Influence of Multiple Sterilization on Performance of Titanium Pegs When Measuring Implant Stability With Resonance Frequency Analyses.

This in vitro study was conducted to investigate the repeatability of the implant stability quotients (ISQ) measured with multipegs after numerous sterilizations and to detect the exact time when the readings start to deviate. Multipegs were sterilized with 3 different methods (autoclaved, autoclaved + ultrasonic cleaner, chemical disinfection + autoclaved) and grouped according to the method applied. All specimens were put into the autoclave with sealed packages every time they were sterilized. Each specimen was sterilized 50 times according to the technique described in its group after an ISQ measurement was performed. Results of the 2-way analysis of variance showed that neither the sterilization method nor the cycles, nor their interaction, were statistically significant. A multipeg may be reused multiple times after sterilization procedures and may be more cost-effective than a disposable smartpeg for checking implant stability after confirming these results in further investigations.

Reliability and validity of the Turkish version of oral health impact profile for edentulous subjects.

PURPOSE: The validated translations of the OHIP-EDENT exist in different languages; however, there is no reliable and validated Turkish translation. The present study was conducted to evaluate the reliability and to validate the Oral Health Impact Profile in edentulous subjects translated to Turkish (OHIP-EDENT-T). MATERIALS AND METHODS: The study sample included 104 conventional complete denture wearers (58 women and 46 men, mean age: 61.13 ± 9.43 years). The original English version of OHIPEDENT was translated into Turkish using a forward-backward method and applied to the subjects. The reliability of the OHIP-EDENT-T was evaluated using internal consistency and the test-retest method. Validity was determined as construct and convergent validity. The construct validity of OHIP-EDENT-T was assessed using exploratory and confirmatory factor analysis. RESULTS: The Cronbach's alpha value for OHIP-EDENT-T was 0.890. The intraclass correlation coefficient (ICC) was 0.749 for the OHIP-EDENT-T total score, and ICCs for the subscales ranged from 0.630 (95% CI = 0.501-0.823) to 0.859 (95% CI = 0.531-0.897), indicating good to excellent agreement. The Kaiser-Meyer-Olkin value for sampling adequacy was 0.820 and results of Bartlett's sphericity test indicated statistical significance (χ2=1139.767; df=171, p=0.001). This showed that factorial analysis could be applied to the data set. The three-factor structure of the scale explained 81.1% of the observed variance. The agreement of the three-factor solution was further tested with confirmatory factor analysis, and the fit index was found to be acceptable (chi-square fit test=1.449, RMSEA=0.040, GFI=0.94, CFI=0.93). CONCLUSION: Within the limitations of this study, it can be concluded that OHIP-EDENT-T is a valid and reliable instrument for evaluating the quality of life of edentulous patients.

Initial Stability Measurements of Implants Using a New Magnetic Resonance Frequency Analyzer With Titanium Transducers: An Ex Vivo Study.

The establishment of dental implant stability is mandatory for successful osseointegration. Resonance frequency analysis (RFA) is the most frequently used method for the clinical measurement of implant stability. The purpose of the present study was to evaluate the reliability of the recently developed RF analyzer Penguin RFA and to compare it with the traditional RF analyzer Osstell ISQ. Sixty implants were inserted into fresh steer vertebrae and pelvis. Implant stability was measured using Penguin RFA by its transducers (multipegs) and Osstell ISQ by its transducers (smartpegs). Additionally, stability was measured by multipegs with Osstell ISQ and by smartpegs with Penguin RFA. The intraobserver and interobserver reliability of Penguin RFA were estimated by the intraclass coefficient (ICC). Mean implant stability quotients (ISQs) measured with Osstell ISQ were higher than the ISQs measured with Penguin RFA (P < .05). The intra- and interobserver reliability of Penguin RFA were considered as excellent (ICC > 0.7). For Osstell ISQ, no significance in ISQs was detected between the readings by smartpegs and multipegs (P > .05), while for Penguin RFA ISQs by smartpegs were significantly higher than the ISQs by multipegs (P <.05). The recently developed Penguin RFA is reliable and can be used in clinical practice for the measurement of dental implant stability regardless of the bone type. The multipegs originally manufactured for the Penguin RFA is also compatible with Osstell ISQ.

A Comparison of the Color Stability of Conventional and CAD/CAM Polymethyl Methacrylate Denture Base Materials.

OBJECTIVE: The aim of this study was to evaluate the color stability of a heat polymerized resin, an auto-polymerizing resin, a urethane dimethacrylate resin and a CAD/CAM PMMA block resin stored in different storage media. MATERIALS AND METHODS: 60 disc-shaped specimens (15×2 mm) were fabricated for each group. A total of 240 disc-shaped specimens were thermal-cycled for 5,000 cycles. Then specimens were randomized into 4 groups (n= 15) according to storage media: coffee, coke, red wine and distilled water (control group). The color measurement of each sample was performed using a spectrophotometer before and after storage (after 7 and 30 days), and color changes (ΔE) were calculated. RESULTS: All the denture base materials demonstrated dissimilar color changes after stored in the different storage media in both evaluation stages. In all storage media, CAD-CAM denture base resins showed the minimum in color change. In all denture base resins, red wine showed a higher degree of color change than coke or coffee. CONCLUSION: The color stability of CAD-CAM denture base resins is better than any of the other kind of denture base resins. The color change values of all groups except Eclypse stored in red wine had clinically detectable values.

Is clinical experience important for obtaining the primary stability of dental implants with aggressive threads? An ex vivo study

Background: The aim of this study was to investigate the clinicians' experience on maintaining the primary stability of implants with aggressive threads belonging to a novel dental implant system. Material and Methods: Three hundred implants with aggressive threads were inserted in fresh bovine ribs mimicking Type IV bone by five clinicians which were classified according to their previous experience of total number of implant insertion. An independent examiner measured the primary stability of all implants after insertion by using resonance frequency analysis (RFA), electronic percussive testing (EPT) and removal torque methods. Results: No significant differences were detected between the stability values measured by the clinicians (p> 0.05) except the Periotest values (PTVs) of the non-experienced clinician. PTVs of the non-experienced clinician were significantly higher than the PTVs of the expert and good clinicians (p<0.05). Significantly higher stability values were detected in the secondary insertion of the non-experienced clinician as compared to her initial insertion values (p<0.05). No significant differences were detected between the first and second measurements of the other clinicians (p> 0.05). Conclusions: Within the limitations of this ex-vivo study, it may be concluded that experience does not play an important role in maintaining the stability of implants with aggressive threads

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The Influence of Implant Shape on Primary Stability of Implants With a Thread Cutting and Forming Design: An Ex Vivo Study.

The design of an implant has a great effect on primary stability. The purpose of this study was to determine the differences in primary stability between straight and tapered Neoss ProActive implants in type I and type III bones using resonance frequency analysis (RFA) and electronic percussive testing (EPT) methods. Fresh cow vertebrae and pelvis were used as models of type III and type i bone, respectively. Implants of 2 different designs-straight and tapered Neoss ProActive implants with a thread cutting and forming (TCF) design, both 3.5-mm wide and 11-mm long-were placed in both types of bone (n = 60). The primary stability of all implants was measured by an experienced clinician blinded to the study protocol using the EPT and RFA devices. No statistically significant difference was found between the implant stability quotients and the percussive test values of straight and tapered implants in either bone type. Within the limitations of this ex vivo study, it may be concluded that the shape of an implant with a TCF design does not affect primary stability.

The behavior of polyetheretherketone healing abutments when measuring implant stability with electronic percussive testing.

BACKGROUND: It is unknown whether it is possible to measure implant stability with polyetheretherketone (PEEK) healing abutments using electronic percussive testing (EPT). PURPOSE: To investigate the reliability of the percussive test values (PTVs) measured with PEEK healing abutments and to compare them with the PTVs measured with titanium healing abutments. MATERIAL AND METHODS: Thirty dental implants were inserted into the fresh pelvis belonging to a cow. Titanium healing abutments (2 and 5 mm), PEEK healing abutments (5 mm), and prepable standard titanium abutments (5 mm) were screwed to the implants, respectively, and PTVs were measured by two examiners using a wireless EPT device. Differences in PTVs between different dental implant components were evaluated using Friedman's test with post hoc Wilcoxon signed-rank test and Bonferroni correction. Inter and intra-observer reliabilities were detected using interclass correlation coefficients (ICCs) RESULTS: The mean PTVs obtained using the PEEK healing abutments were significantly higher than the mean PTVs obtained using the other abutments for both examiners (P < .01). The ICCs for intra-observer reliability were detected as poor for PEEK healing abutments; and excellent for the other abutment types for both examiners. The ICCs for the inter-observer reliability between the two examiners were poor (0.25) for PEEK healing abutments, and excellent for the 2 and 5 mm titanium healing abutments and for standard abutments (0.82, 0.84 and 0.93, respectively). CONCLUSION: Within the limitations of this in vitro study, it may be concluded that EPT measurements should be avoided using PEEK healing abutments because of the poor reliability.

Effect of Over-the-Counter Topical Agents on Denture-Induced Traumatic Lesions: A Clinical Study.

PURPOSE: To investigate the effects of over-the-counter products on the healing of denture-induced ulcerations and patients' self-reported pain. MATERIALS AND METHODS: A total of 140 patients with acute denture-induced ulcerations were randomized into seven treatment groups: denture grinding (control); topical application of corn oil gel (placebo); triester glycerol oxide gel; D-panthenol gel; D-panthenol mouthwash; L-arginine mouthwash; and hyaluronic acid gel. Healing and self-reported pain were assessed after 1, 3, and 7 days of treatment. RESULTS: The percentage of healed lesions in the mandible and maxilla after 7 days was 67% and 65%, respectively. The only significance in healing was for mandibular lesions at 3 days after application of L-arginine mouthwash; at this period, the healing rate was significantly higher than d-panthenol gel, d-panthenol mouthwash, and hyaluronic acid gel (P < .05). CONCLUSION: Denture grinding as the current protocol for acute denture-induced ulcerations should remain as the default.

Distal extension mandibular removable partial denture with implant support.

This case report describes the fabrication of a distal extension removable partial denture (RPD) of a 65-year-old man with implant support. Loss of fibroelasticity of the peripheral tissues and reduced mandibular vestibular sulcular depth due to a previous surgical resection and radiotherapy at the right side were the main clinical factors that created difficulty for denture retention and stability. The fabrication of a mandibular RPD supported by anterior teeth and two bilaterally placed implants in the molar area to convert from Kennedy Class 1 design to Kennedy Class 3 implant-bounded RPD is reported. Retention and stability of the denture were improved with implant support on the distal extension site of the RPD. The common clinical problems about distally extended RPDs are lack of retention and stability due to the movement around the rotational axis. Dental implant placement to the distal edentulous site minimizes the potential dislodgement of the RPD is popular. Implant-supported RPD can be suggested as an advantageous and cost-effective treatment option for the partially edentulous patients.

Comparison of the Primary Stability of Two Implant Designs in Two Different Bone Types: An In Vitro Study.

PURPOSE: Achievement of primary stability upon surgical placement of dental implants is a key factor for successful osseointegration and depends mainly on implant-related factors. The aim of this study was to compare and assess the primary stability of implants with active and regular threads in type 2 as well as type 4 bone. MATERIALS AND METHODS: Fresh cow vertebrae and a pelvis were used as models of type 4 bone and type 2 bone, respectively. Implants with two different designs-regular-threaded and active-threaded-both 4.3 mm wide and 13 mm long, were placed in both types of bone (n = 80). Stability measurements were completed by four prosthodontists using two different Periotest devices and resonance frequency analysis. Statistical analyses were performed with the Mann-Whitney U test. RESULTS: No statistically significant differences were found between the implant types in either type of bone in the stability measured with different methods. For both implant types, the mean resonance frequency values in type 2 bone were statistically significantly higher than in type 4 bone, whereas the mean Periotest values in type 2 bone were statistically significantly lower than in type 4 bone. CONCLUSION: Within the limitations of this in vitro study in bone types 2 and 4, the active-threaded implant, which was invented to increase primary stability, did not show higher primary stability compared to a regular-threaded implant.

Determination of the Optimum Torque to Tighten the Smartpegs of Magnetic Resonance Frequency Analyses Devices: An Ex Vivo Study.

The aim of this study was to find an optimal value for tightening the Smartpegs for magnetic radiofrequency analysis devices (RFAs) devices. Thirty implants were placed in 3 cow ribs. The RFA value of each implant was measured in buccal and mesial directions after tightening the Smartpegs with 1, 3, 4, 8, 9, 10, and 11 Ncm. Additionally, 4 different examiners measured the RFA after hand tightening the Smartpegs, and the results were compared. The buccal implant stability quotient (ISQ) values when the Smartpegs were tightened to 1Ncm were significantly lower than the ISQ values when the Smartpegs were tightened to 3, 4, 8, 9, 10, and 11 Ncm (P < .05). The mesial ISQ values when the Smartpegs were tightened to 1, 3, and 4 Ncm were significantly lower than the ISQ values when the Smartpegs were tightened with higher torque values (P < .05). The buccal measurements made by 1 examiner was significantly lower than 3 Ncm (P < .05), and the buccal measurements made by 1 examiner was significantly lower than 4 Ncm (P < .05). The mesial ISQ values measured by 2 examiners were significantly lower than 3 Ncm (P < .05), and the mesial ISQ values measured by the other 2 examiners were significantly lower than 8 Ncm (P < .05). The tightening of the Smartpegs should be standardized by the manufacturer to a range of 5-8 Ncm in order to gain reliable objective RFA values, instead of leaving it to subjective finger pressure.

The Evaluation of the Reliability of Periotest for Implant Stability Measurements: An In Vitro Study.

Periotest (Medizintechnik Gulden, Modautal, Germany) is a widely accepted implant stability measurement method, although the reliability is not well known. The aim of this in vitro study was to investigate the reliability of the Periotest in implant stability measurements. Thirty implants were placed in 3 cow ribs. The stability of each implant was measured by insertion torque, resonance frequency analyses, and Periotest and then compared. The Periotest values (PTVs) were measured by 4 different examiners. The measurements were repeated twice in both the buccal and mesial directions, for each implant at 2-hour intervals and the intra- and interobserver reliability of Periotest was measured. Results showed that the intraobserver reliability of the Periotest was excellent for the buccal PTVs but fair to poor for the mesial PTVs. The interobserver reliability of the Periotest was excellent for the buccal PTVs but poor for the mesial PTVs. No significance was found between the PTVs and IT values (P = .803) and PTVs and ISQ values, whereas a 47.1% significant correlation was detected between the IT values and ISQ values (P = .009). The present study indicates that only Periotest measurements from buccal result in excellent intra- and interobserver reliability for the quantification of the implant stability.

Comparative ex vivo evaluation of two electronic percussive testing devices measuring the stability of dental implants.

BACKGROUND: A comparative ex vivo study was performed to determine electronic percussive test values (PTVs) measured by cabled and wireless electronic percussive testing (EPT) devices and to evaluate the intra- and interobserver reliability of the wireless EPT device. METHODS: Forty implants were inserted into the vertebrae and forty into the pelvis of a steer, a safe distance apart. The implants were all 4.3 mm wide and 13 mm long, from the same manufacturer. PTV of each implant was measured by four different examiners, using both EPT devices, and compared. Additionally, the intra- and interobserver reliability of the wireless EPT device was evaluated. RESULTS: Statistically significant differences (P <0.05) were observed between PTVs made by the two EPT devices. PTVs measured by the wireless EPT device were significantly higher than the cabled EPT device (P <0.05), indicating lower implant stability. The intraobserver reliability of the wireless EPT device was evaluated as excellent for the measurements in type II bone and good-to-excellent in type IV bone; interobserver reliability was evaluated as fair-to-good in both bone types. CONCLUSION: The wireless EPT device gives PTVs higher than the cabled EPT device, indicating lower implant stability, and its inter- and intraobserver reliability is good and acceptable.

Evaluation of possible prognostic factors for the success, survival, and failure of dental implants.

PURPOSE: To analyze the prognostic factors that are associated with the success, survival, and failure rates of dental implants. MATERIAL AND METHODS: Data including implant sizes, insertion time, implant location, and prosthetic treatment of 1656 implants have been collected, and the association of these factors with success, survival, and failure of implants was analyzed. RESULTS: The success rate was lower for short and maxillary implants. The failure rate of maxillary implants exceeded that of mandibular implants, and the failure rate of implants that were placed in the maxillary anterior region was significantly higher than other regions. The failure rates of implants that were placed 5 years ago or more were higher than those that were placed later. CONCLUSIONS: Anterior maxilla is more critical for implant loss than other sites. Implants in the anterior mandible show better success compared with other locations, and longer implants show better success rates. The learning curve of the clinician influences survival and success rates of dental implants.

Assessment of demographic and clinical data related to dental implants in a group of Turkish patients treated at a university clinic.

PURPOSE: This retrospective study analyzed the distribution of the dental implants with regards to age and gender of the patients and type of indication for the implant therapy, as well as the location, dimension and type of the implants. MATERIALS AND METHODS: The data of demographics (age and gender), type of indication for implant therapy, anatomical location, dimensions (length and diameter) and type (bone and tissue level) of 1616 implants were recorded from patient charts between January 2000 and January 2010. Descriptive statistics were analyzed using a chi-squared test for demographic parameters, type of indication, tooth position, anatomical location, implant dimensions and type (α=.05). RESULTS: The patient pool comprised of 350 women and 266 men, with a mean age of 52.12 ± 13.79 years. The difference in n% of the implants of the age groups was statistically significant between the types of indications. The difference in the position of the implants was statistically significant between the n% of the implants of all age groups. Gender did not significantly vary, except that the diameter of the implants was significantly higher for the standard diameter implants in males. The difference between the implant positions was statistically significant when considered according to indication. The relationship between implant length and anatomical location was statistically significant. CONCLUSION: The indication for dental implant use is age dependent and the type and size of the implant seems to be strongly related to the location of the implant.

Titanium hypersensitivity. A hidden threat for dental implant patients?

Titanium and its alloys have been widely used for dental prosthetic devices because of their superior mechanical properties and biocompatibility. However, the incidence of titanium hypersensitivity or allergy is still unknown and the discussion about its existence is ongoing. Unexplained implant failures have also forced dental clinicians to investigate the possibility of titanium hypersensitivity or allergy. This review focuses on the potential of dental implant-related titanium hypersensitivity or allergic reactions. It includes an examination of the existing scientific literature and current knowledge. Evidence-based data and studies related to titanium hypersensitivity in dental implant patients are also discussed.

Evaluation of the closest speaking space in different dental and skeletal occlusions.

STATEMENT OF PROBLEM: The closest speaking space (CSS) together with the vertical overlap of anterior teeth during the production of the /s/ sound have not been previously investigated with respect to differences in dental and skeletal orthodontic classifications. PURPOSE: The purpose of this study was to investigate the CSS in dental and skeletal occlusions and to analyze the cause and effect relationship of the CSS and the amount of the vertical overlap of anterior teeth. MATERIAL AND METHODS: Poly vinylsiloxane interocclusal registration material was placed bilaterally onto the occlusal surfaces of premolar and molar teeth of 155 native Turkish speaking adolescent and young adult dentate participants, who were then asked to pronounce the word seyis. The thinnest point between the maxillary and mandibular teeth was recorded in millimeters as the CSS. The occlusion of each participant was classified according to the Angle dental and Steiner skeletal classifications. The differences in CSS values within each classification were statistically analyzed with the Kruskal-Wallis test, and the correlation between the CSS and the vertical overlap was statistically analyzed with the Spearman Rho Correlation tests (P<.05). RESULTS: The differences in the CSS were only significant between Angle Class II division 2 and Class III groups (P=.034), while the differences in the CSS between skeletal classes were not significant. The correlation between the amount of CSS and the amount of vertical overlap was not significant. CONCLUSIONS: The results showed that regardless of dental and skeletal occlusions, average CSS values could be used to determine the occlusal vertical dimension of prosthetic restorations.

Multidisciplinary treatment of non-syndromic oligodontia.

Oligodontia is the agenesis of 6 or more teeth, excluding third molars. The etiology of congenital absence of teeth is believed to be rooted in heredity or developmental anomalies. The absence of teeth in patients can cause aesthetic, functional, and psychological problems, particularly if the anterior region is involved. This case report describes the multidisciplinary treatment approach toward a patient 17 years of age with non-syndromic oligodontia, with absence of 11 permanent teeth. Genetic counseling revealed non-syndromic, autosomal-recessive-linked oligodontia. The objectives of the first phase of therapy were pre-prosthetic orthodontic space opening for proper positioning of the missing teeth and correction of inter-maxillary relations, as a prerequisite for proper prosthetic restoration. The second phase of therapy was prosthetic restoration of the missing teeth and provision of occlusion with full-mouth porcelain fused to metal crowns and bridges after increasing occlusal vertical dimension by 2 mm.

Effect of post-polymerization heat-treatments on degree of conversion, leaching residual MMA and in vitro cytotoxicity of autopolymerizing acrylic repair resin.

OBJECTIVES: This study evaluated the effect of post-polymerization heat-treatments on degree of conversion (DC), residual methyl methacrylate concentration (MMA(r)) and in vitro cytotoxicity of autopolymerizing acrylic repair resin. METHODS: A total of 336 specimens were prepared by bench- and hydroflask-curing and subjected to post-polymerization heat-treatments: a) water immersion at 60°C for 30 min, b) microwaving at 500 W for 3 min, c) combined use of water immersion and microwaving d) no treatment (as control). Specimens were eluted in cell culture medium for 1, 2, 5 and 7 days. DC and MMA(r) in eluates were measured by FTIR spectrometry and HPLC, respectively. In vitro cytotoxicity of eluates on L-929 fibroblasts was determined by XTT assay. Data were statistically analyzed with Dunn's multiple comparison and Pearson correlation tests (p≤0.05). RESULTS: DC was highest (99.9%) in bench- and hydroflask-cured groups which were subjected to water immersion. At all elution periods, MMA(r) was detected in eluates of all treatment groups and were higher in bench-cured groups than hydro-flask cured groups. Cell proliferation values indicated slightly cytotoxic effect throughout 7 days; regardless of the curing method or post-polymerization treatment. The correlation between MMA(r) and cell proliferation was negative after elution of 1, 2, 5 days and was only statistically significant (p<0.05) at 5 days. At elution of 7 days, the correlation was positive with no significance. SIGNIFICANCE: Post-polymerization heat-treatment of autopolymerizing acrylic repair resin by immersion in water at 60°C for 30 min is clinically recommended to improve the DC while reducing the leaching residual MMA.

Effect of leaching residual methyl methacrylate concentrations on in vitro cytotoxicity of heat polymerized denture base acrylic resin processed with different polymerization cycles.

OBJECTIVES: Residual methyl methacrylate (MMA) may leach from the acrylic resin denture bases and have adverse effects on the oral mucosa. This in vitro study evaluated and correlated the effect of the leaching residual MMA concentrations ([MMA]r) on in vitro cytotoxicity of L-929 fibroblasts. MATERIAL AND METHODS: A total of 144 heat-polymerized acrylic resin specimens were fabricated using 4 different polymerization cycles: (1) at 74ºC for 9 h, (2) at 74ºC for 9 h and terminal boiling (at 100ºC) for 30 min, (3) at 74ºC for 9 h and terminal boiling for 3 h, (4) at 74ºC for 30 min and terminal boiling for 30 min. Specimens were eluted in a complete cell culture medium at 37ºC for 1, 2, 5 and 7 days. [MMA]r in eluates was measured using high-performance liquid chromatography. In vitro cytotoxicity of eluates on L-929 fibroblasts was evaluated by means of cell proliferation using a tetrazolium salt XTT (sodium 3´-[1-phenyl-aminocarbonyl)-3,4-tetrazolium]bis(4-methoxy-6-nitro)benzenesulphonic acid) assay. Differences in [MMA]r of eluates and cell proliferation values between polymerization cycles were statistically analyzed by Kruskal-Wallis, Friedman and Dunn's multiple comparison tests. The correlation between [MMA]r of eluates and cell proliferation was analyzed by Pearson's correlation test (p<0.05). RESULTS: [MMA]r was significantly (p<0.001) higher in eluates of specimens polymerized with cycle without terminal boiling after elution of 1 and 2 days. Cell proliferation values for all cycles were significantly (p<0.01) lower in eluates of 1 day than those of 2 days. The correlation between [MMA]r and cell proliferation values was negative after all elution periods, showing significance (p<0.05) for elution of 1 and 2 days. MMA continued to leach from acrylic resin throughout 7 days and leaching concentrations markedly reduced after elution of 1 and 2 days. CONCLUSION: Due to reduction of leaching residual MMA concentrations, use of terminal boiling in the polymerization process for at least 30 min and water storage of the heat-polymerized denture bases for at least 1 to 2 days before denture delivery is clinically recommended for minimizing the residual MMA and possible cytotoxic effects.