Cordless digital workflow for scanning implant-supported prostheses at the abutment level: A dental technique.

A custom abutment produced from a digital scan can be used to develop an implant-supported prosthesis with ideal contours. A scan body is used to obtain information about the location of the implant fixture, and the scan body has a special scan region that facilitates superimposition. This dental technique indirectly obtains the margin of the definitive prosthesis by designing the special scan region on a custom abutment and superimposing prescanned abutment data onto intraoral scanned data.

Efficacy of plasma treatment for surface cleansing and osseointegration of sandblasted and acid-etched titanium implants.

PURPOSE: This study was conducted to evaluate the effects of plasma treatment of sandblasted and acid-etched (SLA) titanium implants on surface cleansing and osseointegration in a beagle model. MATERIALS AND METHODS: For morphological analysis and XPS analysis, scanning electron microscope and x-ray photoelectron spectroscopy were used to analyze the surface topography and chemical compositions of implant before and after plasma treatment. For this animal experiment, twelve SLA titanium implants were divided into two groups: a control group (untreated implants) and a plasma group (implants treated with plasma). Each group was randomly located in the mandibular bone of the beagle dog (n = 6). After 8 weeks, the beagle dogs were sacrificed, and volumetric analysis and histometric analysis were performed within the region of interest. RESULTS: In morphological analysis, plasma treatment did not alter the implant surface topography or cause any physical damage. In XPS analysis, the atomic percentage of carbon at the inspection point before the plasma treatment was 34.09%. After the plasma treatment, it was reduced to 18.74%, indicating a 45% reduction in carbon. In volumetric analysis and histometric analysis, the plasma group exhibited relatively higher mean values for new bone volume (NBV), bone to implant contact (BIC), and inter-thread bone density (ITBD) compared to the control group. However, there was no significant difference between the two groups (P > .05). CONCLUSION: Within the limits of this study, plasma treatment effectively eliminated hydrocarbons without changing the implant surface.

Effect of Porcine- and Bovine-Derived Xenografts with Hydroxypropyl Methylcellulose for Bone Formation in Rabbit Calvaria Defects.

In this study, hydroxypropyl methylcellulose (HPMC) was mixed with particle-type xenografts, derived from two different species (bovine and porcine), to increase the manipulability of bone grafts and compare the bone regeneration ability. Four circular defects with a diameter of 6 mm were formed on each rabbit calvaria, and the defects were randomly divided into three groups: no treatment (control group), HPMC-mixed bovine xenograft (Bo-Hy group), and HPMC-mixed porcine xenograft (Po-Hy group). At eight weeks, micro-computed tomography (µCT) scanning and histomorphometric analyses were performed to evaluate new bone formation within the defects. The results revealed that the defects treated with the Bo-Hy and the Po-Hy showed higher bone regeneration than the control group (p < 0.05), while there was no significant difference between the two xenograft groups (p > 0.05). Within the limitations of the present study, there was no difference in new bone formation between porcine and bovine xenografts with HPMC, and bone graft material was easily moldable with the desired shape during surgery. Therefore, the moldable porcine-derived xenograft with HPMC used in this study could be a promising substitute for the currently used bone grafts as it exhibits good bone regeneration ability for bony defects.

Comparison of fit and trueness of zirconia crowns fabricated by different combinations of open CAD-CAM systems.

PURPOSE: This study aims to clinically compare the fitness and trueness of zirconia crowns fabricated by different combinations of open CAD-CAM systems. MATERIALS AND METHODS: Total of 40 patients were enrolled in this study, and 9 different zirconia crowns were prepared per patient. Each crown was made through the cross-application of 3 different design software (EZIS VR, 3Shape Dental System, Exocad) with 3 different processing devices (Aegis HM, Trione Z, Motion 2). The marginal gap, absolute marginal discrepancy, internal gap(axial, line angle, occlusal) by a silicone replica technique were measured to compare the fit of the crown. The scanned inner and outer surfaces of the crowns were compared to CAD data using 3D metrology software to evaluate trueness. RESULTS: There were significant differences in the marginal gap, absolute marginal discrepancy, axial and line angle internal gap among the groups (P < .05) in the comparison of fit. There was no statistically significant difference among the groups in terms of occlusal internal gap. The trueness ranged from 36.19 to 43.78 µm but there was no statistically significant difference within the groups (P > .05). CONCLUSION: All 9 groups showed clinically acceptable level of marginal gaps ranging from 74.26 to 112.20 µm in terms of fit comparison. In the comparison of trueness, no significant difference within each group was spotted. Within the limitation of this study, open CAD-CAM systems used in this study can be assembled properly to fabricate zirconia crown.

The oral microbiome of implant-abutment screw holes compared with the peri-implant sulcus and natural supragingival plaque in healthy individuals.

PURPOSE: An implant-supported prosthesis consists of an implant fixture, an abutment, an internal screw that connects the abutment to the implant fixture, and the upper prosthesis. Numerous studies have investigated the microorganisms present on the implant surface, surrounding tissues, and the subgingival microflora associated with peri-implantitis. However, there is limited information regarding the microbiome within the internal screw space. In this study, microbial samples were collected from the supragingival surfaces of natural teeth, the peri-implant sulcus, and the implant-abutment screw hole, in order to characterize the microbiome of the internal screw space in healthy subjects. METHODS: Samples were obtained from the supragingival region of natural teeth, the peri-implant sulcus, and the implant screw hole in 20 healthy subjects. DNA was extracted, and the V3-V4 region of the 16S ribosomal RNA was sequenced for microbiome analysis. Alpha diversity, beta diversity, linear discriminant analysis effect size (LEfSe), and network analysis were employed to compare the characteristics of the microbiomes. RESULTS: We observed significant differences in beta diversity among the samples. Upon analyzing the significant taxa using LEfSe, the microbial composition of the implant-abutment screw hole's microbiome was found to be similar to that of the other sampling sites' microbiomes. Moreover, the microbiome network analysis revealed a unique network complexity in samples obtained from the implant screw hole compared to those from the other sampling sites. CONCLUSIONS: The bacterial composition of the biofilm collected from the implant-abutment screw hole exhibited significant differences compared to the supra-structure of the implant. Therefore, long-term monitoring and management of not only the peri-implant tissue but also the implant screw are necessary.

A prospective multicenter clinical study on the efficiency of detachable ball- and spring-retained implant prosthesis.

PURPOSE: This prospective clinical study was conducted to evaluate the clinical usefulness of the freely detachable zirconia ball- and spring-retained implant prosthesis (BSRP) through a comparative analysis of screw- and cement-retained implant prosthesis (SCRP). MATERIALS AND METHODS: A multi-center, randomized, prospective clinical study evaluating the clinical usefulness of the detachable zirconia ball- and spring-retained implant prostheses was conducted. Sixty-four implant prostheses in 64 patients were examined. Periodic observational studies were conducted at 0, 3, 6, and 12 months after delivery of the implant prosthesis. Factors such as implant success rate, marginal bone resorption, periodontal pocket depth, plaque and bleeding index, and prosthetic complications were evaluated, respectively. RESULTS: During the 1-year observation period, all implants survived without functional problems and clinical mobility, showing a 100% implant success rate. Marginal bone resorption was significantly higher in the SCRP group than in the BSRP group only at the time of implant prosthesis delivery (P = .043). In all observation periods, periodontal pocket depth was slightly higher in the BSRP group than in the SCRP group, but there was no significant difference (P > .05). The modified plaque index (mPI) scores of both groups were moderate. Higher ratio of a score 2 in modified sulcus bleeding index (mBI) was observed in the BSRP group in the 6- and 12-months observation. CONCLUSION: Within the limitations of this study, the newly developed zirconia ball- and spring-retained implant prosthesis could be considered as an applicable and predictable treatment method along with the existing screw- and cement-retained prosthesis.

Comparison of retentive force and wear pattern of Locator® and ADD-TOC attachments combined with CAD-CAM milled bar.

PURPOSE: The purpose of this study was to investigate changes in retention and wear pattern of Locator® and ADD-TOC attachments on a digital milled bar by performing chewing simulation and repeated insertion/removal of prostheses in fully edentulous models. MATERIALS AND METHODS: Locator (Locator®; Zest Anchors Inc., Escondido, CA, USA) was selected as the control group and ADD-TOC (ADD-TOC; PNUAdd Co., Ltd., Busan, Republic of Korea) as the experimental group. A CAD-CAM milled bar was mounted on a master model and 3 threaded holes for connecting a bar attachment was formed using a tap. Locator and ADD-TOC attachments were then attached to the milled bar. Simulated mastication and repeated insertion/removal were performed over 400,000 cyclic loadings and 1,080 insertions/removals, respectively. Wear patterns on deformed attachment were investigated by field emission scanning electron microscopy. RESULTS: For the ADD-TOC attachments, chewing simulation and repeated insertion/removal resulted in a mean initial retentive force of 24.43 ± 4.89 N, which were significantly lower than that of the Locator attachment, 34.33 ± 8.25 N (P < .05). Amounts of retention loss relative to baseline for the Locator and ADD-TOC attachments were 21.74 ± 7.07 and 8.98 ± 5.76 N (P < .05). CONCLUSION: CAD-CAM milled bar with the ADD-TOC attachment had a lower initial retentive force than the Locator attachment. However, the ADD-TOC attachment might be suitable for long-term use as it showed less deformation and had a higher retentive force after simulated mastication and insertion/removal repetitions.

Gut microbial shifts by synbiotic combination of Pediococcus acidilactici and lactulose in weaned piglets challenged with Shiga toxin-producing Escherichia coli.

Development of alternatives to in-feed antibiotics in the swine industry have been the focused of many pig gut microbiota studies to improve animal health. In this study, we evaluated the effects of probiotic Pediococcus acidilactici (PRO), prebiotic lactulose (PRE), and their synbiotic combination (SYN) on gut microbiota using 16S rRNA gene sequencing in weaned piglets challenged with Shiga-toxin producing Escherichia coli (STEC). Our data showed that prebiotics, probiotics and synbiotics improved the intestinal health in weaned piglets. No significant differences were observed in species richness and species diversity in weaned piglets fed prebiotics, probiotics and their synbiotic combination. However, beta diversity analysis revealed distinct clustering of the microbiota of according to dietary treatment and by oral challenge of STEC. At the phylum level, Firmicutes to Bacteroidetes ratio was lower in the dietary treatment groups than the control group. Oral supplementation of prebiotics, probiotics and synbiotics enriched the abundance of Prevotella and Roseburia. Succinivibrio was elevated in PRO group; however, Phascolarctobacterium was depleted with STEC challenge regardless of dietary treatment. Overall, our data showed that administration of synbiotics in piglets improved intestinal health through gut microbiota modulation. Our data indicated that prebiotics, probiotics and their synbiotic combination could promote intestinal health through gut microbiota modulation in weaned piglets.

Evaluation of Clinical Accuracy of Implant Abutment-Level Impression Technique Using Digital Superimposition of Customized Abutment.

Taking a conventional implant abutment-level impression with the gingival retraction technique can cause side effects such as gingival recession and bleeding. In order to overcome these problems, an impression technique using digital superimposition of the customized abutment is newly introduced. In this technique, digital impression data and pre-scanned abutment data are superimposed to reproduce the abutment's location and shape on computer-aided design software. The present investigation was conducted to evaluate the clinical accuracy of the newly adapted digital superimposition impression technique by assessing the fit of fabricated prostheses. The results showed clinical efficacy of this technique, satisfying both convenience and clinically acceptable marginal and internal fit.

Preliminary Animal Study on Bone Formation Ability of Commercialized Particle-Type Bone Graft with Increased Operability by Hydrogel.

The purpose of this study was to evaluate the bone-generating ability of a new bovine-derived xenograft (S1-XB) containing hydrogel. For control purposes, we used Bio-Oss and Bone-XB bovine-derived xenografts. S1-XB was produced by mixing Bone-XB and hydrogel. Cell proliferation and differentiation studies were performed to assess cytotoxicities and cell responses. For in vivo study, 8 mm-sized cranial defects were formed in 16 rats, and then the bone substitutes were transplanted into defect sites in the four study groups, that is, a Bio-Oss group, a Bone-XB group, an S1-XB group, and a control (all n = 4); in the control group defects were left empty. Eight weeks after surgery, new bone formation areas were measured histomorphometrically. In the cell study, extracts of Bio-Oss, Bone-XB, and S1-XB showed good results in terms of the osteogenic differentiation of human mesenchymal stem cells (hMSCs) and no cytotoxic reaction was evident. No significant difference was observed between mean new bone areas in the Bio-Oss (36.93 ± 4.27%), Bone-XB (35.07 ± 3.23%), and S1-XB (30.80 ± 6.41%) groups, but new bone area was significantly smaller in the control group (18.73 ± 5.59%) (p < 0.05). Bovine-derived bone graft material containing hydrogel (S1-XB) had a better cellular response and an osteogenic effect similar to Bio-Oss.

Influence of an Implant Fixture including a Freely Removable Micro-Locking Implant Prosthesis on Peri-Implant Tissues and Implant Prostheses: A Prospective Clinical Study.

This prospective study was undertaken to evaluate the clinical usefulness of a newly developed one-piece, screw-free, and micro-locking implant system, which was designed to overcome the shortcomings of the existing implant systems. Thirty-eight patients were recruited and randomly and equally assigned to an experimental group (micro-locking one-piece fixture, MLF; n = 19) or a control group (micro-locking abutment, MLA). Cumulative implant survival rates, marginal bone resorptions, probing depths, plaque indices, bleeding indices, and complications were obtained by using clinical and radiographic findings at 6 months and 12 months after prosthesis placement. Complications that occurred multiple times for single implants were counted. During the 12 month observation period, survival rates were 100% in both groups. No significant intergroup differences were observed for marginal bone resorption, probe depth, or bleeding index. However, mean plaque index was significantly lower in the MLF group at 12 months (p < 0.05). During the 12-month observation period, food impaction (26.3%) was the main complication in the MLF group and screw loosening (5.3%), prosthesis detachment (5.3%), and food impaction (5.3%) were observed in the MLA group. The results of this study suggest that the one-piece micro-locking implant system offers a predictable treatment method.

Effects of Gamma Radiation-Induced Crosslinking of Collagen Type I Coated Dental Titanium Implants on Osseointegration and Bone Regeneration.

This study aimed to compare two methods of crosslinking collagen type I on implanted titanium surfaces, that is, using glutaraldehyde (GA) or gamma-rays (GRs), in a beagle dog model. For in vivo experiments, implants were allocated to three groups and applied to mandibular bone defects in beagle dogs; Group SLA; non-treated Sandblasted, large grit, acid-etched (SLA) implants, Group GA; SLA implants coated with GA crosslinked collagen type I, Group GR; SLA surface implants coated with collagen type I and crosslinked using 25 kGy of 60Co gamma radiation. New bone µCT volumes were obtained, and histologic and histometric analyses were performed in regions of interest. The GR group had significantly better new bone areas (NBAs) and bone to implant contact (BIC) results than the SLA group (p < 0.05), but the GA and GR groups were similar in this respect. New bone volumes and inter-thread bone densities (ITBD) were non-significantly different in the three groups (p > 0.05). Within the limits of this study, gamma-ray collagen crosslinking on titanium implants can be considered a substitute for glutaraldehyde crosslinking.

Retrospective Clinical Study of a Freely Removable Implant-Supported Fixed Dental Prosthesis by a Microlocking System.

This retrospective clinical study was conducted to evaluate the clinical usefulness of a freely removable microlocking implant prosthesis (MLP) that was developed to overcome the problems with conventional implant prostheses. A total of 54 patients (male: 31, female: 23) and 100 implant prostheses were included. Patients were divided into three groups such as 6-12 months, 12-18 months, and 18-24 months according to the used period after implant prosthesis delivery, and the patients in each group were recalled for examinations of survival rate, marginal bone resorption, peri-implant soft tissue indices, and complications. The prosthetic complications were analysed by combining the recorded chart data during the periodic checks including the last call for this study. During a 2-year observation period, all the implants showed a 100% survival rate without clinical mobility and functional problems. There was no significant difference in marginal bone resorption, plaque index, and bleeding index over the observation period after implant prosthesis delivery. Probing depth of the 18-24 months group (1.5 ± 0.19 mm) was significantly lower than that of the 6-12 months group (p < 0.05). The main complication was abutment loosening (4%), followed by implant prosthesis fracture (2%) and food impaction (2%) which were recorded. Within the limits of the present study, the implant prostheses with MLP are considered to be an applicable and predictable treatment method.

Comparison of clinical fit of three-unit zirconia fixed prostheses fabricated using chairside and labside CAD/CAM systems.

The purpose of this study was to assess the clinical fit provided by EZIS system, the newly commercialized chairside CAD/CAM system. Prostheses were fabricated with the chairside CAD/CAM system (CS) and labside CAD/CAM system (LS) and marginal, axial, and occlusal fit of the prostheses were compared and analyzed by using replica technique. CS group presented significantly lower fit in all the three fits compared to LS group. Differences in marginal fit, axial fit, and occlusal fit were 12.57 µm (P < 0.001), 3.32 µm (P < 0.05), and 17.20 µm (P < 0.05), respectively. Newly commercialized EZIS system yielded clinically feasible fit; however, further researches covering its biomechanical, physiological, stability aspects are required to promote active clinical use.

Evaluation of 1-Ethyl-3-(3-Dimethylaminopropyl) Carbodiimide Cross-Linked Collagen Membranes for Guided Bone Regeneration in Beagle Dogs.

The purpose of this study was to evaluate the bone regeneration efficacy of an 1-ethyl-3-(3-dimethylaminopropyl) carbodiimide (EDC)-cross-linked collagen membrane for guided bone regeneration (GBR). A non-cross-linked collagen membrane (Control group), and an EDC-cross-linked collagen membrane (Test group) were used in this study. In vitro, mechanical, and degradation testing and cell studies were performed. In the animal study, 36 artificial bone defects were formed in the mandibles of six beagles. Implants were inserted at the time of bone grafting, and membranes were assigned randomly. Eight weeks later, animals were sacrificed, micro-computed tomography was performed, and hematoxylin-eosin stained specimens were prepared. Physical properties (tensile strength and enzymatic degradation rate) were better in the Test group than in the Control group. No inflammation or membrane collapse was observed in either group, and bone volumes (%) in defects around implants were similar in the two groups (p > 0.05). The results of new bone areas (%) analysis also showed similar values in the two groups (p > 0.05). Therefore, it can be concluded that cross-linking the collagen membranes with EDC is the method of enhancing the physical properties (tensile strength and enzymatic degradation) of the collagen membranes without risk of toxicity.

Wear Characteristics of Dental Ceramic CAD/CAM Materials Opposing Various Dental Composite Resins.

The aim of this study was to evaluate the wear properties of opposed dental ceramic restorative CAD/CAM materials and several posterior direct restorative composite resins. Three kinds of dental ceramics CAD/CAM materials (monolithic zirconia, lithium disilicate, leucite) and four dental composite resins-that is, MI Gracefil, Gradia Direct P, Estelite Σ Quick, and Filtek Supreme Ultra-were used in this study. For each of the 12 groups (three ceramics × four composite resins), five each of a canine-shaped ceramic specimen and a cuboidal shape opposing composite resin were prepared. All of the specimens were tested in a thermomechanical loading machine (50 N, 100,000 cycles, 5/55 °C). Wear losses of ceramic specimens and composite resin specimens were evaluated using a three-dimensional profiling system and an electronic scale, respectively. Statistical analyses were performed using the Kruskal-Wallis test and Mann-Whitney U test with Bonferroni's correction. Zirconia showed significantly less volumetric loss than lithium disilicate or leucite regardless of composite resin type (p > 0.05/3 = 0.017), and that Estelite Σ Quick showed significantly more weight loss than Filtek Supreme Ultra, MI Gracefil, or Gradia Direct P regardless of ceramic type (p > 0.05/6 = 0.083). Zirconia showed less volumetric loss than lithium disilicate or leucite. Some composite resins opposing ceramics showed considerable weight loss.

Bone Regeneration Using a Three-Dimensional Hexahedron Channeled BCP Block Combined with Bone Morphogenic Protein-2 in Rat Calvarial Defects.

It is important to obtain sufficient bone mass before implant placement on alveolar bone, and synthetic bone such as biphasic calcium phosphate (BCP) has been studied to secure this. This study used a BCP block bone with a specific structure of the three-dimensional (3D) hexahedron channel and coating with recombinant human bone morphogenetic protein-2 (rhBMP-2) impregnated carboxymethyl cellulose (CMC) was used to examine the enhancement of bone regeneration of this biomaterial in rat calvarial defect. After the preparation of critical-size calvarial defects in fifteen rats, defects were divided into three groups and were implanted with the assigned specimen (n = 5): Boneplant (untreated 3D hexahedron channeled BCP block), Boneplant/CMC (3D hexahedron channeled BCP block coated with CMC), and Boneplant/CMC/BMP (3D hexahedron channeled BCP block coated with CMC containing rhBMP-2). After 4 weeks, the volumetric, histologic, and histometric analyses were conducted to measure the newly formed bone. Histologically, defects in the Boneplant/CMC/BMP group were almost completely filled with new bone compared to the Boneplant and Boneplant/CMC groups. The new bone volume (P < 0.05) and area (P < 0.001) in the Boneplant/CMC/BMP group (20.12% ± 2.17, 33.79% ± 3.66) were much greater than those in the Boneplant (10.77% ± 4.8, 16.48% ± 9.11) and Boneplant/CMC (10.72% ± 3.29, 16.57% ± 8.94) groups, respectively. In conclusion, the 3D hexahedron channeled BCP block adapted rhBMP-2 with carrier CMC showed high possibility as an effective bone graft material.

Evaluation of synbiotics as gut health improvement agents against Shiga toxin-producing Escherichia coli isolated from the pig.

Colibacillosis is one of the major health problems in young piglets resulting in poor health and death caused by Escherichia coli producing F18 pili and Shiga toxin 2e. It is pivotal to reduce colibacillosis in weaned piglets to enhance production performance. In this study, we evaluated synbiotics as the gut health improvement agents in the mouse model challenged with Shiga toxin-producing E. coli (STEC) isolated from piglets. Prebiotic lactulose was formulated with each 5.0 × 106 CFU/mL of Pediococcus acidilactici GB-U15, Lactobacillus plantarum GB-U17, and Lactobacillus plantarum GB 1-3 to produce 3 combinations of synbiotics. A total of 40 three weeks old BALB/c mice were randomly assigned to 4 groups (n = 10): a control group and 3 synbiotics treated groups. Each treatment groups were daily administrated with 5.0 × 106 CFU/mL of one synbiotics for the first week, and every 3 days during the second week. All the mice were challenged with 8.0 × 108 CFU/mL of STEC 5 days after animals began to receive synbiotics. Mice treated with synbiotics based on Pediococcus acidilactici GB-U15 and Lactobacillus plantarum GB-U17 significantly improved daily weight gain compared to mice in other groups. While mice treated with GB-U15 showed better fecal index, no significant differences were observed among groups. Gross lesion and histopathological evaluations showed that mice treated with GB-U15 moderately improved recovery from STEC infection. In conclusion, our results suggest that the synbiotics formulated with lactulose and Pediococcus acidilactici GB-U15 have potential benefits to prevent and improve colibacillosis in weaned piglets.