Repositioning accuracy of the implant- and abutment-level prosthetic components used in conventional and digital workflows.

OBJECTIVES: To evaluate the repositioning accuracy of the implant- and abutment-level impression components (impression abutments and implant scan bodies) and implant abutments (with and without anti-rotational hex index); also, to estimate the tightening torque influence on the positional stability of abutments. METHODS: Seven types of prosthetic components (n = 7) [impression pick-up copings (PC), implant scan bodies (ISB), non­hex and hex titanium base implant abutments (TB H and TB NH), multi-unit impression copings (MU PC), multi-unit implant scan bodies (MU ISB), and multi-unit caps (MU C) (Medentika GmbH)] were tested. For repositioning accuracy tests a coordinate measuring machine (CMM) was used. During assembly 15 Ncm torque for all components was applied. After measurement, only hex and non­hex abutments were torqued to 25 Ncm and their coordinates were again recorded to assess torque influence. The procedure was repeated 7 times for each component. Linear and 3D deviations, angulation to the vertical axis, and axial rotation were calculated. The Kruskal-Wallis test was used to compare the measurements between the groups. A post-hoc test (Mann-Whitney U test) was used for pairwise comparison to determine the influence of the torque (α=0.05). RESULTS: Implant- and abutment-level components used for digital scans showed different positional discrepancies compared to ones used for conventional impressions and ranged from 10 to 37 µm. Hex abutments demonstrated statistically significantly lower 3D deviations (4.4 ± 7.1 µm) compared to non­hex abutments (8.7 ± 6.1 µm). Torque influence was significantly lower for hex abutments than for non­hex abutments. CONCLUSIONS: Repositioning inaccuracies were found in all implant- and abutment-level impression components (impression abutments and implant scan bodies) and all abutments (with and without anti-rotational hex index) tested. Final tightening of the components could cause further positional discrepancies. CLINICAL SIGNIFICANCE: The misfit of the prosthetic components used in conventional and digital workflows stays in the clinically acceptable range. Even when multiple connections and disconnections on the track of the laboratory preparation is needed, it should not have a negative influence for single teeth reconstructions. However, in the complex cases with multiple implants, repetitive repositioning of the prosthetic components may lead to the accumulation of vertical, horizontal and rotational errors leading to the clinical problems with the passive fit of the final framework.

Emergence profile management in the esthetic zone.

OBJECTIVE: Implantation and prosthodontics in the anterior zone are considered the most difficult procedures in dentistry. Creating an appropriate emergence profile is necessary to achieve both stable peri-implant tissues and esthetically acceptable outcomes with implant-supported restorations, especially when conditions are limited. This article provides clinical recommendations and presents solutions on how to establish a proper emergence profile when unfavorable clinical outcomes occur. MATERIALS AND METHODS: Online database PubMed and Cochrane Library were searched by using the following keywords in various combinations: dental implant, emergence profile, esthetic zone and soft tissue shaping. All studies fulfilling the selection criteria were carefully reviewed and 8 studies that met the principles were selected for this review. CLINICAL CONSIDERATIONS: The emergence profile is influenced by multiple factors, including the position of the implant and the surrounding soft tissues. It is essential to have a thorough understanding of different zones of the emergence profile and their relationship with various factors, such as implant position and soft tissue quality. The guidelines presented in this article shows possible manipulations on the restoration design according to implant position and surrounding soft tissues. CONCLUSIONS: Implant position and soft tissue condition have to be evaluated carefully before making prostheses in order to achieve the proper esthetic view. Understanding distinctive emergence profile characteristics results in the best possible esthetic outcome. CLINICAL SIGNIFICANCE: Acknowledgement of how to design an emergence profile when clinical conditions are not in clinician's favor helps to accomplish sufficient results.

Oral Health among Adult Residents in Vilnius, Lithuania.

According to the World Health Organization (WHO) oral conditions may be determined by social, biological, behavioral, and psychosocial factors. The study assessed oral health status and its determinants associated with oral health conditions among adult residents in Vilnius, Lithuania. A total of 453 of 35-74-year-olds participated (response rate 63%). A self-reported questionnaire was administered. Dental caries experience (D3MFS score), periodontal probing depth (PPD), andnumber of missing teeth were assessed clinically. Data were analyzed using χ2 test, independent samples t-test, and multivariable linear regression. The mean (sd) of D3MFS scores was 67.3 (33.5), the mean (sd) number of teeth with PPD 4+ mm was 5.9 (5.3), prevalence of periodontitis was 33%, the mean (sd) number of missing teeth was 6.9 (6.8), and prevalence of total edentulism was 3.8%. Medication use was associated with all oral health conditions, while age was associated with caries experience, and missing teeth. Sugar-containing diet was associated with caries experience, and missing teeth, and smoking with caries experience and periodontal status. Systemic diseases were associated with periodontal status, while behavioral determinants, last dental visit, and use of fluoridated toothpaste were associated with missing teeth. Oral health status among adult Vilnius residents was poor. Oral conditions were associated with both biological and behavioral determinants. Oral health promotion should focus on modifying behavioral determinants.

Live cell imaging reveals different modes of cytotoxic action of extracts derived from commonly used luting cements.

OBJECTIVE: To compare cytotoxicity of extracts derived from commonly used luting cements: Hoffmann's Zinc Phosphate (ZPC), GC Fuji Plus Resin Modified Glass Ionomer (RMGIC) and 3M ESPE RelyX Unicem Resin Cement (RC) on primary human gingival fibroblasts (HGFs). DESIGN: HGFs were exposed to different concentrations of the ZPC, RMGIC and RC extracts. The cytotoxicity was assessed with the PrestoBlue Cell Viability Reagent and viable cells were counted by a haemocytometer using the trypan blue exclusion test. In order to determine the primary mechanism of the cell death induced by extracts from different luting cements, the real-time monitoring of caspase-3/-7 activity and membrane integrity of cells was employed. RESULTS: The extracts from the RMGIC and ZPC decreased the metabolic activity and numbers of viable cells. Unexpectedly, the extracts from the RC evoked only small effects on the metabolic activity of HGFs with a decreasing number of viable cells in a dose-and time-dependent manner. The live cell imaging revealed that the apoptosis was the primary mechanism of a cell death induced by the extracts derived from the RMGIC, whereas the extracts from the RC and ZPC induced a cell death through a necrotic and caspase-independent pathway. CONCLUSIONS: The apoptosis was the primary mechanism of the cell death induced by the extracts derived from the RMGIC, whereas the extracts from the RC and ZPC induced a cell death via a necrotic pathway. We suggest that metabolic assays commonly used to assess the cytotoxicity of luting cements should be validated by alternative methods.

Cytotoxicity of commonly used luting cements -An in vitro study.

The study aimed to 1) evaluate the cytotoxicity of luting cements: Hoffmann's Zinc Phosphate (Hoffmann's ZP), GC Fuji Plus Resin Modified Glass Ionomer (Fuji Plus RMGI) and 3M ESPE RelyX Unicem Resin Cement (RelyX Unicem RC) and 2) test if pre-washing reduces the cements' cytotoxicity. In vitro human gingival fibroblast (HGF) culture model was chosen. The cytotoxicity was evaluated by MTT test, the cell viability -by staining the cells with AO/EB dye mixture. The means±SD of Cell Survival Ratio (CSR%) were compared among different cement types under two testing conditions, with or without cement pre-washing. The CSR%s were compared by ANOVA and linear multiple regression (LMR). Hoffmann's ZPC was less cytotoxic, while Fuji Plus RMGIC and RelyX Unicem RC were more cytotoxic (ANOVA, p<0.001). The type of cement and cement pre-washing jointly explained 90% of cell survival (LMR, p<0.001, adjusted squared R=0.889). The commonly used luting cements such as Hoffmann's ZP, Fuji Plus RMGI and RelyX Unicem RC may have a cytotoxic potential.

In vitro evaluation of cytotoxicity of permanent prosthetic materials.

OBJECTIVES: To assess qualitative and quantitative cytotoxicity effect on permanent prosthetic materials to human gingival fibroblasts. METHODS: Human gingival tissues were collected (with informed consent) from patients undergoing periodontal surgical procedures and fibroblasts were cultured in vitro. Cell type was determined by performing proteomic analysis. Selected prosthetic materials including titanium, feldspathic ceramic, gold and chrome-cobalt alloy specimens (5×2 mm) were fabricated. The toxicity of prepared specimens was tested by exposing them to cell culture medium for 48, 72, 96 and 120 hours at 37°C under sterile conditions. Cell viability was estimated using MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) assay. The data concerning cell viability were statistically analyzed using two-way ANOVA test and Tukey multiple comparison test. RESULTS: Results obtained after 48 hours showed no toxic effect of titanium compared to control group. Cytotoxic effect was observed in gold alloy and feldspathic ceramic, however, it was not significant compared to control group. Chrome-cobalt alloy significantly reduced cell viability compared to control group (p≤0.001). Cytotoxicity diminished with increasing incubation time of specimens. After 120 hours of incubation all tested materials, except chrome-cobalt alloy, had no cytotoxicity. CONCLUSIONS: Titanium proved to be non-toxic. Gold alloy and feldspathic ceramic had short-term cytotoxic effect. Chrome-cobalt alloy had highest cytotoxic effect on fibroblast cells.