Biomechanical analysis of the press-fit effect in a conical Morse taper implant system by using an in vitro experimental test and finite element analysis.

STATEMENT OF PROBLEM: The press-fit (Morse taper) implant system is commonly used to restore edentulous areas. However, abutment screws in this system may be damaged because of the 2- or 3-piece design, consequently causing complications. How these damaging situations occur is unclear. PURPOSE: The purpose of this in vitro and finite element analysis (FEA) study was to elucidate the mechanisms of the press-fit implant system underlying abutment screw damage. MATERIAL AND METHODS: The ANKYLOS implant system was used as a simulation model and for experimental test specimens. The experimental test was performed by using a material test system, and the obtained data were used to validate the FEA outcome. In the FEA simulation, the bilinear material property and nonlinear contact conditions were applied to simulate the process of tightening the abutment screw between the abutment and implant. A force of 300 N was then applied to the abutment to investigate the stress distribution and deformation of the implant system. RESULTS: In the experimental test, the fracture site of all specimens was observed at the abutment-screw thread. All implants and abutments exhibited permanent bending deformation. The results of the FEA simulation generally concurred with the experimental outcomes. CONCLUSIONS: The abutment torque used to generate the press-fit contact interface between the abutment and implant induced stresses within the implant components, substantially increasing the failure probability of the conical implant system during function.

Mechanical analysis of a dental implant system under 3 contact conditions and with 2 mechanical factors.

STATEMENT OF PROBLEM: A unidiameter abutment attached to a large-diameter implant has been reported to result in an unexpectedly high failure rate, inconsistent with the general understanding of dental implant mechanics. PURPOSE: The purpose of this finite element analysis study was to investigate the mechanical mechanism underlying these unexpected failures with the hypothesis that the cold welding or interference fit interface between abutment and implant increases the failure probability of a large-diameter implant system with a unidiameter abutment. MATERIAL AND METHODS: A conical implant system with different abutment gingival heights and implant diameters was analyzed for 3 contact conditions of the abutment-implant interface (bond and frictional coefficients of 0.3 and 0.7). A computer model was created using computed tomography images, and an oblique load of 100 N was applied to the abutment to determine the mechanical effect of the implant diameter and gingival height under the 3 contact conditions. RESULTS: When the abutment-implant interface was bonded, the peak stress of the abutment increased and that of the bone decreased with increasing implant diameter. When friction was applied to the abutment-implant interface, the peak stress of the implant, screw, and bone decreased with increasing implant diameter. Furthermore, the peak stress of the implant system and bone increased when the abutment gingival height increased under all contact conditions. CONCLUSIONS: Cold wielding or interference fit at the abutment-implant interface can prevent a screw fracture; however, it puts high stress on the unidiameter abutment neck when the implant diameter is increased. Screw loosening may lead to a slide between the abutment and implant, considerably increasing the stress of the screw. A system with a narrow diameter implant may cause an implant fracture rather than an abutment fracture when friction is applied to the abutment-implant interface.

Milling properties of low temperature sintered zirconia blocks for dental use.

To investigate the milling properties of different yttria-tetragonal zirconia polycrystalline (Y-TZP) block materials by applying a dental computer numerical control (CNC) milling center. Low temperature sintering zirconia block denoted by KMUZ (experimental) with two commercial zirconia blocks for T block made in Taiwan and a G block made in Germany were compared for the milling properties. Seventy-two specimens were milled using the same CNC milling center, and properties were evaluated by measuring the weight loss (g), milling time (s), margin integrity (%) and broken diameter (µm). The crystalline phases contents were identified by X-ray diffraction and the microstructures of the sintering specimens were observed by scanning electron microscopy and transmission electron microscopy. The mean milling time of G and KMUZ were significantly shorter than T (P<0.05). The KMUZ samples exhibited the least weight loss among the three kinds of blocks (P<0.05). The percentages of marginal integrity after milling were high in G and KMUZ but low in T (P<0.05). The mean broken diameters were from 90µm to 120µm. The phase transformation of t-ZrO2 (KMUZ: 7.4%, G: 5.9%, T: 3.2%) to m-ZrO2 when facing the milling pressure in ZrO2 blocks was observed by XRD. The result of TEM microstructure of KMUZ revealed that Y and Si were soluble in grain boundaries. The results show that the milling properties of KMUZ were better than one commercial T and near the G. The hindered grain growth, as a result of the Y3+ content in the grain boundaries, also plays a role in promoting the abnormal grain growth of 3Y-TZP.

Effect of different acidities of electrolyzed water on dentin surface roughness, decalcification and microhardness -a preliminary study.

This study investigated the exposed coronal superficial dentin of 28 human molars were immersed in strongly acidic electrolyzed water (AW group), neutral electrolyzed water (NW group), 5% sodium hypochlorite (negative control, NL group), or deionized water (positive control, DW group). Microhardness was determined at 5-min intervals for 60 min. Surface roughness, energy dispersive X-ray spectroscopy and scanning electron microscopy analyses were performed after 5 and 60 min. Reductions in microhardness were observed in the AW, NW and NL groups, with further decreases as immersion time increased. Surface roughness was also markedly greater, and the Ca/P ratio markedly decreased, in the AW group. Prolonged immersion of dentin in strongly acidic electrolyzed water markedly decreased the microhardness and Ca/P ratio and markedly increased surface roughness. Prolonged immersion can lead to greater softening effect in dentin depending on the acidity of the electrolyzed water used.

Effects of denture maintenance on satisfaction levels of Taiwanese elderly using removable partial dentures: a pilot study.

OBJECTIVE: The aim of this study was to evaluate the correlation between patient satisfaction with removable partial dentures and denture maintenance by patients, including regular application of denture adhesives and cleansers. BACKGROUND: The success of removable partial dentures depends on patient satisfaction with dentures and their regular denture maintenance. MATERIALS AND METHODS: Demographic information, the Oral Impacts on Daily Performance (OIDP) indicator and details of denture maintenance (including the use of denture cleansers and adhesives) were collected from 193 (41.5% men and 58.5% women) participants by using questionnaires. A dentist performed oral examinations to evaluate denture function according to the OIDP items photographically and recorded the number of remaining teeth and Kennedy's classification. RESULTS: Most participants were satisfied with their removable partial dentures and tended to have higher satisfaction levels than the dentist's estimation. Further, those using denture adhesives and cleansers had higher satisfaction levels than those not using such denture maintenance. CONCLUSIONS: Appropriate education regarding denture use is important because regular denture maintenance by patients affects their degree of satisfaction with dentures, as well as the dentist's skill and the patient's oral condition. Dentists could use this information to predict the potential success of dentures.

Emergence angles of the cementoenamel junction in natural maxillary anterior teeth.

STATEMENT OF THE PROBLEM: Fabrication of normal crown contour to maintain gingival health is difficult in the absence of emergence angle data. PURPOSE: The aim of this study was to measure the geometric values of the emergence angles on the cementoenamel junction (CEJ) for natural maxillary anterior teeth. MATERIAL AND METHODS: This study collected 148 natural permanent maxillary anterior teeth (74 central incisors, 59 lateral incisors, and 15 canines) with intact cervixes for this study. The teeth were scanned with a three-dimensional (3D) scanner to construct 3D models. This study measured the emergence angles of the cervical CEJ on the zenith of labial, palatal, mesial, and distal, for each tooth. RESULTS: Measurements made on 148 maxillary anterior teeth showed the emergence angle to be within a narrow range from 11.30° to 15.26°, irrespective of the tooth location. There were no statistically significant differences between any two groups (p > 0.05). CONCLUSIONS: On the basis of measurements taken from natural teeth, we conclude that the emergence angles of the CEJ in natural maxillary anterior teeth should be 15° from the root surface. CLINICAL SIGNIFICANCE: The information presented in this article may be useful in helping to create dental restorations with optional emergence angles over the CEJ in natural maxillary anterior teeth. Prior to the treatment the dentist should consider not only the fit of the crown, but also the emergence angles and contours of the soft tissues surrounding the involved teeth.

FEM analysis of the mandibular first premolar with different post diameters.

Several reports have pointed out that endodontically treated teeth can lack strength, and that the teeth can be reinforced using posts. However, it has not been clear how to select posts that meet the needs of most clinical situations, particularly in terms of the post diameter, which has a major influence on the occurrence of root fracture. The purpose of this study was to analyze the stress distributions of posts of various diameters during masticatory loads using a finite element method. A 3-dimensional (3D) finite element model of a lower first premolar was developed. We used the image software Geomagic Studio (3D Digital 2002; Geomagic, Research Triangle Park, NC, USA) to reduce the post diameter by 6 ratios to a root diameter of 20, 30, 40, 50, 60, and 80% and then individually implemented them into the root of a tooth. A chewing static force of 100 N was applied as a 45° diagonal load on the buccal cusp tip, and the σ(von Mises) and σ(max) stresses were calculated. Analysis of the σ(von Mises) values revealed that the stresses were concentrated in the middle 1/3 of both the post and the root surface for all models, as were the σ(max) values. The results also indicated that when the diameter of the post was 50% of that of the root, the stress distributions of the post and the root surface were most favorable. In conclusion, the clinical implications of the results will need to be further studied and discussed.

Horizontal pull-out strength of orthodontic infrazygomatic mini-implant: an in vitro study.

PURPOSE: New modified mini-implants have recently come into use for reinforcing skeletal anchorage in orthodontic application. The aim of this study was to investigate the influence of the design of a mini-implant on its mechanical strength. MATERIALS AND METHODS: We measured the insertion torques and horizontal pull-out strengths of 3 brands of infrazygomatic mini-implants (AbsoAnchor, Bioray, and Lomas; 2 mm for all). Five implants of each brand were manually driven 6 mm into the artificial bone. Significant differences in various parameters among the brands were investigated with the Kruskal-Wallis test. RESULTS: There was no significant relationship between insertion torque and horizontal pull-out strength. The Bioray mini-implants had significantly greater horizontal pull-out strength than the AbsoAnchor mini-implants. CONCLUSIONS: The design of the mini-implant can influence its insertion torque and horizontal pull-out strength. In our findings, the horizontal pull-out strength of all mini-implants placed in the infrazygomatic crest was significantly greater than the orthodontic force applied.

Mechanical strength of orthodontic infrazygomatic mini-implants.

Orthodontic anchorages have recently been reinforced by newly developed mini-implants. The aim of the present study was to investigate the mechanical strengths of infrazygomatic mini-implants. We measured the insertion torque and pull-out strength of three brands of infrazygomatic mini-implants (AbsoAnchors, Bioray, and Lomas). All three mini-implants were 2 mm in diameter, and five of each brand were manually driven 6 mm into artificial bone. Significant differences among the brands were investigated with Kruskal-Wallis tests. We found no significant relationship between insertion torque and pull-out strength in any individual brand. Among the three brands of infrazygomatic mini-implants, we found no significant difference in mechanical strength. The design of an infrazygomatic mini-implant may be the most important factor determining its mechanical strength.

The stability of intraoral vertical ramus osteotomy and factors related to skeletal relapse.

BACKGROUND: Intraoral vertical ramus osteotomy (IVRO) and sagittal split ramus osteotomy (SSRO) have been advocated as two major procedures for the correction of mandibular prognathism. However, only a few reports with at least a 2-year follow-up period describe the long-term stability especially of the IVRO method. This study aimed to identify factors contributing to skeletal relapse after a 2-year postoperative follow-up period. METHODS: A set of three standardized lateral cephalograms were obtained from each subject, taken preoperatively (T1), immediately postoperatively (T2), and 2 years postoperatively (T3). Relapse was defined as forward movement of the menton (Me) after a 2-year follow-up period. Two angular measurements (SNB and SN-occlusal plane angle) and five linear measurements (horizontal Me, vertical Me, overbite, anterior facial height, and mandibular length) were compared immediately after the operation and at the 2-year follow-up visit. RESULTS: The mean setback of the menton was 12.8 mm, and the mean relapse was 1.3 mm (10.2% = 1.3/12.8). The magnitude of the setback was not significantly accounted for in the relapse. There were weak correlations between the relapse and the concerned factors, namely, overbite, anterior facial height, mandibular length SNB, and SN-occlusal plane angle). CONCLUSION: The current study confirmed the stability of IVRO in the treatment of mandibular prognathism.

The biomechanical analysis of relative position between implant and alveolar bone: finite element method.

BACKGROUND: The purpose of this study is to analyze biomechanical interactions in the alveolar bone surrounding implants with smaller-diameter abutments by changing position of the fixture-abutment interface, loading direction, and thickness of cortical bone using the finite element method. METHODS: Twenty different finite element models including four types of cortical bone thickness (0.5, 1, 1.5, and 2 mm) and five implant positions relative to bone crest (subcrestal 1, implant shoulder 1 mm below bone crest; subcrestal 0.5, implant shoulder 0.5 mm below bone crest; at crestal implant shoulder even with bone crest; supracrestal 0.5, implant shoulder 0.5 mm above bone crest; and supracrestal 1, implant shoulder 1 mm above bone crest) were analyzed. All models were simulated under two different loading angles (0 and 45 degrees) relative to the long axis of the implant, respectively. The three factors of implant position, loading type, and thickness of cortical bone were computed for all models. RESULTS: The results revealed that loading type and implant position were the main factors affecting the stress distribution in bone. The stress values of implants in the supracrestal 1 position were higher than all other implant positions. Additionally, compared with models under axial load, the stress values of models under off-axis load increased significantly. CONCLUSIONS: Both loading type and implant position were crucial for stress distribution in bone. The supracrestal 1 implant position may not be ideal to avoid overloading the alveolar bone surrounding implants.

Pain perception during miniplate-assisted orthodontic therapy.

Miniplate and screw devices are widely used for fracture repair and fixation of osteotomies. Currently, these miniplate systems are being used as orthodontic treatments for skeletal anchorage. However, despite the widespread use of these treatments, patients are apprehensive when they need to undergo miniplate procedures. Recently, we assessed pain perception using the visual analog scale (VAS) score (0-100 mm) in patients who had undergone miniplate procedures. Thirty miniplates were positioned in the maxilla as skeletal anchors for orthodontic treatment. On the first day after insertion of the fixed orthodontic appliances, the mean VAS score was 36.3 mm. The mean VAS score at 24 hours after insertion of the miniplate was 58 mm. Three months after orthodontic force was applied to the miniplate, the mean VAS scores during eating and speaking gradually decreased to 20 mm and 15 mm, respectively. The mean VAS score at 24 hours after removal of the miniplate was 41.3 mm. Three months after removal of the skeletal anchors, the VAS score decreased to 5 mm. Eighty-eight percent of patients stated that they would be prepared to undergo these new and more efficient treatment modalities in the future. The miniplate system was successfully used in this study as a skeletal anchor, and the patients could endure the pain and discomfort of this orthodontic treatment.

Method of retention control for compromised periodontal bone support abutment of conical crown retained denture.

Conical crown-retained dentures (CCRD) show a higher survival rate and greater patient satisfaction than transitional removable partial dentures during long-term follow-up. However, unsustainable denture retention force on supporting abutments after initial delivery and loss retention are frequently seen in long-term follow-up of clinical cases. The main causes are insufficient information concerning denture retention designs and the retention-tolerance of the supporting abutments. Monitoring by dental technicians of the quality of dental prostheses is critical. This case report describes an optimal method for CCRD construction that determines and distributes an optimal denture retention force on the supporting abutments to allow the patient to easily remove the denture while ensuring that the CCRD remains in place during physiologic activities. Oral rehabilitation with CCRD should consider the condition of the abutment periodontal support, the interarch occlusal relationship, supplemental fatigue of the terminal abutment, and patient's estimated bite force. The effects of friction on the abutment's inner crown were based on an optimal a angle. The dental laboratory used these measurements to fabricate a CCRD using a Koni-Meter to adjust the retention of the inner crown. This method protects the abutments and reduces the wear between the inner and outer crowns. The CCRD achieved good esthetic results and physiologic functions. Periodic long-term follow-up of the patient and CCRD after initial placement is recommended.

Bone stress analysis of various angulations of mesiodistal implants with splinted crowns in the posterior mandible: a three-dimensional finite element study.

PURPOSE: Ideally, implants for dental prostheses should be placed parallel to each other. However, anatomic limitations sometimes make nonparallel implants necessary. The purpose of this study was to determine the bone stresses on implants tilted at various angles and to determine what arrangements might carry a higher risk of failure. MATERIALS AND METHODS: Three-dimensional finite element models were constructed using the mean values measured for the Asian mandible in the first and second molar areas. Eight implants were divided into three tilting types: parallel implants (P1(PP), P2(MM), and P3(DD)), convergent implant apices (C1(PD) and C2(MP)), and divergent implant apices (D1(DP), D2(DM), and D3(PM)). A biting load of 200 N was applied vertically and obliquely on the occlusal central fossa of the splinted crowns. The main effects of each level of the three investigated factors (loading type, relationship of implant apices, and distal tilting of one or both implants) in terms of the stress values were computed for all models. RESULTS: The loading type was the main factor affecting the stress in bone when comparing implant apices and distal tilting of the implant body. When loading was combined with distal tilting, the stress values were significantly increased, especially in models P3(DD) and C1(PD). CONCLUSION: The loading type is the main factor affecting the stress distribution for different implantation arrangement. Moreover, placement of the implants with distal tilting should be avoided in the posterior mandible.

The difference between two oral appliances in treating obstructive sleep apnea: a case report.

Oral appliances are a range of devices that are designed to alter upper airway patency. The efficiency of these appliances for treatment of obstructive sleep apnea (OSA) has been rarely discussed. This case report describes two designs of mandibular repositioning appliances used to treat OSA. A 36-year-old man was diagnosed with mild OSA by his physician. A single-piece, soft oral appliance and a two-piece, acrylic appliance were used in this patient. Polysomnography was performed three times (baseline, and with the single-piece, and two-piece appliances). The apnea/hypopnea index was improved significantly with both appliances, but to a greater degree with the single-piece soft appliance. Our study concluded that oral appliances may assist in the management of OSA.

Effects of compressive residual stress on the morphologic changes of fibroblasts.

Recently, the term tensotaxis was proposed to describe the phenomenon that tensile stress or strain affects cell migration. Even so, less attention has been paid to the effects of compressive stress on cell behavior. In this study, by using an injection-molded method combined with photoelastic technology, we developed residual stress gradient-controlled poly-L-lactide discs. After culturing NIH-3T3 fibroblasts on the stress gradient substrate, the cell distributions for high- and low-stress regions were measured and compared. Our results showed that there were significantly more cells in the low-compressive stress region relative to their high-stress analogs (p < 0.05). In addition, NIH-3T3 fibroblasts in the low-compressive stress region expressed more abundant extensive filopodia. These findings provide greater insight into the interaction between cells and substrates, and could serve as a useful reference for connective tissue development and repair.

Clinical evaluation of semi-adjustable articulators: reproducibility of sagittal condylar path inclination assessed by a jaw-tracking system with six degrees of freedom.

PURPOSE: To validate whether the data for individual patients are correctly reproduced in sagittal condylar path inclination of the articulator, the data obtained by the conventional anterior check bite method and the data obtained by a jaw-tracking system with six degrees of freedom were compared. METHODS: In 5 subjects (4 males and 1 female) with healthy tooth alignments, 5 anterior check bites were obtained from each subject. Sagittal condylar path inclination was measured using seven types of semi-adjustable articulator. Next, the anterior gliding movement was measured 5 times in all 5 subjects using a jaw-tracking system with six degrees of freedom (MMJI- E, Shofu Inc. Kyoto, Japan. The sagittal condylar path inclination data obtained with semi-adjustable articulators were compared to those obtained by the jaw-tracking system using the two-way analysis of variance and Fisher's PLSD method (alpha = 0.05). RESULTS: In measurements of the same subjects for five types of articulators with the check bite method, significant differences were observed by two-way analysis of variance, and differences in measurements among articulators were found (p < 0.01). Regarding the sagittal condylar path inclinations measured with Hanau-184 Wide-View and Dentatus ARL articulators, significant differences were observed on both right and left sides compared with the jaw-tracking system. With the Denar Centri-Check System and Denar Mark II, significant differences were observed on one side (p < 0.05). CONCLUSION: Denar Cadiax Compact, Hanau Condyle Repositioner, and Hanau H2O are recommended for more accurate measurements of the sagittal condylar path inclination.

Stress analysis of different angulations of implant installation: the finite element method.

Clinically, many implant cases with different angulation over the lower posterior area have been found. The purpose of this study was to analyze the bony stress with different implant tilting during normal masticatory load using the finite element method (FEM), with the hope of discovering a desirable installation of implant. A three-dimensional finite element method was employed to analyze the bony stress generated by different angulation designs (15 degrees) of implant bodies. Eight solid models of the mandibular first and second molars were built up and then transferred to a mesh model in FEM (ANSYS) to perform a stress analysis. A simulated load (400 N) was applied to the splinted crowns with vertical and horizontal forces. The loading sites were on the central fossa of the splinted crowns. For stress distribution, some designs will be better than a parallel installation. The results suggested that not all implant bodies tilting with the splinted crowns lead to stress concentration.

Reconstruction of the soft palate in oral cancer to repair an operative defect with speech aid prosthesis: a case report.

A soft palate defect may result from surgical resection, and its consequences could include hypernasal speech and nasal regurgitation of food and liquids. A speech aid prosthesis fabricated for patients can improve nasal emission during speech, and assist in preventing nasal regurgitation of food. This article presents a case of the reconstruction of a soft palate defect by prosthetic obturation.

Connecting rigidities of various precision attachments compared with the conical crown retained telescope.

The purpose of this investigation was to observe the connecting rigidity of various precision attachments and to compare their connecting rigidities with the conical crown retained telescope (CCT). The connecting rigidity of a retainer was assessed using the flexibility test to measure the mesial and distal end displacements. Four precision attachments were analyzed: the dovetail slide attachment beyeler, cylindrical slide attachment, Spang Stabilex and Mini SG. The CCT was used as the control. Although there were many statistically significant differences between the displacements with the various attachments, displacements when vertically loaded were very small: all mesial end displacements were within 3 microm and distal end displacements were 21.4 microm. The largest of the mesial end displacements when horizontally loaded was as large as 44.5 microm (dovetail slide beyeler), while the others were all below 16.5 microm. The same phenomena occurred with the distal end displacements when horizontally loaded: the largest was seen with the dovetail slide beyeler, followed sequentially by the Spang Stabilex, CCT, cylindrical slide, and the Mini SG. The distal displacement with the dovetail slide beyeler was as large as 75.2 microm; those with the others were all below 31.2 microm, with numerous statistically significant differences between the displacements with the various attachments. Thus, connecting rigidities of rigid precision attachments are very similar to CCT, and only the dovetail slide beyeler attachment is too weak to resist horizontal displacement force.