUSIONS: The implant angulation of 30° significantly (p < 0.05) reduced the fracture resistance of overlaying CAM-milled zirconia single crowns. Reducing the core thickness from 0.8 mm to 0.4 mm did not affect (p > 0.05) the fracture resistance of overlaying CAM-milled zirconia single crowns.

Marginal adaptation and micro-porosity of class II restorations of a high copper amalgam and a palladium-free gallium-based alloy.

The aim of the current investigation was to compare the marginal adaptation and internal porosity of a gallium (Ga)-based alloy (Galloy) with a high copper amalgam (Permite C DP) when used in moderately sized conventional class II cavities. Ten dentists placed two restorations of each material in standardized class II cavities in typodont teeth set in a phantom head. The proximal surfaces of the restored teeth were subsequently examined using an optical microscope and colour photographs were taken. The teeth were then serially sectioned before being re-examined microscopically and re-photographed. Three dentists rated the photographs of the restorations on two occasions, 2 weeks apart, for marginal adaptation and internal porosity using a six and five point scoring criteria, respectively. Inter- and intra-examiner agreements were assessed with weighted kappa statistics. The Ga-based alloy exhibited inferior marginal adaptation and a significantly higher level of porosity and internal defects compared with the dental amalgam. Marginal defects were mainly concentrated at the gingival third of the proximal boxes for both alloys. The poor marginal adaptation and extensive internal porosity detected for the Ga-based alloy was attributed to the difficulty in the alloy condensation related mainly to the 'stickiness' of the alloy to the condensers and to the rapid change in the plasticity of the alloy during condensation. This could possibly be a factor in the post-operative complications reported with the clinical use of this alloy.

Influence of fibre position on the flexural properties and strain energy of a fibre-reinforced composite.

The introduction of laboratory-processed composite systems and fibre reinforcement techniques have increased the possibilities for the prosthetic replacement of missing tooth tissues. Laboratory fabrication variables may significantly influence the properties of the final prosthesis. During the construction of a fibre-reinforced bridge it is necessary to place the fibre at some distance from the fitting surface of the restoration in the pontic region. No guidelines are available for optimal fibre placement in this respect. The purpose of this study was to assess the influence of placing ultra high molecular weight polyethylene (UHMWPE) fibre at five different distances from the tensile side of test samples on flexural properties and the strain energy stored within the dental composite. The results of this investigation showed that whilst moving the fibre reinforcement away from the tensile side by up to 1.5 mm led to a significant reduction in flexural strength, there was no significant decline in the increase in strain energy stored within the tested composite until this distance was exceeded.

Handling characteristics of a palladium-free gallium-based alloy compared with a high copper dental amalgam in a simulated clinical trial.

The aim of the current study was to compare the handling characteristics of a palladium-free gallium-based alloys (Galloy) with those of a high-copper amalgam (Permite C). The study had a particular interest in the evaluation of the direct placement delivery system used with both alloys. Ten dentists participated in the current study. Each placed two amalgam and two gallium-based alloy restorations in conventional class II cavities prepared in acrylic typodont teeth. None of the participating dentists had used the direct placement delivery system or had any previous experience with gallium-based alloy and no practice was allowed beforehand. The restorations were evaluated according to the following criteria: ease of loading the cavity (delivery system), ease of condensation, capacity to produce and sustain contact area, ease of carving, resistance to damage during removal of the matrix band, overall quality of the restoration and the available working time. Each criterion was given a score on a scale of 1-5 (1: very poor, 2: poor, 3: fair, 4: good, 5: very good). The results showed no statistically significant difference in the evaluated criteria between the two alloys (P > 0.05) except for criterion number 2 (ease of condensation, P=0.0005).

The influence of fibre placement and position on the efficiency of reinforcement of fibre reinforced composite bridgework.

The effect of placement of ultra-high molecular weight polyethylene (UHMWPE) fibres on the flexural properties and fracture resistance of a direct dental composite was investigated. The UHMWPE fibres are increasingly being used for the reinforcement of laboratory fabricated resin composite crown and bridgework. The aim of this study was to assess the effect of a commonly used laboratory fabrication variable on the in vitro strength of beam shaped specimen simulating a three-unit fixed bridge. Four groups (10 specimens per group) of Herculite XRV were prepared for flexural modulus and strength testing after reinforcement with UHMWPE fibres. Two groups of control specimens were prepared without any fibre reinforcement. Half the specimen groups were stored in distilled water and the other groups were stored dry, both at 37 degrees C for 2 weeks before testing. The results of this study showed that placement of fibre at or slightly away from the tensile side improved the flexural properties of the composite in comparison with the unreinforced control specimen groups whilst the mode of failure differed according to fibre position. Scanning electron microscope (SEM) investigation revealed that placement of the fibre slightly away from the tensile side favoured crack development and propagation within the resin bridging the interfibre spaces in addition to debonding parallel to the direction of fibre placement. Laboratory fabrication variables may effect the strength of fibre reinforced bridgework significantly.