Effect of Disinfection on the Bond Strength between Denture Teeth and Microwave-Cured Acrylic Resin Denture Base.

PURPOSE: Denture tooth debonding is a common complication for denture wearers; however, the effect of complete denture disinfection on bonding between denture teeth and acrylic resin remains unclear. The aim of this study was to evaluate the effect of disinfection methods on the bond strength between denture teeth and microwave-cured acrylic resin denture base. MATERIALS AND METHODS: Three commercial brands of denture teeth (Trilux, Biolux, Vipi Dent Plus) and one microwave-cured acrylic resin denture base were tested. Each brand of denture teeth was divided into seven groups (n = 6; estimated by partial Eta squared). The specimenss of groups H and Cl were immersed in 1% sodium hypochlorite and 4% chlorhexidine digluconate for 7 days, respectively. In group Br, the specimens were subjected to toothbrush simulation under 200 g of force for 20,000 cycles. In groups Br-H and Br-Cl, the specimens were brushed and further disinfected with 1% sodium hypochlorite and 4% chlorhexidine digluconate, respectively. In control groups 1 (Co1) and 2 (Co2), the specimens were stored in distilled water for 50 ± 2 hours and 7 days, respectively. Shear bond strength testing was performed at the resin/tooth interface in a universal testing machine at a 1 mm/min crosshead speed. The failure pattern was quantified and classified into adhesive, cohesive, or mixed. Data were analyzed using two-way ANOVA and Tukey HSD test (α = 0.05). RESULTS: Disinfection with 1% sodium hypochlorite (p = 0.031), brushing (p < 0.0001), and association of brushing with either 1% sodium hypochlorite (p < 0.0001) or 4% chlorhexidine digluconate (p = 0.01) reduced the bond strength between denture teeth and microwave-cured acrylic resin denture base. All commercial brands of denture teeth presented a similar bond strength (p > 0.05). The failure pattern was predominantly adhesive independent of the disinfection method and denture tooth brand. CONCLUSIONS: Disinfection with sodium hypochlorite, brushing, and the association of mechanical and chemical methods reduced the bond strength between denture tooth and microwave-cured acrylic resin denture base.

Bone augmentation and autogenous transplantation of premolar to the site of the fissure in a cleft palate patient.

This article presents a case report of autogenous tooth transplantation to the site of the fissure, in addition to bone augmentation with graft of autogenous bone harvested from the iliac crest, performed in a cleft palate patient, who had insufficient bone volume. A non-syndromic 10-year-old girl, with a unilateral cleft lip and palate, incisal transforamen fissures, agenesis of the maxillary left central incisor and both maxillary lateral incisors, was treated with autogenous bone graft in the cleft area. The orthodontic treatment plan was to replace the missing lateral incisors with the maxillary canines and to extract the mandibular first premolars. One of the mandibular premolars was extracted from its site with 2/3 of its root formation completed and transplanted to the maxillary left central incisor area. After orthodontic treatment, the anatomic crowns were characterized with composite resin. Autogenous tooth transplantation can be performed in the area of the fissure in young cleft palate patients, by performing bone graft augmentation before transplantation of the tooth, to gain sufficient recipient alveolar bone volume. A multidisciplinary approach is mandatory for the success of this clinical procedure, especially in cleft palate patients.

Mapping Bone Marrow Cell Response from Senile Female Rats on Ca-P-Doped Titanium Coating.

Chemical and topographical surface modifications on dental implants aim to increase the bone surface contact area of the implant and improve osseointegration. This study analyzed the cellular response of undifferentiated mesenchymal stem cells (MSC), derived from senile rats' femoral bone marrow, when cultured on a bioactive coating (by plasma electrolytic oxidation, PEO, with Ca2+ and P5+ ions), a sandblasting followed by acid-etching (SLA) surface, and a machined surface (MSU). A total of 102 Ti-6Al-4V discs were divided into three groups (n = 34). The surface chemistry was analyzed by energy dispersive spectroscopy (EDS). Cell viability assay, gene expression of osteoblastic markers, and mineralized matrix formation were investigated. The cell growth and viability results were higher for PEO vs. MSU surface (p = 0.001). An increase in cell proliferation from 3 to 7 days (p < 0.05) and from 7 to 10 days (p < 0.05) was noted for PEO and SLA surfaces. Gene expression for OSX, ALP, BSP, and OPN showed a statistical significance (p = 0.001) among groups. In addition, the PEO surface showed a higher mineralized matrix bone formation (p = 0.003). In conclusion, MSC from senile female rats cultured on SLA and PEO surfaces showed similar cellular responses and should be considered for future clinical investigations.

Evaluation of a two-step pouring technique for implant-supported prostheses impression.

The aim of this study was to evaluate the efficacy of a pouring technique for implant-supported prostheses impressions. A metallic matrix (control group) with two implants positioned at 90 and 65 degrees was fabricated. The matrix was submitted to the direct transfer impression technique. In group CP (conventional pouring - n = 10), casts were obtained by the conventional pouring technique. In group EP (experimental pouring - n = 10), the analogs were embraced with latex tubes before the first pouring and then submitted to a second pouring. Vertical misfit and implants/analogs inclinations were evaluated. Data were analyzed by analysis of variance and Tukey's test (p < .05). Results demonstrated significant difference (p < .05) between control and experimental groups for misfit measurement in perpendicular implant/analog and between control group and group EP in leaning implant/analog. Considering inclination, there were significant differences (p < .05) between control and experimental groups for leaning analogs. Independently of the pouring technique, perpendicular implants produced more accurate casts.

Characterization of chemically treated Ti-Zr system alloys for dental implant application.

Materials and surfaces developed for dental implants need to withstand degradation processes that take place in the oral cavity. Therefore, the aim of the study was to develop and evaluate the topographical, mechanical, chemical, electrochemical and biological properties of Ti-xZr alloys (x = 5, 10, and 15 wt%) with two surface features (machined and double acid etched). Commercially pure titanium (cpTi) and Ti-6Al-4V alloy were used as controls. Surface characterization was performed using dispersive energy spectroscopy, X-ray diffraction, scanning electron microscopy, atomic force microscopy, profilometry and surface energy. The mechanical properties were assessed using Vickers microhardness, elastic modulus and stiffness. The electrochemical behavior analysis was conducted in a body fluid solution (pH 7.4). In addition, MC3T3-E1 cells were used to determine the impact of material and surface treatment on cell morphology by SEM analysis. Data were analyzed by two-way ANOVA and Bonferroni test (α = 0.05). Ti-Zr alloys showed lower surface roughness, elastic modulus and stiffness, as well as higher hardness and surface energy when compared to cpTi. Ti-Zr system increased the polarization resistance values and significantly decreased the capacitance, corrosion current density (icorr), and passivation current density (ipass) values. The acid treatment increased the resistance and corrosion potential of the oxide layer. SEM data analysis demonstrated that Ti-Zr alloys displayed normal cell attachment/spreading and slightly changed cell morphology in the double etched surface. In conclusion, Zr addition and surface treatment altered surface, mechanical, biological and electrochemical properties of Ti material.

The role of nicotine, cotinine and caffeine on the electrochemical behavior and bacterial colonization to cp-Ti.

Although smoking promotes deleterious effect to bone healing, there is a lack of study investigating its role on the implant structure and biofilm growth. We hypothesized that nicotine, cotinine and caffeine would impair the corrosion resistance of commercially-pure titanium (cp-Ti) and would enhance Streptococcus sanguinis biofilm growth. Neither the smoking products nor the caffeine affected the corrosion tendency (P>.05) and the oxide layer resistance (P=.762) of cp-Ti. Lower capacitance values were noted in the presence of nicotine (P=.001) and cotinine (P=.0006). SEM showed no pitting corrosion, and the EDS spectra did not differ among groups. Nicotine (300µg/mL) induced higher surface roughness (P=.03) and greater surface change of cp-Ti. Nicotine at 3µg/mL, and cotinine at 0.3 and 3µg/mL increased the number of viable cells (P<.05). Biofilm exposed to nicotine (0.3, 3 and 30µg/mL) (P=.025, .030, .040, respectively) and cotinine (3 and 30µg/mL) (P=.027, .049, respectively) enhanced carbohydrate content. Biofilm biomass and protein content were similar among groups (P>.05). These findings suggest a greater biofilm accumulation in smokers, a risk factor that may lead to peri-implantitis.

Effect of bleaching agents and soft drink on titanium surface topography.

The effects of carbamide peroxide, hydrogen peroxide and cola soft drink on the topographic modifications of commercially-pure titanium (CP-Ti) and Ti-6Al-4V were investigated. Ti discs were divided into 18 groups (n = 4) based on the solution treatment and Ti type. Specimens were immersed in 3 mL of each solution for 4 h per day (for the remaining 20 h, discs were left dry or immersed in artificial saliva) for 15 days. For control, specimens were immersed in only artificial saliva. Ti surfaces were examined using scanning electron (SEM) and atomic force (AFM) microscopes and their surface roughness (in µm) and surface chemical modifications were investigated. Data were analyzed by ANOVA and Tukey's test (α = 0.05). Groups immersed in 35% hydrogen peroxide showed the highest roughness (Ra) (171.65 ± 4.04 for CP-Ti and 145.91 ± 14.71 for Ti-6Al-4V) (p < 0.05), followed by groups treated with carbamide peroxide 16% (110.91 ± 0.8 for CP-Ti and 49.28 ± 0.36 for Ti-6Al-4V) and 35% (65.67 ± 1.6 for CP-Ti and 53.87 ± 1.98 for Ti-6Al-4V); treatment with artificial saliva did not affect the results. These values were statistically superior to those observed prior to the treatment and to those of the control group (31.0 ± 0.99 for CP-Ti and 29.95 ± 0.58 for Ti-6Al-4V). Cola soft drink did not alter the surface roughness of either Ti type (p > 0.05). SEM and AFM revealed dramatic changes in the specimens surfaces immersed in the 35% hydrogen peroxide, mainly for CP-Ti. No detectable chemical modifications on the Ti surface were observed. Bleaching agents promoted significant changes in Ti topography, which could affect the longevity of implants treatments.

Non-linear 3D finite element analysis of full-arch implant-supported fixed dentures.

Despite the necessity for faster clinical protocols for immediate loading of implant-supported dentures, there is a lack of biomechanical studies to confirm the rigid splinting effectiveness. We compared the stress in mandibular full-arch implant-supported fixed dentures under immediate loading through three-dimensional finite element analysis. Edentulous human mandible models were restored with a 4-implant fixed denture. Implants were splinted with a metallic framework and submitted to conventional loading (group A-control), with acrylic resin and submitted to immediate loading (group B), with a metallic framework and submitted to immediate loading (group C), and with acrylic resin and a prefabricated distal bar and submitted to immediate loading (group D). Models were supported by masticatory muscles. A 100-N oblique load was applied on the first molar. Group A presented the lowest stress and implant displacement values, whereas group D showed the highest values. In bone, groups under immediate loading exhibited the highest stress, whereas the group experiencing conventional loading showed an approximately 50% reduction. All groups submitted to immediate loading presented similar stress values in peri-implant bone. The loading protocol influenced the stress and implant displacement, but the design of the fixed denture did not affect the stress in the peri-implant bone. Rigid splinting of implants submitted to immediate loading is not essential for treatment success.

Effects of dextrose and lipopolysaccharide on the corrosion behavior of a Ti-6Al-4V alloy with a smooth surface or treated with double-acid-etching.

Diabetes and infections are associated with a high risk of implant failure. However, the effects of such conditions on the electrochemical stability of titanium materials remain unclear. This study evaluated the corrosion behavior of a Ti-6Al-4V alloy, with a smooth surface or conditioned by double-acid-etching, in simulated body fluid with different concentrations of dextrose and lipopolysaccharide. For the electrochemical assay, the open-circuit-potential, electrochemical impedance spectroscopy, and potentiodynamic test were used. The disc surfaces were characterized by scanning electron microscopy and atomic force microscopy. Their surface roughness and Vickers microhardness were also tested. The quantitative data were analyzed by Pearson's correlation and independent t-tests (α = 0.05). In the corrosion parameters, there was a strong lipopolysaccharide correlation with the Ipass (passivation current density), Cdl (double-layer capacitance), and Rp (polarization resistance) values (p<0.05) for the Ti-6Al-4V alloy with surface treatment by double-acid-etching. The combination of dextrose and lipopolysaccharide was correlated with the Icorr (corrosion current density) and Ipass (p<0.05). The acid-treated groups showed a significant increase in Cdl values and reduced Rp values (p<0.05, t-test). According to the topography, there was an increase in surface roughness (R2 = 0.726, p<0.0001 for the smooth surface; R2 = 0.405, p = 0.036 for the double-acid-etching-treated surface). The microhardness of the smooth Ti-6Al-4V alloy decreased (p<0.05) and that of the treated Ti-6Al-4V alloy increased (p<0.0001). Atomic force microscopy showed changes in the microstructure of the Ti-6Al-4V alloy by increasing the surface thickness mainly in the group associated with dextrose and lipopolysaccharide. The combination of dextrose and lipopolysaccharide affected the corrosion behavior of the Ti-6Al-4V alloy surface treated with double-acid-etching. However, no dose-response corrosion behavior could be observed. These results suggest a greater susceptibility to corrosion of titanium implants in diabetic patients with associated infections.

Influence of abutment-to-fixture design on reliability and failure mode of all-ceramic crown systems.

OBJECTIVE: Evaluate the effect of implant connection designs on reliability and failure modes of screw-retained all-ceramic crowns. METHODS: Central incisor ceramic crowns in zirconia abutments were screwed and torqued down to external hexagon (EH), internal hexagon (IH) and Morse taper (MT) implant systems. Single-load-to-fracture (SLF) test (n=4 per group) determined three step-stress fatigue profiles with specimens assigned in the ratio of 3:2:1. Fatigue test was performed under water at 10 Hz. Use level probability Weibull curves and reliability for missions of 50,000 cycles at 400 N and 200 N were calculated (90% confidence bounds-CB). Weibull probability distribution (90% CB) was plotted (Weibull modulus vs characteristic strength) for comparison between the groups. Fractographic analyses were conducted under polarized-light microscopy and SEM. RESULTS: Use level Weibull probability calculation indicated that failure was not associated with fatigue in groups EH (ß=0.63), IH (ß=0.97) and MT (ß=0.19). Reliability data for a mission of 50,000 cycles at 400 N revealed significant reliability differences between groups EH (97%), IH (46%) and MT (0.5%) but no significant difference at 200 N between EH (100%) and IH (98%), and IH and MT (89%). Weibull strength distribution (figure) revealed ß=13.1/η=561.8 for EH, ß=5.8/η=513.4 for IH and ß=5.3/η=333.2 for MT. Groups EH and IH exhibited veneer cohesive and adhesive failures. Group IH also presented adhesive failure at zirconia/titanium abutment insert while MT showed fracture at abutment neck. SIGNIFICANCE: Although group EH presented higher reliability and characteristic strength followed by IH and MT, all groups withstood reported mean anterior loads.

Color degradation of acrylic resin denture teeth as a function of liquid diet: ultraviolet-visible reflection analysis.

The effect of different beverages on acrylic resin denture teeth color degradation is evaluated. Ten acrylic resin denture teeth brands were evaluated: Art Plus (AP), Biolux (BX), Biotone IPN (BI), Magister (MG), Mondial 6 (MD), Premium 6 (PR), SR Vivodent PE (SR), Trilux (TR), Trubyte Biotone (TB), and Vipi Dent Plus (VP). Teeth were immersed in staining solutions (coffee, cola, and orange juice) or artificial saliva (control) (n=6) for 1, 7, 15, or 30 days. Specimen colors were evaluated spectrophotometrically based on the Commission Internationale d'Eclairage L*a*b* system. Color differences (ΔE) were calculated between the baseline and post-staining results. Data were evaluated by analysis of variance and Tukey test (α = 0.05). BI (1.82 ± 0.95) and TR (1.78 ± 0.72) teeth exhibited the greatest ΔE values, while BX (0.88 ± 0.43) and MD (1.09 ± 0.44) teeth were the lowest, regardless of solution and measurement period, and were different from BI and TR teeth (P < 0.05). Cola and coffee promoted higher denture teeth color alterations than orange juice and saliva (P < 0.05). Saliva generated the lowest denture teeth color alterations. Greater immersion times caused higher denture teeth color changes. The lifespan of removable dentures and the aesthetic satisfaction of several edentulous patients may be increased with the use of stain-resistant artificial denture teeth.

What is the role of lipopolysaccharide on the tribocorrosive behavior of titanium?

In an oral environment, titanium dental implants are exposed to a complex degradation process which is predominantly influenced by the intermittent mechanical events (mastication), continuous exposure to varying chemical solutions (saliva and food) and formation of microbiological (biofilm). Several studies have investigated the chemical corrosion and mechanical resistance of titanium; however, very few attempted to report on the effects of combined chemical, mechanical and microbiological interactions, which simulates the oral environment. A new multi-disciplinary research area, "tribocorrosion" (a combined study of wear and corrosion), was used to address such issues. The tribocorrosive nature of titanium in artificial saliva (pH 6.5) with lipopolysaccharide (LPS) was investigated. Twenty-four titanium discs (12 mm diameter, 7 mm thickness), were divided into 8 groups (n=3) as a function of material (commercially pure titanium (cpTi) and titanium-aluminum-vanadium (TiAlV) alloy) and LPS concentrations (0, 0.15, 15 and 150 µg/ml). Sliding duration (2000 cycles), frequency (1.2 Hz) and load (20 N) parameters mimicked the daily mastication process. Electrochemical impedance spectroscopy was conducted before and after tribocorrosion to comprehend the changes in corrosion kinetics. Worn surfaces were examined using white-light-interferometry and scanning electron microscopy. Total weight loss and roughness values were calculated. LPS affected the tribocorrosive behavior of both titanium types. LPS statistically accelerated the ion exchange between titanium and saliva, and reduced the resistance of the titanium surface against corrosion (p<.05). Sliding events decreased the protectiveness of the titanium surface. In general, TiAlV exhibited better corrosion behavior, but both titanium types showed similar in total weight loss (p>.05). LPS significantly increased the cpTi weight loss (p=.041), and the roughness of the surface (p<.001). In summary, LPS negatively affected the corrosion/wear behavior of titanium, which may contribute to the failure of dental implants.

Biomechanical evaluation of internal and external hexagon platform switched implant-abutment connections: An in vitro laboratory and three-dimensional finite element analysis.

OBJECTIVES: The aim of this study was to assess the effect of abutment's diameter shifting on reliability and stress distribution within the implant-abutment connection for internal and external hexagon implants. The postulated hypothesis was that platform-switched implants would result in increased stress concentration within the implant-abutment connection, leading to the systems' lower reliability. METHODS: Eighty-four implants were divided in four groups (n=21): REG-EH and SWT-EH (regular and switched-platform implants with external connection, respectively); REG-IH and SWT-IH (regular and switched-platform implants with internal connection, respectively). The corresponding abutments were screwed to the implants and standardized maxillary central incisor metal crowns were cemented and subjected to step-stress accelerated life testing. Use-level probability Weibull curves and reliability were calculated. Four finite element models reproducing the characteristics of specimens used in laboratory testing were created. The models were full constrained on the bottom and lateral surface of the cylinder of acrylic resin and one 30° off-axis load (300N) was applied on the lingual side of the crown (close to the incisal edge) in order to evaluate the stress distribution (s(vM)) within the implant-abutment complex. RESULTS: The Beta values for groups SWT-EH (1.31), REG-EH (1.55), SWT-IH (1.83) and REG-IH (1.82) indicated that fatigue accelerated the failure of all groups. The higher levels of σ(vM) within the implant-abutment connection observed for platform-switched implants (groups SWT-EH and SWT-IH) were in agreement with the lower reliability observed for the external hex implants, but not for the internal hex implants. The reliability 90% confidence intervals (50,000 cycles at 300N) were 0.53(0.33-0.70), 0.93(0.80-0.97), 0.99(0.93-0.99) and 0.99(0.99-1.00), for the SWT-EH, REG-EH, SWT-IH, and REH-IH, respectively. SIGNIFICANCE: The postulated hypothesis was partially accepted. The higher levels of stress observed within implant-abutment connection when reducing abutment diameter (cross-sectional area) resulted in lower reliability for external hex implants, but not for internal hex implants.

Evaluation of a two-step pouring technique for implant-supported prostheses impression

The aim of this study was to evaluate the efficacy of a pouring technique for implant-supported prostheses impressions. A metallic matrix (control group) with two implants positioned at 90 and 65 degrees was fabricated. The matrix was submitted to the direct transfer impression technique. In group CP (conventional pouring - n=10), casts were obtained by the conventional pouring technique. In group EP (experimental pouring - n=10), the analogs were embraced with latex tubes before the first pouring and then submitted to a second pouring. Vertical misfit and implants/analogs inclinations were evaluated. Data were analyzed by analysis of variance and Tukey's test (p<.05). Results demonstrated significant difference (p<.05) between control and experimental groups for misfit measurement in perpendicular implant/analog and between control group and group EP in leaning implant/analog. Considering inclination, there were significant differences (p<.05) between control and experimental groups for leaning analogs. Independently of the pouring technique, perpendicular implants produced more accurate casts.

O objetivo do estudo foi avaliar a eficacia de uma tecnica de vazamento para moldagens de proteses sobre implante. Uma matriz metalica (grupo controle) contendo dois implantes posicionados a 90° e 65° de inclinacao foi confeccionada. A matriz foi submetida a tecnica de moldagem de transferencia direta. No grupo CP (vazamento convencional - n=10), os modelos foram obtidos atraves da tecnica de vazamento convencional. No grupo EP (vazamento experimental - n=10), os analogos dos implantes foram revestidos por tubos de latex anteriormente ao primeiro vazamento e, entao, submetidos a um segundo vazamento. A desadaptacao vertical e a inclinacao dos implantes/analogos foram avaliadas. Os dados foram submetidos a Analise de Variancia e teste de Tukey (p<.05). Os resultados demonstraram diferenca significante (p<.05) entre os grupos controle e experimentais para a mensuracao da desadaptacao no implante/analogo perpendicular e entre os grupos controle e EP em relacao ao implante/analogo inclinado. Considerando a inclinacao, houve diferencas (p<.05) entre os grupos controle e experimentais em relacao a implante /analogos inclinados. Independentemente da tecnica de vazamento, implantes perpendiculares geraram modelos mais precisos.