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

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

Immediate Loading of Zygomatic Implants Using a Dual Scan Technique.

The immediate loading protocol has become increasingly popular due to the progressive growth in demand for a reduction in treatment times. The possibility of applying this protocol would depend on certain important factors. The application of the digital workflow mentioned in the protocol guarantees rapidity, precision, and esthetics. This report aims to describe a fully digital workflow using a dual scan impression technique to fabricate immediate fixed complete dentures (FCDs) for zygomatic and standard implants. A 58-year-old female patient requested treatment for her severely atrophic maxilla, and four unrehabilitated implants in the mandible. After proper diagnosis and planification, four zygomatic implants and two standard implants were placed. During the surgery, transmucosal abutments were placed on all implants. After suturing, the positions of the implants were recorded using a stereophotogrammetric technique, creating a standard tessellation (STL) file. In the lower arch, the second phase of the surgery was carried out: the transmucosal abutments were placed, and then the implant positions were recorded in the same way. The soft tissues were rescanned after suturing with an intraoral scanner (IOS), and all STL files were aligned to obtain the virtual final models. The pre-design after virtual modifications was aligned with the definitive models. The provisional prostheses were milled and placed after six hours after the surgery, and the definitive prostheses were placed six months after the surgery. The dual scan technique used obtained a precise fit for both the provisional and definitive FCDs. This technique might be an effective and reliable alternative for the fabrication of immediate and definitive screw-retained FCDs in a completely digital workflow. The time taken for scanning and fabrication was reduced, and the clinician's and patient's satisfaction were improved.

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

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

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

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

Luminescent and Magnetic Tb-MOF Flakes Deposited on Silicon.

The synthesis of a terbium-based 2D metal-organic framework (MOF), of formula [Tb(MeCOO)(PhCOO)2] (1), a crystalline material formed by neutral nanosheets held together by Van der Waals interactions, is presented. The material can be easily exfoliated by sonication and deposited onto different substrates. Uniform distributions of Tb-2D MOF flakes onto silicon were obtained by spin-coating. We report the luminescent and magnetic properties of the deposited flakes compared with those of the bulk. Complex 1 is luminescent in the visible and has a sizeable quantum yield of QY = 61% upon excitation at 280 nm. Photoluminescence measurements performed using a micro-Raman set up allowed us to characterize the luminescent spectra of individual flakes on silicon. Magnetization measurements of flakes-on-silicon with the applied magnetic field in-plane and out-of-plane display anisotropy. Ac susceptibility measurements show that 1 in bulk exhibits field-induced slow relaxation of the magnetization through two relaxation paths and the slowest one, with a relaxation time of τlf ≈ 0.5 s, is assigned to a direct process mechanism. The reported exfoliation of lanthanide 2D-MOFs onto substrates is an attractive approach for the development of multifunctional materials and devices for different applications.

A Multifunctional Dysprosium-Carboxylato 2D Metall-Organic Framework.

We report the microwave assisted synthesis of a bidimensional (2D) MOF of formula [Dy(MeCOO)(PhCOO)2 ]n (1) and its magnetically diluted analogue [La0.9 Dy0.1 (MeCOO)(PhCOO)2 ] (1 d). 1 is a 2D material with single-ion-magnet (SIM) behaviour and 1 d is a multifunctional, magnetic and luminescent 2D material. 1 can be exfoliated into stable nanosheets by sonication.

Osseointegration around dental implants biofunctionalized with TGFß-1 inhibitor peptides: an in vivo study in beagle dogs.

The aim of this study was to evaluate the effect of biofunctionalization with two TGF-ß1 inhibitor peptides, P17 and P144, on osseointegration of CP-Ti dental implants. A total of 36 implants (VEGA, Klockner®) with 3.5 × 8 mm internal connection were used in this study, divided in three groups: (1) control group (n = 12), (2) implants which surfaces were biofunctionalized with P17 peptide inhibitor (n = 12), (3) implants with surfaces biofunctionalized by P144 peptide (n = 12). Three implants, one from each group, were inserted in both hemimandibles of 6 beagle dogs, 2 months after tooth extraction. Two animals were sacrificed at 2, 4 and 8 weeks post implant insertion, respectively. The samples were analyzed by Backscattering Scanning Electron Microscopy (BS-SEM) and histological analysis. Histomorphometric analysis of bone to implant contact (BIC), peri-implant bone fraction (BF) and interthread bone (IB) were carried out. Bone formation around implants measured by quantitative analysis, BS-SEM, was significantly higher in the P17-biofunctionalized implants, 4 and 8 weeks after the implantation. Histomorphometric analysis of BIC, BF and IB showed higher values in the P17-biofunctionalized group at initial stages of healing (2 weeks) and early osseointegration both at 4 and 8 weeks. For P144 biofunctionalized implants, the histomorphometric values obtained are also higher than control group. Accordingly, better results in the experimental groups were proven both by the quantitative and the qualitative analysis. Surface biofunctionalization with TGF-ß1 inhibitor peptides, P17 and P144, resulted in better quantitative and qualitative parameters relative to implant osseointegration.

Biofunctionalization with a TGFß-1 Inhibitor Peptide in the Osseointegration of Synthetic Bone Grafts: An In Vivo Study in Beagle Dogs.

OBJECTIVES: The aim of this research was to determine the osseointegration of two presentations of biphasic calcium phosphate (BCP) biomaterial-one untreated and another submitted to biofunctionalization with a TGF-ß1 inhibitor peptide, P144, on dental alveolus. Materials and Methods: A synthetic bone graft was used, namely, (i) Maxresorb® (Botiss Klockner) (n = 12), and (ii) Maxresorb® (Botiss Klockner) biofunctionalized with P144 peptide (n = 12). Both bone grafts were implanted in the two hemimandibles of six beagle dogs in the same surgical time, immediately after tooth extraction. Two dogs were sacrificed 2, 4, and 8 weeks post implant insertion, respectively. The samples were submitted to histomorphometrical and histological analyses. For each sample, we quantified the new bone growth and the new bone formed around the biomaterial's granules. After optical microscopic histological evaluation, selected samples were studied using backscattered scanning electron microscopy (BS-SEM). Results: The biofunctionalization of the biomaterial's granules maintains a stable membranous bone formation throughout the experiment timeline, benefitting from the constant presence of vascular structures in the alveolar space, in a more active manner that in the control samples. Better results in the experimental groups were proven both by quantitative and qualitative analysis. Conclusions: Synthetic bone graft biofunctionalization results in slightly better quantitative parameters of the implant's osseointegration. The qualitative histological and ultramicroscopic analysis shows that biofunctionalization may shorten the healing period of dental biomaterials.

In vitro cell response on CP-Ti surfaces functionalized with TGF-ß1 inhibitory peptides.

Osseointegration of implants is conversely related to the generation of a fibrous tissue capsule around the implant by the host environment. Although TGF-ß1 plays many roles in regeneration processes, it is the cytokine to be mostly associated to the production of fibrotic tissue and thus, its inhibition has demonstrated to be beneficial to prevent several fibrotic reactions. Surface biofunctionalization enables the immobilization of biologically active molecules on an implant surface to tailor the biological response of the host. Here, we studied in vitro biological effects of biofunctionalized CP-Ti surfaces with a TGF-ß1 inhibitor peptide, P144. A reliable biofunctionalization process that tethers P144 peptides to commercially pure titanium was developed. Differentiation of human mesenchymal stem cells, osteoblasts and fibroblasts on P144-functionalized and control surfaces was assessed at the gene expression and protein production levels. Results showed that P144-functionalized surfaces reduced expression and production of fibrotic differentiation markers and increased osteoblastic differentiation markers. Therefore, biofunctionalization of surfaces with TGF-ß1 inhibitor peptides are an alternative promising strategy for inducing osseointegration around medical devices and implants.

Evaluation of bone loss in antibacterial coated dental implants: An experimental study in dogs.

The aim of this study was to evaluate the in vivo effect of antibacterial modified dental implants in the first stages of peri-implantitis. Thirty dental implants were inserted in the mandibular premolar sites of 5 beagle dogs. Sites were randomly assigned to Ti (untreated implants, 10units), Ti_Ag (silver electrodeposition treatment, 10units), and Ti_TSP (silanization treatment, 10units). Coated implants were characterized by scanning electron microscopy, interferometry and X-ray photoelectron spectroscopy. Two months after implant insertion, experimental peri-implantitis was initiated by ligature placement. Ligatures were removed 2months later, and plaque formation was allowed for 2 additional months. Clinical and radiographic analyses were performed during the study. Implant-tissue samples were prepared for micro computed tomography, backscattered scanning electron microscopy, histomorphometric and histological analyses and ion release measurements. X-ray, SEM and histology images showed that vertical bone resorption in treated implants was lower than in the control group (P<0.05). This effect is likely due to the capacity of the treatments to reduce bacteria colonization on the implant surface. Histological analysis suggested an increase of peri-implant bone formation on silanized implants. However, the short post-ligature period was not enough to detect differences in clinical parameters among implant groups. Within the limits of this study, antibacterial surface treatments have a positive effect against bone resorption induced by peri-implantitis.

Surface immobilization and bioactivity of TGF-ß1 inhibitor peptides for bone implant applications.

TGF-ß1 is the most related cytokine with the production of fibrotic tissue. It plays an important role on the production of collagen by fibroblasts and other types of cells. The inhibition of this cytokine reduces fibrosis in various types of tissue. Biofunctionalization of dental and orthopedic implants with biomolecules enables modification of the physical, chemical and biochemical properties of their surfaces to improve its biological and clinical performance. Our objective was to develop a reliable method to immobilize oligopeptides on Ti surfaces to obtain a surface with TGF-ß1 inhibitory activity that will potentially minimize fibrotic encapsulation of implants during the process of osseointegration. We covalently immobilized TGF-ß1 inhibitor P17-peptides on Ti surfaces and assessed by characterizing each step of the process that we successfully biofunctionalized the implant surfaces. High amounts of peptides were anchored and homogeneously distributed on the surfaces with mechanical and thermochemical stability after in vitro simulated challenges. Notably, the immobilized peptides retained their TGF-ß1 inhibitory activity in vitro. Thus, these biofunctional coatings are potential candidates for inducing a fast and reliable osseointegration in vivo.

Anhydride-functional silane immobilized onto titanium surfaces induces osteoblast cell differentiation and reduces bacterial adhesion and biofilm formation.

Bacterial infection in dental implants along with osseointegration failure usually leads to loss of the device. Bioactive molecules with antibacterial properties can be attached to titanium surfaces with anchoring molecules such as silanes, preventing biofilm formation and improving osseointegration. Properties of silanes as molecular binders have been thoroughly studied, but research on the biological effects of these coatings is scarce. The aim of the present study was to determine the in vitro cell response and antibacterial effects of triethoxysilypropyl succinic anhydride (TESPSA) silane anchored on titanium surfaces. X-ray photoelectron spectroscopy confirmed a successful silanization. The silanized surfaces showed no cytotoxic effects. Gene expression analyses of Sarcoma Osteogenic (SaOS-2) osteoblast-like cells cultured on TESPSA silanized surfaces reported a remarkable increase of biochemical markers related to induction of osteoblastic cell differentiation. A manifest decrease of bacterial adhesion and biofilm formation at early stages was observed on treated substrates, while favoring cell adhesion and spreading in bacteria-cell co-cultures. Surfaces treated with TESPSA could enhance a biological sealing on implant surfaces against bacteria colonization of underlying tissues. Furthermore, it can be an effective anchoring platform of biomolecules on titanium surfaces with improved osteoblastic differentiation and antibacterial properties.

Fatigue life of bioactive titanium dental implants treated by means of grit-blasting and thermo-chemical treatment.

OBJECTIVE: This study focuses on the fatigue behavior of titanium dental implants as-received, with a grit-blasted surface and with a new bioactive surface treatment (2Steps). BACKGROUND: The 2Step process consists of (1) an initial grit-blasting process to produce a micro-rough surface, followed by (2) a combined thermo-chemical treatment that produces a potentially bioactive surface, that is, that can form an apatitic layer when exposed to biomimetic conditions in vitro. The 2Step treatment produced micro-rough and apatitic coating implants. METHODS: Residual stresses were determined by means of X-ray diffraction. The fatigue tests were carried out at 37°C on 500 dental implants, and the S-N curve was determined. The fatigue-crack nucleation for the different treatments was analyzed. RESULTS: The fatigue tests show that the grit-blasting process improves the fatigue life. This is a consequence of the layer of compressive residual stresses that the treatment generates in titanium surfaces. Dental implants that had its surfaced prepared with the 2Step procedure (grit-blasting and thermo-chemical treatment) had its fatigue life decreased by 10% due to the incorporation of oxygen to the surface and the relaxation of the compressive residual stress produced by the heat treatment. CONCLUSIONS: Thermo-chemical treatment is an excellent compromise between the improvement of bioactive and mechanical long-life behaviors.

Surface biofunctionalization by covalent co-immobilization of oligopeptides.

Functionalization of implants with multiple bioactivities is desired to obtain surfaces with improved biological and clinical performance. Our objective was developing a simple and reliable method to obtain stable multifunctional coatings incorporating different oligopeptides. We co-immobilized on titanium surface oligopeptides of known cooperative bioactivities with a simple and reliable method. Appropriately designed oligopeptides containing either RGD or PHSRN bioactive sequences were mixed and covalently bonded on CPTES-silanized surfaces. Coatings made of only one of the two investigated peptides and coatings with physisorbed oligopeptides were produced and tested as control groups. We performed thorough characterization of the obtained surfaces after each step of the coating preparation and after mechanically challenging the obtained coatings. Fluorescence labeling of RGD and PHSRN peptides with fluorescence probes of different colors enabled the direct visualization of the co-immobilization of the oligopeptides. We proved that the coatings were mechanically stable. The surfaces with co-immobilized RGD and PHSRN peptides significantly improved osteoblasts response in comparison with control surfaces, which assessed the effectiveness of our coating method to bio-activate the implant surfaces. This same simple method can be used to obtain other multi-functional surfaces by co-immobilizing oligopeptides with different targeted bioactivities--cell recruitment and differentiation, biomineral nucleation, antimicrobial activity--and thus, further improving the clinical performance of titanium implants.

Analysis of tantalum implants used for avascular necrosis of the femoral head: a review of five retrieved specimens.

AIM: The effective results shown in the porous systems of tantalum employed for the use of osseointegrates has been demonstrated by means of animal experimentation. However, there is a total lack of any research studies on the osseointegration of tantalum implants from retrieval of the same after a period of time whereby the material had been implanted within the human body. MATERIALS AND METHODS: For this study, five rod implants used for the treatment of avascular necrosis of the femoral head were retrieved following collapse of the femoral head and conversion to total hip arthroplasty. The time of implantation ranged between six weeks and twenty months. RESULTS: Observation during this study has confirmed the effectiveness of osseointegration within this period of time. New bone was observed around and within the porous system of the on rod devices at retrieval date. The bone ingrowth, however, proved to be slower and less intense than that resulting within animal species during the first few months after implantation. CONCLUSIONS: Nevertheless, the results obtained in the quantitative assessment of this process proved to be similar to those results achieved by other authors in previous experimental work studies.

In vitro evaluation of surface topographic changes and nickel release of lingual orthodontic archwires.

The objective of the article is to study surface topographic changes and nickel release in lingual orthodontic archwires in vitro. Stainless steel (SS), nickel-titanium (NiTi) and copper-nickel-titanium (CuNiTi) lingual orthodontic archwires were studied using atomic absorption spectrometry for nickel release after immersion in a saline solution. Surface roughness changes were measured using atomic force microscopy. Differences between groups were analyzed using independent sample t-tests. Statistically significant changes in roughness were seen in all archwires except NiTi. Surface changes were most severe in the CuNiTi alloy. SS archwires released the highest amount of nickel. In conclusion, only roughness changes in CuNiTi archwires seemed to be clinically significant. The amount of nickel released for all archwires tested is below the levels known to cause cell damage.

[Osteointegration of porous tantalum stems implanted in avascular necrosis of the hip]. / Osteointegración de vástagos de tantalio poroso implantados en necrosis avasculares de la cadera.

Efficacy of osteointegration of tantalum porous systems has been demonstrated through animal experimentation. However, there is a lack of studies that evaluate osteointegration of implants retrieved after a period of implantation in humans. For this study, eight rod implants used for the treatment of avascular necrosis of the femoral head were retrieved following collapse of the femoral head and conversion to total hip arthroplasty. The time of implantation ranged between six weeks and twenty three months. Observation during this study has confirmed effectiveness of osseointegration within this period of time. New bone was observed around and within the porous system of the on rod devices at retrieval date. Bone in growth however, proved to be of a slower and less intense degree than that resulting within animal species during first months after implantation. Nevertheless, the results obtained in the quantitative evaluation of this process proved to be similar to those results achieved by other authors in previous experimental studies.

Aging of retrieved zirconia femoral heads.

Yttria-stabilized tetragonal zirconia may undergo extensive transformation to the monoclinic phase under mechanical and/or hydrothermal stress, with degradation of mechanical and tribologic properties. We hypothesized progressive phase transformation of zirconia in service in vivo is directly related to the time of implantation and to patient-related factors. The subsequent decrease in fracture toughness and increase in surface roughness and wear are related to the increased monoclinic content. We performed a study on 47 yttria-stabilized tetragonal zirconia femoral heads retrieved from failed total hip arthroplasties after 2 to 10 years implantation. Age, weight, and activity of the patients were retrieved from clinical records. Monoclinic content, fracture toughness, surface roughness, and wear were measured. Strong correlations were found between monoclinic content in the weightbearing surface and time of implantation (r = 0.97) and between increase in monoclinic content and decrease in fracture toughness (r = -0.92), increase in surface roughness (r = 0.88), and increase in surface wear (r = 0.89). No correlation was observed between the increase in monoclinic content and the age, weight, or activity of the patients. Aging of zirconia in vivo is then a function of time in service, and the loss of surface properties is caused by the corresponding increase in monoclinic content.

Oxidized nickel-titanium foams for bone reconstructions: chemical and mechanical characterization.

This work examines NiTi foams that have been treated using a new oxidation treatment for obtaining Ni-free surfaces that could allow the ingrowth of living tissue, thereby increasing the mechanical anchorage of implants. A significant increase in the real surface area of these materials can decrease corrosion resistance and favour the release of Ni. This chemical degradation can induce allergic reactions or toxicity in the surrounding tissues. This study determines the porosity, surface characteristics, phase transformation, mechanical properties, corrosion behaviour and Ni release into the simulated body fluid medium of foams treated by a new surface oxidation treatment that produces Ni-free surfaces. These foams have pores in an appropriate range of sizes and interconnectivity, and thus their morphology is similar to that of bone. Their mechanical properties are biomechanically compatible with bone. The titanium oxide on the surface significantly improves corrosion resistance and decreases nickel ion release, while barely affecting transformation temperatures.