Influence of remaining coronal tooth morphology with resin abutment and fiber post on static and dynamic fracture resistances.

This study aimed to clarify the fracture resistance of resin abutments built on endodontically treated roots with the remaining coronal teeth via static and cyclic loading tests. Endodontically treated bovine roots, which had a remaining coronal tooth covered with an occupied area for a quarter and half of the circumference at the tensile side or covered the circumference at both the tensile and compressive sides, were fabricated to build up to the resin abutment. Fracture resistance was evaluated via static and cyclic loading tests by applying a load of 30° to the tooth axis. Half of the circumference of the remaining coronal tooth showed a significantly higher static fracture load and survival rate. The remaining coronal tooth on the compressive side improved the dynamic fracture resistance associated with severe fractures. The occupied area and location of the remaining coronal tooth affected the static and dynamic fracture resistances.

Early changes in asporin levels in osteoarthritis of the temporomandibular joint.

OBJECTIVES: The present study aimed to elucidate the pathogenesis of temporomandibular joint (TMJ) osteoarthritis (TMJ-OA) in a mouse model. We investigated morphological and histological changes in the head of mandible cartilage and early immunohistochemical (IHC) changes in transforming growth factor (TGF)-ß, phosphorylated Smad-2/3 (p-Smad2/3), a TGF-ß signaling molecule, and asporin. METHODS: TMJ-OA was induced in a mouse model through unilateral partial discectomy. Micro-computed tomography (micro-CT) and safranin-O staining were performed to morphologically and histologically evaluate the degeneration of the head of mandible caused by TMJ-OA. IHC staining for TGF-ß, p-Smad2/3, and asporin was performed to evaluate the changes in protein expression. RESULTS: In the experimental group, three-dimensional (3D) morphometry revealed an enlarged head of mandible and safranin-O staining showed degeneration of cartilage tissue in the early stages of TMJ-OA compared to the control group. IHC staining revealed that TGF-ß, p-Smad2/3, and asporin expression increased in the head of mandible cartilage before the degeneration of cartilage tissue, and subsequently decreased for a short period. CONCLUSION: The findings suggested a negative feedback relationship between the expression of asporin and the TGF-ß/Smad transduction pathway, which may be involved in the degeneration of the head of mandible in the early stages of TMJ-OA. Asporin is a potential biomarker of the early stages of TMJ-OA, which ultimately leads to the irreversible degeneration of TMJ tissues.

A Case of Anterior Single Tooth Implant with Fractured Zirconia Abutment due to Trauma.

In recent years, a wide variety of materials have been used in dental implant treatment. In selecting the superstructures and abutments to be used it is important to consider their potential effect on the stability and durability of the planned implant. Excessive force applied to an implant during maintenance commonly results in complications, such as fracture of the superstructure or abutment, and loosening or fracture of the screws. This report describes a case of implant treatment for a 23-year-old man with esthetic disturbance due to trauma to the maxillary anterior teeth. The left maxillary central incisor could not be conserved due to this trauma, which had been caused by a traffic accident. After extraction, the tooth was restored with an anterior bridge. The crown of the left maxillary lateral incisor was fractured at the crown margin and, at the patient's request, implant treatment was selected as the restorative treatment for the missing tooth. A thorough preoperative examination was performed using placement simulation software. One titanium screw-type implant was placed in the maxillary left central incisor under local anesthesia. An all-ceramic crown with a zirconia frame was placed as a screw-fixed direct superstructure. At one year postoperatively, however, the superstructure and abutment became detached due to trauma. The fractured zirconia abutment was removed and replaced with a remanufactured abutment and superstructure. The patient has reported no subsequent dental complaint over the last 11 years. In this case, a surface analysis of the fractured zirconia abutment was performed. The scanned images revealed a difference in the fracture surfaces between the tensile and compressive sides, and electron probe microanalysis demonstrated the presence of titanium on the fracture surface. It was inferred that the hard zirconia abutment had scraped the titanium from the internal surface of the implant.

Effects of the application of low-temperature atmospheric plasma on titanium implants on wound healing in peri-implant connective tissue in rats.

PURPOSE: This study aimed to clarify the effects of surface modification of titanium (Ti) implants by low-temperature atmospheric pressure plasma treatment on wound healing and cell attachment for biological sealing in peri-implant soft tissue. METHODS: Hydrophilization to a Ti disk using a handheld low-temperature atmospheric pressure plasma device was evaluated by a contact angle test and compared with an untreated group. In in vivo experiments, plasma-treated pure Ti implants using a handheld plasma device (experimental group: PL) and untreated implants (control group: Cont) were placed into the rat upper molar socket, and samples were harvested at 3, 7 and 14 days after surgery. Histological evaluation was performed to assess biological sealing, collagen- and cell adhesion-related gene expression by reverse transcription quantitative polymerase chain reaction, collagen fiber detection by Picrosirius Red staining, and immunohistochemistry for integrins. RESULTS: In in vivo experiments, increased width of the peri-implant connective tissue (PICT) and suppression of epithelial down growth was observed in PL compared with Cont. In addition, high gene expression of types I and XII collagen at 7 days and acceleration of collagen maturation was recognized in PL. Strong immunoreaction of integrin α2, α5, and ß1 was observed at the implant contact area of PICT in PL. CONCLUSIONS: The handheld low-temperature atmospheric pressure plasma device provided hydrophilicity on the Ti surface and maintained the width of the contact area of PICT to the implant surface as a result of accelerated collagen maturation and fibroblast adhesion, compared to no plasma application.

Two Cases of Idiopathic Condylar Resorption Due to Temporomandibular Joint (TMJ) Osteoarthritis Remodeled by Different Treatment Modalities.

Condylar resorption is a condition of progressive and significant mandibular head resorption. We treated two patients with condylar resorption caused by temporomandibular joint (TMJ) osteoarthritis. The first patient was a 22-year-old female at the time of the initial examination. She had a history of orthodontic treatment and came to the clinic with a number of symptoms, including difficulty opening the mouth. Idiopathic condylar resorption was diagnosed, an occlusal splint was placed for approximately one year, and the patient was followed up for 12 years. The second patient was a 20-year-old female who had completed non-extraction orthodontic treatment by the age of 17 years. She came to the clinic with esthetic issues, such as an anterior open bite. Implant anchor screws were placed in the alveolar bone of the anterior teeth and intermaxillary fixation was performed. Case 1 had 12 years of follow-up, with CT scan results showing remodeling of the condylar. Case 2 is expected to shorten treatment time. However, the CT scan showed remodeling and improvement in the chief complaint.

Subgingival titanium wire implantation induces weak inflammatory responses but does not promote substantial T cell activation.

Titanium is a biocompatible material commonly used for dental treatments. However, the detailed mechanism underlying the weak biological activity of titanium has not been elucidated. We investigated both the inflammatory responses and T cell activation induced by solid titanium in the gingiva in mice. Both titanium and nickel wire implantation promoted neutrophil infiltration into the gingiva on day 2. Nickel, but not titanium, wire implantation enhanced proinflammatory cytokine expression and dendritic cell activity in gingival tissue by day 2. Nickel wire implantation enhanced the activity of T cells in draining lymph nodes on day 5. Moreover, T cell and neutrophil infiltration and elevated proinflammatory cytokine expression in the gingival tissue were still observed on day 5. However, no such augmented biological responses were observed after titanium wire implantation. These findings suggest that, unlike nickel, solid titanium does not induce sufficient inflammatory responses leading to T cell activation in gingival tissue.

The effect of scanning pathways on trueness and precision in full-arch optical impression.

BACKGROUND: In this study, we investigated the effects of differences in scanning pathways during optical impression on the trueness and precision of full-arch impressions. METHODS: Reference data were obtained using a laboratory scanner. All optical impressions were measured across the dental arch using TRIOS® 3 in four different pathways. The reference and optical impression data were superimposed using the best-fit method. The criteria for superimposition were based on the starting side of the dental arch (partial arch best-fit method, PB) and based on the full arch (full arch best-fit method, FB). The data were compared between the left and right molars (starting and ending sides). The scan deviations for trueness (n = 5) and precision (n = 10) were obtained for each group by calculating the root mean square (RMS) of the deviation at each measurement point. Visual observations using superimposed color map images revealed variations in trueness. RESULTS: There were no significant differences in scanning time or amount of scan data between the four scanning pathways. Trueness did not differ significantly among the four pathways with respect to the starting and ending sides, regardless of the superimposition criteria. Precision with PB was significantly different between scanning pathways A and B, and pathways B and C for the starting sides, and between scanning pathways A and B, and pathways A and D for the ending sides. In contrast, there was no significant difference between the starting and ending side in pathways for FB. Regarding PB, color map images showed a large error range in the direction toward the molar radius for the occlusal surface and cervical regions on the ending sides. CONCLUSION: Differences in the scanning pathways did not affect trueness, regardless of the superimposition criteria. On the other hand, differences in the scanning pathways affected the precision of the starting and ending sides with PB. Scanning pathways B and D were more precise on the starting and ending sides, respectively.

Dimensional changes of buccal bone in the edentulous maxilla with telescopic-retained implant-supported fixed dental prostheses.

STATEMENT OF PROBLEM: The buccal bone in an edentulous maxilla loses thickness over time because of physiological changes. However, the dimensional changes of the buccal bone in an edentulous maxilla with an implant-supported fixed dental prosthesis are unknown. PURPOSE: The purpose of this retrospective clinical study was to evaluate cone beam computed tomography (CBCT) images of the dimensional changes of the buccal bone in edentulous maxillae with complete arch telescopic-retained implant-supported fixed dental prostheses (CTI-FDPs) after 6 years by using a professional retrieval system. MATERIAL AND METHODS: This study included 17 participants with edentulous maxillae who had been provided with CTI-FDP with 121 taper joint implants. A three-dimensional radiographic analysis by using CBCT was performed at implant insertion (0 years) and after 6 years. Vertical and horizontal bone measurement values were evaluated. During horizontal bone thickness measurement, 4 different levels, 0, 2, 4, and 6 mm apical to the implant shoulder, were evaluated as bone value (BV)0mm, BV2mm, BV4mm, and BV6mm, respectively. The BVs were compared with the Wilcoxon signed-rank test and Kruskal-Wallis test (α=.05). In addition, the Spearman rank correlation coefficient was used to identify 0yBV factors that influence the 6yBVs. A nonlinear regression analysis was used to clarify the slopes of 0yBVs and 6yBV0mm. RESULTS: Significant decreases in vertical and horizontal BVs were found between 0 years and 6 years (P<.05). However, no significant difference was observed in bone loss at 6 years at any of the vertical and horizontal measurement points (P≥.05). When 0yBVs related to 6yBV0mm were analyzed, 0yBV0mm and 0yBV2mm showed strong correlations with 6yBV0mm (|r|≥.7). In the regression analysis, a 0yBV0mm of 0.58 mm and 0yBV2mm of 0.78 mm could be critical factors associated with a 6yBV0mm of 0 mm. A 6yBV0mm of 0yBV0mm more than 0.58 mm was significantly higher than a 6yBV0mm of 0yBV0mm less than 0.58 mm (P<.001). Moreover, a 6yBV0mm of 0yBV2mm more than 0.78 mm was significantly higher than a 6yBV0mm of 0yBV2mm less than 0.78 mm (P<.001). CONCLUSIONS: The buccal bone in an edentulous maxilla with fixed implant-supported prostheses lost significant vertical and horizontal bone thicknesses after 6 years. At implant insertion, both a 0.58-mm buccal bone on the platform and a 0.78-mm buccal bone at 2 mm apical to the implant shoulder are necessary for longer term maintenance of bone on the platform of implants specifically supporting CTI-FDPs.

Regeneration of sensory nerve branches in extraction socket and surrounding alveolar bone in rat: immunohistochemical observation of the axon and myelin sheath changes.

The purpose of this study was to investigate the process and derivation of the distribution of the sensory nerves that appear in the extraction socket and surrounding alveolar bone following tooth extraction. The right mandibular first molar of rats and periodontal ligament were extracted as a single mass, and the mandible was harvested after days 1, 3, 5, and 7 after extraction. Serial sections of 7 µm thickness were prepared for the proximal root (Section A), buccolingual root (Section B), and centrifugal root (Section C) of the first molar. H-E staining and immunohistochemical staining with anti-S100 antibody and anti-NF-L antibody were carried out. The presence of nerve fiber bundles in the blood clot was already evident on post-extraction day 3, and on post-extraction day 7. On day 3, the number of axons in Sections B and C had greatly decreased, indicating that, after extraction, the connection between peripheral nerve tissue and the trigeminal ganglion was temporarily markedly reduced in the region of the alveolar branch. Although the myelin sheaths were regenerating on day 5, the majority of the axons of the alveolar branches extending from the inferior alveolar nerve were seen to be extremely thin and scattered, despite their further regeneration. The above results suggest that the newly myelinated nerves are actually derived from the bone marrow to the extraction socket, so few nerves, rather than being derived from the alveolar branches that had innervated the extracted tooth.

Sintering distortion of monolithic zirconia in 4-unit fixed partial denture: Effect of layered structure and vertical milling area.

Layered-type zirconia disks, which offer color gradation from enamel to cervical shade, have been employed in recent years to replicate the shades of natural teeth. The layered structure is effective at replicating colors and has helped popularize monolithic zirconia restorations. However, the sintering shrinkage of zirconia is very large; thus, controlling the sintering distortion is very important. Thus, the objective of this study was to determine the influence exerted by the layered structure of the zirconia disk and the vertical milling area on the sintering distortion. An experimental fixed partial denture (FPD) was designed based on a 4-unit monolithic zirconia FPD. A single-composition (SC)-type disk with no shade and a single-composition-layered (SCL)-type disk with shade gradation were selected for this study. In particular, three milling areas, the top end of the disk (area I), vertical center (area II), and bottom end of the disk (area III), were investigated. Moreover, the sintering distortions generated by the experimental FPDs were measured. Results showed that sintering distortion in 4-unit monolithic zirconia FPDs occurred in all SC and SCL areas. Additionally, the sintering distortions were affected by the layered structure of the zirconia disks, the degree of which depended on the milling area (area I > area II > area III). Thus, when fabricating dental prosthesis using SCL zirconia disks, the milling area must be selected considering both the color adjustment and sintering distortion.

Patient with Poor Esthetic Anterior Tooth Position Treated with Lithium Disilicate Mesial Cantilever Single-retainer Fixed Partial Denture: A Case Report.

We report a case of fixed prosthetic treatment for poor esthetics due to the position of the maxillary left lateral incisor in a 43-year-old woman. Initial examination revealed no carious lesions, but the tooth axis of the maxillary right canine showed mesial inclination of approximately 15°. Orthodontic treatment was first proposed but was declined by the patient as they did not wish to undergo a prolonged period of therapy. Therefore, recovery by extraction of the maxillary right lateral incisor and prosthetic treatment was proposed as an alternative. The method to be used for application of a 3-unit fixed partial denture and implant treatment was explained to the patient. She refused to give consent to this plan as well, however, due to concerns regarding the need to cut a lot from a non-problematic tooth and the length of time such treatment would require. Therefore, the problem was finally treated by application of a cantilever single-retainer fixed partial denture while giving sufficient consideration to extraction and occlusal contact. Lithium disilicate was used for the material of the prothesis. At 1 year after completion of treatment, no problem was observed with either the prosthetic appliance or the abutment teeth.

Influence of Tooth Mold Materials in Composite Resin CAD/CAM Crown Destructive Test.

A range of experimental designs have been used in destructive testing of composite resin CAD/CAM crowns. Various materials have been adopted for the abutment in such tests, including human or bovine dentin, stainless steel, PMMA, and composite resin, the selection of which is made in accordance with study objective or preference of the researcher. The purpose of this study was to determine how the material selected for the abutment material affected fracture load and maximum displacement. Destructive tests were conducted on composite resin crowns of the same design. Three types of material were used for the abutments together with 2 types of adhesive material. Images of each sample were acquired before destruction using a microfocus X-ray CT scanner to confirm the feasibility of a non-destructive test.The load required to fracture the composite CAD/CAM resin crowns depended on the abutment material used, with a decrease being observed in the order of composite resin, stainless steel, and PMMA. Maximum displacement decreased in the order of PMMA, composite resin, and stainless steel. Differences in the material used for setting (adhesive resin or polycarboxylate cement) showed no effect on fracture load. These results indicate that the load required to achieve destruction of resin CAD/CAM crowns varies according to the abutment material used.

Low-temperature degradation of high-strength Y-TZP (yttria-stabilized tetragonal zirconia polycrystal).

The objective of this study was to investigate the low temperature degradation characteristics of 2 types of high strength yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) in order to evaluate its suitability for implant body, implant superstructure or abutment. Disk-shaped conventional Y-TZP (0.25 mass% alumina) subjected to hot isostatic press treatment (HIP-Y-TZP) and Y-TZP/4Al2O3 with additional alumina (4.0 mass%) were mirror-polished. Accelerated aging tests with 134°C for 5 h at 0.2 MPa and 180°C for 5 h at 1.0 MPa were performed using an autoclave. Biaxial flexural strength and crystal phases were evaluated. Strength decreased as the proportion of monoclinic phase increased after accelerated aging treatment for both types of high-strength Y-TZPs. Despite the low alumina content, HIP-Y-TZP showed higher static strength and strength after accelerated aging treatment compared to Y-TZP/4Al2O3. However, both types of Y-TZP had adequate strength to be used as dental restorations even after accelerated aging treatment, therefore, its clinical suitability was considered high.

A randomized, 12-month controlled trial to evaluate non-inferiority of early compared to conventional loading of modSLA implants in single tooth gaps.

BACKGROUND: The aim of the study was to evaluate whether early loading of implants with a chemically modified sandblasted, large-grit, acid-etched (SLA) (SLActive®) surface was non-inferior to conventional loading in terms of change in crestal bone level. METHODS: This was a randomized, controlled, multicenter study. Patients requiring single-tooth rehabilitation in the posterior maxilla or mandible received implants and were randomized to receive a provisional restoration in occlusal load after 25 ± 3 days (early loading) or after 13 ± 1 weeks (conventional loading). The primary endpoint was change in crestal bone level between implant placement (baseline) and 6 months. Secondary endpoints included change in crestal bone level between baseline and 12 months, implant survival and success rates, and patient satisfaction. RESULTS: Of the 84 patients enrolled, 78 received implants and were randomized onto the early loading (41 patients) and conventional loading (37 patients) groups. The mean change in crestal bone level between baseline and 6 months was 0.56 ± 0.58 and 0.51 ± 0.62 mm for early and conventional loading, respectively; at 12 months, the mean change was 0.76 ± 0.60 and 0.73 ± 0.77 mm, respectively. Implant survival and success at 12 months were 100 % for both groups. Patient satisfaction was similar between the groups, except that more patients in the early loading group were satisfied or highly satisfied with the time taken for fitting. CONCLUSION: The study demonstrated that early implant loading was non-inferior to conventional implant loading in terms of crestal bone level change in a Japanese patient population in short follow-up period and single tooth gaps in molar regions.

Translucency and flexural strength of monolithic translucent zirconia and porcelain-layered zirconia.

This study aims to investigate the effectiveness of monolithic translucent TZP with different colors and porcelain-layered TZP by evaluating their colors and strengths. Different mixing ratios of Zpex to Zpex-Yellow as translucent TZP, conventional opaque TZP (TZ-3YB-E) (Tosoh, Tokyo) as a control, and veneering porcelain (CERABIEN ZR, body porcelain, Noritake, Tokyo) with shade A3 as a typical shade. Disk-shaped specimens of 13 mm diameter and 1.5 mm thickness were prepared. These specimens were observed under reflected and transmitted light, and the translucency parameter (TP) values were measured. Strength was also evaluated with flexural strength in a biaxial bending test. The TP values of the monolithic TZP, Zpex100>Zpex70>Zpex50>TZ3YB, were larger in this order. The flexural strength of all the monolithic TZP showed approximately 1,000 MPa. It is suggested that colored translucent TZP is clinically useful when used as monolithic restorations.

Comparison of Gene Expression in Peri-implant Soft Tissue and Oral Mucosal Tissue by Microarray Analysis.

PURPOSE: Implant placement entails disruption of the epithelial continuity, which can lead to various complications. Therefore, the area of mucosal penetration is of particular interest clinically. The goal of the present study was to compare gene expression in peri-implant soft tissue (PIST) with that in oral mucosal tissue (OMT) using microarray analysis, and to investigate which genes were specifically expressed in PIST. MATERIALS AND METHODS: The bilateral upper first molars were extracted from 4-week-old rats and titanium alloy implants placed only in the left-side extraction sockets. Four weeks after surgery, samples were harvested from the left-side PIST and right-side OMT and total RNA samples isolated. Microarray analysis was used to compare gene expression in PIST and OMT, which was then confirmed using quantitative real-time polymerase chain reaction. Immunohistochemical staining was also performed to confirm protein level expression. RESULTS: The number of genes expressed with more than a twofold change in PIST compared with OMT was 1,102, of which 750 genes were upregulated and 352 genes were downregulated. The messenger RNA (mRNA) expression of three selected genes-Ceacam1, Ifitm1, and MUC4-were more significantly expressed in PIST than in OMT(P < .01). Immunohistochemical localization of CEACAM1, IFITM1, and MUC4 was observed in PIST, but no immunoreaction was recognized in OMT. CONCLUSION: The result of microarray analysis showed that, because of implant placement, 750 genes were upregulated in PIST compared with OMT. CEACAM1, IFITM1, and MUC4 were specifically upregulated in PIST.

Influence of titanium ions on cytokine levels of murine splenocytes stimulated with periodontopathic bacterial lipopolysaccharide.

PURPOSE: Titanium (Ti) is frequently used in dental implants because of its excellent corrosion resistance, mechanical properties, and biocompatibility. However, Ti ions may be slowly released as a result of corrosion, contributing to peri-implantitis, a major cause of dental implant failure. This study examined the influence of Ti ions on cytokine levels in murine splenocytes, an immunocompetent cell type, stimulated with Aggregatibacter actinomycetemcomitans lipopolysaccharide (LPS) and the influence of Ti ions on splenocyte viability. MATERIALS AND METHODS: Splenocytes were prepared from 5- to 10-week-old male C57BL/6 mice and BALB/c mice. Cytokine levels in culture supernatants from murine splenocytes stimulated with A actinomycetemcomitans LPS were determined with enzyme-linked immunosorbent assay. A tetrazolium salt assay was carried out to evaluate the cytotoxicity of Ti ions against murine splenocytes. RESULTS: The present study demonstrated that Ti ions influence cytokine levels in LPS-stimulated splenocytes. Significantly higher values (P < .05) were observed for interleukins 1ß, 6, and 10; interferon-γ; tumor necrosis factor alpha; and granulocyte macrophage colony-stimulating factor in the culture supernatants of LPS-stimulated splenocytes of both mouse strains in the presence of Ti ions, as compared to the absence of Ti ions. Tetrazolium salt assay confirmed that the Ti ions used in this study did not affect the viability of murine splenocytes. CONCLUSION: This study suggests that Ti ions enhanced cytokine production induced by periodontopathic bacterial LPS.

Wear behavior between zirconia and titanium as an antagonist on fixed dental prostheses.

The aim of this in vitro study was to investigate the wear behavior of the abrader when tetragonal zirconia polycrystal (TZP), cp-titanium (CpTi) and Ti-6Al-4V alloy (TiAlV) were used as the antagonist on fixed dental prostheses (FDPs). Both hemisphere abrader and flat substrate specimens were prepared using TZP, CpTi and TiAlV. Two-body wear tests were performed in distilled water, and the wear volume of the abrader specimen was measured to evaluate the wear behavior. In addition, scanning microscopic observation and an electron probe micro-analysis were performed to elucidate the underlying mechanism of the wear. The wear volume of CpTi and TiAlV abrader specimens was approximately 20 times larger than that of TZP abrader specimen against all substrate specimens. This is due to the differences in hardness between the ultra-hardness of TZP and the comparatively low hardness of CpTi and TiAlV. The wear volume of CpTi and TiAlV abrader specimens against the TZP substrate was significantly smaller than for the CpTi and TiAlV substrates despite the hardness of TZP being much larger than those of CpTi and TiAlV. This phenomenon may be based on the adhesive wear mechanism. Elements of Ti, Al and V originating in the TiAlV substrate were detected adhering to the abrader CpTi specimen. These results suggest that FDPs of CpTi and TiAlV are susceptible to wear against not only TZP but also CpTi and TiAlV in contrast to TZP FDPs.

Influence of surface treatment of yttria-stabilized tetragonal zirconia polycrystal with hot isostatic pressing on cyclic fatigue strength.

Hot isostatic pressing processed yttria-stabilized tetragonal zirconia polycrystal (HIP Y-TZP) has the potential for application to implants due to its high mechanical performance. The aim of this study was to investigate the influence of surface treatment of HIP Y-TZP on cyclic fatigue strength. HIP Y-TZP specimens were subjected to different surface treatments. Biaxial flexural strength was determined by both static and cyclic fatigue testing. In the cyclic fatigue test, the load was applied at a frequency of 10 Hz for 10(6) cycles in distilled water at 37°C. The surface morphology, roughness, and crystal phase of the surfaces were also evaluated. The cyclic fatigue strength (888 MPa) of HIP Y-TZP with sandblasting and acid-etching was more than twice that of Y-TZP as specified in ISO 13356 for surgical implants (320 MPa), indicating the clinical potential of this material.

Dental implant treatment after improvement of oral environment by orthodontic therapy.

A 57-year-old man presented with mesial inclination of the lower right first molar caused by untreated loss of the second premolar. The occlusal relationship was restored by dental implant treatment following improvement of the intraoral environment by orthodontic therapy. At his initial visit, the interdental spacing in the molar-premolar region was inadequate, as the first molar had mesially inclined into the extraction space of the second premolar. The patient had also lost the second molar and complained of masticatory problems on the right side. It was considered necessary to restore the second molar and improve the occlusal relationship with the first molar to recover occlusal function on the right side. After orthodontic therapy to correct the position of the mesially inclined tooth, occlusal restoration was carried out by dental implant treatment. The patient's clinical condition has remained excellent at over 5 years 2 months post-surgically and the patient is satisfied with the treatment outcome. The combination of dental implant treatment and orthodontic therapy were effective in improving the intraoral environment in this patient, indicating the efficacy of interdisciplinary treatment planning and practice.