Effect of surface treatment and manufacturing process on the shear bond strength of veneering composite resin to polyetherketoneketone (PEKK) and polyetheretherketone (PEEK).

STATEMENT OF PROBLEM: Polyaryletherketones (PAEKs) are high-performance polymer materials in which polyetheretherketone (PEEK) and polyetherketoneketone (PEKK) are the most used. Although mechanical and shear bonding strength tests have been performed on the 2 materials, studies on the influence of processing on bonding are scarce. PURPOSE: The purpose of this in vitro study was to determine the influence of the surface treatment and the manufacturing process on the shear bond strength of veneering composite resin to PEKK and PEEK. MATERIAL AND METHODS: Thirty pressed PEKK, 30 milled PEKK, and 30 milled PEEK specimens were distributed in 6 groups (n=13) as per the manufacturing process and treatment surface. The specimens were either treated with airborne-particle abrasion with 110-µm aluminum oxide, or no surface treatment was applied. Moreover, the PEKK specimens were grouped regarding their manufacturing process, as either milled or heat-pressed. The specimens were all bonded by using a methyl methacrylate-based adhesive (visio.link), and composite resin (Gradia Revolution 2) was bonded to the specimens. An Instron universal machine was used to calculate the shear bond strength between the PEEK or PEKK and the composite resin. Two specimens from each group had their topography modification assessed with a scanning electron microscope. Statistical analysis was performed by using a 3-way ANOVA for multiple comparisons (α=0.05) RESULTS: The groups that were surface treated with 110-µm aluminum oxide (Al2O3) before bonding showed significantly higher shear bond strength (P=.001) than the other groups. However, no statistically significant difference was observed among the groups, regardless of the manufacturing process (milled or heat-pressed) (P=.607). CONCLUSIONS: PEEK and PEKK surfaces treated with 110-µm aluminum oxide airborne-particle abrasion displayed better shear bond strength to composite resin. The manufacturing process (milled or heat-pressed) did not significantly affect the bond strength of PEKK when subjected to the same bonding process.

A maxillomandibular record for a removable partial denture by using polyvinyl siloxane and the metal framework: A dental technique.

The accuracy of the maxillomandibular record influences the relationship of the definitive cast and therefore the success of a prosthesis. This article describes a technique in which polyvinyl siloxane is used to both stabilize a removable partial denture on the edentulous ridge and being the recording material itself. The technique is practical and time efficient, allowing the clinician to perform this step in a single appointment.

Uprighting a mesially tilted mandibular left second molar with anchorage from a dental implant.

Mesial tilting of adjacent teeth may appear after the removal of a tooth, leading to a lack of restorative space. This dental technique presents a method of uprighting a mesially tilted adjacent tooth by using a dental implant as anchorage.

A fully digital approach to fabricating a CAD-CAM ceramic crown to fit an existing removable partial denture.

The use of a fully digital approach to fabricate an anatomic contour crown to fit an existing removable prosthesis allows the dentist and the dental laboratory technician to work efficiently in a digital environment. This report presents a series of patient treatments involving the fabrication of an anatomic contour monolithic zirconia crown to retrofit an existing removable partial denture. A complete digital workflow comprises an intraoral digital scan and computer-aided design and computer-aided manufacturing (CAD-CAM) technology.

Composition, phase analysis, biaxial flexural strength, and fatigue of unshaded versus shaded Procera zirconia ceramic.

STATEMENT OF THE PROBLEM: Recent interest in shaded zirconia has raised questions about the relative stability of the tetragonal phase after colorant oxide additions. PURPOSE: The purpose of this in vitro study was to evaluate the effects of fatigue cycling on the stability of a commercially available dental zirconia (Procera) in both unshaded and shaded compositions by measuring the change in biaxial flexural strength (BFS) after 500 000 cycles at 80-N loads and in phase composition as detected by x-ray diffraction (XRD). MATERIAL AND METHODS: Partially stabilized zirconia disks (NobelProcera) were fabricated in unshaded and shaded forms (12 mm diameter × 0.8 mm thick). Specimens were analyzed by energy-dispersive x-ray spectroscopy (EDS) and by wavelength-dispersive x-ray spectroscopy (WDS) for oxide compositions which indicated the presence of small amounts of Fe-O (0.13 ±0.10 wt %) in the shaded specimens. XRD focused on the tetragonal (T) and monoclinic (M) peaks in the 20 to 40 degrees 2θ range. The disks were polished on 1 side, cyclically loaded (80N, 500 000 cycles, custom 4-station fatigue test machine), and tested for residual BFS after cycling. Unshaded (U) and shaded groups (S) were compared before (U1, S1) and after (U2, S2) load cycling with XRD and residual BFS. RESULTS: Residual BFS (MPa) for specimens before (U1=856 ±99 versus S1= 842 ±40) and after fatigue (U2=772 ±65 versus S2= 718 ±68) were statistically different (U1 versus U2; S1 versus S2; U2 versus S2, P<.05). The XRD of U1 and S1 specimens revealed tetragonal and cubic zirconia. U2 and S2 specimens contained tetragonal zirconia, with the initial appearance of small amounts of monoclinic zirconia after fatigue cycling. Monoclinic detection was measured on the tension side of the tested specimens and varied between tests at the center and radially at 4 mm. CONCLUSIONS: The results indicated shaded materials more readily transform the tetragonal to the monoclinic phase during load cycling than unshaded ones. However, extrapolating the effects of any shortening of the service life of zirconia compositions is difficult. The potential mitigating effects of other factors such as the thermal postprocessing of porcelain veneers, stains on zirconia, or effects of water have yet to be investigated.

Cyclic Loading Effect on Color Stability of Unshaded versus Shaded Zirconia.

STATEMENT OF PROBLEM: Shaded versions of dental zirconia may improve initial color matching to teeth, but might change color with cyclic mechanical loading. PURPOSE: The purpose of this study was to measure the color of unshaded and shaded zirconia dental ceramic before and after cyclic mechanical loading and calculate color differences (ΔE). MATERIAL AND METHODS: Disk-shaped specimens (N = 30, Nobel Procera, 0.8 mm thick, 12 mm diameter) of unshaded or shaded zirconia (intrinsically shaded by small oxide modifications) were fabricated by the Nobel Biocare using standard CAD-CAM processing. Milled surfaces were polished. CIE L*a*b* values were measured (Konica Minolta spectrophotometer) before and after mechanical cycling (custom modified Leinfelder test machine, biaxial flexure loading, load = 80 N × 500,000 cycles, dry), and L*a*b* individual differences and ΔE color differences were calculated and compared (ANOVA, p < 0.05). RESULTS: Mean L*a*b* values for the unshaded group before (U1 = 86.165, -0.887, 0.372) and after (U2 = 84.860, -0.805, 0.097) cyclic loading were compared to the shaded group before (S1 = 75.281, -0.679, 23.251) and after (S2 = 74.961, -1.233, 22.439) cyclic loading. All color variables for both unshaded and shaded groups were significantly different between before and after cyclic loading (p < .004) except for the L* value of the shaded group. The ΔE for unshaded (1.441 ± 0.495) versus shaded (1.252 ± 0.363) were statistically different but clinically the change would not be detectable at this point. CONCLUSIONS: The color of the unshaded and shaded zirconia specimens was influenced by cyclic loading (p < 0.05). Color changes were detectable but small at levels up to 500,000 cycles, and remained clinically acceptable at that point. CLINICAL SIGNIFICANCE: It is important to acknowledge any possible color changes that might occur in zirconia restorations, especially in the esthetic zone. Minor color changes that are individually imperceptible to the human eye within different restorative components may be compounded to produce clinically significant color change that is not aesthetically acceptable.

Fixed maxillary and mandibular zirconia implant frameworks milled with anatomically contoured molars: a clinical report.

Retrospective studies on restoring the patients with complete edentulism have reported a variety of complications, including the excessive wear and fracture of the acrylic resin teeth. Approaches to slow the process of wear include the use of porcelain teeth or altering the occlusal surface of acrylic resin teeth with amalgam or gold. Two 1-piece fixed zirconia implant frameworks masked with gingival porcelain and stained anatomically contoured first and second molars and individual ceramic crowns were used to restore both arches to optimum function and esthetics. This clinical report describes the steps for one method of providing the fixed prosthetic needs of the patients who is edentulous.

Material options for restoring intentionally misaligned implants on maxillary edentulous arch: a clinical report.

Without major bone grafting procedures, anatomic challenges may dictate less than ideal implant placement. When surgical correction is impossible, it may be possible to place implants on an angle and use angled abutments to compensate. This article presents 2 patient treatments where angled abutments were used to facilitate the fabrication of an implant-supported fixed complete-arch prosthesis. In both scenarios the supporting bars for the prostheses were milled in titanium. Soft tissue shaded ceramic was used to simulate the soft tissues for one patient and soft tissue shaded composite resin was used for the second. The prostheses were completed by cementing 12 individual crowns on each bar.

Masking ability of zirconia with and without veneering porcelain.

PURPOSE: The present study compared changes in CIE L*a*b* color coordinates of substrates of different colors when covered with zirconium oxide discs (Procera) and with such discs if veneered with two shades of porcelain. MATERIAL AND METHODS: Forty background substrates were fabricated and divided into four groups depending on the color of the substrates: white, black, gray, and tooth-colored (Vita shade A3). The initial color of the substrates was measured using a colorimeter. The color of the substrates covered with plain zirconium oxide discs and with zirconium oxide discs veneered with porcelains of two shades (Vita shade A1 and B4) was measured. The color difference between the substrates, the substrates covered with plain discs, and the substrates covered with veneered discs was calculated, and the data were statistically analyzed with one-way ANOVA and multiple paired t-test. RESULTS: For each group of substrates, the resulting colors were significantly different when the substrates were covered by either plain zirconium oxide discs or zirconium oxide discs veneered with Vita shade A1 or B4 porcelain. CONCLUSION: While zirconium oxide coping material alone has a degree of masking ability, the resulting color of a restoration can be further modified with the veneering porcelain.

Precision of fit of titanium and cast implant frameworks using a new matching formula.

Statement of the Problem. Fit of prosthodontic frameworks is linked to the lifetime survival of dental implants and maintenance of surrounding bone. Purpose. The purpose of this study was to evaluate and compare the precision of fit of milled one-piece Titanium fixed complete denture frameworks to that of conventional cast frameworks. Material and Methods. Fifteen casts fabricated from a single edentulous CAD/CAM surgical guide were separated in two groups and resin patterns simulating the framework for a fixed complete denture developed. Five casts were sent to dental laboratories to invest, cast in a Palladium-Gold alloy and fit the framework. Ten casts had the resin pattern scanned for fabrication of milled bars in Titanium. Using measuring software, positions of implant replicas in the definitive model were recorded. The three dimensional spatial orientation of each implant replica was matched to the implant replica. Results. Results demonstrated the mean vertical gap of the Cast framework was 0.021 (+0.004) mm and 0.012 (0.002) mm determined by fixed and unfixed best-fit matching coordinate system. For Titanium frameworks they were 0.0037 (+0.0028) mm and 0.0024 (+0.0005) mm, respectively. Conclusions. Milled one-piece Titanium fixed complete denture frameworks provided a more accurate precision of fit then traditional cast frameworks.

Fabrication of a cast-based implant surgical guide using guide sleeves.

A unique method for fabricating cast-based surgical guides is presented. A proposed position and mesiodistal angulation of the implant are verified with periapical radiography and registered with a commercially available guide sleeve. The sleeve is attached to a surgical guide made of light-polymerized acrylic resin. The surgical guide can be used in a broad range of situations and allows for accurate implant placement in a prosthetically driven position with surgical access and visibility, simplicity, and cost efficiency.

Nonrigid connection of tooth with implants in the esthetic zone with a ceramic restoration: a clinical report.

Restoring edentulous areas with fixed prostheses can be challenging, especially when key abutment teeth are missing and implant placement is not an option. Sometimes, clinicians are faced with situations where teeth have to be connected with implants even though long-term prognosis of those connections may be questionable. This clinical report presents a connection of 2 implants with 1 tooth in the esthetic zone with a nonrigid connection. Two zirconia custom abutments and 1 zirconia coping definitively cemented on the tooth were used. A zirconia superstructure, veneered with porcelain, was cemented with provisional cement on the abutments and the coping.

Maxillary implant-supported bar overdenture and mandibular implant-retained fixed denture using CAD/CAM technology and 3-D design software: a clinical report.

The implant-supported bar overdenture and the implant-retained fixed complete denture are appropriate treatment choices for patients with inadequate bone volume in the posterior maxilla and mandible, respectively. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology has broadened the scope and application of those treatment options, allowing for prosthodontically-driven implant placement and ideal substructure design for optimal esthetics and biomechanics. This report describes the fabrication of a maxillary implant-supported milled titanium bar with attachments and an overdenture, and a mandibular implant-retained fixed complete denture with milled titanium substructure.

Translucency of shaded zirconia core material.

STATEMENT OF PROBLEM: With the development of various zirconia core shades, questions arise regarding the effect of the shaded zirconia on the translucency of ceramic crowns. PURPOSE: The purpose of this study was to investigate the translucency of the 3 Procera Zirconia shaded core materials. The hypothesis was that differences exist in the translucency of various shaded zirconia cores. MATERIAL AND METHODS: Disk-shaped (0.6 ± 0.01 × 12 mm) zirconia core (Procera Zirconia) specimens (n=90) were fabricated by the manufacturer using a CAD/CAM process. The disks were fabricated in 3 groups according to shade (light, medium, intense) (n=30). A spectrophotometer was used to measure contrast ratio (CR) which is indicative of translucency. One-way ANOVA was conducted to determine significant differences among the shades (α=.05). RESULTS: A significant difference in translucency between the light and intense shades (P=.030) and the medium and intense shades (P<.001) was observed. There was no significant difference between the light and medium shades (P=.15). CONCLUSIONS: Shaded zirconia is partially translucent. In addition, significant differences in translucency measurements were identified between specific shades.

Rehabilitation of malpositioned implants with a CAD/CAM milled implant overdenture: a clinical report.

Dentists may be faced with the challenge of restoring unfavorably placed implants. In some instances, previously integrated implants may be from different manufacturers. This clinical report describes the rehabilitation of a patient with a maxillary CAD/CAM implant bar-supported overdenture that presented with malpositioned implants, from different manufacturers, including one from a discontinued implant system.

A maxillary anterior partially edentulous space restored with a one-piece zirconia implant fixed partial denture: a clinical report.

This article describes the treatment provided to a patient who presented with a partially edentulous maxillary anterior space exhibiting severe resorption of the residual ridge. Two endosseous implants were placed to retain the prosthesis, which restored the missing teeth. A 1-piece zirconia implant fixed partial denture with individual all-ceramic crowns was used to replace the missing portions of the soft and hard tissues. This clinical report details the treatment of this restorative dilemma.

The dynamic natures of implant loading.

STATEMENT OF PROBLEM: A fundamental problem in fully understanding the dynamic nature of implant loading is the confusion that exists regarding the torque load delivered to the implant complex, the initial force transformation/stress/strain developed within the system during the implant complex assembly, and how the clamping forces at the interfaces and the preload stress impact the implant prior to any external loading. PURPOSE: The purpose of this study was to create an accurately dimensioned finite element model with spiral threads and threaded bores included in the implant complex, positioned in a bone model, and to determine the magnitude and distribution of the force transformation/stress/strain patterns developed in the modeled implant system and bone and, thus, provide the foundational data for the study of the dynamic loading of dental implants prior to any external loading. MATERIAL AND METHODS: An implant (Brånemark Mark III), abutment (CeraOne), abutment screw (Unigrip), and the bone surrounding the implant were modeled using HyperMesh software. The threaded interfaces between screw/implant and implant/bone were designed as a spiral thread helix assigned with specific coefficient of friction values. Assembly simulation using ABAQUS and LS-DYNA was accomplished by applying a 32-Ncm horizontal torque load on the abutment screw (Step 1), then decreasing the torque load to 0 Ncm to simulate the wrench removal (Step 2). The postscript data were collected and reviewed by HyperMesh. A regression analysis was used to depict the relationships between the torque load and the mechanical parameters. RESULTS: During the 32-Ncm tightening sequence, the abutment screw elongated 13.3 mum. The tightening torque generated a 554-N clamping force at the abutment/implant interface and a 522-N preload. The von Mises stress values were 248 MPa in the abutment at the abutment-implant interface, 765 MPa at the top of the screw shaft, 694 MPa at the bottom of the screw shaft, 1365 MPa in the top screw thread, and 21 MPa in the bone at the top of the implant-bone interface. This study also identified various characteristic isosurface stress patterns. The maximum stress magnitude to complete the von Mises stress joint pattern in the present model was 107 MPa during screw tightening, and was reduced to 104 MPa with removal of the wrench. Various specific stress patterns were identified within all elements of the implant complex during the assembly simulation. CONCLUSIONS: During the torque moment application, the abutment screw was elongated, and every 1.0-mum elongation of the screw was equivalent to a 47.9-N increase of the preload in the implant complex. The ideal index to determine the preload amount was the contact force at the interface between the screw threads and the threaded screw bore. The isosurface mode identified various characteristic stress patterns developed within the implant complex at the various interfaces during the assembly simulation. These patterns are the (1) spiral and ying-yang pattern of the XY stress, (2) spring, cap, clamping, and preload pattern of the ZZ stress, and (3) bone holding and joint pattern of the von Mises stress.

Effect of varying coping thickness on early load-to-fracture strength of Procera AllCeram copings cemented with 2 resin-modified glass-ionomer cements.

OBJECTIVES: Clinical situations may dictate that Procera AllCeram copings (Nobel Biocare) be fabricated or adjusted to a 0.40-mm coping thickness rather than the standard 0.60 mm. The goal of the present study was to determine the relative strength of 0.40-mm aluminum oxide copings versus standard 0.60-mm aluminum oxide copings and ascertain the effect of luting agents on the load-to-fracture value of the copings. METHOD AND MATERIALS: Forty prefabricated grade 2 titanium dies, premilled to standardized dimensions of a mandibular molar, were scanned using Procera CAD/CAM. Twenty aluminum oxide copings were ordered in the standard 0.60 mm thickness and 20 in 0.40 mm. Two cements were selected. Ten copings of each thickness were cemented to the titanium dies with RelyX Luting (3M ESPE) and 10 of each thickness with Fuji Plus cement (GC). Immediately after cementation, copings were placed under 5-kg static load for 10 minutes and then stored for 1 week in a 100% humidity chamber. At the time of testing, the samples were inspected and placed in a jig to ensure uniform vertical force application. Samples were loaded to fracture at 0.5 mm/min using an Instron universal testing machine. Results were recorded and statistically analyzed using the unpaired Student's t > test. Significance was determined at confidence level P> = or < .05. RESULTS: Mean load-to-fracture for the copings cemented with RelyX Luting was 451 N for 0.40-mm and 884 N for 0.60-mm copings, and for the copings cemented with Fuji Plus, 808 N and 1,701 N, respectively. CONCLUSIONS: Aluminum oxide copings of 0.60 mm showed significantly greater load-to-fracture values than 0.40 mm copings, regardless of the luting agent used. Within the independent comparisons, copings cemented with Fuji Plus exhibited higher load-to-fracture values than copings cemented with RelyX Luting cement.

Resistance to dislodgement of zirconia copings cemented onto titanium abutments of different heights.

STATEMENT OF PROBLEM: For patients with limited interocclusal space, standard height implant abutments may not be usable. Shorter abutments may be desirable. PURPOSE: The purpose of this study was to determine the effect of the height of titanium abutments on the tensile strength required to dislodge zirconia copings. MATERIAL AND METHODS: Two experimental groups of abutments were prepared: (1) 4.3-mm platform width implant abutment with a 6.5-mm height (control), and (2) a 4.3-mm platform width implant abutment with a 5.5-mm height (shorter). Each abutment had 5 zirconia copings (custom designed) fabricated through a 3-dimensional computer-assisted design (3-D CAD) process by scanning an identical wax pattern. The zirconia copings were designed to have a 6-mm projection above the titanium abutment to accommodate a 2-mm hole. A wire was inserted through this hole to attach the zirconia coping to a universal testing machine. Each abutment was placed onto an implant embedded in a brass base designed to fit onto the universal testing machine. The zirconia copings were cemented onto the abutments with a provisional luting agent (Improv), and a tensile force was applied at a crosshead speed of 0.5 mm/min. The removal force was recorded for each specimen. An unpaired t test was used for the statistical analysis (alpha =.05). RESULTS: The mean force (SD) necessary to remove the zirconia copings (Newtons) from the 6.5-mm titanium abutment (198.09 (28.83)) was higher (P=.0078) than for the 5.5-mm abutment (124.89 (36.388)). CONCLUSIONS: By increasing the height of the abutment 1 mm and maintaining the diameter of the abutment, the resistance to tensile forces increased significantly between the 2 abutment dimensions evaluated.