Implant digital impression accuracy using extraoral scanners: a three-dimensional analysis

Aim: To analyze the accuracy of extraoral systems (Ceramill Map400+, AutoScan-DS200+, and E2) in full implantprosthetic rehabilitation three-dimensionally. Methods: A metallic edentulous maxilla with four implants was digitalized by a contact scanner (MDX-40 - Roland, control) and used as a control image to compare with other images generated by three laboratory scanners (10 samples per group). Letters identified all the four components: A and D angled 45º, and B and C parallel. The BioCAD software exported the images (.STL) to compare and verify deviations of the analogs on the X, Y, and Z axes. The nonparametric Kruskal-Wallis test and the two-way ANOVA on ranks with a post hoc Tukey test analyzed the data with 5% significance. Results: No statistical differences were observed in the accuracy between the extraoral scanners (p=0.0806). However, when analyzing only the components, component D was more accurate when scanned with Ceramill Map400+ compared with AutoScan DS200+ (p<0.001) and with E2 (p=0.002). Conclusions: All extraoral systems assessed showed digitalization accuracy but with more deviations in angled implants. The Ceramill Map400+ scanner showed the best results for the digital impression of a complete arch

A randomised crossover clinical trial of masticatory function in complete denture wearers with conventional and lingualised balanced occlusion.

OBJECTIVES: The purposes of the present study were as follows: (1) to conduct a randomised crossover clinical trial to evaluate masticatory performance in wearers of conventional complete dentures in both arcs with conventional balanced occlusion (CBO) and lingualised balanced occlusion (LBO), using almonds as natural test food chewed for (a) 30 chewing cycles, (b) 40 chewing cycles and (c) until the subject felt ready to swallow and (2) to perform a randomised crossover clinical trial of oral health self-perception through the Geriatric Oral Health Assessment Index (GOHAI) questionnaire. BACKGROUND: During rehabilitation with full dentures, achieving stability and retention is essential for masticatory performance. A factor that can act is the appropriate occlusal scheme to be used, although the literature is full of discussions as to the most suitable occlusal scheme to be used, being CBO and LBO the most used in complete dentures. MATERIALS AND METHODS: The clinical trial was conducted with 30 participants (14 males and 16 females; average age 65.8 years). A base of interchangeable posterior teeth in the lower dentures was used, thereby changing the occlusal schemes without needing to make another complete denture. The masticatory tests and GOHAI application were conducted in two sessions: first with each occlusal scheme, and second only after participants did not report discomfort with dentures. The analysis of variance for the mixed repeated-measures test (ANOVA) was used to verify the results (α = 0.05). RESULTS: The results showed no difference in masticatory performance according to the occlusal scheme (P = .519). The masticatory performance increased with the number of cycles (P < .001) tested, regardless of the type of occlusion scheme, and oral health self-perception was higher after the second masticatory evaluation session (P = .027). CONCLUSION: The masticatory performance was similar between the two occlusal schemes, increasing according to the number of chewing cycles. The adaptive period is relevant, regardless of the occlusion scheme, because the time factor was decisive for the improvements noted in the oral health self-perception of the participants (according to the GOHAI results).

Influence of filling materials on the fracture resistance of resin composite used for sealing screw access hole / Influência dos materiais de preenchimento na resistência a fratura das resinas compostas utilizadas para selamento do orifício de acesso ao parafuso

Introduction: Screw-retained restorations have a screw access hole (SAH) sealed with resin composite aiming at safe-guarding the aesthetic features of the ceramic veneer. The loss or wear of the resin composite applied in sealing the SAH is among the most common complications in implant prosthodontics, as the fracture of ceramic veneer. Objective: Evaluate the influence of sealant materials on the fracture resistance of resin composite applied in sealing screw access hole in screwed (SAH) implants. Material and method: The samples were produced from UCLA abutments in metallic NiCr alloy with subsequent application of ceramic. After asperisation and conditioning ceramic surface, was applied silane and dentin adhesive, before sealing the conduits with resin composites Z100 and P60. Nine groups (n=10) were evaluated: sealing with Z-100 (ZNC) and P-60 (PNC) without obturation of SAH; sealing with Z100 (ZCP) and P-60 (PCP) with absorbent cotton; Z100 (ZPT) and P60 (PPT) with polytetrafluoroethylene; Z100 (ZGP) and P60 (PGP) with gutta-percha and a cemented ceramic crown (ICS). After the fracture resistance test, the data were analyzed using two-way ANOVA and Tukey HSD tests (p<.05). Result: The fracture mode was evaluated by scanning electron microscope. Irrespective of the filling material, the highest mean values of fracture resistance were observed in the sealing with P60 (p=.002). When combined with resins composed of a sealing material, the results obtained were: ZGP: 805.5N/ PGP: 929.5N

Introdução: As próteses parafusadas possuem orifício de acesso ao parafuso (SAH), os quais são selados com resina composta. Sua perda ou desgaste está entre as complicações mais comuns em próteses sobre implantes, associadas a fratura da lâmina cerâmica. Objetivo: Assim, é importante avaliar a influência dos materiais de selamento na resistência à fratura de resina composta aplicada ao SAH no selamento de prótese sobre implantes parafusadas. Material e método: As amostras foram produzidas utilizando pilares UCLA em liga metálica de NiCr com posterior aplicação de cerâmica. Após asperização e condicionamento da superfície cerâmica, foram aplicados silano e adesivo dentinário, antes da selagem dos condutos com as resinas compostas Z100 e P60. Foram avaliados nove grupos (n = 10): selamento com Z-100 (ZNC) e P-60 (PNC) sem selamento do SAH; selamento com Z100 (ZCP) e P-60 (PCP) com algodão absorvente; Z100 (ZPT) e P60 (PPT) com politetrafluoroetileno; Z100 (ZGP) e P60 (PGP) com guta-percha e coroa de cerâmica cimentada (ICS). Após o teste de resistência à fratura, os dados foram analisados usando ANOVA de dois fatores e testes Tukey HSD (p<0,05). O tipo de fratura foi avaliado por microscópio eletrônico de varredura. Resultado Independentemente do material obturador, os maiores valores médios de resistência à fratura foram observados no selamento com P60 (p=0,002). Quando combinados com resinas compostas por um material de selamento, os resultados obtidos foram: ZGP: 805,5N/ PGP: 929,5N

Accuracy of Impression Techniques with Maxillary Angled Implants Using Trays and Multifunctional Guides.

PURPOSE: The purpose of this study was to evaluate in vitro the accuracy of different splinting techniques using transfers combined with different tray types. MATERIALS AND METHODS: The research group fabricated a maxillary master cast with four implants and a passive metallic bar on this master cast. For the impression techniques, 48 casts were used with six different impression techniques: (1) metal tray with resin splinted transfers, (2) metal tray with metal and resin splinted transfers, (3) plastic tray with resin splinted transfers, (4) plastic tray with metal and resin splinted transfers, (5) multifunctional guide with resin splinted transfers, and (6) multifunctional guide with metal and resin splinted transfers (n = 8) using polyvinyl siloxane impression material. This study used a passive metallic bar to measure the malalignment between the framework and the analogs (A, B, C, and D) in 2D and 3D. The master and experimental casts were scanned with a contact scanner to compare the accuracy in 3D impression techniques. Discrepancies between the analogs were measured in three x-, y-, and z-axes. RESULTS: There was no statistically significant difference (P > .05) between the groups in vertical malalignments (2D). In the 3D evaluation, for the z-axis and combination of xz-axis, plastic tray with metal, and resin splinted transfers (z = 487 µm; xz = 888 µm), there was a statistically significant difference compared with the multifunctional guide and resin splinted transfers (z = 772 µm; xz = 1,380 µm). When analyzing by analog, in C, the multifunctional guide with metal and resin splinted transfers (302 µm) presented a statistically significant difference compared with the multifunctional guide and resin splinted transfers (492 µm). CONCLUSION: The evaluation methods for the accuracy impression technique presented different results between them. There was no difference in vertical malalignments (2D), but in 3D, the bonding with metal and acrylic resin presented better results than the bond with only acrylic resin when using the plastic tray and multifunctional guide, respectively, in the z-axis and the combination between the xz-axes. The bonding technique of the transfers with metal and acrylic resin presents better results in the 3D analysis for the multifunctional guide impressions.

Effect of sintering temperature on microstructure, flexural strength, and optical properties of a fully stabilized monolithic zirconia.

STATEMENT OF PROBLEM: Fully stabilized monolithic zirconia (FSZ) has been developed as an alternative to zirconia veneered with porcelain. However, how sintering conditions might affect its microstructure and optical and mechanical properties is unclear. PURPOSE: The purpose of this in vitro study was to determine the effect of different sintering temperatures on the microstructure and optical and mechanical properties of FSZ. MATERIAL AND METHODS: Bar-shaped FSZ specimens were prepared and divided into 2 groups (n=15) according to final sintering temperatures (1450 °C and 1600 °C). The average reflectance, opacity, translucency parameter, and sum of light absorption-scattering values were obtained by using a spectrophotometer, and ΔE00 was calculated. The 3-point bend test was performed in a universal testing machine. Scanning electron microscopy (SEM) was conducted for microstructure analysis. Crystalline phase quantification was obtained by X-ray diffraction (XRD). Data were analyzed by using D'Agostino-Pearson and Student t tests (α=.05). RESULTS: A significant difference was detected in the reflectance and sum of light absorption-scattering values between the 2 groups. The translucency parameter, opacity, and flexural strength showed no statistical differences. ΔE00 was 0.98. XRD indicated cubic (47.41% for 1450 °C; 46.04% for 1600 °C) and tetragonal content (52.59% for 1450 °C; 53.96% for 1600 °C). No monoclinic content was found. SEM images showed more definite grain boundaries in the 1600-°C group. Mean grain size was 0.49 µm for the 1450-°C group and 1.99 µm for the 1600-°C group. CONCLUSIONS: Higher sintering temperatures increased the grain size but did not change the crystal phase concentration. A significant difference was found in the reflectance and sum of light absorption-scattering, but no differences were found among the translucency parameter, opacity, or flexural strength.

Implant-supported double-bar overdenture to reestablish lip support in an atrophic maxilla: a case report.

Prosthodontic treatment for edentulous maxillae with severe bone loss is a challenge to clinicians. Although implant-supported, fixed maxillary complete dentures are increasingly common, they are not always able to provide adequate lip support without a buccal overextension in patients with bone loss. The overextended buccal flange makes it difficult for patients to clean under the prosthesis. This case report describes rehabilitation of an atrophic maxilla through an implant-supported double-bar overdenture designed to resolve difficulties in oral hygiene maintenance that were caused by the buccal overextension of the prosthetic flange in a previous implant-supported fixed complete denture. In addition to reestablishing lip support, overdentures with a double-bar system provide retention and stability, because the prosthesis is only removed for cleaning by the patient with the help of a specific key. Implant-supported double-bar overdentures represent a viable and versatile option for rehabilitation of atrophic maxillae.

One-year prospective clinical study comparing patient satisfaction and masticatory performance of mandibular overdentures supported by one versus two implants.

OBJECTIVE: There is a lack of clinical evidence on mandibular overdentures (MOD) supported by a single implant. To compare patient satisfaction and masticatory performance in MOD supported by one versus two implants in a two-group parallel randomized clinical trial. MATERIAL AND METHODS: Twenty-one patients wearing new maxillary and mandibular complete dentures (CDs) were randomly divided to receive one (GI, n = 11) or two (GII, n = 10) implants in the mandibular arch. Four months after implant placement, o-ring abutments were installed in the implants, and matrix attachments were placed in the lower complete dentures. Patient satisfaction with their dentures and masticatory performance were compared at baseline, 3, 6, and 12 months after the procedure. Data on patient satisfaction were analyzed using the Friedman test and the Mann-Whitney U test. Data on masticatory performance were analyzed using one-way repeated measures analysis of variance (ANOVA) and Student's t test (α=0.05). RESULTS: Both groups exhibited a significant increase in overall patient satisfaction in all periods evaluated (p<0.05), except for GI after 12 months, which had values similar to baseline (p=0.74). Satisfaction levels of GI and GII were similar at baseline, 3 and 6 months, but GII showed higher satisfaction levels (p=0.01) than GI at 12 months. GI and GII exhibited a significant increase (p<0.05) in masticatory performance for all periods relative to baseline. However, GII had higher masticatory performance with dentures than GI, regardless of the period (p<0.05). CONCLUSION: MOD supported by two implants demonstrated better patient satisfaction in the follow-up at 12 months and better masticatory performance than MOD supported by one implant.

Influence of Cusp Inclination and Type of Retention on Fracture Load of Implant-Supported Crowns

Abstract There are few informations about the influence of cusp inclination on the fracture strength of implant-supported crowns. The study aimed to evaluate the influence of cusp inclination and retention type on fracture load in implant-supported metal-ceramic single crowns. Sixty crowns were made, classified as cemented and screw-retained with screw access hole (SAH) sealed or not. Standard (33°) and reduced (20°) cusp inclinations were tested for each group (n=10). To support crowns of a mandibular second molar, analogs of external hexagon implants 5.0 were used. The fracture load was measured in a universal testing machine EMIC DL2000 (10 kN load cell; 0.5 mm/min). Two-way ANOVA (retention and cusp inclination) followed by post hoc Tukey’s honest significant difference test was used for the statistical analyses (a=0.05). Crowns with reduced cusp inclination exhibited significantly higher fracture load (p<0.01) than crowns with standard cusp inclination. Cemented crowns showed significantly higher fracture load (p<0.01) than screw-retained crowns. The interaction among these factors was not significant (p>0.05) for the fracture load. The sealing of SAH did not influence the fracture load of screw-retained crowns (p>0.05). In conclusion, fracture load of implant-supported metal-ceramic crowns was influenced by retention and cusp inclination, and there was no influence of the sealing of SAH.

Resumo Existem poucas informações sobre a influência da inclinação de cúspide na resistência à fratura de coroas implantossuportadas. O objetivo do estudo foi avaliar a influência da inclinação de cúspide e do tipo de retenção na carga de fratura de coroas unitárias metalocerâmicas implantossuportadas. Sessenta coroas foram confeccionadas, classificadas como cimentadas e parafusadas com orifício de acesso ao parafuso selado ou não. Cúspides com inclinação padrão (33°) e reduzida (20°) foram testadas para cada grupo (n=10). Para suportar as coroas de um segundo molar inferior, análogos de implante hexágono externo 5.0 foram utilizados. A carga de fratura foi mensurada em máquina de ensaios universais EMIC DL2000 (célula de carga de 10 kN; 0,5 mm/min). ANOVA dois fatores (retenção e inclinação da cúspide) seguido do pós-teste de Tukey da diferença honestamente significativa foi utilizada para análise estatística (a=0,05). Coroas com inclinação de cúspide reduzida exibiram carga de fratura significativamente maior (p>0,05) que coroas com cúspides de inclinação padrão. Coroas cimentadas apresentaram carga de fratura significativamente maior (p<0,01) que coroas parafusadas. A interação entre os dois fatores não foi significante (p>0,05) para a carga de fratura. O selamento do orifício de acesso ao parafuso não influenciou a carga de fratura das coroas parafusadas (p>0,05). Concluindo, a carga de fratura de coroas metalocerâmicas implantossuportadas foi influenciada pelo tipo de retenção e inclinação da cúspide, e não houve influência do selamento do orifício de acesso ao parafuso

Influence of Liquid Lubrication on the Screw-Joint Stability of Y-TZP Implant Abutment Systems.

PURPOSE: To evaluate the effectiveness of abutment screws coated with liquid Vaseline on the screw-joint stability of yttria-stabilized tetragonal zirconia (Y-TZP) abutment systems. MATERIALS AND METHODS: Forty Y-TZP prefabricated abutments, 20 Neodent and 20 Bionnovation, were tightened to 20 Ncm on their respective external hexagon implants, and divided into four groups (n = 10) according to the screws: coated with Vaseline or uncoated. The removal torque (RT) value of the abutment screw was measured before and after loading. A cyclic loading (0.5 × 106 cycles; 15 Hz) between 11 and 211 N was applied. Means were compared using a repeated-measures ANOVA (α = 0.05). RESULTS: There was no significant difference between coated and uncoated screws (p = 0.822). Significant differences were found between the abutment systems (p < 0.001). There was a significant effect of cyclic loading (p < 0.001). CONCLUSIONS: Coated and uncoated screws presented similar effectiveness in maintaining preload. CLINICAL RELEVANCE: The liquid lubricant used in this study does not influence the stability of Y-TZP single-implant restorations.

Vertical Misfit of Single-Implant Abutments Made from Different Materials Under Cyclic Loading.

PURPOSE: Little information is available in the literature regarding the accuracy of marginal fit of abutments made from different materials. The aim of this study was to compare the level of vertical misfit in abutments made from different materials before and after cyclic loading. MATERIALS AND METHODS: Thirty external hexagon implants, 3.75-mm diameter and 13-mm length, were embedded in epoxy resin and divided into three groups according to abutment type (n = 10): (1) machined titanium (Ti) abutments; (2) premachined gold-alloy (Au) abutments; and (3) machined zirconia (Zr) abutments. The abutments were attached to their respective implants by titanium alloy screws at the manufacturer's recommended torque. A cyclic loading (0.5 × 10(6) cycles; 15 Hz) between 11 and 211 N was applied at an angle of 30 degrees to the long axis of the implants. Implant-abutment vertical misfits (µm) were measured at four predetermined points before and after loading with a stereomicroscope at 60× magnification. The group means were compared using a three-way repeated-measure analysis of variance (ANOVA) and Tukey test (α = .05). RESULTS: The results from the ANOVA identified significant effects of the abutment type (P < .001). However, there were no significant effects of cyclic loading (P = .978) or measured surfaces (P = .955). When the abutment groups were compared regardless of cyclic loading and measured surfaces, the Au group showed the highest value of vertical misfit (14.93 ± 0.78), followed by the Ti group (8.53 ± 0.44) and the Zr group (5.64 ± 0.73), with statistically significant differences among them (P < .05). CONCLUSION: The abutment groups showed statistically significant differences in vertical misfit. Zr abutments showed the highest accuracy in terms of marginal fit, and Au abutments showed the lowest. Cyclic loading did not significantly change the level of vertical misfit. All experimental groups presented acceptable values of marginal misfit.

Influence of Sealing of the Screw Access Hole on the Fracture Resistance of Implant-Supported Restorations.

The purpose of this study was to assess the influence of sealing of the screw access hole (SAH) on the fracture resistance of metal-ceramic implant-supported restorations. UCLA abutments were used to make 30 implant-retained mandibular molar restorations and divide equally into three groups: Group SRS: screw-retained restorations with SAH sealed; Group SRNS: screw-retained restorations with SAH not sealed; Group CR: cement-retained restorations. The following protocol was adopted to restore the SAH: the ceramic surface of the SAH was air-abraded with aluminum oxide; etched with 10% hydrofluoric acid; a silane coupling agent and a bonding agent were applied; cotton pellets were used as filling material and P-60 resin composite as restoring material. The cement-retained restorations were cemented with Rely-X U100. A metal rod with a spherical tip of 6.0 mm diameter was used to apply a vertical static load, simultaneously on the buccal and lingual incline cusps, at a crosshead speed of 0.5 mm/min until the fracture of the specimens. Data were analyzed using one-way ANOVA and Dunnet test (p<0.05) for multiples comparisons. The mode of failure was evaluated by a scanning electron microscopy (SEM). No significant difference between screw-retained restorations was found. The highest mean fracture resistance values were observed with CR group. Therefore, it was shown that SAH sealing did not influence the fracture resistance of the screw-retained restorations.

Influence of Sealing of the Screw Access Hole on the Fracture Resistance of Implant-Supported Restorations

Abstract The purpose of this study was to assess the influence of sealing of the screw access hole (SAH) on the fracture resistance of metal-ceramic implant-supported restorations. UCLA abutments were used to make 30 implant-retained mandibular molar restorations and divide equally into three groups: Group SRS: screw-retained restorations with SAH sealed; Group SRNS: screw-retained restorations with SAH not sealed; Group CR: cement-retained restorations. The following protocol was adopted to restore the SAH: the ceramic surface of the SAH was air-abraded with aluminum oxide; etched with 10% hydrofluoric acid; a silane coupling agent and a bonding agent were applied; cotton pellets were used as filling material and P-60 resin composite as restoring material. The cement-retained restorations were cemented with Rely-X U100. A metal rod with a spherical tip of 6.0 mm diameter was used to apply a vertical static load, simultaneously on the buccal and lingual incline cusps, at a crosshead speed of 0.5 mm/min until the fracture of the specimens. Data were analyzed using one-way ANOVA and Dunnet test (p<0.05) for multiples comparisons. The mode of failure was evaluated by a scanning electron microscopy (SEM). No significant difference between screw-retained restorations was found. The highest mean fracture resistance values were observed with CR group. Therefore, it was shown that SAH sealing did not influence the fracture resistance of the screw-retained restorations.

Resumo O objetivo deste estudo foi avaliar a influência do selamento do orifício de acesso ao parafuso (OAP) na resistência à fratura de coroas metalocerâmicas implantossuportadas aparafusadas. Pilares UCLA foram utilizados para fazer 30 molares inferiores implantossuportados e divididos igualmente em três grupos: Grupo AS: coroas aparafusadas com o OAP selado; Grupo ANS: coroas aparafusadas com o OAP não selado; Grupo CC: coroas cimentadas. O seguinte protocolo foi utilizado para selar o OAP: a superfície de cerâmica do OAP foi jateada com óxido de alumínio; condicionada com ácido fluorídrico a 10%; um agente silano e um adesivo dentinário foram aplicados; bolinhas de algodão foram utilizadas como material de preenchimento e a resina composta P-60 como material de restauração. As coroas cimentadas foram cimentadas com Rely-X U100. Uma haste de metal com uma ponta esférica de 6.0 mm de diâmetro foi usada para aplicar uma carga estática vertical, simultaneamente nas vertentes triturantes das cúspides linguais e vestibulares, com 0,5 mm/min velocidade do atuador até a fratura das coroas. Os dados foram analisados através de ANOVA um fator e teste de Dunnett (p<0,05) para as comparações múltiplas. O modo de falha foi avaliado por um microscópio eletrônico de varredura (MEV). Não houve diferença significativa entre restaurações aparafusadas. Os maiores valores médios de resistência à fratura foram observados com o Grupo CC. Portanto, observou-se que o selamento do OAP não influenciou a resistência à fratura das coroas aparafusadas.

Effects of artificial aging conditions on yttria-stabilized zirconia implant abutments.

STATEMENT OF PROBLEM: Most ceramic abutments are fabricated from yttria-stabilized tetragonal zirconia (Y-TZP). However, Y-TZP undergoes hydrothermal degradation, a process that is not well understood. PURPOSE: The purpose of this in vitro study was to assess the effects of artificial aging conditions on the fracture load, phase stability, and surface microstructure of a Y-TZP abutment. MATERIAL AND METHODS: Thirty-two prefabricated Y-TZP abutments were screwed and tightened down to external hexagon implants and divided into 4 groups (n = 8): C, control; MC, mechanical cycling (1×10(6) cycles; 10 Hz); AUT, autoclaving (134°C; 5 hours; 0.2 MPa); and TC, thermal cycling (10(4) cycles; 5°/55°C). A single-load-to-fracture test was performed at a crosshead speed of 0.5 mm/min to assess the assembly's resistance to fracture (ISO Norm 14801). X-ray diffraction (XRD) analysis was applied to observe and quantify the tetragonal-monoclinic (t-m) phase transformation. Representative abutments were examined with high-resolution scanning electron microscopy (SEM) to observe the surface characteristics of the abutments. Load-to-fracture test results (N) were compared by ANOVA and Tukey test (α=.05). RESULTS: XRD measurements revealed the monoclinic phase in some abutments after each aging condition. All the aging conditions reduced the fracture load significantly (P<.001). Mechanical cycling reduced the fracture load more than autoclaving (P=.034). No differences were found in the process of surface degradation among the groups; however, the SEM detected grinding-induced surface flaws and microcracks. CONCLUSIONS: The resistance to fracture and the phase stability of Y-TZP implant abutments were susceptible to hydrothermal and mechanical conditions. The surface microstructure of Y-TZP abutments did not change after aging conditions.

Failure modes of Y-TZP abutments with external hex implant-abutment connection determined by fractographic analysis.

Yttria-stabilized tetragonal zirconia (Y-TZP) was introduced as ceramic implant abutments due to its excellent mechanical properties. However, the damage patterns for Y-TZP abutments are limited in the literature. Fractographic analyses can provide insights as to the failure origin and related mechanisms. The purpose of this study was to analyze fractured Y-TZP abutments to establish fractographic patterns and then possible reasons for failure. Thirty two prefabricated Y-TZP abutments on external hex implants were retrieved from a single-load-to failure test according to the ISO 14801. Fractographic analyses were conducted under polarized-light estereo and scanning electro microscopy. The predominant fracture pattern was abutment fracture at the connecting region. Classic fractographic features such as arrest lines, hackle, and twist hackle established that failure started where Y-TZP abutments were in contact with the retention screw edges. The abutment screw design and the loading point were the reasons for localized stress concentration and fracture patterns.

Reestablishment of Occlusal Vertical Dimension in Complete Denture Wearing in Two Stages.

The assessment and reestablishment of the occlusal vertical dimension (OVD) are considered important factors in the treatment of complete denture wearers. The long-time use of a complete denture can result in jaw displacement due to abrasion of the artificial teeth and residual ridge resorption, causing esthetic complications. Most patients with old dentures and incorrect OVD accept reestablishment of the OVD with new complete dentures, even if they were used to their old dentures. The present clinical report describes a method of gradual reestablishment of OVD using a diagnostic acrylic splint on artificial teeth in old complete dentures before the manufacture of new complete dentures. Clinical Significance. The use of a reversible treatment for reestablishment of the OVD in old complete dentures with a diagnostic occlusal acrylic splint allows for the reestablishment of the intermaxillary relationship, providing physiological conditions of masticatory performance associated with the recovery of facial esthetics in edentulous patients.

Split-Framework in Mandibular Implant-Supported Prosthesis.

During oral rehabilitation of an edentulous patient with an implant-supported prosthesis, mandibular flexure must be considered an important biomechanical factor when planning the metal framework design, especially if implants are installed posterior to the interforaminal region. When an edentulous mandible is restored with a fixed implant-supported prosthesis connected by a fixed full-arch framework, mandibular flexure may cause needless stress in the overall restorative system and lead to screw loosening, poor fit of prosthesis, loss of the posterior implant, and patient's discomfort due to deformation properties of the mandible during functional movements. The use of a split-framework could decrease the stress with a precise and passive fit on the implants and restore a more natural functional condition of the mandible, helping in the longevity of the prosthesis. Therefore, the present clinical report describes the oral rehabilitation of an edentulous patient by a mandibular fixed implant-supported prosthesis with a split-framework to compensate for mandibular flexure. Clinical Significance. The present clinical report shows that the use of a split-framework reduced the risk of loss of the posterior implants or screws loosening with acceptable patient comfort over the period of a year. The split-framework might have compensated for the mandibular flexure during functional activities.

Prótese metalocerâmica associada à prótese metaloplástica implantossuportada em paciente desdentado total / Full maxillary, metal-ceramic implant-supported prosthesis against a complete, mandibular, acrylic implant-supported prosthesis: a case report

A utilização de diferentes métodos e materiais deve ser considerada durante o planejamento de próteses implantossuportadas. Complicações, como fraturas da base de resina acrílica, desgaste e fratura dos dentes, podem ocorrer com frequência, gerando a necessidade de um planejamento cuidadoso para cada paciente, o que pode tornar a seleção do tipo de tratamento mais complexa. Diante disso, este artigo descreve a reabilitação oral de um paciente totalmente edêntulo, portador de prótese tipo protocolo bimaxilar, que apresentava queixa estética, perda de dimensão vertical e fratura em dentes de resina acrílica do arco superior. Após o restabelecimento da dimensão vertical, realizou-se a substituição de suas próteses antigas por uma nova prótese tipo protocolo bimaxilar, sendo que a cerâmica foi utilizada como material de cobertura para o arco superior, e resina como material de cobertura para o arco inferior. Ao final do tratamento, o paciente recebeu placas oclusais lisas bimaxilares para proteger os dentes e implantes de possíveis hábitos parafuncionais. A forma como o tratamento foi conduzido permitiu uma resolução rápida e eficaz, com resultado estético e funcional muito favorável para o paciente.

The use of different methods and materials should be considered during the planning of implant-supported prostheses. Complications such as fractures of the acrylic resin base, wear and fracture of teeth can occur frequently, creating the need for careful planning for each patient, which can make the selection of the type of treatment more complex. Thus, this article describes the oral rehabilitation of a completely edentulous patient with bimaxillary fixed implant-supported prosthesis, with complaints on aesthetics, loss of vertical dimension and fracture of acrylic resin teeth of the upper arch. After the restoration of vertical dimension, his dentures were replaced with new bimaxillary implant-supported fixed prostheses, ceramic and acrylic resin were used as veneering material for maxilla and mandible, respectively. At the end of the treatment, the patient received bimaxillary flat occlusal splints to protect the teeth and implants of possible parafunctional habits. The approach for the treatment allowed a quick and effective resolution, with aesthetic and functional outcomes very favorable for the patient.

Influence of three types of abutments on preload values before and after cyclic loading with structural analysis by scanning electron microscopy.

PURPOSE: To evaluate the effectiveness of three types of abutments in the maintenance of screw joint preload before and after cyclic loading as well as to observe possible microdamage in the structure of the components using a scanning electron microscope (SEM). MATERIALS AND METHODS: Forty-five external-hex implants were embedded in epoxy resin, received their respective abutments, and were randomly divided into three experimental groups (n = 15): (1) machined titanium (Ti) abutments; (2) pre-machined gold (Au) abutments; and (3) machined zirconia (ZrO(2)) abutments. The abutment screws were tightened according to the manufacturer's recommended torque. Initially, a static bending test was performed using five specimens of each group to determine the load applied in the cyclic loading test. Thus, 10 specimens of each group were used to measure the reverse torque value (preload) of the abutment screw before and after loading. A cyclic loading (0.5 × 10(6) cycles; 15 Hz) between 11 and 211 N was applied at an angle of 30 degrees to the long axis of the implants. The group means were compared using analysis of variance and the Tukey test (α = .05). RESULTS: The reverse torque analysis before cyclic loading showed no significant difference among the groups (P > .05). After cyclic loading, all preload means decreased significantly. The lowest decrease in preload was observed in the Ti group, whereas the highest decrease was observed in the ZrO(2) group, with a significant difference noted between them (P = .010). The Au group presented an intermediate decrease, with no significant difference compared to the other groups (P > .05). SEM images showed structural changes in the mating surfaces of the abutments after cyclic loading. CONCLUSION: The load application reduced the preload means significantly in all groups, and more significantly in the ZrO(2) group.

Effectiveness of screw surface coating on the stability of zirconia abutments after cyclic loading.

PURPOSE: Different surface treatments have been developed in attempts to prevent the loosening of abutment screws. The aim of the current study was to compare the effectiveness of titanium alloy screws with tungsten-doped diamond-like carbon (W-DLC) coating and uncoated screws in providing stability to zirconia (ZrO2) ceramic abutments after cyclic loading. MATERIALS AND METHODS: Twenty prefabricated ZrO2 ceramic abutments on their respective external-hex implants were divided into two groups of equal size according to the type of screw used: uncoated titanium alloy screw (Ti) or titanium alloy screw with W-DLC coating (W-DLC/Ti). The removal torque value (preload) of the abutment screw was measured before and after loading. Cyclic loading between 11 and 211 N was applied at an angle of 30 degrees to the long axis of the implants at a frequency of 15 Hz. A target of 0.5 X 106 cycles was defined. Group means were calculated and compared using analysis of variance and the F test (α = .05). RESULTS: Before cyclic loading, the preload for Ti screws was significantly higher than that for W-DLC/Ti screws (P = .021). After cyclic loading, there was no significant difference between them (P = .499). CONCLUSIONS: Under the studied conditions, it can be concluded that, after cyclic loading, both abutment screws presented a significant reduction in the mean retained preload and similar effectiveness in maintaining preload.

Antimicrobial activity of disinfectant agents incorporated into type IV dental stone.

PURPOSE: This study evaluated the antimicrobial activity of two disinfectant agents, 2% chlorhexidine digluconate solution (CHX) and 98% chlorhexidine hydrochloride powder (HYD), incorporated into type IV dental stone at the time of mixing. MATERIAL AND METHODS: Agar diffusion test was used for the following microorganisms: Escherichia coli, Staphylococcus aureus, Bacillus subtilis and Candida albicans. The specimens were grouped in: (1) dental stone mixed with sterile distilled water; (2) paper disc soaked with CHX; (3) dental stone mixed with CHX; and (4) dental stone with incorporation of HYD, in 1% proportion of the dental stone mass and mixed with sterile distilled water. The culture medium was inoculated with microbial suspensions 1 and 24 h after pouring of the dental stone. The antimicrobial activity was evaluated by the average diameter of microbial growth inhibition zones. The data were analysed with a nested anova (p < 0.05) and Tukey test for specific comparisons. RESULTS: The disinfectant agents demonstrated antimicrobial activity against all microorganisms, with the exception of C. albicans, against which the CHX was ineffective in two periods of analysis. Significant differences between disinfectants were found with all microorganisms. CONCLUSION: The disinfectant agents analysed were effective against most of the microorganisms tested, except C. albicans.