Prevention of internal bacterial colonization of dental implants: A comparative longitudinal observational study.

OBJECTIVES: Previous studies have indicated a progressive internal bacterial colonization of implants and possible implications for peri-implant bone loss. The aim of this study was to evaluate a decontamination protocol, two disinfectants, and a sealant for their ability to prevent such a colonization. MATERIALS AND METHODS: Bacterial samples were harvested from the peri-implant sulcus (external) and following abutment removal from the implant cavity (internal) during routine supportive peri-implant care in 30 edentulous patients 2 years after they had obtained two implants. In a split-mouth design, implants were randomly assigned to receive either internal decontamination alone (10% H2 O2 , brush) or additional placement of either sealant (GS), disinfectant agent (CHX-varnish) or disinfectant gel (1% CHX-gel), in the internal cavity before remounting of abutment/suprastructure. Twelve months later, internal and external sampling was repeated. Total bacterial counts (TBCs) were determined using real-time PCR in a total of 240 samples (eight per patient). RESULTS: Total bacterial counts in the internal cavity significantly reduced overall treatment modalities 1 year after the treatments (4.0 [2.3-6.9]-fold reduction; p = .000). No significant differences between the four treatment types were found (p = .348). Comparison of internal and external sampling points revealed significant correlation (R2 = .366; p = .000) with systematically higher TBC counts in external samples. CONCLUSIONS: Within the limitations of the present study, it can be concluded that the use of disinfectant agents or a sealant did not show an additional benefit in the prevention of internal bacterial colonization of implants compared to a decontamination protocol alone.

IMPACT OF LOADING PROTOCOL OF 2-IMPLANT BAR-RETAINED MANDIBULAR OVERDENTURES ON ORAL HEALTH-RELATED QUALITY OF LIFE: A RANDOMIZED CONTROLLED TRIAL.

OBJECTIVES: Aim was to assess whether immediate loading (IL) is more effective than delayed loading (DL) for 2-implant bar-retained mandibular overdentures in terms of oral health-related quality of life (OHRQoL) improvement over a period of 24-month. METHODS: In this randomized controlled trial, 32 edentulous patients (mean age: 65.7 ± 10.6 years, 50.0% female) were included. Potential participants had to be unsatisfied with the retention of their current mandibular complete denture and demanded implant treatment for inclusion in the study. OHRQoL was assessed with the 49-item Oral Health Impact Profile (OHIP) at baseline before treatment and 1, 3, 6, 12, and 24 months after implant loading and insertion of implant-retained bars for overdenture support. A mixed-effects model with patients as random effect and an unstructured covariance matrix was developed to address repeated outcome measurement. RESULTS: Patients' OHRQoL impairment at baseline was substantial indicated by mean OHIP summary score of 45.1 points. OHIP summary scores decreased substantially from baseline to 1-month follow-up to a mean of 33.5 points (P = .020). OHRQoL further improved during study period indicated by OHIP summary score of 25.7 points at 24-month follow-up. Raw treatment effects (IL vs. DL) ranged from -1.2 OHIP points for 12-month follow-up to 5.8 OHIP points for 24-month follow-up. Assuming constant treatment and time effects, treatment effect was small and not statistically significant (-0.7 OHIP points; P= .918). CONCLUSION: A 2-implant bar-retained mandibular overdentures substantially improves OHRQoL over a period of at least 24 months. There seems to be no significant effect of implant loading protocol.

Soft tissue response to different abutment materials: A controlled and randomized human study using an experimental model.

OBJECTIVES: Aim of this study was to compare the soft tissue response to implant abutments made of titanium, zirconia, zirconia veneered with feldspar ceramics and PEEK by various clinical, histological, microbiological, and molecular biological markers in an experimental model. MATERIALS AND METHODS: A total of 40 experimental one-piece healing abutments of four different materials were mounted on bone level implants in 20 volunteering patients (split-mouth design). After a three-month period of open healing, clinical parameters at the abutments were assessed and adjacent mucosa was sampled for inflammatory cytokine mRNA concentrations and histological analysis by a novel method. In addition, PISF samples were obtained for the analysis of periodonto-pathogenic bacteria counts and active MMP-8 levels. Marginal bone level change was measured by intra oral radiographs. RESULTS: Abutments of the different materials did not exhibit significant differences regarding clinical parameters, pathogenic bacteria counts or pro-inflammatory cytokine concentrations. Likewise, no significant differences were detected regarding soft tissue morphology or bone level change. Compared to titanium abutments, significantly less mononuclear inflammatory cells were detected in the mucosa at abutments made of zirconia veneered with feldspar ceramics. CONCLUSIONS: All examined abutment materials exhibited a similar soft tissue response compared to titanium and histological data did not reveal early signs of elevated inflammation caused by PEEK- and feldspar-veneered zirconia abutments. Due to the short observation period and the small sample size, a final conclusion on the long-term suitability of those abutment materials cannot be drawn. However, based on the presented data, we consider further studies on that subject as appropriate.

Influence of the loading protocol and platform switching in two-implant bar-retained overdentures: 3-year results from a randomized controlled equivalence clinical trial.

OBJECTIVES: To test the null hypothesis that vertical peri-implant bone level alterations (ΔIBL) are equivalent in immediately (IL) and 3-month post-placement (DL) loaded implants in mandibular implant overdentures (IODs) on two implants. MATERIALS AND METHODS: Thirty-two patients receiving two interforaminal implants, one with a platform-switched and one with a platform-matching abutment were randomly assigned to the IL or DL group (allocation ratio 1:1). All implants were primarily splinted with chairside-customized bars, converting the existing removable complete dentures to IODs. Standardized radiographs were recorded. The influence of the loading protocol (IL vs. DL), implant platform (platform switched vs. platform matching), implant site (43 vs. 33), participant age (≤65 vs. >65 years), and definition of baseline (implant placement vs. implant loading) were analyzed, applying linear regression analyses (α = 0.05). The equivalence range was [-0.4; 0.4]. RESULTS: Three participants of the IL group were lost during follow-up. The overall mean ΔIBL was -0.96 ± 0.89 mm. The ΔIBL was equivalent in terms of the implant platform and implant site but not in terms of participant age (in favor of more elderly participants) and the loading protocol. A significantly smaller ΔIBL was observed in the IL when the baseline was considered to be implant placement (p = .017), but not when it was considered to be implant loading (p = .084). CONCLUSION: Immediate loading of primary-splinted implants in two-implant bar-retained overdentures, seems beneficial relative to loading 3 months post-placement, with respect to ΔIBL. The ΔIBL were equivalent in terms of platform switching.

Comparison of irrigation protocols for the internal decontamination of dental implants-results of in vitro and in vivo studies.

OBJECTIVES: Previous investigations have shown a progressive bacterial colonization of the internal cavities of two-piece dental implants with possible implications for peri-implant bone loss. The aim of the study was to compare different irrigation protocols for the internal decontamination of implants in vitro and in vivo. MATERIALS AND METHODS: In the in vitro part, 80 samples were obtained 24 h after inoculation with an aliquot of subgingival bacteria from 40 implants as follows: before and after either cleaning with a brush and an irrigation solution (irrigation-brush-irrigation: test) or repeated irrigation alone (irrigation-irrigation: control). In the clinical study, 40 samples from twenty partially edentulous patients contributing each with one implant were collected after removal of abutment and suprastructure with sterile paper points immediately before and after decontamination and subsequently analyzed for total bacterial counts (TBC) by real-time-PCR. Irrigation solutions were chlorhexidine (0.2% (CHX)), H2 O2 (10%), alcohol (70%, (ALC)), and NaCl (0.9%). Differences in proportional reduction of TBC between the four irrigation solutions were analyzed. RESULTS: Irrigation with H2 O2 showed the highest effect in both parts of the study (relative TBC reduction in vitro: H2 O2 : 87.1%, CHX: 56.9%, ALC: 43.7%, NaCl: 42.7%; in vivo: H2 O2 : 51.4%, ALC: 30.4%, NaCl: 26.3%, CHX: 7.1%). The additional use of a brush showed no beneficial effect (p = 0.088). Overall, H2 O2 was superior to all other irrigation solutions with regard to relative TBC reduction. CONCLUSIONS: The present results indicate the potential of an irrigation protocol that includes a 10% H2 O2 solution for the internal decontamination of implants. (ClinicalTrials.gov NCT01917305).

Short strategic implants for mandibular removable partial dentures: One-year results from a pilot randomized crossover abutment type study.

OBJECTIVES: The present pilot study analyzed two abutment types (a retentive ball and a non-retentive dome) in implant-assisted removable partial dentures (IARPDs) on 6 mm short implants with respect to clinical, radiological, and patient-reported outcomes (PROs), during the first year. MATERIALS AND METHODS: Two implants were placed bilaterally in mandibular molar sites, converting existing free-end removable partial dentures (RPDs) to IARPDs. Twelve subjects were randomized to initially receive either the dome (Group A, n = 6) or the ball abutment (Group B, n = 6). After eight weeks, the abutments were exchanged. After another 8 weeks, the participants were given the choice of one of the abutments. Mean values and standard deviations (SD) were calculated, and random-effect linear regression analyses were applied to analyze marginal bone level alterations and PROs (α < .05). RESULTS: Twelve participants were included in the study; however, one dropout occurred. Patient ratings increased significantly in both study groups. The majority of the participants (82%) ultimately chose the ball abutment. The implant survival rate was 100%, and the success rate was 90.9% twelve months after implant placement (mean peri-implant bone-loss: -1.2; SD: 0.6 mm) without a statistically significant difference between the study groups, in terms of clinical- and radiological outcomes. CONCLUSION: Placing 6 mm short implants at mandibular molar sites of RPD wearers seems to be a viable treatment option, based on this investigation with a short-term follow-up. Although only minor differences between the two abutments were observed, patients seem to prefer the ball over the dome abutment.

Novel method to obtain human non-separated histological samples for the assessment of peri-implant soft tissue response: A feasibility study.

OBJECTIVES: To introduce a standardized and less invasive clinical model that provides histological information on the abutment-mucosa interface in humans. MATERIALS AND METHODS: New experimental healing abutments were left in an open healing position on bone-level implants in the interforaminal region of the mandibles in six edentulous patients. The one-piece abutments were hollow cylinder-shaped with two lateral openings that allow for ingrowth of the peri-implant mucosa into the central abutment cavity. After three months of healing, abutments and ingrown mucosa were sampled and processed for histological analysis in a non-separated resin-embedding technique. To test the validity of the new model, the ingrown tissue was compared to the peri-implant mucosa around the same samples. RESULTS: None of the experimental abutments exhibited signs of failure, and all samples showed mucosal ingrowth to the inner-abutment cavity. Comparison of ingrown tissue and peri-implant mucosa revealed no significant differences regarding the traits: tissue morphology, quality of collagen fibers, and adherence to the abutment. Ingrown mucosa exhibited a tendency for higher leukocyte infiltration. CONCLUSIONS: The presented model is a promising approach to reduce invasiveness during the sampling process for human non-separated abutment biopsies.

In vitro cytotoxicity of different dental resin-cements on human cell lines.

Adhesive resin-cements are increasingly used in modern dentistry. Nevertheless, released substances from resin materials have been shown to cause cellular toxic effects. Disc-shaped specimens from 12 different resin cements and one conventional zinc phosphate cement were prepared and used for direct stimulation of five different human cell lines via transwell cell culture system or in an indirect way using conditioned cell culture media. Cytotoxicity was determined using LDH and BCA assays. All tested cements led to a decrease of cell viability but to a distinct extent depending on cell type, luting material, and cytotoxicity assay. In general, cements exhibited a more pronounced cytotoxicity in direct stimulation experiments compared to stimulations using conditioned media. Interestingly, the conventional zinc phosphate cement showed the lowest impact on cell viability. On cellular level, highest cytotoxic effects were detected in osteoblastic cell lines. All resin cements reduced cell viability of human cells with significant differences depending on cell type and cement material. Especially, osteoblastic cells demonstrated a tremendous increase of cytotoxicity after cement exposure. Although the results of this in vitro study cannot be transferred directly to a clinical setting, it shows that eluted substances from resin cements may disturb osteoblastic homeostasis that in turn could lead to conditions favoring peri-implant bone destruction. Thus, the wide use of resin cements in every clinical situation should be scrutinized. A correct use with complete removal of all cement residues and a sufficient polymerization should be given the utmost attention in clinical usage.

Platform switching in two-implant bar-retained mandibular overdentures: 1-year results from a split-mouth randomized controlled clinical trial.

OBJECTIVES: The concept of platform switching is widely applied in current implant dentistry; however, the influence on peri-implant bone-level alterations (ΔIBL), especially in the field of implant overdentures (IODs), remains inconclusive. Therefore, the present study aimed to test the alternative hypothesis that there is an equivalent ΔIBLs at platform-switching and platform-matching implant abutments in 2-implant bar-retained IODs. MATERIALS AND METHODS: Two interforaminal implants were placed in 32 subjects, who were randomly assigned to either an immediate- or a 3-month post-placement loading group. Furthermore, one implant in each subject was randomly assigned to receive a platform-switched abutment (test), and one a platform-matching abutment (control). The implants were splinted with prefabricated, chairside customized bars. ΔIBL was recorded by using customized radiograph holders at implant placement, implant loading, 3 months, 6 months, and 12 months after loading. RESULTS: After 1 year, equivalent ΔIBL could be identified (test: -0.51 mm ± 0.49 versus control: -0.56 mm ± 0.52; p < .001). ΔIBL increased over time and was more pronounced in the delayed-loaded implants (-0.87 mm ± 0.61) relative to the immediately loaded implants (-0.35 mm ± 0.43; p = .022). CONCLUSIONS: The prosthetic concept of platform switching does not necessarily lead to reduced bone loss. Immediate-loading of implants, primarily splinted with a bar, might be beneficial regarding peri-implant bone-level alterations over a short-term period.

A novel blue light laser system for surgical applications in dentistry: evaluation of specific laser-tissue interactions in monolayer cultures.

OBJECTIVES: The objective of this study was to examine a new blue light diode laser system (445 nm) for dental soft tissue surgery on cellular level. MATERIALS AND METHODS: An in vitro cell culture model was established to evaluate the effects of the 445-nm diode laser in comparison to an established infrared diode laser (IR). Monolayer cell cultures were irradiated and wound healing was morphometrically measured. Fluorescence staining was used for proof of potential DNA double-strand breaks as well as cytoskeleton alterations. Cellular live/dead discrimination was performed and temperature development during laser irradiation was measured with a thermographic infrared camera. RESULTS: A characteristic zone formation was detected after irradiation with both wavelengths. Despite a larger wound area after irradiation with 445 nm, due to its higher temperature development, this laser system showed a faster wound healing in comparison to the IR laser. No increase of devitalized cells was documented with higher distances between laser tip and cell layer and thus without thermal interaction. Neither cytoskeleton alteration nor DNA double-strand breaks could be recorded after irradiation in non-contact mode. CONCLUSIONS: The blue diode laser system demonstrated an excellent direct thermal coupling to cells and tissues without side effects even by reduced power settings. CLINICAL RELEVANCE: The blue diode laser seems to be a promising technology for clinical application due to high absorption of blue light without major side effects in adjacent tissues even by reduced power settings.

Functional characterization of the parathyroid hormone 1 receptor in human periodontal ligament cells.

OBJECTIVES: Intermittent parathyroid hormone (PTH) exerts anabolic effects on bone and has been approved for osteoporosis therapy. The dual actions of PTH are mediated primarily through the parathyroid hormone 1 receptor (PTH1R). Upon ligand binding, PTH1R activates diverse signaling pathways, including cAMP/protein kinase A (PKA)- and phospholipase C/protein kinase C (PLC/PKC)-dependent pathways. PTH1R has been abundantly studied in bone cells. Knowledge on PTH1R characteristics and physiology in periodontal ligament (PDL) cells is still in its infancy. MATERIALS AND METHODS: We characterized PTH1R in PDL cells in terms of its cellular localization, binding affinity, and signal transduction and compared these characteristics to those of MG63 osteoblast-like cells. RESULTS: PTH1R mRNA/protein was identified in PDL and MG63 cells. PTH1R was mainly localized on the plasma membrane, in vesicular structures inside the cell, and, to some extent, in the nucleus of both cell types. Binding characteristics of PTH1R were cell type specific, with PDL cells demonstrating a lower binding affinity. The response of cAMP and active PKC production in MG63 cells was dose dependent with increasing PTH(1-34) concentration, whereas in PDL cells, it was regulated biphasically. However, we observed a cross talk between the cAMP/PKA and PLC/PKC signaling pathways, which were regulated diametrically opposed at a given concentration of PTH(1-34). CONCLUSION: These data indicate that, albeit the similarity in its subcellular distribution, PTH1R in PDL cells exhibits characteristics different from those in MG63 cells, pointing to the cell type specificity of this receptor. CLINICAL RELEVANCE: The findings further elucidate the characteristics of PTH action in dental tissues and widen the theoretical basis for the development of anabolic treatment strategies.

Efficacy of Virtual Preparation Simulators Compared to Traditional Preparations on Phantom Heads.

BACKGROUND: Virtual simulators are increasingly being introduced in dental education. This study investigates whether virtual simulators offer comparable or superior educational efficacy when compared to traditional phantom simulators. MATERIALS AND METHODS: Participants were randomly allocated into groups: Virtual Preparation (SIM; n = 30) and Traditional Preparation (FRA; n = 30). Students were tasked with preparing tooth 36 for a full-cast crown during free practice for four days. Faculty staff provided feedback to both groups. Examinations were administered and graded by three examiners (preclinical and clinical consultants and a dental surgery consultant). Additionally, a survey was conducted to assess each training concept. RESULTS: The FRA group achieved significantly better grades in the preparation exam evaluations by all three examiners, compared to the SIM group. Interrater reliability showed only moderate agreement, with the clinical examiner giving better grades than the other two. The questionnaire results indicate that while participants managed with the virtual system, they preferred the analog system for exams and patient preparation. CONCLUSION: Virtual simulators do not seem to be as good when it comes to practicing for a preparation exam or clinical preparation, especially for unexperienced students. However, they still appear to be useful as an additional tool for introducing students to the topic of preparation.

Influence of Cementation Mode and Ferrule Design on the Fatigue Resistance of Monolithic Zirconia Endocrowns.

Background: Classic endocrowns made of dental ceramics are considered a promising alternative to traditional post-endodontic restorations. The use of circular ferrules in endocrowns is a topic of controversial discussion. Therefore, the present study aims to evaluate the effect of ferrule design and cementation mode on the fatigue resistance of zirconia endocrowns. Methods: Eighty human molars were divided into four groups (n = 20): NFC (no-ferrule, conventional cementation), NFA (no-ferrule, adhesive luting), FC (ferrule, conventional cementation) and FA (ferrule, adhesive luting). Both the classic and the modified endocrown preparation with a two-millimeter ferrule design were carried out. Endocrowns were fabricated from zirconia using the CEREC system. After thermocycling, specimens were loaded according to the step-stress test up to 1500 N. Results: Failure rate was low; 88.8% of total specimens passed the step-stress test. Fractures were distributed between all groups; no significant differences in fatigue resistance were detected for preparation design and cementation mode. Conclusions: Endocrowns appear to be a promising concept for endodontically treated molars. Ferrule and also cementation mode have only a minor influence on fatigue resistance of zirconia endocrowns. However, at very high forces, the marginal area of the ferrule represents a weak point.

Potential immune modularly role of glycine in oral gingival inflammation.

Gingival epithelial cells (GECs) represent a physical barrier against bacteria and are involved in the processes of innate immunity. Recently, an anti-inflammatory and immune-modulatory effect of the amino acid glycine has been demonstrated. However, there is only little information about the immune-modulatory effects of glycine in oral tissues. This study aimed to investigate the existence and role of the glycine receptor in gingival tissue analyzing tissues/cells from extracted human molars via immunohistochemical analysis. In vitro, GECs were challenged by inflammatory conditions with IL-1 ß alone or in combination with glycine and analyzed for cytokine expression of IL6/IL8 via real-time PCR. On protein level, the effect of nuclear translocalization of NF κ B protein p65 was analyzed using immunofluorescence analysis. A distinct proof of the GlyR in oral gingival tissue and keratinocytes could be demonstrated. Isolated challenge of the keratinocytes with IL-1 ß as well as with glycine resulted in an upregulation of IL6 and IL8 mRNA expression and activation of NF κ B pathway. The presence of glycine in combination with the inflammatory stimulus led to a significant decrease in inflammatory parameters. These results indicate a possible anti-inflammatory role of glycine in gingival inflammation and encourage further research on the utility of glycine in the prevention or therapy of inflammatory periodontitis.

Clinical retention force development of double crowns.

This study deals with the development of the retentive forces of double crowns intraorally measured. Twenty-five combined fixed-removable prostheses with a total of 84 double crowns were included in the study. The intraoral measurement was performed at 72 defined measuring points directly adjacent to the double crowns of the dentures. The measurement was performed 4-6 weeks (baseline), 6 months (recall 1), and 18 months (recall 2) after the insertion of the restoration. A specifically designed measuring device was used. The median values for the single measuring points reached 4.705 N at the baseline, 5.190 N after 6 months, and 3.740 N after 18 months. The measured values were analyzed according to differences between the median retention forces at the three defined points in time. The statistical analysis of the median values showed no statistical difference for the retention force change after 6 months but for the decrease until the second recall (Mann-Whitney test). The retention force per denture was calculated by a summation of the single measuring points. At the baseline, 12.9 N was reached. The forces did only decrease slightly and were not statistically significant. The results indicate that retention force values of double crowns, measured intraorally at the patient, do not relevantly change clinically within the first 1.5 years. Within the limitations of this study, it can be stated that wear does not influence the retentive forces of double crowns within the first 18 months. After this period the retention force should be still sufficient for denture retention.

Telescopic crowns: extra-oral and intra-oral retention force measurement--in vitro/in vivo correlation.

OBJECTIVE: This study deals with the determination of the retentive forces of telescopic crowns measured extra- and intra-orally and the correlation of these values. BACKGROUND: The telescopic denture is a well-documented solution for prosthetic rehabilitation for a partially edentulous jaw. Acceptable retention forces are needed to avoid inadvertent removal of the denture during movement of the jaws. Recent literature suggests 3-7 N per attachment to be acceptable. These values are only supported by in vitro studies. In vivo data are scarce, and a correlation of the in vitro and in vivo values is lacking. MATERIAL AND METHODS: Twenty-five combined fixed-removable prostheses with a total of 72 double crowns were used for extra-oral retention force measurement prior to cementation (in vitro). The intra-oral measurement was performed at 72 defined measuring points of the dentures 4-6 weeks after prosthetic rehabilitation (in vivo). A specifically designed measuring device was used. RESULTS: The rank correlation showed that the in vitro and in vivo values correlate with each other (Spearman's ρ = 0.5052). Additionally, it was found that the median values measured before (1.97N) insertion of the dentures were significantly lower than after (4.70N) insertion (Mann-Whitney test, p ≤ 0.0001). CONCLUSION: The retention forces measured before and after insertion of the denture correlate with each other although their dimension is significantly higher after insertion. The reason for this behaviour might be some tilting during removal. Nevertheless, the correlation allows a prediction of the clinically relevant forces by a measurement of the extra-orally measured retentive values.

Converting Bilateral Free-End Removable Partial Dentures to Implant-Assisted Removable Partial Dentures Using 6 mm Short Implants: Patient-Reported Outcomes of a Prospective Clinical Study.

The study assessed oral health-related quality of life (OHRQoL) of patients who received two 6 mm short implants in mandibular molar sites, converting existing bilateral free-end removable partial dentures (RPDs) to implant-assisted RPDs (IARPDs). After a postsurgical healing period of 4 months, the participants received a non-retentive dome abutment for 8 weeks, and then a retentive ball abutment for another 8 weeks. Afterwards, the participants made their final choice on which abutment to keep. The final follow-up was 1 year after implant placement. OHRQoL was evaluated with the 49-items version of the Oral Health Impact Profile (OHIP-49) at the abutment exchanges and the final follow-up. Furthermore, numerical rating scales were used to analyze patient satisfaction after 1 year. Questionnaire data of 13 participants were evaluated. Overall, OHRQoL increased with both the dome (p = 0.02) and the ball abutments (p < 0.001), without a significant difference between the abutments (p = 0.953). The questionnaires revealed an improvement in terms of oral situation, quality of life, and masticatory capacity (all p < 0.01). Patients showed a significant preference for the ball abutments (p < 0.001). Converting RPDs to IARPDs resulted in significant improvement of OHRQoL. Patients seem to prefer retentive over non-retentive abutments, although no differences in terms of OHRQoL were observed.

Misfit of Complete Maxillary Dentures' Posterior Palatal Seal following Polymerisation with Four Different Autopolymerising Resins: An In Vitro Study.

BACKGROUND: The majority of complete dentures are still conventionally manufactured using a flask-and-pack technique. However, the polymerization process may introduce a distortion of the denture body. The aim of this study was to evaluate the three-dimensional fit of the posterior palatal seal of maxillary complete dentures with the original impression, and to give recommendations for scraping. METHODS: Four autopolymerising resins were used to manufacture 40 palatal plates each for high, medium and flat palates (total n = 120). The misfit was captured by taking a reline impression with a highly fluid silicone, the dimensions of which were measured with a flat-bed scanner. RESULTS: The shape of the palate had a significant impact (median p = 0.0435), but not the resin type (median p = 0.2575). It was largest for the flat palate and smallest for the high palate. The largest misfit was observed in the palatal midline area (flat-palate average median: 685 µm; high and medium palates: 620 µm) decreasing towards the lateral and anterior regions. CONCLUSIONS: The results suggest compensating for the palatal misfit that occurs with autopolymerising resins by scraping a postdam of an approximately 0.7 mm depth to the master cast, decreasing towards the anterior and lateral areas. In high and medium palates, the scraping could be less pronounced.

Conical crowns with electroplated gold copings: retention force changes caused by wear and combined off-axial load.

OBJECTIVES: The aim of this study was to examine the wear behavior of conical crowns of gold alloy and zirconium dioxide ceramics facing electroplated gold copings. METHODS: The conical crowns were milled in Group A of a cast gold alloy (Degunorm(®), DeguDent(®)) and B zirconium dioxide (Cercon(®), DeguDent(®)). Fifteen specimens were milled per group with a conicity of 2°. The electroplated coping was established by direct electroforming with the Solaris system (DeguDent(®)) and glued into a framework. An apparatus accomplishing 5000 wear cycles performed the wear test. After each of the cycles, extra axial forces (80 N) were loaded 1 million times on an extension of the framework. The retentive forces and the correlating distance during insertion and separation were measured. The wear test was separated in a start phase, an initial wear phase and the long-term wear period. The retention force value and the force-distance integral of the first 0.3 mm of each cycle were calculated. RESULTS: The changes of retention force (ΔF) and integral (ΔF(d)) differed significantly between both groups in the start phase (ΔF: A -1.85 N, B +1.39 N, P=0.0028; ΔF(d): A -0.155 N mm, B +0.2685 N mm, P=0.0378) and the initial wear phase. The long-term wear period showed no differences in force and integral development. As a statistical test for the comparison of the median values of the two groups, the Mann-Whitney test was used. The median force never fell below 4 N or exceeded 12 N. CONCLUSIONS: Within the limitations of this study, the conical crowns tested showed clinically acceptable retentive properties. The values of about 4-6 N mentioned as sufficient in the recent literature were always attained. As the most retentive elements for dentures, both groups showed the main changes in retentive forces during the first 2000 cycles. The retention force development of the zirconia group appears to be less excursive over the whole wear test.