Eighteen-Month Outcomes of Titanium Frameworks Using Computer-Aided Design and Computer-Aided Manufacturing Method.

PURPOSE: The aim of the report is to introduce a new software and a new scanner with a noncontact laser probe and to present outcomes of computer-aided design and computer-aided manufacturing titanium frameworks using this new software and scanner with a laser probe. MATERIALS AND METHODS: Seven patients received 40 implants placed using a 1-stage protocol. After all implants were planned using an implant planning software (NobelClinician), either 5 or 6 implants were placed in each edentulous arch. Each edentulous arch was treated with a fixed dental prosthesis using implant-supported complete-arch milled-titanium framework using the software (NobelProcera) and the scanner. All patients were followed up for 18 ± 3 months. Implant survival, prosthesis survival, framework fit, marginal bone levels, and maintenance requirements were evaluated. RESULTS: One implant was lost during the follow-up period, giving the implant survival rate of 97.5%; 0.4 ± 0.2 mm marginal bone loss was noted for all implants after 18 ± 3 months. None of the prostheses needed a replacement, indicating the prosthesis success rate of 100%. CONCLUSION: The results of this clinical study suggest that titanium frameworks fabricated using the software and scanner presented in this study fit accurately and may be a viable option to restore edentulous arches.

Evaluation of mandibular lingual foramina related to dental implant treatment with computerized tomography: a multicenter clinical study.

BACKGROUND: Bleeding can be one of the severe complications during implant placement or other surgeries. Presurgical assessment of the area should be performed precisely. Thus, we examined lingual vascular canals of the mandible using dental computerized tomography (CT); define the anatomical characteristics of canals and the relationship with mandibular bone. METHODS: One thousand sixty-one foramina in 639 patients, in 5 dental clinics, were included in this multicenter study. Distance between crest and lingual foramen, tooth apex and lingual foramen, distance from mandibular border, diameter of lingual foramen, canal type, anastomosis, and location of foramen were examined. RESULTS: Foramen was 18.33 ± 5.45 mm below the bony crest and 17.40 ± 7.52 mm from the mandibular border, with men showing larger measurements. The mean diameter of lingual foramina was 0.89 ± 0.40 mm; 76.8% canal type was mono; 51.8% patients presented with median lingual canal-foramen (MLC) and 21.1% with lateral lingual foramen. Diameter of MLC was statistically larger. CONCLUSIONS: With a large sample group, results represented that lingual foramina could be visualized with dental CT, providing useful data for mandibular implant surgeries. Findings suggest that vascular canals and several anastomoses exist in the anterior mandible extending through premolar and molar regions as well. It is imperative to consider these vessels with the dental CT before and during the mandibular surgery to prevent threatening hemorrhage.

An investigation of the effect of scaling-induced surface roughness on bacterial adhesion in common fixed dental restorative materials.

STATEMENT OF PROBLEM: Bacterial plaque must be routinely removed from teeth, adjacent structures, and prostheses. However, the removal of this plaque can inadvertently increase the risk of future bacterial adhesion. PURPOSE: The purpose of this investigation was to assess the change in the surface roughness of 3 different surfaces after dental prophylactic instrumentation and how this influenced bacterial adhesion. MATERIAL AND METHODS: Forty specimens each of Type III gold alloy, lithium disilicate, and zirconia were fabricated in the same dimensions. The specimens were divided into 4 groups: ultrasonic scaler, stainless steel curette, prophylaxis cup, and control. Pretreatment surface roughness measurements were made with a profilometer. Surface treatments in each group were performed with a custom mechanical scaler. Posttreatment surface roughness values were measured. In turn, the specimens were inoculated with Streptococcus mutans, Lactobacillus acidophilus, and Actinomyces viscosus. Bacterial adhesion was assessed by rinsing the specimens with sterile saline to remove unattached cells. The specimens were then placed in sterile tubes with 1 mL of sterile saline. The solution was plated and quantified. Scanning electron microscopy was performed. The statistical analysis of surface roughness was completed by using repeated-measures single-factor ANOVA with a Bonferroni correction. RESULTS: The surface roughness values for gold alloy specimens increased as a result of prophylaxis cup treatment (0.221 to 0.346 Ra) (P<.01) and stainless steel curette treatment (0.264 to 1.835 Ra) (P<.01). The results for bacterial adhesion to gold alloy proved inconclusive. A quantitative comparison indicated no statistically significant differences in pretreatment and posttreatment surface roughness values for lithium disilicate and zirconia specimens. In spite of these similarities, the overall bacterial adherence values for lithium disilicate were significantly greater than those recorded for gold alloy or zirconia (P<.05). Instrumentation of the lithium disilicate and zirconia with the stainless steel curette significantly increased bacterial adhesion compared with the control (P<.05). CONCLUSIONS: The results of this investigation indicate that Type III gold alloy exhibited increased surface roughness values after stainless steel curette and prophylaxis cup treatments. Zirconia was less susceptible to bacterial adhesion than lithium disilicate, and greater bacterial adhesion was found for the stainless steel curette than the other instrumentation methods.

Removal of a fractured locator abutment screw fragment.

BACKGROUND: Although, dental implants have been a predictable option to support several types of restorations, mechanical problems are not uncommon. Retaining and abutment screw loosenings/fractures are one of the most common technical problems. AIM: To present a step-by-step technique in order to remove a broken locater abutment screw fragment. MATERIALS AND METHODS: A 56-year-old, edentulous man with a fractured locator abutment screw in an implant was referred to our clinic from a private practice. His dentist placed a narrow platform locator abutment onto a regular platform implant and the fracture occurred. Attempts to remove the fractured fragment using a periodontal probe and a manual screw removal driver were unsuccessful. RESULTS: This clinical report presents a situation in which a fractured locater abutment screw fragment was successfully removed using an implant repair kit. CONCLUSION: A fractured locater abutment screw fragment was successfully removed using an implant repair kit including drills, drill guides and tapping instruments. To avoid similar complications, it is recommended to use appropriate manufacturer specified torque values in conjunction with compatible restorative components. CLINICAL SIGNIFICANCE: Retaining and abutment screw loosenings/fractures are one of the most common mechanical problems associated with the implant components. This clinical report showed how to remove a broken screw fragment using proper armamentarium and technique, which might help clinicians eliminate similar problems.

A technique for fabricating a milled titanium complete-arch framework using a new CAD/CAM software and scanner with laser probe.

By using traditional casting procedures, accurately fitting of complete-arch frameworks that are screwed on multiple implants is difficult to achieve. The introduction of computer-aided design and manufacturing (CAD/CAM) techniques for fabricating custom 1-piece titanium frameworks simplifies this challenge and reduces time spent by the restorative dentist. This report presents a milled titanium complete-arch mandibular framework using a new planning software and a new scanner using non-contact laser probe, which eliminates the need for wax pattern fabrication.

Assessment of Radiodensity at Mandibular Periapical Bone Sites using Three-Dimensional Cone-Beam Computed Tomography.

Objectives: The aims of this retrospective study were to objectively assess bone density values obtained by cone-beam computed tomography and to map the periapical and inter-radicular regions of the mandibular bone. Material and Methods: In total, periapical bone regions of 6898 roots scanned by cone-beam computed tomography were evaluated retrospectively, and the results were recorded using Hounsfield units (HU). Results: The correlation between periapical HU values of adjacent mandibular teeth were strongly positive (P ˂ 0.01). The anterior region of the mandible yielded highest mean HU value (633.55). The mean periapical HU value of the premolar region (470.58) was higher than that was measured for molar region (374.58). The difference between furcation HU values of the first and second molars was unnoticeable. Conclusions: The results of this study have tried to evaluate the periapical regions of all mandibular teeth, which could ease to predict the bone radiodensity before implant surgery. Even though the Hounsfield units provide the average radio-bone density, a site-specific bone tissue evaluation of each case is essential for appropriate cone-beam computed tomography preoperative planning.

Effects of Crest Morphology on Lingual Concavity in Mandibular Molar Region: an Observational Study.

Objectives: The aim of this radiological study is to evaluate the lingual concavity dimensions and possible implant length in each posterior tooth region according to posterior crest type classification by using cone-beam computed tomography. Material and Methods: According to inclusion criteria, 836 molar teeth regions from 209 cone-beam computed tomography images were evaluated. Posterior crest type (concave, parallel, or convex), possible implant length, lingual concavity angle, width, and depth were recorded. Results: In each posterior tooth region, concave (U-type) crest was detected most frequently while convex (C-type) was the lowest. Possible implant length values were higher in second molar regions than first molars. Lingual concavity width and depth were decreasing from second molars to first molars for both sides. Additionally, lingual concavity angle showed higher values in second molar sites than first molars. In all molar teeth regions, lingual concavity width values were the highest in concave (U-type) crest type while they were the lowest in convex (C-type) crest type (P < 0.05). Lingual concavity angle values were recorded as the highest in concave (U-type) and the lowest in convex (C-type) crest type at the left first molar and right molars (P < 0.05). Conclusions: The lingual concavity dimensions and possible implant length may vary according to crest type and edentulous tooth region. Due to this effect, the surgeons should examine crest type clinically and radiologically. All parameters in the present study are decreasing while moving from anterior to posterior as well as from concave (U-type) to convex (C-type) morphologies.

Primary stability/mobility of 1-stage and 2-stage dental implants: a comparative in vitro study.

PURPOSE: To evaluate the primary stability of 1-stage (nonsubmerged) and 2-stage (submerged) implants via newest wireless resonance frequency (RF) analyzer and newer wireless mobility measuring (MM) device. MATERIALS AND METHODS: Six 1-stage dental implants with internal hex connection and six 2-stage dental implants, 4.1 mm in diameter and 11.5 mm in length, were inserted bilaterally into the first premolar, second premolar, and first molar regions of 6 standard mandibular transparent self-curing acrylic resin models. After that, the periimplant circular bone defects were created in millimeter increments ranging between 0 and 5 mm to the same extent on all implants. RESULTS: Implant stability quotient values significantly decreased at 1-stage and 2-stage implants when periimplant defects increased. Similar implant stability quotient values were found for both implant types; however, significantly lower MM values were noted for 2-stage implants. Irrespective of implant systems, the results indicated a significant association between wireless RF analyzer and wireless MM device. CONCLUSION: Both wireless RF analyzer and wireless MM device were adequate in assessing implant stability. There was no difference between 2-stage and 1-stage implant systems, except lower MM values were noted for nonsubmerged implants.

Analysis of the relationship between the surface topography of prepared tooth surfaces and data quality of digital impressions from an intraoral scanner.

BACKGROUND/PURPOSE: With the rise of digitalization in dentistry, intraoral scanners and digital impressions have recently been adopted by many clinicians. The aim of this study was to investigate surface topography of prepared teeth and the accuracy of digital impressions. MATERIALS AND METHODS: Twenty mandibular typodonts, containing left first premolar and left first molar abutment teeth manufactured by using CAD/CAM, were used in this study. An intraoral scanner was used to scan each typodont, and each STL file generated was exported in high resolution (Group H), moderate resolution (Group M), and low resolution (Group L). All 60 files were inspected in a 3-D mesh processing software. For each file, the number of triangulation points in the meshwork were obtained for both abutment teeth. RESULTS: The measurements obtained from the 3-D mesh processing software revealed that the mean number of triangulation points on the 3-D surface of the abutment teeth (20 premolars + 20 M) were 790,625 ± 98,890 dots in Group H, 592,283 ± 74,881 dots in Group M, and 198,067 ± 19,328 dots in Group L. Significant differences were found between Group H and M (p < 0.05), Group H and L (p < 0.001), and Group M and L (p < 0.01). CONCLUSION: The outcomes of this study reveal that there are strong correlations between the data quality of digital impressions and surface topography of prepared teeth. Therefore, the utilization of STL files in high resolution format is the recommended choice for clinicians engaging in a digital workflow process.

Evidence-Based Clinical Outcomes of Immediate and Early Loading of Short Endosseous Dental Implants: A Meta-analysis.

PURPOSE: Short dental implants serve as a valuable alternative for patients with limited bone height. Immediate or early provisionalization facilitates a more physiologic environment for the gingival tissues to be modeled. The purpose of this meta-analysis was to systematically review and evaluate the implant survival and marginal bone loss with immediate and early loading protocols of short dental implants (≤ 6 mm). MATERIALS AND METHODS: A literature search (electronic and manual) was conducted to identify studies with a focused PICO question: "In patients with short dental implants, does loading time affect treatment outcomes?" Studies using an immediate or early loading protocol for restoration of short implants with a mean follow-up of at least 1 year, and refraining from the use of advanced surgical procedures (sinus floor elevation, bone augmentation), were included. After evaluating patient selection and outcome reporting biases, a meta-analysis was conducted to assess implant survival and bone loss for studies fulfilling the inclusion criteria. Bone loss differences between immediate and early loading protocols were evaluated by Student t test, and Spearman correlation analysis was used to analyze the trends between crown-to-implant (C/I) ratio and bone loss. RESULTS: A total of 396 studies with patients receiving short implants (≤ 6 mm) with immediate or early prosthetic loading protocols were identified. For the 7 included studies, the pooled implant survival rate for 322 implants with a follow-up ranging from 1 to 10 years (5 years) was 91.63% (95% CI: 88% to 94%), with a mean bone loss effect estimate of 0.52 ± 0.1 mm (z = 3.07, P < .002). The differences observed in the mean bone loss for studies using immediate loading as opposed to early loading were not statistically significant. A moderate but significant positive correlation was observed between the C/I ratio and mean bone loss levels (r = 0.67, P = .02). CONCLUSION: Short implants with immediate or early loading protocols have satisfactory long-term treatment prospects with satisfactory implant survival rates and minimal bone loss.

Influence of various metal oxides on mechanical and physical properties of heat-cured polymethyl methacrylate denture base resins.

PURPOSE: To evaluate the effect of various metal oxides on impact strength (IS), fracture toughness (FT), water sorption (WSP) and solubility (WSL) of heat-cured acrylic resin. MATERIALS AND METHODS: Fifty acrylic resin specimens were fabricated for each test and divided into five groups. Group 1 was the control group and Group 2, 3, 4 and 5 (test groups) included a mixture of 1% TiO2 and 1% ZrO2, 2% Al2O3, 2% TiO2, and 2% ZrO2 by volume, respectively. Rectangular unnotched specimens (50 mm × 6.0 mm × 4.0 mm) were fabricated and droptower impact testing machine was used to determine IS. For FT, compact test specimens were fabricated and tests were done with a universal testing machine with a cross-head speed of 5 mm/min. For WSP and WSL, discshaped specimens were fabricated and tests were performed in accordance to ISO 1567. ANOVA and Kruskal-Wallis tests were used for statistical analyses. RESULTS: IS and FT values were significantly higher and WSP and WSL values were significantly lower in test groups than in control group (P<.05). Group 5 had significantly higher IS and FT values and significantly lower WSP values than other groups (P<.05) and provided 40% and 30% increase in IS and FT, respectively, compared to control group. Significantly lower WSL values were detected for Group 2 and 5 (P<.05). CONCLUSION: Modification of heat-cured acrylic resin with metal oxides, especially with ZrO2, may be useful in preventing denture fractures and undesirable physical changes resulting from oral fluids clinically.