Inflammatory and adhesion profile of gingival fibroblasts to lithium disilicate ceramic surfaces.

OBJECTIVES: Lithium disilicate (LS) ceramic emerges as a compelling option for customized implant abutments. However, ensuring its safety and reliability requires clarification on key aspects, notably its impact on inflammation and potential for cell adhesion. This study delves into these considerations, examining the influence of LS ceramic on cytokine release and the transcriptional profile of human gingival fibroblasts (hGFs) in direct contact with various LS surfaces. METHODS: hGFs were cultured on LS disks featuring three distinct surfaces (unpolished, polished, and polished glaze), while titanium disks served as reference material and cells cultured directly on plates as controls. The surface of the disks was analyzed using a scanning electron microscope. The cell metabolism was analyzed by MTT test, cytokine release by MAGPIX and the expression of genes related to cell adhesion was evaluated by qPCR. RESULTS: The disks exhibited similar topography with smooth surfaces, except for the unpolished LS disks, which had an irregular surface. Contact with LS surfaces did not substantially reduce cell metabolism. Moreover, it generally decreased cytokine release compared to controls, particularly pro-inflammatory mediators like IL-1ß, IL-6, and TNF-α. Significantly increased expression of genes related to cell adhesion to LS was observed, comparable to titanium, the gold standard material for implant abutments. SIGNIFICANCE: This study unveils that LS ceramic not only fails to trigger pro-inflammatory cytokine release, but also significantly enhances gene expression associated with cell adhesion. These mechanisms are closely linked to gene pathways such as PTK2, SRC, MAPK1, and transcription factors ELK-1 and MYC. In summary, the findings underscore LS ceramic's potential as a biocompatible material for implant abutments, shedding light on its favorable inflammatory response and enhanced cell adhesion properties.

Wide Restorative Emergence Angle Increases Marginal Bone Loss and Impairs Integrity of the Junctional Epithelium of the Implant Supracrestal Complex: A Preclinical Study.

AIM: To assess the influence of the emergence angle on marginal bone loss (MBL) and supracrestal soft tissue around dental implants. MATERIALS AND METHODS: In six mongrel dogs, the mandibular premolars and molars were extracted. After 3 months of healing, four dental implants were placed in each hemimandible. The implants were randomly allocated to receive one of four customized healing abutments, each with a different value of the restorative emergence angle: 20°, 40°, 60° or 80°. Intra-oral radiographs were taken after placing the healing abutments and at 6, 9, 16 and 24 weeks of follow-up. Then, micro-CT and undecalcified histology and synchrotron were performed. MBL over time was analysed with generalized estimating equations (GEEs) and adjusted for baseline soft-tissue thickness. RESULTS: From implant placement to 24 weeks, GEE modelling showed that the MBL at mesial and distal sites consistently increased over time, indicating MBL in all groups (p < 0.001). The model indicated that MBL varied significantly across the different restorative angles (angle effect, p < 0.001), with 80° showing the greatest bone loss. Micro-CT, histology and synchrotron confirmed the corresponding trends and showed that wide restorative angles (60° and 80°) impaired the integrity of the junctional epithelium of the supracrestal tissue. CONCLUSIONS: A wide restorative angle increases MBL and impairs the integrity of the junctional epithelium of the implant supracrestal complex.

Human gingival fibroblast response on zirconia and titanium implant abutment: A systematic review.

PURPOSE: The peri-implant region, where restoration interfaces with mucosal tissue, plays an essential role in overall implant success and is just as important as osseointegration. The implant abutment materials are in intimate contact with human gingival fibroblasts (HGFs). This study compares the proliferation of HGFs between zirconia and titanium abutments used in dental implants. METHODS: An electronic search was performed using PubMed, EMBASE, and Web of Science databases. English articles based on in vitro studies testing HGFs proliferation on zirconia and titanium implant abutment materials were included. A quality assessment of the selected study was performed using the web-based Science in Risk Assessment and Policy (SciRAP) tool. The HGFs proliferation and cellular morphology tests on zirconia and titanium materials from the included studies were summarized, exploring the role of material surface characteristics. RESULTS: The electronic search yielded 401 studies, of which 17 were selected for inclusion. Zirconia exhibited comparable or superior efficacy in promoting the proliferation of HGFs compared to titanium. Observations on cellular morphology showed similar outcomes for both materials. Establishing a definitive relationship between contact angle, surface roughness, and their influence on cellular response remains challenging due to the varied methodological approaches in the reviewed studies. CONCLUSION: Based on the findings of this systematic review, zirconia shows comparable reliability to titanium as an abutment material for HGFs proliferation, with comparable or superior HGFs proliferative outcomes.

The Reuse of Healing Abutments: A Questionnaire-Based Survey.

Healing abutments (HA) are used in second-stage implant surgery to create the optimal peri-implant environment. Despite being a component intended only for short-term use, it remains in the mouth for a few weeks to several months and stays in close contact with organic debris, intraoral fluids, and bacteria. Reusing the HAs modifies their surfaces, expands the coating layer's porosity, and promotes bacterial colonization at the HA-implant interface in addition to the previous contamination. Therefore, the study's goals were to determine the frequency of HA reuse, examine the sterilizing and disinfection techniques employed, and examine the factors that contributed to the dental professionals in the Indian state of Maharashtra utilizing these components again when placing dental implants. For the study, 150 dentists who worked in the field of implantology were chosen. An online questionnaire issued via email and WhatsApp was used to collect data, which started in January 2023. The survey was designed to store the demographic information and responses of the participants, and it was made available through Google Forms. By the end of February 2023, the responses had been gathered. Tables and graphs were used to present the study outcomes that were based on the statistical analysis. The analysis employed the Chi-square test, with a p-value of 0.05 deemed statistically significant. There were 150 answers in all, with 44% women and 56% men. Merely 7.4% of participants do not reuse healed abutments, compared to 92.6% who follow this procedure. The respondents were also asked about the number of times they reused the HAs, 69% of the implantologists reused the same component countless times, while 31% reused it only once. All the respondents reported sterilizing the HAs before reuse and the method used for sterilization was autoclave (96.4%) and UV chamber (3.6%). In response to a question concerning informing patients about the reuse of HAs, 77.6% of implantologists stated they do not interact with patients, while only 22.4 reported doing so. Implantologists in the state of Maharashtra, India reuse HAs and use heterogeneous methods for disinfection and autoclave sterilization.

Biomechanical behaviour of tilted abutment after fixed partial denture restoration of CAD/CAM materials.

BACKGROUND: Failure to restore missing teeth in time can easily lead to the mesial tilting of the distal abutment teeth. However, a fixed partial denture (FPD) can improve stress conduction and distribution and prevent periodontal injuries. In these more complex cases, it is necessary to consider various factors comprehensively to improve conventional treatment planning and achieve better results. METHODS: We selected a patient with a missing first molar and a mesial inclination of the second molar, leaving inadequate space or bone mass for implant denture restoration, necessitating an FPD for restoration. Three-dimensional finite element analysis (3D-FEA) combined with photoelastic analysis were used to explore how the inclination angle (0 ‒ 30°) and different dental restoration materials (zirconia, lithium disilicate, polymer-infiltrated ceramic network, and resin composite) affect the biomechanical behaviour of FPD‒abutments‒periodontal tissue complex. RESULTS: The stress was easily concentrated in the FPD connectors, enamel shoulder collar, periapical area, and root bifurcation. The stress on FPD and the periodontal ligament (PDL) of the second premolar increased with an increase in the elastic modulus of FPD, with an opposite trend in the abutments, the alveolar bone, and the PDL of the second molar. The stress on the FPD and alveolar bone increased with increased inclination angle of the distal abutment. The stress on two abutments and their PDL were positively correlated with the inclination angle in two stages; however, when the inclination angle > 12°, the second premolar and its PDL showed a negative correlation. CONCLUSIONS: FPDs can be used for restoration within 24° of distal abutment inclination, but protecting the abutments (< 12° especially) and the periodontal tissue (> 12° especially) must be taken seriously. For this purpose, an FPD material with higher strength is recommended.

Enhancing Retention in Digit Rehabilitation: Implant-Assisted Silicone Finger Prosthesis for an Amputated Thumb.

This case report details the prosthetic replacement of a thumb lost due to traumatic amputation. The primary goal of this replacement was to restore the thumb's functionality, enabling the patient to resume daily activities such as writing and holding objects. A silicone prosthesis, anchored by an osseointegrated implant in the metacarpal bone, was used for this purpose. In this instance, a young female's thumb stump was functionally rehabilitated with the assistance of bone-anchored implants and room-temperature-vulcanizing silicones. At the follow-up appointment, no complications were observed, and the prosthesis remained in excellent condition, requiring no additional intervention. Utilizing bone-anchored implants to enhance retention in short stumps post-amputation proves to be one of the most effective methods to restore function and improve the daily lives of such patients.

Influence of repeated implant-abutment manipulation on the prevalence of peri-implant diseases in complete arch restorations. A retrospective analysis.

PURPOSE: To evaluate the effects of repeated abutment manipulation on the prevalence of peri-implant diseases. MATERIALS AND METHODS: A total of 27 edentulous patients (n = 108 implants) immediately restored with double-crown retained implant-supported prostheses were identified for this retrospective study. The test included the one-abutment, one-time care concept (n = 18 patients, n = 72 implants, OAOT) and the control abutment replacement (n = 9 patients, n = 36 implants, AR). A mixed effects model regression was conducted for the variable diagnosis (healthy, peri-implant mucositis, and peri-implantitis) with predictors abutment replacement (presence/absence), number of abutment replacement, category of keratinized mucosa (KM) (2 < KM ≥2 mm), and radiographic bone loss (BL). RESULTS: After 3-15 years (mean 10.2 ± 2.8 years), the prevalence of peri-implant mucositis and peri-implantitis in patients in the AR group was 11.1% and 88.9%, corresponding to 22.2% and 55.6% at the implant level, respectively. In OAOT group, none of the implants showed peri-implant mucositis, whereas the prevalence for peri-implantitis at patient and implant level amounted to 5.6% and 5.6%, respectively. The increased number of abutment replacements was significantly associated with the increased probability to diagnose peri-implant mucositis and peri-implantitis (OR: 6.13; 95% CI [2.61, 14.39]) (p < 0.001), whereas the presence of keratinized mucosa was not founded as a significant cofounder. The estimated mean BL in AR group was 1.38 mm larger than in OAOT group (p = 0.0190). CONCLUSIONS: The OAOT concept was associated with a lower prevalence of peri-implant diseases.

Effect of polishing process on torque loss ratio and microgap of selective laser melting abutment: an in vitro study.

BACKGROUND: The purpose of this in vitro study was to investigate the effect of polishing post-treatment process on the torque loss ratio and microgap of Selective Laser Melting (SLM) abutments before and after mechanical cycling test through improving the surface roughness of the implant-abutment interface. MATERIALS AND METHODS: Forty SLM abutments were fabricated, with 20 underwent minor back-cutting, designated as polishing, in the implant-abutment interface. The abutments were divided into three groups: SLM abutments (group A), original abutments (group B), and polished SLM abutments (group C), each containing 20 abutments. Surface roughness was evaluated using a laser microscope. Implant-abutment specimens were subjected to mechanical cycling test, and disassembly torque values were measured before and after. Scanning electron microscope (SEM) was used to measure microgap after longitudinal sectioning of specimens. Correlation between surface roughness, torque loss ratio, and microgap were evaluated. LSD's test and Tamhane's T2 comparison were used to analyze the data (α = 0.05). RESULTS: The Sz value of polished SLM abutments (6.86 ± 0.64 µm) demonstrated a significant reduction compared to SLM abutments (26.52 ± 7.12 µm). The torque loss ratio of polished SLM abutments (24.16%) was significantly lower than SLM abutments (58.26%), while no statistically significant difference that original abutments (18.23%). The implant-abutment microgap of polished SLM abutments (2.38 ± 1.39 µm) was significantly lower than SLM abutments (8.69 ± 5.30 µm), and this difference was not statistically significant with original abutments (1.87 ± 0.81 µm). A significant positive correlation was identified between Sz values and the ratio of torque loss after cycling test (r = 0.903, P < 0.01), as well as Sz values and the microgap for all specimens in SLM abutments and polished SLM abutments (r = 0.800, P < 0.01). CONCLUSION: The findings of this study indicated that the polishing step of minor back-cutting can lead to a notable improvement in the roughness of SLM abutments interface, which subsequently optimized the implant-abutment fit. It can be seen that the application of minor back-cutting method has advanced the clinical use of SLM abutments.

Influence of the Composition of Provisional Luting Materials on the Bond Strength of Temporary Single-Tooth Crowns on Titanium Abutments.

In addition to zinc oxide-based cements, resin-based materials are also available for temporary cementation. The aim of this in vitro study was to determine the influence of the different material compositions on temporary bonds. In nine test series (n = 30), temporary bis-acrylate single-tooth crowns were bonded onto prefabricated titanium abutments with nine different temporary luting materials. After simulating an initial (24 h, distilled water, 37 °C), a short-term (7 days, distilled water, 37 °C) and a long-term provisional restoration period (12h, distilled water, 37 °C; thermocycling: 5000 cycles) in subgroups (n = 10), the bond strength was examined using a combined tensile-shear test. Statistical analysis was performed by univariate analysis of variance or a non-parametric Kruskal-Wallis test, followed by post hoc tests. Of the three resin-based materials, two showed significantly higher bond strength values compared to all other materials (p < 0.001), regardless of the storage procedure. The resin-based materials were followed by eugenol-free and eugenol-containing zinc oxide materials. Significant intragroup differences were observed between the composite-based materials after all storage periods. This was only observed for some of the zinc oxide-based materials. The results show that under in vitro conditions, not only the composition of the temporary luting materials but also the different storage conditions have a significant influence on temporary bonds.

Clinical Outcomes of Single Tooth Implant Placement in the Mandibular Region: A Case Report.

The most frequent reasons why people lose their teeth are trauma, dental caries, developmental defects, and genetic abnormalities. Dental implants have become a popular alternative to traditional dentures and bridges due to their ability to restore function through osseointegration. This case report presents a 35-year-old male with a two-year history of a missing lower right molar due to caries. With no systemic health issues or harmful habits, the patient underwent dental implant placement after a thorough evaluation and cone-beam computed tomography (CBCT) analysis. A parallel-sided, threaded implant was placed in the 46 region. Postoperative care included antibiotics, analgesics, and follow-up visits. Second-stage surgery was done, which was followed by impression-making and healing abutment placement. The final crown was cemented with careful occlusion verification. The patient exhibited excellent healing and was scheduled for regular follow-ups to ensure successful implant integration and function restoration.

Optimizing Function and Aesthetics in Kennedy Class 1 Prosthetic Rehabilitation: A Case Report.

When dealing with a partially edentulous patient requiring rehabilitation for a distal extension, the situation becomes challenging if the patient is unwilling to consider placing implants or using a removable prosthesis. A patient with partial tooth loss may find it difficult to receive a satisfactory repair, especially if the missing teeth are at the back. The surrounding gum tissue and the underlying bone ridges provide support for dentures that encase natural teeth. During functional activities, these components are frequently exposed to different stresses, which can substantially affect the remaining natural teeth and bone structure. Precision attachments are complex devices made up of two parts: one incorporated into a detachable dental prosthesis and the other fastened to the natural teeth. Their function is to give the prosthetic stability and retention. A fixed partial denture is impractical when there is no distal abutment. However, by offering a combination prosthesis, this difficulty can be solved. Without requiring surgery, this method provides the benefit of a fixed prosthesis. We are presenting a case of management for a 56-year-old patient with unilateral distal extension with a combined prosthesis of acrylic retained by an extra coronal precision attachment system.

Effect of cement type, luting protocol, and ceramic abutment material on the shade of cemented titanium-based lithium disilicate crowns and surrounding peri-implant soft tissue: a spectrophotometric analysis.

PURPOSE: The objective of the study was to analyze the impact of cement, bonding pretreatment, and ceramic abutment material on the overall color results of CAD-CAM ceramic crowns bonded to titanium-based hybrid abutments. MATERIALS AND METHODS: For single implant restoration of a maxillary lateral incisor a total of 51 CAD-CAM-fabricated monolithic lithium disilicate crowns were fabricated and subsequently bonded onto 24 lithium disilicate Ti-base abutments, 24 zirconia Ti-base abutments and 3 resin abutment replicas as a control group. The 48 copings were cemented with three definitive and one provisional cement on both grit-blasted and non-blasted Ti-bases. The color of each restoration and surrounding artificial gingiva was measured spectrophotometrically at predefined measuring points and the CIELAB (ΔEab) color scale values were recorded. RESULTS: The color outcome of ceramic crowns bonded to hybrid abutments and soft tissues was affected differently by cements of different brands. Grit-blasting of Ti-bases prior to cementing CAD-CAM copings affected the color results of all-ceramic crowns. There was a significant difference (P = .038) for the median ΔE value between blasted and non-blasted reconstructions at the cervical aspect of the crown. Full-ceramic crowns on zirconia Ti-base abutments exhibited significantly lower ΔE values below the threshold of visibility (ΔE 1.8). In all subcategories tested, the use of a highly opaque temporary cement demonstrated the lowest median ΔE for both the crown and the artificial gingiva. CONCLUSION: Various cements, core ceramic materials and airborne particle abrasion prior to bonding can adversely affect the color of Ti-base supported ceramic crowns and peri-implant soft tissue. However, zirconia CAD-CAM copings and an opaque cement can effectively mask this darkening.

Comparison of misfit and roughness of CAD-CAM ZrO, selective laser sintered CoCr and preformed Ti implant abutment crowns.

BACKGROUND: Marginal misfit and surface roughness of customized implant abutments is critical for restorative success. However, little is known about the comparison of misfit and surface roughness of CAD-CAM Zirconium oxide (ZrO), selective laser melting (SLM) Cobalt Chrome (CoCr) and preformed abutments. The aim of the study is to investigate the relation of misfit and micro-roughness of selective laser melting (SLM), preformed and CAD-CAM implant abutments. METHODS: Thirty internal connection, endosseous dental implants (Ø 4.0 mm x 10 mm, Dentium) were mounted in Polymethyl methacrylate vertically. Ten preformed Titanium alloy (Ti) abutments with 1 mm soft tissue height and Ø 4.5 mm were included as controls. Ten each of Y-TZP and SLM-CoCr, abutment/crowns were fabricated using CAD-CAM milling (CAD-CAM-ZrO) and SLM techniques. Surface micro-roughness (Ra) of the fabricated implant abutment/crown was evaluated with a 3D optical non-contact microscope. All implant restorations were torqued to implants (30 Ncm) using a Tohnichi BTGE digital torque gauge and were analyzed with Bruker micro-CT (Skyscan 1173) to detect micro-gaps at pre-selected points at implant abutment interface. The Ra and misfit data were compared using ANOVA, Tukey-Kramer, Kruskal-Wallis test and Pearson correlation (p < 0.05). RESULTS: Mean Ra among SLM CoCr abutments [0.88 (0.09) µm] were lower than CAD-CAM-ZrO and higher than preformed Ti abutments. Horizontal misfit among SLM-CoCr [45.43 (9.41) µm] and preformed Ti [36.87 (13.23) µm] abutments was not statistically different (p > 0.05). Misfit was significantly higher in Y-TZP samples compared to SLM-CoCr (p = 0.031) and preformed Ti abutments (p = 0.01). Preformed Ti abutments showed significantly lower misfit compared to SLM-CoCr abutments (p = 0.01). A positive linear correlation was observed between the surface roughness (Ra) and vertical misfit (r = 0.61, p < 0.05). CONCLUSION: SLM CoCr abutments showed rough surface compared to preformed Ti abutments, while horizontal misfit was comparable among SLM-CoCr and preformed abutments. Misfit was significantly greater in Y-TZP abutments, compared to SLM and preformed abutments. SLM abutment fabrication technique needs further improvement to provide better fit and surface topography.

Assessing peri-implant bacterial community structure: the effect of microbiome sample collection method.

BACKGROUND: Oral microbiota comprises polymicrobial communities shaped by mutualistic coevolution with the host, contributing to homeostasis and regulating immune function. Nevertheless, dysbiosis of oral bacterial communities is associated with a number of clinical symptoms that ranges from infections to oral cancer. Peri-implant diseases are biofilm-associated inflammatory conditions affecting the soft and hard tissues around dental implants. Characterization and identification of the biofilm community are essential for the understanding of the pathophysiology of such diseases. For that sampling methods should be representative of the biofilm communities Therefore, there is a need to know the effect of different sampling strategies on the biofilm characterization by next generation sequencing. METHODS: With the aim of selecting an appropriate microbiome sampling procedure for periimplant biofilms, next generation sequencing was used for characterizing the bacterial communities obtained by three different sampling strategies two months after transepithelial abutment placement: adjacent periodontal crevicular fluid (ToCF), crevicular fluid from transepithelial abutment (TACF) and transepithelial abutment (TA). RESULTS: Significant differences in multiple alpha diversity indices were detected at both the OTU and the genus level between different sampling procedures. Differentially abundant taxa were detected between sample collection strategies, including peri-implant health and disease related taxa. At the community level significant differences were also detected between TACF and TA and also between TA and ToCF. Moreover, differential network properties and association patterns were identified. CONCLUSIONS: The selection of sample collection strategy can significantly affect the community composition and structure. TRIAL REGISTRATION: This research is part of a randomized clinical trial that was designed to assess the effect of transepithelial abutment surface on the biofilm formation. The trial was registered at Trial Registration ClinicalTrials.gov under the number NCT03554876.

Examination of Various Abutment Designs Behavior Depending on Load Using Finite Element Analysis.

Studies on dental implant abutments' geometric design and material selection offer significant innovations and results. These studies aim to improve the abutments' functionality and aesthetic performance, minimize microcavities' formation, and ensure implant-supported prostheses' longevity. For example, CAD-CAM fabricated custom abutments have been found to produce a better marginal fit and fewer microgaps than standard abutments. In an in vitro study, transepithelial abutments offered lower microgap values than titanium-based abutments and provided a better fit at the implant-abutment interface. It is known that studies to improve mechanical and biological performance with Polyether Ether Ketone (PEEK) material have been addressed. New materials such as PEEK and zirconia have offered significant advantages in biocompatibility and aesthetics. Along with those studies, different abutment designs are also important. Abutment geometry is optimized to improve stress distribution and minimize peri-implant bone loss. In implant and abutment connections with different angles, mechanical life performances may vary depending on static and dynamic load. These studies emphasize the importance of material research on different types of connections to improve dental implants' durability, homogeneous load distribution, and reliability. The abutment parts used in implant treatment are insufficient to distribute the load homogeneously against chewing pressure due to their materials and geometry. Non-uniform load distribution damages the abutment and the prosthetic crown, accelerating the wear process. This study aimed to create different abutment designs to improve dental implants' biomechanical performance and longevity. This study aimed to increase the mechanical durability of the implant-abutment connection by reducing stress concentrations in response to masticatory compression on the abutment in different directions and forces and to guarantee the long-term success of the implant system by providing a more homogeneous stress distribution. It aimed to apply different forces in the axial direction to these models in a simulation environment and to calculate and compare the deformation and stress load distribution. As a method, three-dimensional models of the parts used in implant treatments and forming the implant system were designed. Different abutment designs were created with these models. Taking the current material values used in implant treatments as a reference, finite element analysis (FEA) was performed by applying different axial loads to each implant system model in the ANSYS software (version 24.1). Comparative analysis graphs were prepared and interpreted for the stress values obtained after the applied load. This study evaluated the mechanical performance of different abutment models (A, B, C, D, and E) under a 100 N load using the Kruskal-Wallis test. The Kruskal-Wallis test showed significant differences between the groups (p < 0.001). The greatest difference was observed between models E and A (q' = 6.215), with a significant difference also found between models C and A (q' = 3.219, p < 0.005). Regarding stress values, the highest stress on the abutment was observed in Model B (97.4 MPa), while the lowest stress was observed in Model E (9.6 MPa). The crown exhibited the highest stress in Model B (22.7 MPa) and the lowest in Model E (17.3 MPa). The implant stress was highest in Model C (14.8 MPa) and lowest in Model B (11.3 MPa). The stress values for the cortical bone and cancellous bone were quite similar across the models, showing no significant differences. These findings indicate that the abutment design and material selection significantly impact mechanical performance. Among the implant systems created with five different abutment models, in which the existing abutment geometry was also compared, homogeneous and axial distribution of the load on the abutment was achieved, especially with viscoelastic and surface area increased abutment designs. Clinically, the inadequacy and limited mounting surface or geometry of the abutments used in today's implant treatment applications have led to different design searches. It was concluded that the designs in this study, which are considered alternatives to existing abutment models, contribute positively to the mechanical life of the abutment material, considering the von Mises stresses and directions. This study brings a new perspective to today's practices and offers an alternative to treatment practices.

Comparison of Aesthetic, Mechanical Outcome, and Bone Loss in Angulated Screw Channels (ASCs) and Cement-Retained Implant-Supported Prosthesis: A Case-Control Study.

Angulated-screw channels (ASCs) allow the clinician to employ screw-retained restorations in almost all cases, as the access hole can be moved away from the vestibular portion of the crown, where it would jeopardize the final esthetic result. The objective of this study was to compare screw-retained restorations employing ASCs with restorations cemented on angled abutments. In this study, 30 subjects, equally divided into two groups: group 1 (cemented restorations on angulated abutments) and group 2 (screw-retained restorations adopting ASCs), were treated and retrospectively compared after 2 years using the pink esthetic score (PES) and the white esthetic score (WES). All restorations were in use at the last follow-up, with a survival rate of 100%. Three mechanical complications were observed (2 chippings and 1 crown came loose), with a success rate of 93% in group 1 and 87% in group 2 (p > 0.05). No statistically significant differences were reported regarding the esthetic outcome; the marginal bone loss (MBL) showed better results for the screw-retained restorations, both at the distal aspect (group 1 = 0.98 mm ± 0.16; group 2 = 0.45 mm ± 0.06; p = 0.006) and at the mesial aspect (group 1 = 1.04 ± 0.27; group 2 = 0.45 ± 0.005; p < 0.001). From an esthetical perspective, screw-retained restorations with ASCs and cemented restorations on angulated abutments are both effective means of restoring implants; both have excellent esthetic outcomes, but screw-retained restorations have reduced bone loss when compared to cemented ones but are more prone to mechanical complications. Still, our results must be cautiously observed given the reduced dimension of our sample. Larger studies are needed to confirm our findings.

Clinical outcomes of single implant supported crowns utilising the titanium base abutment: A 7.5-year prospective cohort study.

OBJECTIVE: To assess radiographic, clinical and patient-reported outcomes of single zirconia implant-supported crowns on titanium base abutments (TBA) over a 7.5-year period. METHODS: Twenty-four patients received bone-level titanium implants and screw-retained zirconia implant crowns utilising TBA. Marginal bone level (MBL), clinical parameters (probing depth-PD, bleeding on probing-BoP, plaque control record-PCR), technical complications (USPHS criteria) and patient satisfaction were assessed at crown delivery (baseline), 1 year (FU-1) and at 7.5 years (FU-7.5) of follow-up. RESULTS: Eighteen patients were available for re-examination at 7.5 years. The mean MBL at FU-7.5 (0.35 ± 0.20mm) did not significantly change compared to baseline (0.54 ± 0.39, p=.352) and to FU-1 (0.54 ± 0.45mm, p=0.524). From baseline to 7.5 years, the mean PD increased significantly, from 3.0 ± 0.6mm to 3.7 ± 0.8mm (p=0.005). However, BoP and PCR did not significantly change; (BOP: from 27.1 ± 20.7% to 25.0 ± 20.0%, p=0.498; PCR: from 11.1 ± 21.2% to 25.0 ± 25.1%, p=0.100). Nine patients presented with more than one bleeding site. This denoted a peri-implant mucositis prevalence of 50%, whilst none of the implants presented peri-implantitis. One incidence of minor and major ceramic chipping were reported on 2 out of the 18 crowns, resulting in a prosthetic survival rate of 94.4%. Seventeen patients were highly satisfied with their result. CONCLUSION: Single implant-supported zirconia crowns on TBA displayed: (i) minor number of technical complications, (ii) high prosthetic survival rate, (iii) stable marginal bone level and (iv) high patient satisfaction at 7.5 years. CLINICAL IMPLICATIONS: Titanium base abutments despite their high use in clinical practice, lacked medium- and long-term studies. The presented findings highlight their clinical performance at 7.5 years as they display satisfying radiographic, clinical and patient-related outcomes. TBA appear to be a suitable abutment choice for medium-term implant-supported restorations.

In vitro assessment of cementation of CAD/CAM fabricated prostheses over titanium bases. A systematic review.

OBJECTIVES: The objective of this study is to investigate the outcomes of clinically relevant laboratory studies regarding the cementation of implant-supported restorations over ti-bases. MATERIALS AND METHODS: The present study has been conducted according to PRISMA statement. An electronic search was performed, including publications up to March 2024, to identify studies investigating the parameters affecting the cementation between ti-bases and CAD/CAM prostheses. An assessment of the internal validity was performed, using a custom-made risk of bias tool (QUIN). RESULTS: From the included studies, 40.1% were reported on luting systems, 25% on ti-base surface treatment, 25% on restoration surface, 21.8% on restoration material, and 18.7% on ti-base height. The majority of the included studies were associated with a medium risk of bias. In the absence of micro-retentive features, air-abrasion of ti-bases with a minimum height of 3.5 mm can be beneficial for restoration's retention. The bonding performance can vary not only between different bonding systems but also for different applications within the same system, based on a restoration's material and surface treatment as well as on ti-base height and surface treatment. CONCLUSIONS: The height of the ti-base seems to be the prevailing factor as it constitutes the prerequisite for other modifications of the bonding surfaces to have an advantageous effect. Since the parameters that can affect bonding performance between ti-base and restoration can interact with each other, it is important for the clinician to focus on verified bonding protocols.

The Effect of Different Abutment Designs and Materials on Stress Distribution in Implants and Peripheral Bones: A Three-Dimensional Finite Element Analysis.

AIMS: To evaluate and compare the distribution of stress patterns around a single implant-supported crown with various abutment designs using different abutment materials. SETTING AND DESIGN: This is an in vitro study to evaluate and compare stress distribution patterns. METHODS: The three-dimensional (3D) finite element models included four stock and four customized abutments made of Titanium, Zirconia, Fibre-Reinforced Composite, and Poly Ether-Ether Ketone (PEEK) attached to an end-osseous root form implant. The models were subjected to a 300 N vertical load at the central fossa and a 150 N oblique load at the centre of the lingual inclines of the buccal cusps of the mandibular molar crown designed on the model. STATISTICAL ANALYSIS USED:  The stress distribution within the implant and the surrounding supporting structures was evaluated using finite element analysis. RESULTS: In all the models, stresses on the implants were observed to be concentrated in the neck of the implants in the first few threads. Irrespective of the abutment design, PEEK abutment transferred greater stresses to implants and Zirconia abutment transferred lesser stresses to implants. In the implants, the customized abutment showed lesser stress values than the stock abutment during oblique loading. CONCLUSIONS: Stresses on implants and cortical bone can be reduced by using Zirconia as an abutment material compared to Titanium, Fibre-Reinforced Composite, and Poly Ether-Ether Ketone material. Customized abutments improve the load transfer between the prosthesis and the implant and the surrounding bone, lessen the micro-movement of the abutments, and distribute the stress more evenly across the implant's component parts.

Effect of Titanium Base Abutment Height and Restorative Material on Torque Maintenance of Hybrid-abutment Restoration with Offset Implant Placement.

PURPOSE: The purpose of this in vitro study was to evaluate the effect of titanium base height on torque loss of monolithic zirconia, lithium disilicate, and polymer-infiltrated ceramic hybrid- abutment restorations for offset placed implant. MATERIALS AND METHODS: Forty-two hybrid- abutment restorations supported by offset placed implants (diameter: 4.2 mm; length: 10 mm) were divided into 6 groups: short titanium base and zirconia (SZ), long titanium base and zirconia (LZ), short titanium base and lithium disilicate (SE), long titanium base and lithium disilicate (LE), short titanium base and polymer-infiltrated ceramic (SP), and long titanium base and polymer-infiltrated ceramic (LP). An adhesive resin cement was used to bond the restoration to the titanium base. The restoration was secured with titanium screw tightened to 30 Ncm by using a calibrated torque meter device. The specimens were exposed to thermocycling (5000 cycles at 5°C to 55°C), then cyclic loaded (120 000 cycles/50 N/1.6 Hz), where the load was placed vertically in mesial fossa of the restoration. After the loosening torque value of the abutment screw was measured by the torque meter device, the torque loss and its percentage were calculated. Two-way ANOVA, one-way ANOVA, and post hoc Tukey tests were used for statistical analysis of the data (α=.05). RESULTS: The 2-way ANOVA test showed significant differences in loosening torque, torque loss and percentage of torque loss across the restorative material (P<.001), no significant difference across the height of titanium base (P=.213) and no significant interaction (P=.845) between restorative material and height of titanium base. Regarding the restoration type, 1-way ANOVA test showed significant difference (F ratio=15.95, P<.001) in torque loss between groups. The mean torque loss value with monolithic zirconia was significantly higher than with lithium disilicate (P=.039) and polymer-infiltrated ceramic (P<.001), respectively. Between the lithium disilicate and polymer-infiltrated ceramic, a significant difference (P=.013) was also found. CONCLUSION: The restorative material had a major effect on the torque maintenance in hybrid-abutment-restoration supported by offset placed implant, while the titanium base abutment height had no influence on it. Compared to lithium disilicate and polymer-infiltrated ceramic materials, monolithic zirconia induced higher torque loss when used as hybrid-abutment-restoration.