In vitro study to analyze reverse torque values of attachment screws with multiple loosening/tightening preload cycles.

PURPOSE: To determine the number of torque/reverse torque cycles attachment screws can withstand before fracture, and to record the magnitude of reverse torque values for each of the 10 cycles of screw tightening and loosening. MATERIALS AND METHODS: The testing assemblies consisted of 30 temporary cylinder/multiunit abutment/internal connection implants (10 each from Dentsply Sirona Astra, Biohorizons, and Zimmer Biomet Dental). The assemblies were inserted into resin blocks, and temporary cylinders were connected to the multiunit abutments with new attachment screws and torqued to the recommended preload (15 Ncm Dentsply Sirona Astra; 15 Ncm Biohorizons; 10 Ncm Zimmer Biomet Dental) using a digital torque gauge instrument (Model 3, MARK-10 Corporation, New York, USA) at room temperature without lubrication. After 24 h, the attachment screws were reverse torqued with the same instrument and the values were recorded. The torque/reverse torque cycles were repeated every 24 h for 10 days. Data were analyzed using mixed model analysis. A second test included torquing the used screws (30) until fracture or stripping occurred. The reverse torque values were recorded and compared with new screws that were torqued until fracture or stripping. A sample of used and new attachment screws from each assembly were viewed under both laser microscope (LEXT OLS4000, 3D Measuring Laser Microscope, Olympus) and scanning electron microscope (JEOL-JSM6510, Tokyo, Japan). Data were analyzed using t-test. RESULTS: Following 10 cycles of torquing and reverse torquing, the reverse torque values measured on day 10 were lesser compared with the reverse torque value measured on day 1 for 29/30 attachment screws (96.6%). According to the t-test used for the second test, the p-values among all three groups were ≥0.9 which were not statistically significant. CONCLUSION: The results of this study indicated that after 10 cycles of torquing and reverse torquing attachment screws, the reverse torque values decreased. There were no statistical differences between the magnitude of torque necessary to fracture new and used attachment screws.

Shear bond strength characteristics on surface treatment modalities of CAD-CAM resin polymers.

PURPOSE: The purpose of this in vitro study was to analyze the shear bond strength of composite resin to a commercially available high-performance polymer material for fixed, screw-retained full arch restorations. MATERIAL AND METHODS: A total of 135 computer-aided design and computer-aided manufacturing, high-performance polymer (HPP) blocks were cut and obtained from discs (Trilor 95, Harvest Dental, Brea, CA). The samples were 10 mm × 10 mm × 10 mm. The specimen surfaces were grouped as untreated (Group A), 50 µm Al2O3 (Group B), 110 µm Al2O3 (Group C), Rocatec (3 M, St. Paul, MN) activated with silica-modified alumina oxide treatment (Group D); and trimmed coarsely with a carbide bur (Group E). Group A samples were used as controls. After surface treatments, the specimens were gently cleansed with oil-free steam and alcohol wipes. Surface conditioning was performed on all physically treated samples.  The manufacturer's recommendations were followed for bonding composite resin to the samples with light-cured Visio.link (Bredent, Chesterfield, UK). Cylinders were veneered with composite resins (diameter 5 mm, height 4 mm) and polymerized on the specimen surfaces through plastic tubes. Twenty-seven specimens were used for each testing group and aging tests were performed. The experimental samples were thermocycled.  Shear bond strength and scanning electron microscopic tests were performed. Means and standard deviations were calculated.  Statistical analysis was performed with post-hoc Tukey tests. RESULTS: Statistical analysis revealed that there was a significant difference between the groups (p<0.001). The highest shear bond strengths were achieved for the specimens bonded with Visio.link without physical surface treatments (270.47 MPa). The lowest bond strengths were found for specimen surfaces abraded with 110 µm Al2O3 (117.03 Mpa) CONCLUSIONS: The results of this laboratory study indicated that the specimens used with Visio.link as provided by the manufacturer had the highest shear bond strengths between the composite resin and high-performance polymer test specimens. Modifications of the high-performance polymer surfaces with carbide burs did not change bonding strengths with the composite materials.

Prosthetic rehabilitation of a maxillary defect with a bone anchored prosthesis: A clinical report.

Mucormycosis is an opportunistic fungal infection that frequently infects sinuses, brain, or lungs and arises mostly in immunocompromised patients. Although its occurrence in the maxilla is rare, debridement and resection of the infected and necrotic area is often the best treatment but usually results in an extensive maxillary defect. Protocols for prosthetic obturation versus microvascular reconstruction have been established and used effectively in tertiary institutions for patients with such large defects. Aramany Class VI defects involving more than half of the palatal surface can be managed effectively by surgical reconstruction using microvascular free flaps as a platform for supporting bone-anchored prostheses. Providing fixed prostheses may offer advantages over a conventional obturator prosthesis in terms of hygiene, function, and esthetics. Nonetheless, fixed prostheses retained by endosseous implants in patients with reconstructive osteomyocutaneous flaps often require a sequential team approach by the surgeon and prosthodontist. This clinical report describes the reconstruction of a maxilla by using a scapular free flap with subsequent prosthetic rehabilitation in a patient with maxillary sinus infection secondary to mucormycosis.

Association Between Early Implant Failure and Prosthodontic Characteristics.

PURPOSE: To identify associations between early implant failure and prosthodontic characteristics that could be used to guide subsequent continuous quality improvement efforts of patient care. MATERIALS AND METHODS: An implant-level analysis was performed in which data were abstracted from a prospective clinical database of all adult patients treated with implants and followed up from January 2000 through December 2014 at the Department of Dental Specialties at Mayo Clinic in Rochester, Minnesota. These data were used to determine time to implant failure. Associations between prosthodontic characteristics and early implant failure were evaluated with Cox proportional hazards regression models and summarized with hazard ratios (HRs) and 95% confidence intervals (CIs). RESULTS: Among 8762 implants in 2787 patients, 395 (4.5%) failed within the first year of placement at a mean (SD) of 127 (97) days (range, 2-364 days). Univariable analysis showed no associations between early implant failure and use of a cover screw, prosthesis, or definitive or provisional prosthesis at implant placement. Three of 25 single crowns failed, and use of a single crown was significantly associated with early implant failure (HR, 3.94; 95% CI, 1.08-14.35; P = 0.04). This study identified no significant associations between prosthodontic characteristics identified after implant placement and early implant failure. CONCLUSIONS: Use of a prosthesis at implant placement, use of a definitive or provisional prosthesis, and early mechanical complications were not associated with increased risk of early implant failure. Quality improvement efforts should focus on aspects of decision making that aim to decrease surgical complications.

Versatility of PEEK as a fixed partial denture framework.

Materials used for fixed partial denture (FPD) frameworks have had properties of excellent strength, durability, and biocompatibility. Some of the materials which have been used till date include alloys, ceramics, and high-performance polymers such as zirconia, Ni-Cr, lithium disilicate, and so on. All these, though excellent, have their advantages and disadvantages. Hence, the search has always been on for a better material. One such material, which has made its foray into dentistry in the recent times, is polyetheretherketone (PEEK). It is a semicrystalline thermoplastic material. PEEK has an excellent chemical resistance and mechanical properties that are retained at high temperatures. The versatility of PEEK as a dental material for FPD framework was evaluated in this case report.

A cephalometric analysis of Class II dentate subjects to establish a formula to determine the occlusal plane in Class II edentate subjects: A neo adjunct.

PURPOSE: Occlusal plane (OP) differs considerably in participants with skeletal Class I and Class II participants. In this study, cephalometrics has been used to help in the determination of orientation of the OP utilizing the nonresorbable bony anatomic landmarks in skeletal Class II participants and an attempt has been made to predict and examine the OP in individuals with skeletal class II jaw relationship. MATERIALS AND METHODS: One hundred dentulous participants with skeletal Class II malocclusion who came to the hospital for correcting their jaw relationship participated in the study. Their right lateral cephalogram was taken using standardized procedures, and all the tracings were manually done by a single trained examiner. The cephalograms which were taken for the diagnostic purpose were utilized for the study, and the patient was not exposed to any unnecessary radiation. The numerical values obtained from the cephalograms were subjected to statistical analysis. Pearson's correlation of <0.001 was considered significant, and a linear regression analysis was performed to determine a formula which would help in the determination of orientation of the OP in Class II edentulous participants. RESULTS: Pearson's correlation coefficient and linear regression analysis were performed, and a high correlation was found between A2 and (A2 + B2)/(B2 + C2) with "r" value of 0.5. A medium correlation was found between D2 and (D2 + E2)/(E2 + F2) with "r" value of 0.42. The formula obtained for posterior reference frame through linear regression equation was y = 0.018* × +0.459 and the formula obtained for anterior reference frame was y1 = 0.011* × 1 + 0.497. It was hypothesized that by substituting these formulae in the cephalogram obtained from the Class II edentate individual, the OP can be obtained and verified. CONCLUSION: It was concluded that cephalometrics can be useful in examining the orientation of OP in skeletal Class II participants.