Rehabilitation of a patient with mandibular flexure using contemporary glass-infiltrated high performance CAD-CAM polymers: A clinical report with 1-year follow-up.

Mandibular flexure is a phenomenon generated by the action of the muscles of mastication and other muscles in the head and neck region which can lead to prosthetic and biological complications such as pain, material fracture, and bone loss around dental implants. To avoid such complications, dividing the mandibular prostheses into 3 short-span prostheses or sectioning at the midline has been suggested. This clinical report presents the management of an edentulous patient with clinically detectable mandibular flexure treated with a 1-piece metal-free complete arch implant-supported prosthesis.

The Role of Intraoral Scanners in the Shade Matching Process: A Systematic Review.

PURPOSE: The variation in findings with regards to the accuracy and precision of intraoral scanners for shade selection are no doubt confusing for clinicians who may find it difficult to make evidence-based decisions. The aim of this systematic review is to provide a comprehensive and in-depth assessment of available studies to determine the viability of using intraoral scanners for the purpose of shade matching. The PICO-guided research question is as follows: when shade matching, are intraoral scanners as valid as visual or other digital shade measuring devices in determining tooth colors. METHODS: Electronic databases including PubMed/MEDLINE, SCOPUS, EBSCO, Cochrane, and ProQuest were systematically searched for articles published between January 1, 2011 and December 30, 2021 using the main search terms: "intraoral scanners," "scanners," "TRIOS," "CEREC," "Planmeca," "Medit," "digital dentistry" in concurrence with one of the following keywords: "EasyShade" OR "shade selection" OR "shade matching" OR "shade" OR "tooth color" OR "tooth shade" OR "digital shade matching." Bibliographies of included articles and the following journals were searched for relevant articles: Journal of Prosthetic Dentistry, Journal of Prosthodontics, Journal of Esthetic and Restorative Dentistry, Journal of Advanced Prosthodontics, and Journal of Dentistry. A total of 15 articles were included in the review. RESULTS: Intraoral scanners are highly repeatable for shade matching, and outperformed visual shade matching. Accuracy varied significantly between studies, with the majority recommending the use of visual shade matching to confirm/verify the intraoral scanner results. Setting intraoral scanners to the Vita 3D Master shade guide improved both accuracy and precision. Shade matching with intraoral scanners may be influenced by external factors such as ambient light sources and incorrect use or manipulation. CONCLUSION: Intraoral scanners set to the Vita 3D Master shade guide may be used for shade matching, but shade should be verified with visual shade matching. Further studies are required to address limitations of current studies.

Strength of titanium-zirconium alloy implants with a conical connection after implantoplasty.

STATEMENT OF PROBLEM: Peri-implantitis occurs around dental implants, and implantoplasty has been used to address this ongoing disease; however, the changes to the physical properties of an implant after implantoplasty have not been well documented. PURPOSE: The purpose of this in vitro study was to determine the effect of implantoplasty on fracture strength and the load required for plastic deformation after cyclic fatigue on dental implants. MATERIAL AND METHODS: Twenty-six titanium/zirconium (TiZr) alloy implants (Roxolid Bone Level Implant; 4.1×10 mm) were embedded with 50% thread exposure and divided into 4 groups based on whether they had implantoplasty treatment by using different diamond rotary instruments and/or cyclic loading at 250 N for 2 million cycles: C0 (control, no cyclic loading), T0 (test, no cyclic loading), CM (control, cyclic loading), and TM (test, cyclic loading). After implantoplasty and/or cyclic loading, all implants underwent a load-to-failure test. The maximum fracture strength (FS) and load required for the onset of plastic deformation (PD) were recorded in Newtons. One-way ANOVA and nonparametric comparisons with control by using the Dunn and Wilcoxon method for joint ranking were used for statistical analysis. RESULTS: The mean ±standard deviation FS for C0, CM, T0, and TM was 1465.2 ±86.4 N, 1480.7 ±64.1 N, 1299.3 ±123.8 N, and 1252.1 ±85.7 N, respectively. The mean ±standard deviation load for onset of PD for C0, CM, T0, and TM was 860.2 ±88.1 N, 797.0 ±130.5 N, 776.5 ±181.8 N, and 631.3 ±84.5 N, respectively. The TM group had a significantly lower FS and PD than the C0, CM, and T0 groups (P<.05) CONCLUSIONS: Both fracture strength (FS) and the onset of plastic deformation (PD) were significantly reduced after a TiZr alloy implant received implantoplasty and cyclic loading.

Comparison of Post Space Volume Changes Following Fiber Post Removal Using Er,Cr:YSGG Laser Versus Ultrasonic Instrument.

PURPOSE: The purpose of this in vitro study was to compare the post space volume changes following removal of glass fiber posts in endodontically treated teeth by using erbium, chromium:yttrium-scandium-gallium-garnet (Er,Cr:YSGG) laser to the conventional ultrasonic method. MATERIALS AND METHODS: Twelve single-root human extracted teeth were cut into 13 mm near cementoenamel junction (CEJ), and then underwent endodontic treatment. The post spaces were prepared to 8 mm in length. Glass fiber posts were inserted with self-curing resin cement. Specimens were randomly assigned to laser or ultrasonic methods for their post removal. Post space volumes were measured using microcomputed tomography (micro-CT) before post cementation and after post removal. Dentin thickness was measured after post removal at coronal, middle, and apical third of the root canal space. Paired t-test and t-test were used to compare space volumes between before post cementation and after post removal, and between laser and ultrasonic groups, respectively. RESULTS: Six specimens were tested for each group. The average volume change was 6.499 mm3 in laser and 7.418 mm3 in ultrasonic method. There was not a significant difference between laser and ultrasonic group in respect of post space volume changes (p = 0.71). Both methods showed significant volume increase following post removal (p < 0.05). Significantly less dentin was lost when laser was used for post removal in the coronal portion of the post space (p = 0.002). CONCLUSIONS: Er,Cr:YSGG laser can be used as effective option, comparable to the conventional ultrasonic method when removing posts in endodontically treated teeth. Laser has the potential to provide conservative post removal.

Evaluation of clinical parameters for the stability of 2 types of miniscrews.

INTRODUCTION: The purpose of this research was to compare insertion techniques and effects on mechanical and clinical parameters between 2 types of miniscrews. METHODS: Forty-four consecutive patients whose orthodontic treatment involved the use of miniscrews (miniscrew A [MA] and miniscrew B [MB]) for anchorage were included in this study. Miniscrews were placed with predrilling or self-drilling; peak maximum insertion torque (MIT) and Periotest values were measured. Cone-beam computed tomography was performed after the insertion of miniscrews and root proximity determination; cortical bone thickness was also analyzed. Periotest values were measured after the application of orthodontic force. RESULTS: Self-drilling produced higher Periotest values (P <0.01) for MA and higher MIT (P <0.01) for MB with closer root proximity (P <0.05). MB had higher MIT and Periotest values with drilling compared with MA (P <0.05); MB also showed closer root proximity (P <0.05). Successful miniscrews had lower MIT (P <0.05) for MB and lower Periotest values (P <0.01) for both MA and MB, with significantly more distant root proximity (P <0.01). Self-drilling produced higher Periotest values at the time of placement (P <0.01) and after 4 weeks (P <0.05) in MA. Drilling produced higher Periotest values for MB at the time of placement (P <0.05). MIT had positive correlations with Periotest values for MB with self-drilling (P <0.01) and with root proximity for MA with drilling (P <0.01). Periotest values had negative correlations with root proximity for MA and the MB group with drilling (P <0.01). CONCLUSIONS: For miniscrews with larger diameters, higher MIT may result in more mobility (higher Periotest values). Drilling can avoid root contact and enhance primary stability, thus producing lower Periotest values.

Multiscale characterization of ovariectomized rat femur.

Estrogen deficiency activates bone resorbing cells (osteoclasts) and to a lesser extent bone forming cells (osteoblasts), resulting in a gap between resorption and formation that leads to a net loss of bone. These cell activities alter bone architecture and tissue composition. Thus, the objective of this study is to examine whether multiscale (10-2 to 10-7 m) characterization can provide more integrated information to understand the effects of estrogen deficiency on the fracture risk of bone. This is the first study to examine the effects of estrogen deficiency on multiscale characteristics of the same bone specimen. Sprague-Dawley female rats (6 months old) were obtained for a bilateral ovariectomy (OVX) or a sham operation (sham). Micro-computed tomography of rat femurs provided bone volumetric, mineral density, and morphological parameters. Dynamic mechanical analysis, static elastic and fracture mechanical testing, and nanoindentation were also performed using the same femur. As expected, the current findings indicate that OVX reduces bone quantity (mass and bone mineral density) and quality (morphology, and fracture displacement). Additionally, they demonstrated reductions in amount and heterogeneity of tissue mineral density (TMD) and viscoelastic properties. The current results validate that multiscale characterization for the same bone specimen can provide more comprehensive insights to understand how the bone components contributed to mechanical behavior at different scales.

Prosthodontic Resident Selection by Postdoctoral Dental Matching Program: A National Survey by Participating Program Director.

PURPOSE: The purpose of this study was to obtain information about the resident selection and Match process that occurred for the Commission on Dental Accreditation (CODA)-accredited Advanced Education in Prosthodontics program in North America from the program directors' perspective, after the first year of implementation. MATERIALS AND METHODS: The list of Advanced Education in Prosthodontics program in CODA-accredited North American institutions was obtained from the ACP central office, and the directors of each program were identified. The surveys were distributed to 48 program directors online and results were compiled. RESULTS: Out of 48 programs, 43 directors responded to and completed the survey (90.0%), where 35 programs participated in the Match process, 5 did not, and 3 were omitted due to incomplete surveys. While the majority of programs did not see any changes in their applicant pool or their quality, 10 programs (25.0%) observed a number of increases in the application and 13 programs (32.5%) observed an increase in the quality of the applications. Among the 35 programs that participated in the Match process, the main reasons for their participation were "fairness" (48.2%), "did not want to keep moving up interview dates" (23.2%), and "have applicants come to interview as planned" (21.4%). Thirty-three programs reported that 75% to 100% of the invited applicants came to the interview (76.7%). The majority of programs that participated in Match expressed satisfaction with the process (29/33, 80.6%). Sixteen programs (45.7%) reported that they matched with 100% of their first selections. CONCLUSION: Overall response of reintroduction of the Match process for advanced prosthodontic resident selection was very positive for majority of the program directors.

Mechanical and clinical evaluation of the effect of microscrew on root proximity and cortical bone thickness.

BACKGROUND/OBJECTIVES: Primary stability is required for successful use of microscrew. This study investigated correlations among biomechanical, morphological, and clinical values in relationship to root contact and different placement locations. MATERIALS/METHODS: Thirty-three microscrews were placed between the molars (n = 18) or in the body of the mandible (n = 15) in three pigs. Insertion torque, Periotest, resonance frequency analysis (RFA), and static and dynamic stiffness were measured. Cone beam computed tomography was performed before and after the insertion of microscrews. Interproximal microscrews were divided into root contacted microscrews (n = 9) and non-root contact microscrews (n = 9). Factorial analysis of variance was conducted, with significance set at P < 0.05. RESULTS: A significant difference was observed between bodily and root contacted microscrews in Periotest, RFA, static and dynamic stiffness, Tanδ, and bone density (RFA, P = 0.045; all others, P < 0.001). A significant difference was observed between bodily and non-root contact microscrews in Periotest, RFA, and bone density (RFA, P = 0.025; all others, P < 0.001). A significant difference was observed in static (P = 0.01) and dynamic (P = 0.038) stiffness between microscrews with and without contact. Dynamic stiffness (P = 0.02) and Tanδ (P = 0.03) showed significant correlations with Periotest results only in bodily microscrews. LIMITATIONS: Since a pig bone was used, some differences in the quality and quantity of the bone might be observed between humans. CONCLUSIONS/IMPLICATIONS: Stiffness values distinguished between microscrews with and without contact. Periotest and RFA results indicated that bodily microscrews were more stable than interproximal microscrews. Periotest and RFA may be useful with large, microscrews and/or in thick cortical bone, but further investigation is required to determine the stability of interproximal microscrews.

The behavior of a zirconia or metal abutment on the implant-abutment interface during cyclic loading.

STATEMENT OF PROBLEM: The effect of different abutment materials on the misfit and stability of the implant-abutment assembly under cyclic loading is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the initial misfit, final misfit, and wear of external hexagon zirconia and metal implant abutments upon cyclic loading. MATERIAL AND METHODS: Forty 4.1-mm regular platform external connection implants were divided into 4 groups with 10 specimens in each group. The prosthetic abutments tested included Completely cast group (CC) (antirotational, castable burnout, custom abutment completely cast in nickel-chromium-titanium), Overcast group (OC) (Co-Cr premachined, antirotational, custom burnout abutment cast in nickel-chromium-titanium), Zirkonzahn group (Z) (antirotational castable, custom Y-TZP abutment produced; Zirkonzahn Prettau), and Neodent group (N) (antirotational castable, custom Y-TZP abutment; Neoshape). Abutments were fixed to the implants with 20-Ncm torque, and all specimens were cyclically loaded at 300 N with 9 Hz for 1 million cycles. The misfit on the implant-abutment interface was evaluated before and after cyclic loading by using an optical linear measuring microscope. Then, the wear of the external hexagon was analyzed by scanning electron microscopy (SEM) at a magnification of ×120. For a statistical analysis, a 1-way ANOVA was used for wear values. The data for the gaps were analyzed with a 2-way ANOVA. Any significant differences were resolved by using the Tukey HSD test (α=.05). RESULTS: The CC (37 ±8 µm) and OC (35 ±5 µm) groups showed significantly larger initial misfit than the Z (4 ±5 µm) and the N (2 ±4 µm) groups (P<.05). After the mechanical cyclic loading, a statistically significant difference was found between the CC group (58 ±9 µm) and the other 3 groups (P<.05). The OC group (41 ±4 µm) showed significantly larger final misfit than the Z (19 ±7 µm) and the N groups (20 ±4 µm) (P<.05). Despite significantly increased misfit in all groups (P<.05), the OC group showed significantly less increased gap (6 µm) than the Z (15 µm) and the N (18 µm) groups, while CC showed the most increase in misfit (21 µm). Conversely, N (1313 ±315 µm2) and Z (735 ±126 µm2) groups showed significantly higher wear rate on the hexagon of external implants. The CC (231 ±182 µm2) and OC (201 ±125 µm2) groups were not statistically different. CONCLUSIONS: Different materials and fabrication techniques resulted in different levels of misfit at the implant-abutment interface. The mechanical cyclic loading aggravated the misfit, regardless of material or fabrication technique. In addition, the difference in the hardness of the abutment materials may lead to different levels of wear on the external hexagon. Zirconia abutments had increased wear and misfit. Premachined, antirotational, castable custom dental implant abutments had the least amount of change in misfit, which may indicate long-term stability at the implant-abutment interface.

Stereographic analog application in implant-supported complete rehabilitation: A dental technique.

This article describes the application of stereographic analogs in complete mouth rehabilitation with implant-supported prostheses. The interarch restorative space and immobile support provided by dental implants allow the fabrication of a recording apparatus for the analysis of mandibular movement. An implant-supported fixed detachable recording apparatus was fabricated, and a stereographic tracing made to reproduce the patient's mandibular border movements.

Evaluations of miniscrew type-dependent mechanical stability.

BACKGROUND: Miniscrew has been widely used as an absolute anchorage in orthodontic treatment. Types of miniscrew with different diameter, length, shape, and thread dimensions may have a substantial effect on mechanical stability of the miniscrew system. Thus, the objective of this study was to evaluate miniscrew type-dependent mechanical stability to assess mechanical properties of miniscrew systems in various thickness of artificial bone block using different measurement tools. METHODS: Two types of miniscrews (15 Tomas and 15 AbsoAnchor) were placed in artificial bone block with different thickness of 1.5, 2.0, 3.0 mm. Values of maximum insertion torque, removal torque, Periotest, implant stability quotient, static stiffness, dynamic stiffness, and energy dissipation ability were assessed for each miniscrew system. FINDINGS: The maximum insertion torque, removal torque, implant stability quotient, static and dynamic stiffness values significantly increased when the miniscrews were placed in thicker bone block while Periotest values decreased. The static stiffness, Periotest and implant stability quotient values were significantly correlated each other and also with other mechanical properties (p < 0.001) except tan δ (p > 0.35). However, the slopes of some correlations and absolute values of measurement were significantly different dependent on the miniscrew types (p < 0.025). INTERPRETATION: The current findings suggest that miniscrew type-dependent calibrations are required to estimate mechanical stability of the miniscrew systems despite the utilization of same measurement tool.

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

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