Comparative analysis of the retention force and deformation of PEEK and PEKK removable partial denture clasps with different thicknesses and undercut depths.

STATEMENT OF PROBLEM: The retentive force and deformation of milled polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) removable partial denture (RPD) frameworks are not well understood. PURPOSE: The purpose of this in vitro study was to assess the retentive force and deformation of PEEK and PEKK Akers clasps with different designs and undercut depths. MATERIAL AND METHODS: A master model containing the first and second molar abutments was used to design Akers clasps of different cross-sectional dimensions, undercut depths (0.5 and 0.75 mm), and materials. The components of the removable partial denture framework also included an occlusal rest and were manufactured using a milling machine (n=5). The fatigue resistance of the Akers clasps was measured before and after deformation regarding the retentive forces. RESULTS: The PEEK2-U50 clasp had the largest retentive force with no significant difference among all groups before and after the insertion and removal cycle. In addition, the increased cross-sectional dimensions of the design resulted in significant differences in retentive forces between the PEEK1 and PEEK2 groups and between the PEEK and PEKK materials. CONCLUSIONS: Increasing the clasp's cross-sectional dimensions significantly impacted retentive forces, especially between different PEEK groups and between PEEK and PEKK materials.

Effect of thickness of externally characterized stains on optical properties of high-translucency zirconia.

OBJECTIVES: There is insufficient information about the effects of the thickness of externally characterized stains or glazes on CIELAB color parameters and the translucency parameter (TP) of 5 mol% yttria partially stabilized zirconia (5Y-PSZ). The present study evaluated the effect of a thickness reduction of the externally characterized or glazed layer on its CIE2000 color parameters and TP00 of 5Y-PSZ. MATERIALS AND METHODS: Twenty-eight specimens were sectioned from 5Y-PSZ blanks. Three brands of powdered stains (namely VI, SH, and IV) and a glaze (GL) were used to extrinsically stain the specimen surfaces (n = 7 per group). After measuring the final thickness and color, specimens of each group were carefully ground and finally polished. The reduced thickness was carefully controlled in decrements of 0.02 mm on the characterized stains or glazed layers at each reduction cycle until the surface of the un-stained zirconia was exposed. The CIELAB color parameters of specimens were measured using a spectrophotometer. Subsequently, differences in lightness (∆L'), chroma (∆C'), and hue (∆H'), and TP00 values and color differences (ΔE00) were calculated using the CIEDE2000 formula to determine differences between the specimen and the un-stained zirconia at each reduction cycle. A paired-samples t-test, two-way mixed-design analysis of variance, and Pearson correlation coefficient were used to analyze the data (α = 0.05). RESULTS: There were no significant differences in lightness, chroma, hue, or TP00 values before or after glazing or after each reduction cycle of the glazed layer. Mean ΔE00 values ranged between 20.94 and 33.55 after applying the externally characterized stains. With a decreased thickness of the characterized stain layer, there were observed that significant decreases in ∆L', ∆H', ∆C', and ΔE00, and significant increases in TP00. CONCLUSIONS: Increasing the thickness of externally characterized stains decreased the lightness and caused the alternation of chroma and hue, whereas these phenomena were not observed in the glazed group. There was a slight change of CIE2000 color parameters and TP00 when the thickness of the characterized layer exceeded 0.06 mm. CLINICAL RELEVANCE: The application and thickness of externally characterized stains can sensitively affect CIE2000 color parameters and translucency of 5Y-PSZ.

Effect of toothbrushing on the optical properties and surface roughness of extrinsically stained high-translucency zirconia.

OBJECTIVES: The effect of toothbrushing on the color, relative translucency, and surface roughness of extrinsically stained zirconia dental restorations is still unclear. The purpose of the present study was to evaluate the optical properties and surface textures of extrinsically stained or glazed partially stabilized zirconia with 5 mol% yttria (5Y-PSZ) after toothbrushing by determining changes in the color, translucency parameter (TP), and surface roughness. MATERIALS AND METHODS: Specimens (2 mm thick; n = 50) were sectioned from 5Y-PSZ blanks. Three brands of powdered stains (namely VI, SH, IV) and a glaze (GL) were used to extrinsically stain the specimen surfaces (n = 10 per group). The specimens were subjected to 10,000-50,000 simulated toothbrushing strokes using a toothpaste slurry (Ora2 PREMIUM Stain clear paste). The color parameters were measured before staining or glazing and before and after simulated brushing. The color changes and TP values can be calculated before and after simulated brushing. The surface roughness was also evaluated. RESULTS: Significant changes were found in the shade and TP values of 5Y-PSZ after extrinsic staining, but no significant changes were found after toothbrushing, irrespective of the staining brand (p > 0.05). The surface roughness of the characterized 5Y-PSZ specimens decreased after toothbrushing, whereas that of the non-characterized 5Y-PSZ group increased. CONCLUSIONS: Toothbrushing markedly affects the surface roughness of extrinsically stained or glazed 5Y-PSZ specimens, whereas no impacts on the color or translucency were observed. CLINICAL RELEVANCE: For esthetic reasons, clinicians and dental technicians prefer to apply extrinsic stains to zirconia restorations, which profoundly affects its appearance. The limited influence of toothbrushing on color and translucency of 5Y-PSZ is promising for clinical applications.

Microstructure, mechanical properties, and retentive forces of cobalt-chromium removable partial denture frameworks fabricated by selective laser melting followed by heat treatment.

STATEMENT OF PROBLEM: The effect of heat treatment on the microstructure and mechanical properties of cobalt-chromium (Co-Cr) removable partial denture (RPD) frameworks fabricated by selective laser melting (SLM) is not well understood. PURPOSE: The purpose of this in vitro study was to evaluate the suitability of SLM-fabricated Co-Cr alloys followed by heat treatment as a framework for RPDs by determining the microstructure and mechanical properties. MATERIAL AND METHODS: Dumbbell specimens and RPD frameworks were fabricated by using SLM followed by heat treatment. The effects of the heat treatment on the microstructure were studied by using optical microscopy, scanning electron microscopy (SEM), and X-ray diffraction (XRD). Tensile and insertion and removal tests were performed to study the mechanical responses of selective laser melting followed by heat treatment specimens, including the ultimate tensile strength (UTS), 0.2% yield strength (0.2% YS), elongation (E), and retentive forces. Specimens fabricated by using the traditional lost-wax process were used as a control (casting) group. RESULTS: X-ray diffraction indicated that the γ-face-centered cubic phase dominated SLM and selective laser melting followed by heat treatment specimens. Results from optical microscopy and SEM showed microstructural changes under different fabrication and postprocessing heat treatments; it was difficult to observe the grain boundary in the SLM group, whereas submicrometer-scale grains had formed in the selective laser melting followed by heat treatment group. The selective laser melting followed by heat treatment group exhibited the highest elongation and retentive forces compared with the casting and SLM groups. CONCLUSIONS: SLM increased the mechanical properties of Co-Cr alloys. Postprocessing heat treatment further enhanced the tensile ductility. It is suggested that SLM followed by heat treatment is an efficient strategy for fabricating RPD frameworks.

Trueness of removable partial denture frameworks additively manufactured with selective laser melting.

STATEMENT OF PROBLEM: Although studies have reported on selective laser melting (SLM)-fabricated removable partial dentures (RPDs), research addressing the trueness of SLM-fabricated RPD metal frameworks is sparse. PURPOSE: The purpose of this in vitro study was to evaluate the trueness of powdered cobalt-chromium (Co-Cr) or titanium-6 aluminum-4 vanadium (Ti-6Al-4V) alloy frameworks for RPDs fabricated by SLM. MATERIAL AND METHODS: A digital scan of a Kennedy class II mandible typodont was obtained to design an RPD framework by using a computer-aided design (CAD) software program (denoted as CRF). Two experimental groups of frameworks were fabricated from the CRF by using SLM in alloys of Co-Cr (SLM-Co-Cr, n=6) and in Ti-6Al-4V (SLM-Ti-6Al-4V, n=6) while a control group was fabricated by using traditional lost-wax casting following stereolithography (CA-Co-Cr, n=6). In total, 18 RPD frameworks were digitally scanned (denoted as CRF), with each scan then superimposed on the CRF and evaluated for discrepancies by using a 3D analysis software program. A nonparametric Kruskal-Wallis test was performed to determine differences in trueness among groups (α=.05). RESULTS: The CA-Co-Cr group showed the highest discrepancy between CEF and CRF. Statistically significant differences were found between the CA-Co-Cr and SLM-fabricated groups (P=.03 for Co-Cr, and P=.016 for Ti-6Al-4V). However, no significant difference was found between the SLM-Co-Cr and SLM-Ti-6Al-4V groups (P=.787). CONCLUSIONS: SLM-fabricated RPD frameworks exhibited higher trueness than CA-Co-Cr fabricated ones, indicating the potential of selective laser melting to produce the geometric shapes required for accurate dental restorations.

Osseointegration of titanium implants with SLAffinity treatment: a histological and biomechanical study in miniature pigs.

PURPOSE: Electrochemical oxidation following sandblasting and acid-etching (SLA) treatment has received interest as a surface modification procedure for titanium (Ti) implants (denoted as an SLAffinity surface); however, little information is available on its impacts on the in vivo performance of SLAffinity-Ti implants. The present study evaluated the osseointegration and biomechanical bone-tissue response to SLAffinity-Ti implants with micro- and nanoporous oxide layers. MATERIALS AND METHODS: The interaction between blood and the tested implants was examined. In total, 144 implants with the following surfaces were used: a standard machined (M-Ti), an SLA-Ti, and an SLAffinity-Ti surface. For each animal, four implants (one M-Ti, one SLA-Ti, and two SLAffinity-Ti) were inserted into the mandibular canine-premolar area for histomorphometric observations and another four implants were inserted into the flat surface on the anteromedial aspect of the rear tibia for removal torque (RT) tests. After 2, 4, and 8 weeks of implantation, histomorphometric and RT tests were conducted. RESULTS: Interactions between blood and implants were better for implants with the SLAffinity-Ti surface. RT tests showed a significant improvement in fixation strength for SLAffinity-Ti implants (84.5 ± 8.7 N-cm) after 8 weeks compared to M-Ti (62.95 ± 11.5 N-cm) and SLAffinity-Ti (76.1 ± 6.6 N-cm) implants. A histological evaluation showed that osseous integration had occurred with all implants after 8 weeks. SLAffinity-Ti implants exhibited 28.5 ± 6.2 % bone-to-implant contact (BIC) at 2 weeks and 84.3 ± 8.1 % at 8 weeks. M-Ti implants exhibited BIC levels of 17.0 ± 5.4 and 76.5 ± 6.3 %, whereas SLA-Ti implants exhibited BIC levels of 28.5 ± 6.2 and 81.1 ± 8.4 % at corresponding time intervals. In terms of the peri-implant bone area (BA), values for SLAffinity-Ti implants ranged from 29.5 ± 4.1 to 88.3 ± 3.0 %. For M-Ti implants, values ranged from 20.3 ± 5.5 to 81.7 ± 4.2 %. For SLA-Ti implants, values ranged from 23.0 ± 3.5 to 84.0 ± 3.6 %. CONCLUSIONS: Electrochemical oxidation increased the oxide layers and improved the blood interaction with SLAffinity-Ti implants, resulting in significantly higher bone apposition with the SLAffinity-Ti implants after 2 and 8 weeks of healing. An increase in resistance for the RT of SLAffinity-Ti implants over the 8-week healing period was also observed. CLINICAL RELEVANCE: The use of SLAffinity-Ti implants has potential for improvement of early osseointegration.

Effects of two surface finishes on the color of cemented and colored anatomic-contour zirconia crowns.

STATEMENT OF PROBLEM: The esthetic appearance of anatomic-contour zirconia restorations is influenced by the shade of the coloring liquid and the optical properties of the luting cements. However, few studies are available on the effects of surface-finishing methods and luting cements on colored anatomic-contour zirconia restorations. PURPOSE: The purpose of this in vitro study was to investigate the effects of surface finishing methods on the color distribution of colored anatomic-contour zirconia crowns before and after being cemented onto abutments. MATERIAL AND METHODS: Implant-supported anatomic-contour zirconia premolar crowns were fabricated and immersed in A3-coloring liquid for 30 seconds. The colored zirconia crowns were separated into 3 groups according to the method of surface treatment: no treatment (N), polishing (P), and glazing (G). The zirconia crowns without coloring liquid application served as the control group. CIELab color coordinates were obtained, and color differences (ΔE) between shaded crowns were calculated with a spectrophotometer. The color stability of the crown before and after cement application was also investigated. RESULTS: Before cement application, the mean color difference between groups N and P was 2.85 ΔE units, whereas the mean ΔE value between groups N and G was 3.27. Mean ΔE values with and without cement application among groups ranged from 2.75 to 3.45 ΔE units. CONCLUSIONS: The color appearance of the colored zirconia crowns was strongly influenced by the surface-finishing methods and luting cement application.

In vitro study of optimal removable partial denture clasp design made from novel high-performance polyetherketoneketone.

PURPOSE: This study aimed to investigate the retentive force and deformation of double Akers' polyetherketoneketone (PEKK) clasps on removable partial dentures (RPDs) with varying designs and undercut depths. METHODS: Thirty double Akers' PEKK clasps with two different widths and heights (Groups I and II) were fabricated using computer-aided design and computer-aided manufacturing (CAD/CAM). Each design was further subdivided (n = 5) into three undercut depths (0.25, 0.50, and 0.75 mm). The retentive force of the clasps was measured after 10 years of clinical use (15,000 insertion/removal cycles), and the deformation of the clasp tips was analyzed before and after cycling. RESULTS: Clasps with 0.50-mm and 0.75-mm undercut depths exhibited greater initial retentive forces (3.15-3.51 N) compared to those in the 0.25-mm undercut group (2.40-2.80 N). Group I maintained consistent retentive forces over the cycles (P = 0.345), whereas Group II showed declining forces after the initial use (P < 0.003). In both groups, the 0.50-mm undercut exhibited a greater retentive force than the 0.25-mm (P < 0.001 and P < 0.004, respectively), with no significant differences between the 0.50-mm and 0.75-mm undercut depths. Despite a lower initial retentive force, the 0.25-mm undercut showed less deformation and clasp tip wear. CONCLUSIONS: The PEKK clasps did not exhibit significantly reduced retentive forces or permanent deformations after 15,000 fatigue cycles. These results suggest that the PEKK polymer displays superior mechanical properties as an esthetic clasp material, and clasps with 0.50-mm and 0.75-mm undercut depths are recommended for long-term clinical use.

An Innovative Design to Enhance Osteoinductive Efficacy and Biomechanical Behavior of a Titanium Dental Implant.

The present study investigated the in vivo bone-forming efficacy of an innovative titanium (Ti) dental implant combined with a collagen sponge containing recombinant human bone morphogenetic protein-2 (BMP-2) in a pig model. Two different concentrations of BMP-2 (20 and 40 µg/mL) were incorporated into collagen sponges and placed at the bottom of Ti dental implants. The investigated implants were inserted into the edentulous ridge at the canine-premolar regions of Lanyu small-ear pigs, which were then euthanized at weeks 1, 2, 4, 8, and 12 post-implantation. Specimens containing the implants and surrounding bone tissue were collected for histological evaluation of their bone-to-implant contact (BIC) ratios and calculation of maximum torques using removal torque measurement. Analytical results showed that the control and BMP-2-loaded implants presented good implant stability and bone healing for all testing durations. After 1 week of healing, the BMP-2-loaded implants with a concentration of 20 µg/mL exhibited the highest BIC ratios, ranging from 58% to 76%, among all groups (p = 0.034). Additionally, they also possessed the highest removal torque values (50.1 ± 1.3 N-cm) throughout the 8-week healing period. The BMP-2-loaded implants not only displayed excellent in vivo biocompatibility but also presented superior osteoinductive performance. Therefore, these findings demonstrate that BMP-2 delivered through a collagen sponge can potentially enhance the early-stage osseointegration of Ti dental implants.

The effect of titanium with electrochemical anodization on the response of the adherent osteoblast-like cell.

PURPOSE: The osseointegration of titanium dental implants is essential for successful therapy, and this is strongly affected by the surface chemistry and roughness. In this study, using electrochemical anodization after sand blasting, and acid etching of Ti surface (SLA), SLA specimens with the high wettability of the thick TiO2 layer (SLAffinity) surface was developed to superimpose the nanoscale topographies on the microscale roughness of SLA surface without greatly altering the surface features. MATERIALS: The surface characteristics of SLAffinity specimens were investigated using scanning electron microscopy, atomic force microscopy, and x-ray photoelectron spectroscopy. The viability and proliferation of osteoblast-like cells (MG63 cells), which were seeded on SLAffinity specimens, were analyzed. RESULTS: Such electrochemically anodized specimens were predominantly composed of bioactive TiO2. The cell culturing tests revealed that the microscale roughness in combination with the nanoscale structures and bioactive properties improved osteoblast viability and differentiation on the SLAffinity surface. CONCLUSION: The favorable biological response of SLAffinity surfaces to MG63 osteoblast-like cells suggested that electrochemical anodization after SLA treatments is a potential procedure for better osseointegration in vivo.

Characterization and Antibacterial Properties of Polyetherketoneketone Coated with a Silver Nanoparticle-in-Epoxy Lining.

Polyetherketoneketone (PEKK) is an alternative material for use in removable partial denture frameworks; these frameworks must exhibit antibacterial properties to reduce the risk of periodontal disease. In the present study, silver nanoparticles (AgNPs) were synthesized via the reduction of silver nitrate with sodium borohydride in a solution containing polyvinyl pyrrolidone (PVP). Transmission electron microscope images and dynamic light scattering confirmed that metallic nanoparticles had been created with an average size of 32 nm. Furthermore, the coating of the PEKK polymeric substrate with 0.5% AgNPs was carried out using an epoxy resin lining at room temperature. Fourier transform infrared (FTIR) spectra confirmed the successful transfer of the AgNP-in-resin lining onto the polymeric substrate. Scanning electron microscopy and atomic force microscopy confirmed that the AgNPs had been uniformly deposited onto the PEKK specimens. Finally, the antibacterial activity of the specimens was tested against Porphyromonas gingivalis. An inhibition zone of 22.5 mm and an antibacterial rate of 83.47% were found for the PEKK coated with 0.5% AgNPs (0.5% Ag-PEKK) compared to an untreated polyetheretherketone (PEEK) substrate, evidencing that 0.5% Ag-PEKK has potential antibacterial properties for implant applications.

Early bone response to machined, sandblasting acid etching (SLA) and novel surface-functionalization (SLAffinity) titanium implants: characterization, biomechanical analysis and histological evaluation in pigs.

The purpose of the present study was to examine early tissue response and osseointegration in the animal model. The surface morphologies of SLAffinity were characterized using scanning electron microscopy and atomic force microscopy. The microstructures were examined by X-ray diffraction, and hardness was measured by nanoindentation. Moreover, the safety and toxicity properties were evaluated using computer-aided programs and cell cytotoxicity assays. In the animal model, implants were installed in the mandibular canine-premolar area of 12 miniature pigs. Each pig received three implants: machine, sandblasted, large grit, acid-etched, and SLAffinity-treated implants. The results showed that surface treatment did affect bone-to-implant contact (BIC) significantly. At 3 weeks, the SLAffinity-treated implants were found to present significantly higher BIC values than the untreated implants. The SLAffinity treatments enhanced osseointegration significantly, especially at early stages of bone tissue healing. As described above, the results of the present study demonstrate that the SLAffinity treatment is a reliable surface modification method.

Research of electrosurgical ablation with antiadhesive functionalization on thermal and histopathological effects of brain tissues in vivo.

Thermal injury and tissue sticking are two major concerns in the electrosurgery. In the present study, the effect of lateral thermal injury caused by different electrosurgical electrodes on wound healing was investigated. An electrosurgical unit equipped with untreated (SS) and titanium oxide layer-coated (TiO2-coated) stainless steel needle-type electrodes was used to create lesions on the rat brain tissue. TiO2 layers were produced by radiofrequency plasma and magnetron sputtering in the form of amorphous (TO-SS-1), anatase (TO-SS-2), and rutile (TO-SS-3) phase. Animals were sacrificed for evaluations at 0, 2, 7, and 28 days postoperatively. TO-SS-3 electrodes generated lower levels of sticking tissue, and the thermographs showed that the recorded highest temperature in brain tissue from the TO-SS-3 electrode was significantly lower than in the SS electrode. The total injury area of brain tissue caused by TO-SS-1 and TO-SS-3 electrodes was significantly lower than that caused by SS electrodes at each time point. The results of the present study reveal that the plating of electrodes with a TiO2 film with rutile phases is an efficient method for improving the performance of electrosurgical units and should benefit wound healing.