CAD-CAM acrylic resin prosthesis superstructure: A technique for fabricating an implant-supported fixed complete denture.

The implant-supported fixed complete denture is a common treatment option in implant prosthodontics but has shortcomings that include the high wear rate of the acrylic resin denture material and the displacement of denture teeth from the denture base. This report describes a method for fabricating implant-supported fixed dental prostheses using computer-aided design and computer-aided manufacturing technology.

Full mouth rehabilitation of a young patient with partial expressions of ectodermal dysplasia: a clinical report.

Ectodermal dysplasia (ED) is a hereditary disorder characterized by the abnormal development of specific tissues and structures of ectodermal origin. This clinical report describes the multidisciplinary approach to the diagnosis and treatment of a 24-year-old patient with partial expression of ED. The treatment plan used dental implants to support fixed prostheses and ceramic restorations to establish acceptable esthetics and provide function.

Design concepts of a removable partial dental prosthesis with implant-supported abutments.

A clinical report is presented that describes the restoration of a severe anterior maxillary ridge defect and pneumatized sinuses with a rotation-path partial removable dental prosthesis and implant-supported abutments. Other treatment options were considered and rejected based on patient preferences and limitations, which included avoiding invasive surgeries. The principles of integrating fixed and removable prosthesis design were applied. However, the clasp design was modified to take into account the direct bone-to-implant contact of the abutments. An esthetic and functional outcome was obtained without any overly invasive surgery.

A technique for retrieving fractured implant screws.

The use of dental implants as a source of support and retention for fixed restorations is common. This report describes the use of a fragment removal instrument together with the use of ultrasonic instrumentation to retrieve a screw fragment.

Treatment planning decisions: implant placement versus preserving natural teeth.

Dental implants are routinely used as a treatment modality for replacing missing teeth. An assessment of whether to extract teeth and place implants or preserve natural dentition can be a complex decision-making process. The purpose of this article is to review some of the factors that influence prosthetic planning of functional and esthetic rehabilitation for patients with diseased dentition either with conventional treatment options or with extractions and replacement with implant-supported prosthesis.

Properties of a proline-containing glass ionomer dental cement.

STATEMENT OF PROBLEM: Proline-containing glass ionomers are promising fast-set dental restorative materials with superior mechanical properties; however, little information is available on other physical properties of this type of glass ionomer. PURPOSE: The objectives of this study were to synthesize and characterize a polyacrylic acid terpolymer containing proline derivative (PD) and to investigate the physical properties of this glass ionomer cement (GIC) and its cytotoxicity in vitro. MATERIAL AND METHODS: A terpolymer of AA (acrylic acid), IA (itaconic acid), and proline derivative (MP) with an 8:1:1 molar ratio was synthesized and characterized. Experimental GIC specimens were made from the synthetized terpolymer with Fuji IX (GC America, Alsip, Ill) commercial glass ionomer powder as recommended by the manufacturer. Specimens were mixed and fabricated at room temperature and were conditioned in distilled water at 37°C for 1 day and 1 week. Vickers hardness was determined with a microhardness tester. The water sorption characteristics and fluoride releasing properties of the specimens were investigated. The in vitro cytotoxicity of the experimental glass ionomer was assessed by evaluating the C2C12 cell metabolism with methyltetrazolium (MTT) assay. Commercial Fuji IX was used as a control for comparison. The data obtained for the experimental GIC (PD) were compared with the control group by using 1- and 2-way ANOVA and the Tukey multiple range test at α=.05. RESULTS: Proline-modified GIC (PD) exhibited significantly higher surface hardness values (Vickers hardness number [VHN] 58 ±6.1) in comparison to Fuji IX GIC (VHN 47 ±5.3) after 1 week of maturation. Statistical analysis of data showed that the water sorption properties of the experimental cement (PD) were significantly greater than those of the control group (P<.05). The experimental GIC showed a significant increase in the amounts of initial fluoride release (P<.05) with continued fluoride release from the bulk of the material. The experimental group showed slightly reduced cell metabolism and cell number in comparison to the control group. However, the results were not statistically different (P>.05). CONCLUSIONS: An amino acid-containing GIC had better surface hardness properties than commercial Fuji IX GIC. This formulation of fast-set glass ionomer showed increased water sorption without adversely affecting the amount of fluoride release. Considering its biocompatibility, this material shows promise not only as a dental restorative material but also as a bone cement with low cytotoxicity.

Encapsulated dental-derived mesenchymal stem cells in an injectable and biodegradable scaffold for applications in bone tissue engineering.

Bone grafts are currently the major family of treatment options in modern reconstructive dentistry. As an alternative, stem cell-scaffold constructs seem to hold promise for bone tissue engineering. However, the feasibility of encapsulating dental-derived mesenchymal stem cells in scaffold biomaterials such as alginate hydrogel remains to be tested. The objectives of this study were, therefore, to: (1) develop an injectable scaffold based on oxidized alginate microbeads encapsulating periodontal ligament stem cells (PDLSCs) and gingival mesenchymal stem cells (GMSCs); and (2) investigate the cell viability and osteogenic differentiation of the stem cells in the microbeads both in vitro and in vivo. Microbeads with diameters of 1 ± 0.1 mm were fabricated with 2 × 10(6) stem cells/mL of alginate. Microbeads containing PDLSCs, GMSCs, and human bone marrow mesenchymal stem cells as a positive control were implanted subcutaneously and ectopic bone formation was analyzed by micro CT and histological analysis at 8-weeks postimplantation. The encapsulated stem cells remained viable after 4 weeks of culturing in osteo-differentiating induction medium. Scanning electron microscopy and X-ray diffraction results confirmed that apatitic mineral was deposited by the stem cells. In vivo, ectopic mineralization was observed inside and around the implanted microbeads containing the immobilized stem cells. These findings demonstrate for the first time that immobilization of PDLSCs and GMSCs in alginate microbeads provides a promising strategy for bone tissue engineering.

Evaluation of the amount of excess cement around the margins of cement-retained dental implant restorations: the effect of the cement application method.

STATEMENT OF PROBLEM: Complete removal of excess cement from subgingival margins after cementation of implant-supported restorations has been shown to be unpredictable. Remaining cement has been shown to be associated with periimplant inflammation and bleeding. PURPOSE: The purpose of this study was to investigate and compare the amount of excess cement after cementation with 4 different methods of cement application for cement-retained implant-supported restorations. MATERIAL AND METHODS: Ten implant replicas/abutments (3i) were embedded in acrylic resin blocks. Forty complete veneer crowns (CVCs) were fabricated by waxing onto the corresponding plastic waxing sleeves. The wax patterns were cast and the crowns were cemented to the implant replicas with either an interim (Temp Bond) or a definitive luting agent (FujiCEM). Four methods of cement application were used for cementation: Group IM-Cement applied on the internal marginal area of the crown only; Group AH-Cement applied on the apical half of the axial walls of the crown; Group AA-Cement applied to all axial walls of the interior surface of the crown, excluding the occlusal surface; and Group PI-Crown filled with cement then seated on a putty index formed to the internal configuration of the restoration (cementation device) (n=10). Cement on the external surfaces was removed before seating the restoration. Cement layers were applied on each crown, after which the crown was seated under constant load (80 N) for 10 minutes. The excess cement from each specimen was collected and measured. One operator performed all the procedures. Results for the groups were compared, with 1 and 2-way ANOVA and the Tukey multiple range test (α=.05). RESULTS: No significant difference in the amount of excess/used cement was observed between the 2 different types of cements (P=.1). Group PI showed the least amount of excess cement in comparison to other test groups (P=.031). No significant difference was found in the amount of excess cement among groups MI, AH, and AA. Group AA showed the highest amount of excess cement. The volume of cement used for group PI specimens was significantly higher than for those in the other groups (P=.001). With respect to the volume of cement loaded into the test crowns no statistically significant difference was observed among other test groups (groups IM, AH, and AA). Group MI used the least amount of cement, followed by group AH and AA. No correlation between the amount of used cement and the amount of excess cement was found in any of the tested groups. CONCLUSIONS: Within the limitations of this in vitro study, the least amount of excess cement was present when a cementation device was used to displace the excess cement before seating the crown on the abutment (Group PI). With this technique a uniform layer of the luting agent is distributed over the internal surface of the crown leaving minimal excess cement when the restoration is seated.

Ultrasonically set novel NVC-containing glass-ionomer cements for applications in restorative dentistry.

The objective of this study is to investigate the effects of application of ultrasound on the physical properties of a novel NVC (N-vinylcaprolactam)-containing conventional glass-ionomer cement (GIC). Experimental GIC (EXP) samples were made from the acrylic acid (AA)-itaconic acid (IA)-NVC synthesized terpolymer with Fuji IX powder in a 3.6:1 P/L ratio as recommended by the manufacturer. Specimens were mixed and fabricated at room temperature and were conditioned in distilled water at 37°C for 1 day up to 4 week. Ultrasound (US) was applied 20 s after mixing by placing the dental scaler tip on the top of the cement and applying light hand pressure to ensure the tip remained in contact with cement without causing any deformation. Vickers hardness was determined using a microhardness tester. The working and setting times were determined using a Gillmore needle. Water sorption was also investigated. Commercial Fuji IX was used as control for comparison (CON). The data obtained for the EXP GIC set through conventional set (CS) and ultrasonically set (US) were compared with the CON group, using one-way ANOVA and the Tukey multiple range test at α = 0.05. Not only ultrasonic (US) application accelerated the curing process of both EXP cement and CON group but also improved the surface hardness of all the specimens. US set samples showed significantly lower water sorption values (P < 0.05) due to improved acid-base reaction within the GIC matrix and accelerated maturation process. According to the statistical analysis of data, significant increase was observed in the surface hardness properties of CS and US specimens both in EXP samples and the CON groups. It was concluded that it is possible to command set GICs by the application of ultrasound, leading to GICs with enhanced physical and handling properties. US application might be a potential way to broaden the clinical applications of conventional GICs in restorative dentistry for procedures such as class V cavity restorations.

Dental students' ability to evaluate themselves in fixed prosthodontics.

Self-evaluation is an essential skill for dental professionals for lifelong learning and improvement through the course of their careers. Students taking a preclinical fixed prosthodontics course were studied. The students were asked to assign themselves a grade upon completion of their timed preparation examination (teeth preparations and provisional restorations), and these were compared with grades given by the faculty. The poorer performing students tended to be less critical with their examination and to overrate their performance whereas the higher performing students were more critical of themselves and underrated their performance.

Measure of microhardness, fracture toughness and flexural strength of N-vinylcaprolactam (NVC)-containing glass-ionomer dental cements.

OBJECTIVES: To investigate the effects of N-vinylcaprolactam (NVC)-containing terpolymers on the fracture toughness, microhardness, and flexural strength of conventional glass-ionomer cements (GIC). METHODS: The terpolymer of acrylic acid (AA)-itaconic acid (IA)-N-vinylcaprolactam (NVC) with 8:1:1 (AA:IA:NVC) molar ratio was synthesized by free radical polymerization and characterized using (1)H NMR and FTIR. Experimental GIC samples were made from a 50% solution of the synthesized terpolymer with Fuji IX powder in a 3.6:1 P/L ratio. Specimens were mixed and fabricated at room temperature. Plane strain fracture toughness (K(Ic)) was measured in accordance with ASTM Standard 399-05. Vickers hardness was determined using a microhardness tester. Flexural strength was measured using samples with dimensions of 2 mm×2 mm×20 mm. For all mechanical property tests, specimens were first conditioned in distilled water at 37°C for 1 day or 1 week. Fracture toughness and flexural strength tests were conducted on a screw-driven universal testing machine using a crosshead speed of 0.5mm/min. Values of mechanical properties for the experimental GIC were compared with the control group (Fuji IX GIC), using one-way ANOVA and the Tukey multiple range test at α=0.05. RESULTS: The NVC-modified GIC exhibited significantly higher fracture toughness compared to the commercially available Fuji IX GIC, along with higher mean values of flexural strength and Vickers hardness, which were not significantly different. SIGNIFICANCE: It was concluded that NVC-containing polymers are capable of enhancing clinically relevant properties for GICs. This new modified glass-ionomer is a promising restorative dental material.

Transitioning patients from teeth to implants utilizing fixed restorations.

The provisional phase of treatment can be the most challenging in implant dentistry. The choice of provisional restoration should be based on esthetic demands, functional requirements, duration, and ease of fabrication. One major obstacle to treatment with implants is the transitional phase between a tooth-supported occlusion and an implant-supported occlusion. This is of particular concern when a patient with a failing dentition has not worn a removable prosthesis before and is planned to have a reconstruction supported by implants.

Critical appraisal. Immediate loading of implants in the esthetic zone.

The predictability of dental implants using the traditional branemark protocol has been well documented. Since its inception, this protocol has been progressively challenged to decrease treatment time, minimize the number of surgical procedures, and maximize esthetic outcomes. Today, in specific clinical situations, implants may be placed and immediately loaded with provisional restorations. Immediate loading in the edentulous mandible has been well documented. There are also good data to show that immediate loading of the edentulous maxilla is also feasible if bone quality is suitable. The focus now has shifted toward immediate loading of implants placed in the esthetic zone. Clinicians have recognized that the challenge of providing anterior tooth replacements is in preserving the hard and soft tissue components that exist around natural teeth. The advantages of immediate restoration are obvious; however, the application of immediate or early load may pose an increased risk of implant failure in single-tooth situations. The prerequisites for achieving and maintaining acceptable results are not fully known. This review examines some of the literature concerning the reliability of early or immediate loading of implants placed in the esthetic zone.

Surgical template stabilization with transitional implants in the treatment of the edentulous mandible: a technical note.

Proper placement and orientation of dental implants is a requirement for the optimum function and esthetics of the definitive restoration. Surgical template stability during the surgical phase is a key element in the success of proper implant placement. Therefore, any clinical tool that enhances the precision of reproduction is of value. This article describes a simple, noninvasive, cost-effective technique for surgical template stabilization utilizing 2 transitional implants placed the same day as the definitive implants.

An interdisciplinary approach to treatment planning in implant dentistry.

The practice of implant dentistry requires an interdisciplinary approach that integrates the knowledge, skills, and experience of all the disciplines of dentistry into a comprehensive treatment plan. The team must examine the anticipated restorative site to determine the suitability of the existing hard and soft tissues for implant placement. Deficiencies in hard and soft tissue, which prevent ideal implant placement, must be recognized and addressed to ensure a more predictable esthetic outcome. This article outlines a comprehensive interdisciplinary treatment philosophy designed for developing the foundation of optimal esthetics in implant dentistry. Cases are presented to illustrate the utility of interdisciplinary treatment in which specialists are recruited to enhance and improve a patient's dental function and esthetics.

Treatment planning: implant-supported partial overdentures.

When multiple anterior teeth are missing, many options of replacement are available. Traditionally, the choice was between a fixed or removable prostheses. Today, with the predictability of dental implants, the options of tooth replacement range from removable partial dentures to implant-supported fixed prostheses. The choice of which restoration that will best provide occlusion and esthetics depends on multiple factors including the number and location of missing teeth, the residual ridge form in relation to the replacement teeth, the relationship of the maxillary and mandibular anterior teeth, the condition of teeth adjacent to the edentulous span, the amount of bone available for implant placement, the patients "smile line" and display of teeth, lip support, and financial constraints. When there is minimal loss of the ridge contour, restorations that emerge from the ridge are the most functional and esthetic restorations, adhesive-type fixed partial dentures, conventional fixed partial dentures, and implant-supported restorations can be indicated with the choice of restoration dependent on a risk benefit and cost benefit analysis. When there is a loss of ridge contour due to residual ridge resorption or trauma, the decision becomes more complex as not only does the tooth structure need to be replaced, the ridge form also has to be replaced. (Figures 1 and 2). This can be assessed clinically as illustrated by Figures 1 and 2 where a dis crepancy in arch form and ridge form in relation to the adjacent teeth and/or opposing arch can be observed. Other considerations are lip support and display of the teeth when smiling. This article presents a case and rationale for implant-supported par tial overdentures. Many authors have written on the merits of com plete overdentures. The complete overdenture has proven to be an improvement over conventional complete prostheses with respect to chewing efficiency, patient comfort and satisfaction. In partial edentulism, the implant-supported overdenture has several advantages, some in common with a removable partial denture.

Use of a removable partial denture in the management of chronic screw loosening.

Lack of posterior support can result in adverse occlusal forces being placed on anterior teeth. These forces may cause fremitus, splaying of the anterior teeth, and even accelerated wear. When implant-supported restorations are used, a common indicator of overload is screw loosening. This clinical report demonstrated conservative management of a patient who presented with multiple episodes of screw loosening of an implant-supported restoration replacing the maxillary left incisor secondary to developing reduced posterior support. Ideal treatment would be to re-establish posterior support by means of implant-supported restorations; however, this option was constrained by finances.

Distortion of disposable plastic stock trays when used with putty vinyl polysiloxane impression materials.

STATEMENT OF PROBLEM: Impressions are made using high-viscosity putty vinyl polysiloxane impression materials in conjunction with disposable plastic stock trays. The impression materials have been shown to be dimensionally stable. However, it remains unclear if the disposable plastic stock trays are rigid enough to resist deformation thus yielding potentially unreliable results. PURPOSE: This study evaluated the rigidity and ability to resist deformation of 6 commercially available disposable plastic stock trays and 1 metal stock tray when used in conjunction with a high-viscosity vinyl polysiloxane impression material. MATERIAL AND METHODS: Ten impressions were made with 1 putty vinyl polysiloxane material (Reprosil Putty) using each of the 6 tested disposable plastic stock trays, Sani-Trays (perforated), Sani-Trays (nonperforated), COE Disposable Spacer Tray (perforated), COE Disposable Spacer Tray (nonperforated), Bosworth Tray-Aways (perforated), Track-it Trays (perforated), and 1 metal stock tray (nonperforated), Cadco Dental Products, as a control on a mandibular plastic model. The dimensions of the tray in cross section at the mandibular right first molar area were measured before, during, and after the impression procedures with an electronic digital caliper. The cross-arch dimensions of the tray were measured at similar intervals. One examiner made all measurements and each measurement was repeatable within +/-0.01 mm. A split plot repeated measures analysis of variance (ANOVA) was performed and 2-sided P -values were calculated (alpha=.05). RESULTS: The results indicated that the disposable plastic trays tested were not sufficiently rigid to resist deformation when used with very high-viscosity putty material. Metal stock trays showed significantly less change in cross-arch dimension than plastic trays (F(1.68)=11.25, P =.001). Metal stock trays also showed significantly less change in cross-sectional arch dimension than plastic trays (F(1.68)=15.15, P<.001). CONCLUSION: When disposable plastic stock trays were tested in conjunction with very high-viscosity impression materials there was distortion of the tray both across the arch and in cross section.

Cervical margin design with contemporary esthetic restorations.

The contemporary dentist has a wide variety of options to use in the restoration of extensively damaged or previously restored teeth. Metal-ceramic and all-ceramic crowns are frequently used to restore esthetics and function. One of the essentials for success with either option is proper tooth preparation, which includes proper selection and preparation of the cervical margin of the preparation.