Torque loss under mechanical cycling of long-span zirconia and titanium-cemented and screw-retained implant-supported CAD/CAM frameworks.

OBJECTIVES: This study evaluated the screw joint stability after cyclic loading of implant-supported titanium and zirconia CAD/CAM frameworks for fixed dental prostheses (FDPs) with different retention methods. MATERIAL AND METHODS: Twenty four one-piece frameworks supported by six threaded implants placed in the maxilla were fabricated using a CAD/CAM technique (NeoShape). Dry-pressed porcelain crowns were luted to the frameworks to standardize the specimens. The specimens were then divided into four groups (n = 6) according to framework material (titanium or zirconia) and retention method for the prosthesis (cement- or screw-retained): G1, Ti-cemented; G2, Ti-screw-retained; G3, Zr-cemented; and G4, Zr-screw-retained. A digital torque ratchet was used to assess the initial preload removal torque. Torque was then reapplied and the specimens were submitted to a 200 N cyclic load, at a frequency of 2 Hz, underwater in controlled temperature of 37°, and for 1 × 106 cycles. An opposing lower dental arch was fabricated using bis-acrylic resin to simulate occlusal contacts in centric. After cyclic loading, postload removal torque was measured. Preload and postload torque loss was expressed as a percentage of the initial load. Data were submitted to a linear mixed-effects model for statistical significance (α = 0.05) to evaluate the effect of cyclic loading in the screw torque loss used with frameworks of different materials and retention methods. RESULTS: Significant screw torque loss (%) was found for the tested groups (before/after cyclic loading, respectively): G1 (39.77/61.83), G2 (37.57/50.96), G3 (34.87/54.10), and G4 (47.56/73.50) (P < 0.05). CONCLUSIONS: The screw removal torque was significantly reduced for all groups in this study after cyclic loading the specimens. Screw-retained zirconia specimens presented the highest torque loss before and after the cyclic loadings compared with the other specimens that were tested.

The use of a mandibular repositioning device for obstructive sleep apnea.

The objective of this study was to verify the effect of a mandibular repositioning device (MRD) on polysomnographic parameters and on the mean electromyographic activity of the masseter and temporal muscles in individuals with obstructive sleep apnea syndrome (OSAS). This is a prospective cohort study conducted at multidisciplinary OSAS center in a tertiary referral center. Nineteen individuals with mild or moderate OSAS associated with Mallampati 3-4 were treated with an MRD during sleep. The subjects underwent diurnal electromyography (EM) and nocturnal polysomnography (PSG) examinations both prior and after initial treatment (3 months with MRD for PSG and 6 and 12 months of treatment for EM). The examinations performed at different times were compared. Comparison of the initial and final polysomnography examination revealed a significant mean reduction of apnea-hypopnea index (AHI) from 13.8 to 7.8. The successful treatment rate with the MRD was 52.6%, and the improved treatment rate was 68.4%. Patients with lower pre-treatment AHI presented higher rates of cure. There was no statistically significant change in electromyography examination among different times. The MRD reduced the apnea-hypopnea index in individuals with enlarged base of tongue and mild and moderate OSAS without damaging the function of the masseter and temporal muscles as determined by electromyography.

Experimental titanium alloys for dental applications.

STATEMENT OF PROBLEM: Although the use of titanium has increased, casting difficulties limit routine use. PURPOSE: The purpose of the present study was to compare the mechanical properties and biocompatibility of the experimental titanium alloys titanium-5-zirconium, titanium-5-tantalum, and titanium-5-tantalum-5-zirconium (in wt%) with those of commercially pure titanium. MATERIAL AND METHODS: Specimens of titanium alloys and commercially pure titanium were cast by using plasma. Their modulus of elasticity and ultimate tensile strength were determined in a universal testing machine. Biocompatibility was evaluated with SCC9 cells. In periods of 1, 4, 7, 10, and 14 days, cell proliferation was evaluated by the (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) tetrazolium reduction assay, and cell viability was evaluated in the 7-day period. Cell morphology was evaluated at 2, 12, and 24 hours. Modulus of elasticity, ultimate tensile strength, and cell viability were analyzed by 1-way ANOVA and the Bonferroni test; cell proliferation data were compared by 2-way ANOVA (alloy versus time) and by the Bonferroni test; and the cell morphology data were analyzed by split-plot design. All statistical tests were performed at the 95% confidence level (P<.05). RESULTS: Titanium-5-tantalum presented the lowest modulus of elasticity and ultimate tensile strength, whereas titanium-5-zirconium and titanium-5-tantalum-5-zirconium were statistically similar to commercially pure titanium. Cell proliferation and viability were not affected by any alloy being similar to those observed for commercially pure titanium. No noticeably differences were found in the morphology of cells cultured on any alloy and commercially pure titanium. CONCLUSION: Experimental alloys, especially titanium-5-zirconium and titanium-5-tantalum-5-zirconium, presented promising mechanical results for future studies and clinical applications. In addition, these alloys, evaluated by cell proliferation, viability, and morphology, were found to be biocompatible in vitro.

Comparison of the correlation of photoelasticity and digital imaging to characterize the load transfer of implant-supported restorations.

STATEMENT OF PROBLEM: Whether splinting or not splinting adjacent implants together can optimize the stress/strain transfer to the supporting structures remains controversial. PURPOSE: The purpose of this study was to compare the photoelasticity and digital image correlation (DIC) in analyzing the stresses/strains transferred by an implant-supported prosthesis. MATERIAL AND METHODS: A polymethylmethacrylate model was made with a combination of acrylic resin replicas of a mandibular first premolar and second molar and threaded implants replacing the second premolar and first molar. Splinted (G1/G3) and nonsplinted (G2/G4) metal-ceramic screw-retained crowns were loaded with (G1/G2) and without (G3/G4) the presence of the second molar. Vertical static loads were applied to the first molar implant-supported crown (50 N-photoelasticity; 250 N-DIC). The resulting isochromatic fringes in the photoelastic models were photographed, and a single-camera 2-dimensional DIC system recorded the deformation at the surface of the resin models. RESULTS: Residual stresses were present in the photoelastic model after screw fixation of the crowns. The following average photoelastic stress results (MPa) were found around the loaded implant: G1 (20.06), G2 (23.49), G3 (30.86), G4 (37.64). Horizontal strains (εxx, %) between the molars averaged over the length of the loaded implant were found by DIC: G1 (0.08 ± 0.09), G2 (0.13 ± 0.10), G3 (0.13 ± 0.11), G4 (0.16 ± 0.11). Splinted crowns transferred lower stresses to the supporting bone when the second molar was absent. The second molar optimized the stress distribution between the supporting structures even for nonsplinted restorations. CONCLUSIONS: Both methods presented similar results and seemed capable of indicating where issues associated with stress/strain concentrations might arise. However, DIC, while apparently less sensitive than photoelasticity, is not restricted to the use of light-polarizing materials.

Digital image correlation analysis on the influence of crown material in implant-supported prostheses on bone strain distribution.

PURPOSE: A digital image correlation (DIC) method for full-field surface strain measurement was used to analyze the effect of two veneering materials for implant supported crowns on the strain distribution within the surrounding bone. METHODS: An epoxy resin model of a bone block was made by housing acrylic resin replicas of a mandibular first premolar and second molar together with threaded implants replacing the second premolar and first molar. Porcelain-veneered (G1 and G3) and resin-veneered (G2 and G4) screw-retained splinted crowns were fabricated and loaded with (G1 and G2) and without (G3 and G4) the presence of the second molar replica. A 2-dimensional DIC measuring system was used to record surface deformation of the bone block model at a frequency of 1.0 Hz during application of a 250-N load. RESULTS: Maximum compressive strains (ɛ(XX), %) were found for the following regions: between molars, G1 (-0.21), G2 (-0.18), G3 (-0.26), and G4 (-0.25); between implants, G1 (-0.19), G2 (-0.13), G3 (-0.19), and G4 (-0.14). The magnitude of strains in the simulated bone block with the resin-veneered crowns was lower than that with porcelain-veneered crowns, irrespective of the presence or absence of the second molar. CONCLUSIONS: The softer resin veneer helped to spread the load more evenly amongst the supporting teeth and implants, thus reducing the strains in the simulant bone block. Conversely, using the harder porcelain veneer resulted in the load being concentrated within one or two teeth or implants, thus leading to higher strain values in the bone block.

Digital image correlation analysis of the load transfer by implant-supported restorations.

This study compared splinted and non-splinted implant-supported prosthesis with and without a distal proximal contact using a digital image correlation method. An epoxy resin model was made with acrylic resin replicas of a mandibular first premolar and second molar and with threaded implants replacing the second premolar and first molar. Splinted and non-splinted metal-ceramic screw-retained crowns were fabricated and loaded with and without the presence of the second molar. A single-camera measuring system was used to record the in-plane deformation on the model surface at a frequency of 1.0Hz under a load from 0 to 250N. The images were then analyzed with specialist software to determine the direct (horizontal) and shear strains along the model. Not splinting the crowns resulted in higher stress transfer to the supporting implants when the second molar replica was absent. The presence of a second molar and an effective interproximal contact contributed to lower stress transfer to the supporting structures even for non-splinted restorations. Shear strains were higher in the region between the molars when the second molar was absent, regardless of splinting. The opposite was found for the region between the implants, which had higher shear strain values when the second molar was present. When an effective distal contact is absent, non-splinted implant-supported restorations introduce higher direct strains to the supporting structures under loading. Shear strains appear to be dependent also on the region within the model, with different regions showing different trends in strain changes in the absence of an effective distal contact.

In vitro cytotoxicity of dental alloys and cpTi obtained by casting.

BACKGROUND: This study aimed to compare the cytotoxicity of base-metal dental alloys and to evaluate if the casting method could influence their cytotoxicity. METHODS: Disks of base-metal dental alloys were cast by two methods: plasma, under argon atmosphere, injected by vacuum-pressure; and oxygen-gas flame, injected by centrifugation, except Ti-6Al-4V and commercially pure titanium (cpTi), cast only by plasma. SCC9 cells were cultured in culture media D-MEM/Ham's F12 supplemented, at 37 degrees C in a humidified atmosphere of 5% carbon dioxide and 95% air, on the previously prepared disks. At subconfluence in wells without disks (control), cell number and viability were evaluated. RESULTS: In plasma method, cpTi and Ti-6Al-4V were similar to control and presented higher number of cells than all other alloys, followed by Ni-Cr. In oxygen-gas flame method, all alloys presented fewer cells than control. Ni-Cr presented more cells than any other alloy, followed by Co-Cr-Mo-W which presented more cells than Ni-Cr-Ti, Co-Cr-Mo, and Ni-Cr-Be. There were no significant differences between casting methods related to cell number. Cell viability was not affected by either chemical composition or casting methods. CONCLUSION: cpTi and Ti-6Al-4V were not cytotoxic while Ni-Cr-Be was the most cytotoxic among tested alloys. The casting method did not affect cytotoxicity of the alloys.