Performance of posterior third-generation monolithic zirconia crowns in a complete digital workflow: A three-year prospective clinical study.

Background/purpose: Translucent monolithic zirconia restorations have recently introduced. The purpose of this study was to evaluate the clinical behavior and the survival rate of the posterior third-generation monolithic zirconia crowns (MZCs) during three years of clinical service. Materials and methods: Twenty-four patients who needed thirty crowns were enrolled in this study. Digital impressions were made, and the crowns were milled and cemented with a resin cement. The crowns outcomes were assessed using the California Dental Association's (CDA) criteria. Gingival index (GI), plaque index (PI), and periodontal probing depth (PPD) for MZCs and contralateral natural teeth (control) were assessed. Margin index (MI) for MZCs was also assessed. Data analysis was conducted using the Wilcoxon signed-rank and the Friedman tests. Results: The 3-year survival rate was 100%. All MZCs were rated as satisfactory throughout the follow-up period, and no biological or mechanical complications were observed. No differences were recorded when GI, PI and PPD at 3-year of follow-up were compared to baseline. No differences were recorded between crowned and control teeth. The MI remained stable throughout the study period. Conclusion: The third-generation monolithic zirconia appears to be a good treatment option for the rehabilitation of posterior single teeth.

Digital workflow for monolithic and veneered zirconia and metal-ceramic posterior fixed partial dentures: A five-year prospective randomized clinical trial.

Purpose To evaluate and compare the survival, success rates, and biological and technical complications of three-unit posterior monolithic and veneered zirconia and metal-ceramic (MC) posterior fixed partial dentures (FPDs) fabricated using a digital workflow and computer-aided design and computer-aided manufacturing (CAD/CAM) over a 5-year follow-up.Methods Ninety patients in need of three-unit posterior FPDs were randomized to receive monolithic zirconia (MZ), veneered zirconia (VZ), and MC restorations (n = 30 each). Teeth preparations were scanned using an intraoral scanner, and restorations were milled and cemented with resin cement. Clinical performance and periodontal parameters were assessed at baseline and yearly up to 5 years after insertion. Data analysis was performed using the Kaplan-Meier method, Friedman test, and Wilcoxon signed-rank test with Bonferroni correction and Mann-Whitney U test.Results The 5-year survival rates of the MZ, VZ, and MC FPDs were 87%, 97%, and 100%, respectively (P = 0.04). Most complications were biological in nature. Only one MZ FPD fractured 58 months after placement. All the restorations were assessed as satisfactory at each recall. Differences were found in the gingival index score over time in the VZ and MC groups. The margin index remained stable throughout the follow-up period in both zirconia groups.Conclusions The results of this study suggest that using a digital workflow to fabricate posterior FPDs is an adequate treatment option and that monolithic zirconia could be a viable alternative to metal-ceramic or veneered zirconia. However, further long-term studies are necessary to provide stronger evidence in patients with bruxism.

Effect of Surface Treatments with Low-Pressure Plasma on the Adhesion of Zirconia.

The purpose of this study was to investigate the effect of low-pressure plasma on the contact angle, shear bond strength (SBS), and the failure mode of zirconia ceramic. Zirconia specimens were divided into three groups according to the surface treatment methods as follows: sandblasting with aluminum oxide (ZR-C), sandblasting with aluminum oxide and oxygen plasma (ZR-CP), and argon plasma (ZR-P). The contact angle, SBS, and surface characteristics were tested after thermocycling. Data analysis was made using the Kruskal-Wallis test and one-way analysis of variance. Plasma treatment significantly reduced the contact angle (p < 0.001) with the lowest value for the Zr-P group. An increase in oxygen and a decrease in carbon was observed on the zirconia surface in both plasma groups. For the SBS, there were significant differences among the groups (p < 0.018), the Zr-CP group showing the highest bond strength. Mixed failures were the most frequent. Plasma treatment was effective in increasing the wettability, increasing the oxygen/carbon ratio without changing zirconia surface morphology. The sandblasting plus plasma with oxygen group exhibited the highest bond strength.

Long term follow-up of a full- arch rehabilitation with an implant-supported overdenture on four zirconia implants and a zirconia bar. A case report.

This clinical report describes a mandibular full-arch rehabilitation by means of an implant-supported overdenture on four zirconia implants. A female patient with an edentulous mandibular arch attended our dental clinic seeking a metal-free mandibular restoration. After oral and radiographic evaluation, four one-piece zirconia implants with conical abutments were placed in the intermentonian region. After a 3-month osseointegration period, an acrylic overdenture with plastic matrices was manufactured, supported by a zirconia bar cemented to the conical abutments of the zirconia implants. Radiographic and clinical follow-up after 12 years observed adequate implant evolution, without any signs of peri-implant disease. Maintenance events were principally the periodic replacement of the plastic matrices and prophylaxis. Key words:Zirconia implants, overdenture, full-arch rehabilitation, dental implants, case report.

Accuracy of Digital Dental Implants Impression Taking with Intraoral Scanners Compared with Conventional Impression Techniques: A Systematic Review of In Vitro Studies.

The aim of this systematic review was to evaluate the in vitro accuracy of dental implants impressions taken with intraoral scanner compared with impressions taken with conventional techniques. Two independent reviewers conducted a systematic electronic search in the PubMed, Web of Science and Scopus databases. Some of the employed key terms, combined with the help of Boolean operators, were: "dental implants", "impression accuracy", "digital impression" and "conventional impression". Publication dates ranged from the earliest article available until 31 July 2021. A total of 26 articles fulfilled the inclusion criteria: 14 studies simulated complete edentation (CE), nine partial edentation (PE) and only two simulated a single implant (SI); One study simulated both CE and SI. In cases of PE and SI, most of the studies analyzed found greater accuracy with conventional impression (CI), although digital impression (DI) was also considered adequate. For CE the findings were inconclusive as six studies found greater accuracy with DI, five found better accuracy with CI and four found no differences. According to the results of this systematic review, DI is a valid alternative to CI for implants in PE and SI, although CI appear to be more accurate. For CE the findings were inconclusive, so more studies are needed before DI can be recommended for all implant-supported restorations.

Randomized clinical trial comparing monolithic and veneered zirconia three-unit posterior fixed partial dentures in a complete digital flow: three-year follow-up.

OBJECTIVES: To evaluate and to compare the clinical performance and survival rate of posterior monolithic and veneered zirconia fixed partial dentures (FPDs). MATERIAL AND METHODS: Sixty 3-unit posterior FPDs were included in the study. The patients were randomly distributed into two groups (n = 30 each) to receive either a monolithic (Zenostar T, Wieland Dental) or veneered zirconia (IPS e.max ZirCAD, Ivoclar Vivadent) FPD. Each patient received only 1 FPD. Tooth preparations were scanned (Trios 3, 3Shape), designed (Dental System 2016, 3 Shape), milled (Zenotec CAM 3.2, Wieland Dental), and cemented with a resin cement. Technical and biological outcomes and periodontal parameters were assessed. Data analysis was made using the Friedman and the Wilcoxon signed-rank tests with the Bonferroni correction and the Mann-Whitney U test. RESULTS: The survival rate at 3 years was 100% for veneered and 90% for monolithic zirconia restorations. Three monolithic zirconia FPDs were lost because of biologic complications. The main complication in the veneered zirconia FPDs was the fracture of the veneering ceramic in 4 of the veneered zirconia FPDs. No fracture of the frameworks was observed in any of the groups. All restorations were assessed as satisfactory after 3 years. No differences in periodontal parameters were observed between the groups. CONCLUSIONS: The results of this study suggest that monolithic zirconia and complete digital flow could be a viable alternative to veneered zirconia in the posterior regions. CLINICAL RELEVANCE: The monolithic zirconia restorations with a digital workflow can be a viable alternative in posterior fixed partial dentures, with good periodontal outcomes. CLINICAL TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (Identifier NCT 04,879,498).

Prospective Clinical Evaluation of Posterior Third-Generation Monolithic Zirconia Crowns Fabricated with Complete Digital Workflow: Two-Year Follow-Up.

Clinical studies on the behavior of posterior translucent monolithic zirconia restorations are lacking. We assessed the clinical outcome and survival rate of posterior third-generation monolithic zirconia crowns over a 2-year period. A total of 24 patients, requiring 30 posterior full-contour restorations were selected. All abutments were scanned, and crowns were milled and cemented with a self-adhesive dual cure cement. Crowns were assessed using the California Dental Association's criteria. Gingival status was assessed by evaluating the gingival index, plaque index, periodontal probing depth of the abutments and control teeth, and the margin index of the abutment teeth. Statistical analyses were performed using the Friedman and the Wilcoxon signed-rank tests. During the 2-year follow-up, no biological or mechanical complications were observed, and the survival and success rate was 100%. All restorations ranked as satisfactory throughout the follow-up period. The gingival index and plaque index were worse at the end of the 2-year follow-up. The margin index was stable during the 2 years of clinical service. No significant differences were recorded in periodontal parameters between crowns and control teeth. Third-generation monolithic zirconia could be a reliable alternative to posterior metal-ceramic and second-generation monolithic zirconia posterior crowns.

Influence of Digital Technologies and Framework Design on the Load to Fracture of Co-Cr Posterior Fixed Partial Denture Frameworks.

PURPOSE: To compare the load to fracture of cobalt-chromium (Co-Cr) 3-unit posterior fixed partial denture (FPD) frameworks manufactured by conventional and digital techniques and to evaluate the influence of the framework design on the fracture load. MATERIAL AND METHODS: Eighty 3-unit Co-Cr posterior FPD frameworks were fabricated with two designs: intermediate pontic (n = 40) and cantilever (n = 40). Each design was randomly divided into four groups (n = 10): casting, direct metal laser sintering, soft metal milling, and hard metal milling. After thermal cycling, all specimens were subjected to a 3-point bending test until fracture. Data were statistically analyzed using one-way ANOVA, Welch and Brown-Forsythe test, Ryan-Einot-Gabriel-Welsch F and Tamhane T2 post hoc test, Student's t test, and Weibull statistics (α = 0.05). RESULTS: Significant differences (p < 0.001; F = 39.59) were found among intermediate pontic frameworks (except between laser sintering and hard metal milling), and cantilevered frameworks (F = 36.75) (except between laser sintering and hard metal milling, and casting and soft metal milling). The cantilever groups showed load to fracture values significantly lower than those of the intermediate pontic (p < 0.001; F = 28.29). The Weibull statistics corroborated the results. CONCLUSIONS: Hard metal milling and laser sintered frameworks exhibited the highest load to fracture values. However, all tested frameworks demonstrated clinically acceptable load to fracture values. The framework design directly affected the fracture load, with drastically lower values in cantilevered frameworks.

Effect of Luting Cement and Convergence Angle of the Preparation on the Internal Fit of Zirconia Restorations.

The objective was to evaluate the effect of luting agents and the preparation design on the internal fit of zirconia restorations. Sixty dies were prepared and divided in occlusal convergence angle of 6° (OC6) and 12° (OC12). CAD/CAM zirconia copings were fabricated (Lava All-Ceramic System). A zinc phosphate cement (ZPC); a glass ionomer cement (GIC); and a resin cement (RC) were studied. Specimens were sectioned and coping/die discrepancies were evaluated through Stereoscopic Microscopy. A closer fit was observed in OC12 when compared to OC6 (p < 0.001). For OC6 no significant differences were observed in between ZPC, GIC, and RC (p > 0.05). For OC12, a significantly closer fit was recorded on the ZPC subgroup when compared to the GIC subgroup (p < 0.001). Preparations of 12 degrees demonstrated a closer internal fit when compared to 6 degrees. Preparations of 12 degrees achieved better internal fit values with ZPC (Fortex) followed by RC (RelyX Unicem), and GIC (Ketac Cem). No differences were found when comparing different luting agents over 6° degrees preparations.

Fracture Load of Metal, Zirconia and Polyetheretherketone Posterior CAD-CAM Milled Fixed Partial Denture Frameworks.

The aim of this study was to investigate the load to fracture and fracture pattern of prosthetic frameworks for tooth-supported fixed partial dentures (FPDs) fabricated with different subtractive computer-aided design and computer-aided manufacturing (CAD-CAM) materials. MATERIALS AND METHODS: Thirty standardized specimens with two abutments were fabricated to receive three-unit posterior FDP frameworks with an intermediate pontic. Specimens were randomly divided into three groups (n = 10 each) according to the material: group 1 (MM)-milled metal; group 2 (L)-zirconia; and group 3 (P)-Polyetheretherketone (PEEK). The specimens were thermo-cycled and subjected to a three-point bending test until fracture using a universal testing machine (cross-head speed: 1 mm/min). Axial compressive loads were applied at the central fossa of the pontics. Data analysis was made using one-way analysis of variance, Tamhane post hoc test, and Weibull statistics (α = 0.05). RESULTS: Significant differences were observed among the groups for the fracture load (p < 0.0001). MM frameworks showed the highest fracture load values. The PEEK group registered higher fracture load values than zirconia samples. The Weibull statistics corroborated these results. The fracture pattern was different among the groups. CONCLUSIONS: Milled metal provided the highest fracture load values, followed by PEEK, and zirconia. However, all tested groups demonstrated clinically acceptable fracture load values higher than 1000 N. PEEK might be considered a promising alternative for posterior FPDs.

RhNPs supported on N-functionalized mesoporous silica: effect on catalyst stabilization and catalytic activity.

Amine and nicotinamide groups grafted on ordered mesoporous silica (OMS) were investigated as stabilizers for RhNPs used as catalysts in the hydrogenation of several substrates, including carbonyl and aryl groups. Supported RhNPs on functionalized OMS were prepared by controlled decomposition of an organometallic precursor of rhodium under dihydrogen pressure. The resulting materials were characterized thoroughly by spectroscopic and physical techniques (FTIR, TGA, BET, SEM, TEM, EDX, XPS) to confirm the formation of spherical rhodium nanoparticles with a narrow size distribution supported on the silica surface. The use of nicotinamide functionalized OMS as a support afforded small RhNPs (2.3 ± 0.3 nm), and their size and shape were maintained after the catalyzed acetophenone hydrogenation. In contrast, amine-functionalized OMS formed RhNP aggregates after the catalytic reaction. The supported RhNPs could selectively reduce alkenyl, carbonyl, aryl and heteroaryl groups and were active in the reductive amination of phenol and morpholine, using a low concentration of the precious metal (0.07-0.18 mol%).

Prospective Clinical Evaluation of Posterior Monolithic Zirconia Fixed Partial Dentures Using a Complete Digital Workflow: Two-Year Follow-Up.

PURPOSE: To evaluate the clinical performance and survival rate of posterior monolithic zirconia fixed partial dentures over a 2-year period. MATERIAL AND METHODS: A total of 20 patients, requiring 20 posterior fixed partial dentures were included in the study. Tooth preparations were scanned, and restorations were milled and cemented with a resin cement. The restorations were assessed for the quality of the surface and the color, anatomical form and marginal integrity. Periodontal status was assessed by determining the plaque index, gingival index, pocket depth, and margin index of the abutment teeth. Data were statistically analyzed using the Friedman and the Wilcoxon signed-rank tests with the Bonferroni correction. RESULTS: The survival rate at 2 years was 100%, and no biological or technical complications were observed. All restorations were assessed as satisfactory. The results obtained for gingival index and plaque index were better at 2 years follow-up, than at baseline. The margin index remained stable throughout the follow-up period. No differences in periodontal parameters were observed between abutment and control teeth. CONCLUSIONS: The high survival rate after 2 years suggest that monolithic zirconia may be an acceptable alternative to metal-ceramic and veneered zirconia restorations in the posterior region. Additional long-term, controlled studies are necessary to confirm the results.

Evaluation of the marginal fit of monolithic crowns fabricated by direct and indirect digitization.

Purpose To evaluate the influence of intraoral and extraoral digitization systems on marginal discrepancy of monolithic lithium disilicate and monolithic zirconia computer-aided design-computer-aided manufacturing (CAD-CAM) crowns.Methods Forty standardized machined stainless steel specimens with the characteristics of a first molar were manufactured and randomly assigned to two groups (n=20 each), depending on their material: monolithic lithium disilicate ceramic (LM), and monolithic zirconia (ZM). Then, each group was subdivided into two depending on the scanning system used: intraoral scanner (IOS), and extraoral scanner (EOS). The digitization process was standardized with two methacrylate devices, one for each scanner. After scanning and manufacturing of the crowns, the marginal discrepancy was measured under a scanning electron microscope (SEM). Data analysis was made using two-way analysis of variance (ANOVA) and the effect size with Cohen's d.Results All the measurements were within the limits considered acceptable. Regardless the restorative material significant differences between scanners were observed, being the effect from low to moderate. However, no differences were observed between the scanners in either the lithium disilicate or zirconia group.Conclusions The intraoral scan showed lower marginal discrepancy than the extraoral scan in CAD-CAM monolithic crowns, but these differences were not observed in each of the ceramic systems.

Effect of cementation and aging on the marginal fit of veneered and monolithic zirconia and metal-ceramic CAD-CAM crowns.

STATEMENT OF PROBLEM: Marginal fit of zirconia restorations is an important criterion for their long-term success. However, in spite of the wide use of zirconia in dentistry, the relationship between marginal fit and low-temperature degradation from aging is unclear. PURPOSE: The purpose of this in vitro study was to compare the marginal adaptation of veneered and monolithic zirconia and metal-ceramic computer-aided design and computer-aided manufacturing (CAD-CAM) crowns before and after cementation and to evaluate the influence of artificial aging on the adaptation of zirconia crowns. MATERIAL AND METHODS: Seventy-two standardized dies were prepared to receive a posterior crown and randomly divided into 6 groups (n=12) as per the material and the presence or not of cement: metal-ceramic, veneered zirconia, and monolithic zirconia. The zirconia groups were subjected to accelerated low-temperature degradation through hydrothermal aging in an autoclave at 131 °C and 0.17 MPa for 5 and 20 hours. A scanning electron microscope with a magnification of ×1000 was used for marginal adaptation measurements, and X-ray diffraction (XRD) was used to characterize phase transformation degradation. The data were statistically analyzed using 2-way ANOVA, repeated measures ANOVA with Greenhouse-Geisser correction, and the t test (α=.05). RESULTS: No significant differences in the marginal discrepancy were recorded among the analyzed groups. The presence of cement did not influence marginal fit in any treatment group. No significant differences were observed in the marginal adaptation values before and after aging (P>.05). After 20 hours of aging, the monoclinic phase increase to 8.3% on veneered zirconia and to 3.1% on monolithic crowns. CONCLUSIONS: Monolithic and bilayer CAD-CAM zirconia crowns showed marginal gaps that were within an acceptable range of clinical discrepancy, regardless of cementation. Marginal adaptation was not influenced by aging. Low-temperature degradation did not lead to a significant transformation from the tetragonal to monoclinic phase.

Allergies to Titanium Dental Implants: What Do We Really Know about Them? A Scoping Review.

The purpose of this scoping review was to describe the current state of knowledge and understanding of allergies to titanium dental implants. A scoping review was conducted following the Prisma Extension for Scoping Reviews checklist. An electronic search was performed in five databases complemented by manual and grey literature searches. Fifty-two relevant papers were included for final review. Titanium particles can be released from the surfaces of dental implants in a process called tribocorrosion, which may contribute to bone loss due to inflammatory reaction. Diverse mechanisms have been described that may trigger allergy to titanium, as well as the clinical signs that manifest as the allergy develops. Allergies to titanium are uncommon but represent a real possibility that should not be overlooked in patients requiring prosthodontic rehabilitation with dental implants. Allergy can trigger a range of symptoms. Patients who have already been diagnosed with allergies to other metals will be more predisposed to suffering an allergy to titanium. Further investigation is needed in order to measure the true scope of these allergies.

Evaluation of Milled Titanium versus Laser Sintered Co-Cr Abutments on the Marginal Misfit in Internal Implant-Abutment Connection.

The precision of fit at the implant-abutment connection is an important criterion for the clinical success of restorations and implants. Several factors are involved among which are the abutment materials and manufacturing techniques. The aim of this study was to investigate the effect of two materials and methods of manufacturing implant abutments, milled titanium versus laser sintered Co-Cr, on the marginal misfit at the implant-abutment interface. Scanning electron microscopes (SEM) were used to geometrically measure the marginal vertical discrepancy of a total of 80 specimens, classified into eight categories, according to the implant system and abutment. The data were statistically analyzed by Student's paired t test, one-way and two-way ANOVA with the Bonferroni-Holm correction at the significance level of p = 0.05. Milled titanium abutments demonstrated the lowest misfit values in the implant systems analyzed. The marginal fit of all the groups was within the clinically acceptable range for implant prostheses.

Comparative analysis of trueness between conventional and digital impression in dental-supported fixed dental prosthesis with vertical preparation.

Biologically oriented preparation technique (BOPT) is a vertical preparation technique without a finish line to create a new anatomic crown with a prosthetic emergence profile. This case report describe the protocol realized digitally in a patient who required a new fixed partial denture (FPD) in the anterior esthetic zone. After time of temporary restoration, definitive conventional (CI) (double-cord retraction and vinyl polysiloxane material), and digital impression (DI) with three different intraoral scanner (IOS) (Trios®, True Definition® and iTero®) were taken. All digital impression were obtained through three different scans: temporary restoration in the mouth after healing period, prepared teeth, and temporary restoration out of the mouth. To establish which of the IOS was the most accurate, it was necessary to compare the STL files obtained from each of the IOS with the STL file of the conventional impression, which was digitized with a laboratory scanner (3Shape D800). All these STL were imported to a software (ExoCAD 2.4 Plovdiv®), and they were superimposed. To establish the difference in trueness with SC, 6 points were chosen, 3 points in teeth, and another 3 points in soft tissue. The mean measurement in terms of trueness in teeth were: STS (0,039 mm), SI (0,054 mm), STD (0,067 mm); and in soft tissue were: STS (0,051 mm), SI (0,09 mm), STD [0,236 mm]. The IOSs showed differences between them in terms of trueness, being the Trios the most accuracy IOS. Final restoration was fabricated and cemented. The patient was examined at 3, 6 and 12 months, without any type of biological or mechanical complications. Digital impression with an IOS seems to be a viable alternative to perform zirconia FPD in the BOPT tecbique. Key words:Intraoral scanners, accuracy, vertical preparation, precision, CAD-CAM, prosthodontics.

Influence of Implant Connection, Abutment Design and Screw Insertion Torque on Implant-Abutment Misfit.

BACKGROUND: An accurate fit at the implant-abutment interface is an important factor to avoid biological and mechanical complications. The aim of this study was to evaluate the marginal misfit at the implant-abutment interface on external and Morse taper connection, with straight and angulated abutments under different insertion torque loads. MATERIALS AND METHODS: A total of 120 implants were used, 60 with external connection (EC) and 60 with Morse taper connection (IC). Straight (SA) (n = 60) and angulated abutments (AA) (n = 60) were randomly screwed to each connection at different torque levels (n = 10 each): 10, 20 and 30 Ncm. All specimens were subjected to thermal and cyclic loading and the misfit was measured by scanning electron microscopy. Data were analyzed with one-way ANOVA, t-test and Kruskal-Wallis test. RESULTS: Significant differences (p < 0.001) were found between connections and abutments regardless of the torque applied. Morse taper connections with straight and angulated abutments showed the lowest misfit values (0.6 µm). Misfit values decreased as torque increased. CONCLUSIONS: The misfit was affected by the type of connection. The type of abutment did not influence the fit in the Morse taper connection. The higher the tightening torque applied the increase in the fit of the implant-abutment interface.