Influence of Multiple Sterilization on Performance of Titanium Pegs When Measuring Implant Stability With Resonance Frequency Analyses.

This in vitro study was conducted to investigate the repeatability of the implant stability quotients (ISQ) measured with multipegs after numerous sterilizations and to detect the exact time when the readings start to deviate. Multipegs were sterilized with 3 different methods (autoclaved, autoclaved + ultrasonic cleaner, chemical disinfection + autoclaved) and grouped according to the method applied. All specimens were put into the autoclave with sealed packages every time they were sterilized. Each specimen was sterilized 50 times according to the technique described in its group after an ISQ measurement was performed. Results of the 2-way analysis of variance showed that neither the sterilization method nor the cycles, nor their interaction, were statistically significant. A multipeg may be reused multiple times after sterilization procedures and may be more cost-effective than a disposable smartpeg for checking implant stability after confirming these results in further investigations.

Initial Stability Measurements of Implants Using a New Magnetic Resonance Frequency Analyzer With Titanium Transducers: An Ex Vivo Study.

The establishment of dental implant stability is mandatory for successful osseointegration. Resonance frequency analysis (RFA) is the most frequently used method for the clinical measurement of implant stability. The purpose of the present study was to evaluate the reliability of the recently developed RF analyzer Penguin RFA and to compare it with the traditional RF analyzer Osstell ISQ. Sixty implants were inserted into fresh steer vertebrae and pelvis. Implant stability was measured using Penguin RFA by its transducers (multipegs) and Osstell ISQ by its transducers (smartpegs). Additionally, stability was measured by multipegs with Osstell ISQ and by smartpegs with Penguin RFA. The intraobserver and interobserver reliability of Penguin RFA were estimated by the intraclass coefficient (ICC). Mean implant stability quotients (ISQs) measured with Osstell ISQ were higher than the ISQs measured with Penguin RFA (P < .05). The intra- and interobserver reliability of Penguin RFA were considered as excellent (ICC > 0.7). For Osstell ISQ, no significance in ISQs was detected between the readings by smartpegs and multipegs (P > .05), while for Penguin RFA ISQs by smartpegs were significantly higher than the ISQs by multipegs (P <.05). The recently developed Penguin RFA is reliable and can be used in clinical practice for the measurement of dental implant stability regardless of the bone type. The multipegs originally manufactured for the Penguin RFA is also compatible with Osstell ISQ.

The Influence of Implant Shape on Primary Stability of Implants With a Thread Cutting and Forming Design: An Ex Vivo Study.

The design of an implant has a great effect on primary stability. The purpose of this study was to determine the differences in primary stability between straight and tapered Neoss ProActive implants in type I and type III bones using resonance frequency analysis (RFA) and electronic percussive testing (EPT) methods. Fresh cow vertebrae and pelvis were used as models of type III and type i bone, respectively. Implants of 2 different designs-straight and tapered Neoss ProActive implants with a thread cutting and forming (TCF) design, both 3.5-mm wide and 11-mm long-were placed in both types of bone (n = 60). The primary stability of all implants was measured by an experienced clinician blinded to the study protocol using the EPT and RFA devices. No statistically significant difference was found between the implant stability quotients and the percussive test values of straight and tapered implants in either bone type. Within the limitations of this ex vivo study, it may be concluded that the shape of an implant with a TCF design does not affect primary stability.

Evaluation of possible prognostic factors for the success, survival, and failure of dental implants.

PURPOSE: To analyze the prognostic factors that are associated with the success, survival, and failure rates of dental implants. MATERIAL AND METHODS: Data including implant sizes, insertion time, implant location, and prosthetic treatment of 1656 implants have been collected, and the association of these factors with success, survival, and failure of implants was analyzed. RESULTS: The success rate was lower for short and maxillary implants. The failure rate of maxillary implants exceeded that of mandibular implants, and the failure rate of implants that were placed in the maxillary anterior region was significantly higher than other regions. The failure rates of implants that were placed 5 years ago or more were higher than those that were placed later. CONCLUSIONS: Anterior maxilla is more critical for implant loss than other sites. Implants in the anterior mandible show better success compared with other locations, and longer implants show better success rates. The learning curve of the clinician influences survival and success rates of dental implants.

Evaluation of the closest speaking space in different dental and skeletal occlusions.

STATEMENT OF PROBLEM: The closest speaking space (CSS) together with the vertical overlap of anterior teeth during the production of the /s/ sound have not been previously investigated with respect to differences in dental and skeletal orthodontic classifications. PURPOSE: The purpose of this study was to investigate the CSS in dental and skeletal occlusions and to analyze the cause and effect relationship of the CSS and the amount of the vertical overlap of anterior teeth. MATERIAL AND METHODS: Poly vinylsiloxane interocclusal registration material was placed bilaterally onto the occlusal surfaces of premolar and molar teeth of 155 native Turkish speaking adolescent and young adult dentate participants, who were then asked to pronounce the word seyis. The thinnest point between the maxillary and mandibular teeth was recorded in millimeters as the CSS. The occlusion of each participant was classified according to the Angle dental and Steiner skeletal classifications. The differences in CSS values within each classification were statistically analyzed with the Kruskal-Wallis test, and the correlation between the CSS and the vertical overlap was statistically analyzed with the Spearman Rho Correlation tests (P<.05). RESULTS: The differences in the CSS were only significant between Angle Class II division 2 and Class III groups (P=.034), while the differences in the CSS between skeletal classes were not significant. The correlation between the amount of CSS and the amount of vertical overlap was not significant. CONCLUSIONS: The results showed that regardless of dental and skeletal occlusions, average CSS values could be used to determine the occlusal vertical dimension of prosthetic restorations.

Titanium hypersensitivity. A hidden threat for dental implant patients?

Titanium and its alloys have been widely used for dental prosthetic devices because of their superior mechanical properties and biocompatibility. However, the incidence of titanium hypersensitivity or allergy is still unknown and the discussion about its existence is ongoing. Unexplained implant failures have also forced dental clinicians to investigate the possibility of titanium hypersensitivity or allergy. This review focuses on the potential of dental implant-related titanium hypersensitivity or allergic reactions. It includes an examination of the existing scientific literature and current knowledge. Evidence-based data and studies related to titanium hypersensitivity in dental implant patients are also discussed.

Prosthetic rehabilitation of a patient after surgical reconstruction of the maxilla: a clinical report.

Prosthetic management of maxillectomy cases is challenging, and a multidisciplinary approach is usually needed. This clinical report describes the treatment provided to a patient who presented with a moderately differentiated squamous cell carcinoma. A two-stage surgical protocol was followed for this purpose. At the first surgery, the anterior maxilla was resected, and the oral and nasal mucosal and osseous defect was reconstructed with an osteocutaneous flap from the radial forearm. At the second surgery, all fascias and the connective tissue between the skin and the bone were resected to provide an optimal thickness for denture stability. Two months after the second surgery, prosthetic rehabilitation was completed with a maxillary telescopic overdenture. During the 15-month follow-up period, the patient's oral condition and physical appearance improved, and no complications occurred.

Reliability and validity of the Turkish version of oral health impact profile for edentulous subjects.

PURPOSE: The validated translations of the OHIP-EDENT exist in different languages; however, there is no reliable and validated Turkish translation. The present study was conducted to evaluate the reliability and to validate the Oral Health Impact Profile in edentulous subjects translated to Turkish (OHIP-EDENT-T). MATERIALS AND METHODS: The study sample included 104 conventional complete denture wearers (58 women and 46 men, mean age: 61.13 ± 9.43 years). The original English version of OHIPEDENT was translated into Turkish using a forward-backward method and applied to the subjects. The reliability of the OHIP-EDENT-T was evaluated using internal consistency and the test-retest method. Validity was determined as construct and convergent validity. The construct validity of OHIP-EDENT-T was assessed using exploratory and confirmatory factor analysis. RESULTS: The Cronbach's alpha value for OHIP-EDENT-T was 0.890. The intraclass correlation coefficient (ICC) was 0.749 for the OHIP-EDENT-T total score, and ICCs for the subscales ranged from 0.630 (95% CI = 0.501-0.823) to 0.859 (95% CI = 0.531-0.897), indicating good to excellent agreement. The Kaiser-Meyer-Olkin value for sampling adequacy was 0.820 and results of Bartlett's sphericity test indicated statistical significance (χ2=1139.767; df=171, p=0.001). This showed that factorial analysis could be applied to the data set. The three-factor structure of the scale explained 81.1% of the observed variance. The agreement of the three-factor solution was further tested with confirmatory factor analysis, and the fit index was found to be acceptable (chi-square fit test=1.449, RMSEA=0.040, GFI=0.94, CFI=0.93). CONCLUSION: Within the limitations of this study, it can be concluded that OHIP-EDENT-T is a valid and reliable instrument for evaluating the quality of life of edentulous patients.

Flexural properties of repaired heat-polymerising acrylic resin after wetting with monomer and acetone.

OBJECTIVES: Repair strength can be improved by treating fractured surfaces of a denture. BACKGROUND: This study investigated flexural properties of heat-polymerised acrylic resin specimens repaired with auto-polymerising and visible light curing (VLC) resins after the repair surfaces were wetted with monomers or acetone. MATERIALS AND METHODS: Fifty-four specimens (65 x 10 x 2.5 mm) were prepared and 48 of them were sectioned to simulate denture fracture. Butt-joint designed repair surfaces were wetted with heat-, auto-polymerising monomers and acetone for 180 s and repaired with auto-polymerising and VLC resins. After repairs, specimens were subjected to three-point bending test and flexural strength, strain, fracture load, modulus of elasticity and deflection values were recorded. Data were analysed with Student t and LSD tests (p < or = 0.05). RESULTS: Overall flexural strength, strain, fracture load and deflection values of specimens repaired with VLC resin were significantly higher than the specimens repaired with auto-polymerising resin for all types of wetting agent (p < 0.05). Within the wetting agents, heat- and auto-polymerising monomers produced the best mechanical properties, while wetting with acetone did not provide superior effect over both monomers. CONCLUSION: In clinical use, wetting the repair surfaces may result in stronger repairs. The use of bonding agent in VLC resin repairs in combination with wetting agent results in improved flexural properties.

Oral health and inflammation in patients with end-stage renal failure.

BACKGROUND/AIMS: End-stage renal disease (ESRD) patients have an increased risk of atherosclerotic complications. In both hemodialysis (HD) patients and the general population, it has become evident that inflammation plays an important role in the pathogenesis of atherosclerotic complications. Oral and dental problems in ESRD patients could be an important source of inflammation, thus treatment of these problems is important to protect these patients from potential infections. The decayed, missing, and filled teeth (DMFT) index is an indicator of oral and dental health status. Our aim was to analyze and compare salivary flow rate (SFR), salivary pH (SpH), salivary buffering capacity (SBC), and DMFT index and plaque index (PI) values in PD patients to HD patients and healthy controls (C) and establish the relationship between these parameters and C-reactive protein (CRP). METHODS: 76 PD patients, 100 HD patients, and 111 Cs were included in the study. SFR (milliliters/minute) was measured in stimulated whole saliva, SpH was measured using the Merck indicator, and SBC was measured according to the method of Ericsson: 1 mL whole saliva was added to 3 mL 0.005 N HCl and a stream of air was passed through this mixture for 20 minutes. Finally, DMFT index and PI values were calculated. RESULTS: No statistically significant differences were found in age or gender distribution among PD, HD, and C groups. There was also no significant difference in time on dialysis between PD and HD groups. SFR was significantly lower in the PD and HD groups than in the C group (1.30 +/- 0.83 and 0.70 +/- 0.32 vs 1.64 +/- 0.45 mL/min) and lower in the HD than in the PD group (p < 0.001). SpH (8.35 +/- 0.43 and 8.12 +/- 0.74 vs 7.16 +/- 0.76) and SBC (7.39 +/- 0.47 and 6.82 +/- 0.70 vs 5.08 +/- 0.73) were significantly higher in the PD and HD groups than in the C group and higher in the PD than in the HD group (p < 0.05 and p < 0.001 respectively). The numbers of filled teeth were significantly higher in the PD than in the HD and C groups (p < 0.001). DMFT index was significantly higher in the PD than in the HD group (p < 0.001). Finally, PI values were significantly higher in the PD and HD groups than in the C group (p < 0.001) and higher in the HD than in the PD group, although this was not statistically significant. In the present study, we also found higher CRP values in HD than in PD patients and a positive correlation between CRP and PI values in PD patients. CONCLUSIONS: PD patients have higher SFR, SpH, and SBC values than HD patients; however, higher DMFT index and higher numbers of filled teeth were observed in PD patients. Compared to healthy controls, patients on dialysis had worse dental and periodontal findings, which might have a role in microinflammation in this group of patients.

The behavior of polyetheretherketone healing abutments when measuring implant stability with electronic percussive testing.

BACKGROUND: It is unknown whether it is possible to measure implant stability with polyetheretherketone (PEEK) healing abutments using electronic percussive testing (EPT). PURPOSE: To investigate the reliability of the percussive test values (PTVs) measured with PEEK healing abutments and to compare them with the PTVs measured with titanium healing abutments. MATERIAL AND METHODS: Thirty dental implants were inserted into the fresh pelvis belonging to a cow. Titanium healing abutments (2 and 5 mm), PEEK healing abutments (5 mm), and prepable standard titanium abutments (5 mm) were screwed to the implants, respectively, and PTVs were measured by two examiners using a wireless EPT device. Differences in PTVs between different dental implant components were evaluated using Friedman's test with post hoc Wilcoxon signed-rank test and Bonferroni correction. Inter and intra-observer reliabilities were detected using interclass correlation coefficients (ICCs) RESULTS: The mean PTVs obtained using the PEEK healing abutments were significantly higher than the mean PTVs obtained using the other abutments for both examiners (P < .01). The ICCs for intra-observer reliability were detected as poor for PEEK healing abutments; and excellent for the other abutment types for both examiners. The ICCs for the inter-observer reliability between the two examiners were poor (0.25) for PEEK healing abutments, and excellent for the 2 and 5 mm titanium healing abutments and for standard abutments (0.82, 0.84 and 0.93, respectively). CONCLUSION: Within the limitations of this in vitro study, it may be concluded that EPT measurements should be avoided using PEEK healing abutments because of the poor reliability.

A Comparison of the Color Stability of Conventional and CAD/CAM Polymethyl Methacrylate Denture Base Materials.

OBJECTIVE: The aim of this study was to evaluate the color stability of a heat polymerized resin, an auto-polymerizing resin, a urethane dimethacrylate resin and a CAD/CAM PMMA block resin stored in different storage media. MATERIALS AND METHODS: 60 disc-shaped specimens (15×2 mm) were fabricated for each group. A total of 240 disc-shaped specimens were thermal-cycled for 5,000 cycles. Then specimens were randomized into 4 groups (n= 15) according to storage media: coffee, coke, red wine and distilled water (control group). The color measurement of each sample was performed using a spectrophotometer before and after storage (after 7 and 30 days), and color changes (ΔE) were calculated. RESULTS: All the denture base materials demonstrated dissimilar color changes after stored in the different storage media in both evaluation stages. In all storage media, CAD-CAM denture base resins showed the minimum in color change. In all denture base resins, red wine showed a higher degree of color change than coke or coffee. CONCLUSION: The color stability of CAD-CAM denture base resins is better than any of the other kind of denture base resins. The color change values of all groups except Eclypse stored in red wine had clinically detectable values.

Interim removable partial dentures: two case reports.

For the partially edentulous patient, an interim denture can provide acceptable short-term function and esthetics by replacing missing teeth and tissues until a definitive restoration can be performed. This article presents two cases that required interim removable partial dentures to maintain function, phonation, and esthetics until clinical conditions allowed for the fabrication of definitive dentures.

Effect of Over-the-Counter Topical Agents on Denture-Induced Traumatic Lesions: A Clinical Study.

PURPOSE: To investigate the effects of over-the-counter products on the healing of denture-induced ulcerations and patients' self-reported pain. MATERIALS AND METHODS: A total of 140 patients with acute denture-induced ulcerations were randomized into seven treatment groups: denture grinding (control); topical application of corn oil gel (placebo); triester glycerol oxide gel; D-panthenol gel; D-panthenol mouthwash; L-arginine mouthwash; and hyaluronic acid gel. Healing and self-reported pain were assessed after 1, 3, and 7 days of treatment. RESULTS: The percentage of healed lesions in the mandible and maxilla after 7 days was 67% and 65%, respectively. The only significance in healing was for mandibular lesions at 3 days after application of L-arginine mouthwash; at this period, the healing rate was significantly higher than d-panthenol gel, d-panthenol mouthwash, and hyaluronic acid gel (P < .05). CONCLUSION: Denture grinding as the current protocol for acute denture-induced ulcerations should remain as the default.

Influence of polymerization method, curing process, and length of time of storage in water on the residual methyl methacrylate content in dental acrylic resins.

This study compared the influence of different polymerization methods (heat, auto-, and microwave energy), different curing processes (in the case of heat- and autopolymerized specimens), and length of storage of the polymerized specimens in distilled water at 37 degrees C on the residual methyl methacrylate (MMA) content in dental acrylic resin specimens. Residual MMA of 120 resin specimens were measured using high-performance liquid chromatography. For the heat-polymerized resins, the lowest residual MMA content was obtained when they were given a long-term terminal boil and then stored in the distilled water for at least 1 day. For the autopolymerized resins, the lowest residual MMA content was obtained when they were additionally cured in water at 60 degrees C and then stored in the distilled water at least 1 day. For the microwave-polymerized resins, the lowest residual MMA content was obtained when they were stored in the distilled water at least 1 month. The lowest overall residual MMA content was obtained from heat-polymerized specimens that were given a long-term terminal boil cure and then stored in the distilled water at least 1 day. Different polymerization methods and curing processes have different effects on residual MMA content. It is thus shown that storing a dental acrylic resin specimen in distilled water at 37 degrees C is a simple but effective method of reducing its residual MMA content.

Distal extension mandibular removable partial denture with implant support.

This case report describes the fabrication of a distal extension removable partial denture (RPD) of a 65-year-old man with implant support. Loss of fibroelasticity of the peripheral tissues and reduced mandibular vestibular sulcular depth due to a previous surgical resection and radiotherapy at the right side were the main clinical factors that created difficulty for denture retention and stability. The fabrication of a mandibular RPD supported by anterior teeth and two bilaterally placed implants in the molar area to convert from Kennedy Class 1 design to Kennedy Class 3 implant-bounded RPD is reported. Retention and stability of the denture were improved with implant support on the distal extension site of the RPD. The common clinical problems about distally extended RPDs are lack of retention and stability due to the movement around the rotational axis. Dental implant placement to the distal edentulous site minimizes the potential dislodgement of the RPD is popular. Implant-supported RPD can be suggested as an advantageous and cost-effective treatment option for the partially edentulous patients.

Determination of the Optimum Torque to Tighten the Smartpegs of Magnetic Resonance Frequency Analyses Devices: An Ex Vivo Study.

The aim of this study was to find an optimal value for tightening the Smartpegs for magnetic radiofrequency analysis devices (RFAs) devices. Thirty implants were placed in 3 cow ribs. The RFA value of each implant was measured in buccal and mesial directions after tightening the Smartpegs with 1, 3, 4, 8, 9, 10, and 11 Ncm. Additionally, 4 different examiners measured the RFA after hand tightening the Smartpegs, and the results were compared. The buccal implant stability quotient (ISQ) values when the Smartpegs were tightened to 1Ncm were significantly lower than the ISQ values when the Smartpegs were tightened to 3, 4, 8, 9, 10, and 11 Ncm (P < .05). The mesial ISQ values when the Smartpegs were tightened to 1, 3, and 4 Ncm were significantly lower than the ISQ values when the Smartpegs were tightened with higher torque values (P < .05). The buccal measurements made by 1 examiner was significantly lower than 3 Ncm (P < .05), and the buccal measurements made by 1 examiner was significantly lower than 4 Ncm (P < .05). The mesial ISQ values measured by 2 examiners were significantly lower than 3 Ncm (P < .05), and the mesial ISQ values measured by the other 2 examiners were significantly lower than 8 Ncm (P < .05). The tightening of the Smartpegs should be standardized by the manufacturer to a range of 5-8 Ncm in order to gain reliable objective RFA values, instead of leaving it to subjective finger pressure.

Comparison of the Primary Stability of Two Implant Designs in Two Different Bone Types: An In Vitro Study.

PURPOSE: Achievement of primary stability upon surgical placement of dental implants is a key factor for successful osseointegration and depends mainly on implant-related factors. The aim of this study was to compare and assess the primary stability of implants with active and regular threads in type 2 as well as type 4 bone. MATERIALS AND METHODS: Fresh cow vertebrae and a pelvis were used as models of type 4 bone and type 2 bone, respectively. Implants with two different designs-regular-threaded and active-threaded-both 4.3 mm wide and 13 mm long, were placed in both types of bone (n = 80). Stability measurements were completed by four prosthodontists using two different Periotest devices and resonance frequency analysis. Statistical analyses were performed with the Mann-Whitney U test. RESULTS: No statistically significant differences were found between the implant types in either type of bone in the stability measured with different methods. For both implant types, the mean resonance frequency values in type 2 bone were statistically significantly higher than in type 4 bone, whereas the mean Periotest values in type 2 bone were statistically significantly lower than in type 4 bone. CONCLUSION: Within the limitations of this in vitro study in bone types 2 and 4, the active-threaded implant, which was invented to increase primary stability, did not show higher primary stability compared to a regular-threaded implant.

The Evaluation of the Reliability of Periotest for Implant Stability Measurements: An In Vitro Study.

Periotest (Medizintechnik Gulden, Modautal, Germany) is a widely accepted implant stability measurement method, although the reliability is not well known. The aim of this in vitro study was to investigate the reliability of the Periotest in implant stability measurements. Thirty implants were placed in 3 cow ribs. The stability of each implant was measured by insertion torque, resonance frequency analyses, and Periotest and then compared. The Periotest values (PTVs) were measured by 4 different examiners. The measurements were repeated twice in both the buccal and mesial directions, for each implant at 2-hour intervals and the intra- and interobserver reliability of Periotest was measured. Results showed that the intraobserver reliability of the Periotest was excellent for the buccal PTVs but fair to poor for the mesial PTVs. The interobserver reliability of the Periotest was excellent for the buccal PTVs but poor for the mesial PTVs. No significance was found between the PTVs and IT values (P = .803) and PTVs and ISQ values, whereas a 47.1% significant correlation was detected between the IT values and ISQ values (P = .009). The present study indicates that only Periotest measurements from buccal result in excellent intra- and interobserver reliability for the quantification of the implant stability.

Effects of water storage of E-glass fiber reinforced denture base polymers on residual methyl methacrylate content.

This study investigated the effect of water storage on residual methyl methacrylate (MMA) content of continuous E-glass fiber (Wetrotex International) reinforced denture base polymers. Heat-polymerization (short- and long-term boiling and conventional curing cycle using Meliodent), autopolymerization (processed in air at room temperature and in water at 60 degrees C with the use of Meliodent Rapid Repair), and microwave-polymerization (3 min at 500 W with the use of Acron MC) were employed. The residual MMA contents of 120 specimens were analyzed by high-performance liquid chromatography at deflasking (control) and after water (37 degrees C) storage of 1 day, 1 week, and 1 month. Bonferroni's pairwise comparison test was used for statistical analysis. Significant reduction were determined only in the long-term terminal boiled heat-polymerized test group at the end of 1 day (p < 0.01), 1 week (p < 0.05) and also 1 month of water storage (p < 0.01). Significant reduction in autopolymerized test groups started even after 1 week of water storage (p < 0.05). Microwave-polymerized test groups did not show a significant residual MMA reduction in all time intervals (p > 0.05). The polymerization methods and cycles applied to the glass fiber reinforced denture base polymers influence both the content and the reduction of residual MMA after water storage.