Influence of bioactive particles and onium salt on the physicochemical properties of experimental infiltrants.

This study evaluated physicochemical properties of experimental infiltrants after addition of hydroxyapatite nanoparticles (HAp) or 58S bioactive glass (BAG) and diphenyliodonium hexafluorophosphate (DPI). The resin matrix was composed of TEGDMA/Bis-EMA (3:1), 0.5 mol% CQ, and 1 mol% EDAB. The blends received or not 0.5 mol% DPI and 10% wt BAG or HAp. Icon was used as commercial control. The groups were characterized by XRD, FT-IR spectrometry, and SEM before and after simulated body fluid (SBF) immersion for up to 7 days. Polymerization kinetics (n =3 ), water sorption and solubility (n=10), and viscosity (n = 3) were surveyed. For polymerization kinetics, the samples were polymerized for 5 min and the data were obtained from 40 s and 5 min. Statistical analysis was made using ANOVA and Tukey's test (a = 0.05). After 7 days of SBF immersion, XRD and FT-IR showed that the HAp crystalline phase was present only in the HAp groups. A lower degree of conversion (DC) and polymerization rate were observed for the Icon and BAG groups, whereas HAp showed higher values. For the BAG group, DPI increased polymerization rate and DC in 40 s. After 5 min, all groups presented DC above 80%. In groups with particles, the HAp groups exhibited higher viscosity, whereas DPI groups showed a decrease in viscosity. Icon had the highest water sorption. To conclude, BAG neither improved the physicochemical properties studied, nor did it show bioactive properties. The addition of DPI reduced viscosity caused by particle addition and also attenuated the DC decrease caused by BAG addition. The addition of bioactive particles to infiltrants should be seen with caution because they increase viscosity and may not bring major clinical improvements that justify their use. DPI might be indicated only if any component is added to the infiltrant to act as a compensation mechanism.

Clinical performance of short and extrashort dental implants with wide diameter: A systematic review with meta-analysis.

STATEMENT OF PROBLEM: Rehabilitation with wide-diameter reduced-length implants has become popular for patients with minimal vertical bone. However, a consensus on the benefits of this approach is lacking. PURPOSE: The purpose of this systematic review with meta-analysis was to evaluate the influence of wide compared with regular diameter on the clinical performance of short (<10 mm) and extrashort (≤6 mm) dental implants used for rehabilitations with single crowns, fixed partial dentures, or both, in the posterior region. MATERIAL AND METHODS: A search in 6 databases was conducted to select randomized controlled trials (RCTs) and nonrandomized controlled trials (N-RCTs). Five meta-analyses were performed, where the risk ratio (RR) was evaluated. The certainty of evidence was evaluated, and the risk of bias was determined from the Joanna Briggs Institute checklist. RESULTS: Fourteen articles were included, 272 wide- and 478 regular-diameter implants. One study presented a low, 3 an unclear, and 11 a high risk of bias. Meta-analyses showed no statistical difference: implant survival, short dental implants in N-RCTs (up to 1 year - RR 1.01 [0.98; 1.03], 1 to 5 years - RR 1.01 [0.94; 1.08], more than 5 years - RR 1.01 [0.97; 1.06]), extrashort dental implants in N-RCTs (RR 1.04 [0.90; 1.20]), RCTs (RR 1.05 [0.88; 1.25]); implant success in N-RCTs (RR 1.01 [0.97; 1.05]); prosthesis success in N-RCTs (RR 1.01 [0.97; 1.05]). CONCLUSIONS: Short and extrashort dental implants with a wide and regular diameter appear to be clinically appropriate options for implant-supported posterior restorations, with high survival, success, and prosthesis success rates.

Influence of bioactive particles and onium salt on the physicochemical properties of experimental infiltrants

Abstract This study evaluated physicochemical properties of experimental infiltrants after addition of hydroxyapatite nanoparticles (HAp) or 58S bioactive glass (BAG) and diphenyliodonium hexafluorophosphate (DPI). The resin matrix was composed of TEGDMA/Bis-EMA (3:1), 0.5 mol% CQ, and 1 mol% EDAB. The blends received or not 0.5 mol% DPI and 10% wt BAG or HAp. Icon was used as commercial control. The groups were characterized by XRD, FT-IR spectrometry, and SEM before and after simulated body fluid (SBF) immersion for up to 7 days. Polymerization kinetics (n =3 ), water sorption and solubility (n=10), and viscosity (n = 3) were surveyed. For polymerization kinetics, the samples were polymerized for 5 min and the data were obtained from 40 s and 5 min. Statistical analysis was made using ANOVA and Tukey's test (a = 0.05). After 7 days of SBF immersion, XRD and FT-IR showed that the HAp crystalline phase was present only in the HAp groups. A lower degree of conversion (DC) and polymerization rate were observed for the Icon and BAG groups, whereas HAp showed higher values. For the BAG group, DPI increased polymerization rate and DC in 40 s. After 5 min, all groups presented DC above 80%. In groups with particles, the HAp groups exhibited higher viscosity, whereas DPI groups showed a decrease in viscosity. Icon had the highest water sorption. To conclude, BAG neither improved the physicochemical properties studied, nor did it show bioactive properties. The addition of DPI reduced viscosity caused by particle addition and also attenuated the DC decrease caused by BAG addition. The addition of bioactive particles to infiltrants should be seen with caution because they increase viscosity and may not bring major clinical improvements that justify their use. DPI might be indicated only if any component is added to the infiltrant to act as a compensation mechanism.

Influence of diameter in the stress distribution of extra-short dental implants under axial and oblique load: a finite element analysis

Aim: This study evaluated the influence of a wide diameter on extra-short dental implant stress distribution as a retainer for single implant-supported crowns in the atrophic mandible posterior region under axial and oblique load. Methods: Four 3D digital casts of an atrophic mandible, with a single implant-retained crown with a 3:1 crown-to-implant ratio, were created for finite element analysis. The implant diameter used was either 4 mm (regular) or 6 mm (wide), both with 5 mm length. A 200 N axial or 30º oblique load was applied to the mandibular right first molar occlusal surface. The equivalent von Mises stress was recorded for the abutment and implant, minimum principal stress, and maximum shear stress for cortical and cancellous bone. Results: Oblique load increased the stress in all components when compared to axial load. Wide diameter implants showed a decrease of von Mises stress around 40% in both load directions at the implant, and an increase of at least 3.6% at the abutment. Wide diameter implants exhibited better results for cancellous bone in both angulations. However, in the cortical bone, the minimum principal stress was at least 66% greater for wide than regular diameter implants, and the maximum shear stress was more than 100% greater. Conclusion: Extra-short dental implants with wide diameter result in better biomechanical behavior for the implant, but the implications of a potential risk of overloading the cortical bone and bone loss over time, mainly under oblique load, should be investigated

Implant-supported crowns with locking taper implant-abutment connection: A systematic review and meta-analysis.

STATEMENT OF PROBLEM: Implant-supported single crowns are more prone to screw loosening than splinted prostheses. Therefore, the locking taper system, which has a screwless abutment, may perform better when associated with this type of rehabilitation. However, systematic reviews on this system are lacking. PURPOSE: The purpose of this systematic review was to evaluate the clinical performance and complications of single crowns retained by the locking taper system. MATERIAL AND METHODS: This systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under CRD42020189921. An electronic search was made in 5 databases and 3 other sources up to February 2021 to select prospective clinical studies evaluating the performance of single crowns retained by the locking taper system by using the outcomes implant survival, success rate, complications, marginal bone loss (MBL), and prosthesis success rate. Four meta-analyses grouped according to the follow-up intervals were performed. The risk of bias of the selected studies was evaluated by using the RoB 2 checklist for randomized controlled trials (RCTs) and Downs and Black for uncontrolled studies. RESULTS: Twelve studies were included: 9 prospective cohort studies and 3 RCTs. A survival rate of 99% (98% to 99%) and a success rate of 97% (92% to 99%) after 5 years were found. Of the total, 2.6% biological and 2.9% prosthetic complications were described. The prosthesis success rate was 97% (96% to 98%) after 5 years. An average of -0.73 mm (-0.93 to -0.52) was found for the MBL after 5 years. The risk-of-bias assessment showed 2 RCTs with high risk and 1 RCT with low risk of bias. Among uncontrolled studies, 2 were classified as poor and 7 as fair. CONCLUSIONS: Single crowns retained by locking taper implants can be safely indicated based on the high survival and success rates achieved in the long term, the maintenance of bone level stability over time, and the low incidence of complications.

Effect of ceramic thicknesses and opacities on water sorption and solubility of a light-curing resin cement by different units

Aim: This study evaluated the water sorption and solubility of a light-cured resin cement, under four thicknesses and four opacities of a lithium disilicate ceramic, also considering three light-emitting diode (LED) units. Methods: A total of 288 specimens of a resin cement (AllCem Veneer Trans ­ FGM) were prepared, 96 samples were light-cured by each of the three light curing units (Valo ­ Ultradent / Radii-Cal ­ SDI / Bluephase II ­ Ivoclar Vivadent), divided into 16 experimental conditions, according to the opacities of the ceramic: High Opacity (HO), Medium Opacity (MO), Low Translucency (LT), High Translucency (HT), and thicknesses (0.3, 0.8, 1.5, and 2.0 mm) (n = 6). The specimens were weighed at three different times: Mass M1 (after making the specimens), M2 (after 7 days of storage in water), and M3 (after dissection cycle), for calculating water sorption and solubility. Results: The higher thickness of the ceramic (2.0 mm) significantly increased the values of water sorption (44.0± 4.0) and solubility (7.8±0.6), compared to lower thicknesses. Also, the ceramic of higher opacity (HO) generated the highest values of sorption and solubility when compared to the other opacities, regardless of the thickness tested (ANOVA-3 factors / Tukey's test, α = 0.05). There was no influence of light curing units. Conclusion: Higher thicknesses and opacities of the ceramic increased the water sorption and solubility of the tested light-cured resin cement

Marginal misfit of heat-pressed milled wax-pattern and CAD/CAM crowns and its effect on stress distribution in implant-supported rehabilitations

Aim: To compare the marginal fit of lithium disilicate CAD/CAM crowns and heat-pressed crowns fabricated using milled wax patterns, and evaluate its effect on stress distribution in implantsupported rehabilitation. Methods: A CAD model of a mandibular first molar was designed, and 16 lithium disilicate crowns (8/group) were obtained. The crown-prosthetic abutment set was evaluated in a scanning electron microscopy. The mean misfit for each group was recorded and evaluated using Student's t-test. For in silico analysis, a virtual cement thickness was designed for the two misfit values found previously, and the CAD model was assembled on an implant-abutment set. A load of 100 N was applied at 30° on the central fossa, and the equivalent stress was calculated for the crown, titanium components, bone, and resin cement layer. Results: The CAD/CAM group presented a significantly (p=0.0068) higher misfit (64.99±18.73 µm) than the heat-pressed group (37.64±15.66 µm). In silico results showed that the heat-pressed group presented a decrease in stress concentration of 61% in the crown and 21% in the cement. In addition, a decrease of 14.5% and an increase of 7.8% in the stress for the prosthetic abutment and implant, respectively, was recorded. For the cortical and cancellous bone, a slight increase in stress occurred with an increase in the cement layer thickness of 5.9% and 5.7%, respectively. Conclusion: The milling of wax patterns for subsequent inclusion and obtaining heat-pressed crowns is an option to obtain restorations with an excellent marginal fit and better stress distribution throughout the implant-abutment set

Influence of luting space of zirconia abutment on marginal discrepancy and tensile strength after dynamic loading.

STATEMENT OF PROBLEM: Although luting space is related to the marginal fit of indirect restorations, information on its influence on the marginal fit and tensile strength of zirconia abutments bonded to titanium bases is lacking. PURPOSE: The purpose of this in vitro study was to evaluate the influence of luting space on the marginal discrepancy and tensile strength of zirconia abutments bonded to a titanium base after dynamic loading. MATERIAL AND METHODS: Ninety implant replicas were embedded in resin blocks to attach 4-mm-high titanium luting bases. Zirconia abutments (Ceramill Zolid FX) were fabricated with different internal luting spaces: 25 µm (G25), 50 µm (G50), or 75 µm (G75). The zirconia abutments were cemented on the titanium bases by using a resin cement (Panavia F 2.0) under a constant load of 20 N. The marginal discrepancy and internal fit of 10 random specimens from each group were evaluated with a stereoscopic microscope at ×50 magnification. The remaining specimens were submitted to the tensile strength test in which half were evaluated after dynamic loading (1.2 million cycles of 200 N at 3.8 Hz) in a mechanical fatigue machine. The tensile strength test was performed using a pullout apparatus coupled to a universal testing machine at a crosshead speed of 0.5 mm/min. The mode of failure was determined by observation at ×50 magnification under a stereomicroscope and classified into adhesive or mixed. The groups were compared by using 2-way ANOVA and the Tukey HSD test (α=.05). RESULTS: Increase in the luting space did not influence the marginal discrepancy (P>.05). All zirconia abutments exhibited lower pullout strength after fatigue simulation (P<.05). G75 demonstrated lower tensile strength than G25 and G50 before and after loading (P<.05). Most failures were adhesive at the zirconia-cement interface. CONCLUSIONS: The increase of the luting space to 75 µm did not influence marginal discrepancy; however, it reduced the tensile strength of a zirconia abutment bonded to a titanium base.

Effect of diphenyliodonium hexafluorophosphate salt on experimental infiltrants containing different diluents.

Non-invasive treatments for caries lesions are increasingly required for oral health; resin infiltration is one possible conservative option. In this study, we evaluated the effects of diphenyliodonium hexafluorophosphate salt (DPI) on experimental resin infiltrants with either (hydroxyethyl)methacrylate (HEMA) or ethanol as the diluent. A monomeric base with diglycidyl methacrylate ethoxylated (BisEMA, 25 wt%) and triethylene glycol dimethacrylate (TEGDMA, 75 wt%), 0.5 mol% of camphorquinone, and 1 mol% of ethyl-4-(dimethylamino)benzoate (EDAB) was prepared. The mixtures were divided into 12 groups according to DPI concentration (0; 0.25; 0.5; 1 mol%) and diluents (10 wt% HEMA, 10 wt% ethanol, or none). Degree of conversion (DC), water sorption (Ws), solubility (Sol), contact angle (CA), and cohesive strength (CS) tests were performed and compared to a commercial infiltrant control group (Icon). Only ethanol negatively affected DC and Sol, but both diluents negatively affected Ws and CS. Nevertheless, the presence of DPI, mainly at the 0.5 mol% concentration, compensated for the negative effects of the diluents. The commercial control group was less effective only for CS. In conclusion, 0.5% DPI seems to be the most suitable concentration to compensate for the negative effects of diluents.

Avaliação radiográfica da interface de reparo em resina bulk fill / Radiographic evaluation of repair interface in bulk fill resin

Objetivo: avaliar radiograficamente a interface de reparo em resina bulk fill (Opus bulk fill ­ FGM) com diferentes protocolos de adesão. Metodologia: foram confeccionados 30 corpos de prova em formato de cubo, nas dimensões de 4mm x 6mm. Os corpos foram randomizados e divididos entre os grupos: G1: ácido fosfórico a 37% (Dentsply) + adesivo (Ambar ­ FGM); G2: ácido fosfórico a 37% (Dentsply) + silano (Prosil ­ FGM) + adesivo (Ambar­FGM) e G3: Adesivo auto-condicionante (Ambar universal ­ FGM). Após os tratamentos, os corpos foram posicionados em uma matriz metálica de 4mm x 8mm para receber novos incrementos de resina bulk fill. Para análise do reparo, as amostras foram submetidas a radiografias digitais (Micro Imagem), com disparo de 0,16 segundos. Aplicou-se o efeito de contraste filtro de tele MI para permitir a avaliação visual. Para análise estatística foi utilizado o teste exato de Fisher. Resultados: o grupo 2 apresentou em metade dos espécimes avaliados, uma interface não visível, porém, não diferiu estatisticamente dos outros grupos que em sua maioria apresentaram a interface visível em mais de 50% da extensão do reparo. Conclusão: os protocolos realizados na interface da resina bulk fill não foram suficientes para gerar diferenças entre as imagens dos grupos tratados.

Objective: evaluate radiographically repair interface in bulk fill resin (Opus bulk fill-FGM) with different protocols of adhesion. Metodology: 30 specimens on the dimensions of 4 mm x 6 mm were made in cube formate. The specimens were randomized and divided between the groups: G1: phosphoric acid at 37% (Dentsply) + sticker (Ambar-FGM), G2: phosphoric acid at 37% (Dentsply) + silane (Prosil-FGM) + sticker (Ambar-FGM) and G3: Self-etching adhesive (universal Amber-FGM). After the treatments, the specimens were placed in a 4 mm x 8 mm metal matrix to receive new increments of resin bulk fill. For the repair analysis, samples were submitted to digital x-rays (Micro image), with triggering of 0.16 seconds. The filter contrast effect tele filter MI to allow visual assessment was applied. For statistical analysis we used the Fisher exact test. Results: group 2 presented in half of the specimens evaluated a not visible interface, however did not differ statistically from the other groups in that in their majority presented the visible interface in more than 50% of the repair extent. Conclusion: the protocols carried out in bulk fill resin interface were not sufficient to generate differences between the images of the treated groups.

Misfit and fracture load of implant-supported monolithic crowns in zirconia-reinforced lithium silicate.

OBJECTIVE: In this study, marginal and internal misfit and fracture load with and without thermal-mechanical aging (TMA) of monolithic ZLS and lithium disilicate (LDS) crowns were evaluated. MATERIAL AND METHODS: Crowns were milled using a computer-aided design/computer-aided manufacturing system. Marginal gaps (MGs), absolute marginal discrepancy (AMD), axial gaps, and occlusal gaps were measured by X-ray microtomography (n=8). For fracture load testing, crowns were cemented in a universal abutment, and divided into four groups: ZLS without TMA, ZLS with TMA, LDS without TMA, and LDS with TMA (n=10). TMA groups were subjected to 10,000 thermal cycles (5-55°C) and 1,000,000 mechanical cycles (200 N, 3.8 Hz). All groups were subjected to compressive strength testing in a universal testing machine at a crosshead speed of 1 mm/min until failure. Student's t-test was used to examine misfit, two-way analysis of variance was used to analyze fracture load, and Pearson's correlation coefficients for misfit and fracture load were calculated (α=0.05). The materials were analyzed according to Weibull distribution, with 95% confidence intervals. RESULTS: Average MG (p<0.001) and AMD (p=0.003) values were greater in ZLS than in LDS crowns. TMA did not affect the fracture load of either material. However, fracture loads of ZLS crowns were lower than those of LDS crowns (p<0.001). Fracture load was moderately correlated with MG (r=-0.553) and AMD (r=-0.497). ZLS with TMA was least reliable, according to Weibull probability. CONCLUSION: Within the limitations of this study, ZLS crowns had lower fracture load values and greater marginal misfit than did LDS crowns, although these values were within acceptable limits.

Misfit and fracture load of implant-supported monolithic crowns in zirconia-reinforced lithium silicate

Abstract Zirconia-reinforced lithium silicate (ZLS) is a ceramic that promises to have better mechanical properties than other materials with the same indications as well as improved adaptation and fracture strength. Objective In this study, marginal and internal misfit and fracture load with and without thermal-mechanical aging (TMA) of monolithic ZLS and lithium disilicate (LDS) crowns were evaluated. Material and methods Crowns were milled using a computer-aided design/computer-aided manufacturing system. Marginal gaps (MGs), absolute marginal discrepancy (AMD), axial gaps, and occlusal gaps were measured by X-ray microtomography (n=8). For fracture load testing, crowns were cemented in a universal abutment, and divided into four groups: ZLS without TMA, ZLS with TMA, LDS without TMA, and LDS with TMA (n=10). TMA groups were subjected to 10,000 thermal cycles (5-55°C) and 1,000,000 mechanical cycles (200 N, 3.8 Hz). All groups were subjected to compressive strength testing in a universal testing machine at a crosshead speed of 1 mm/min until failure. Student's t-test was used to examine misfit, two-way analysis of variance was used to analyze fracture load, and Pearson's correlation coefficients for misfit and fracture load were calculated (α=0.05). The materials were analyzed according to Weibull distribution, with 95% confidence intervals. Results Average MG (p<0.001) and AMD (p=0.003) values were greater in ZLS than in LDS crowns. TMA did not affect the fracture load of either material. However, fracture loads of ZLS crowns were lower than those of LDS crowns (p<0.001). Fracture load was moderately correlated with MG (r=-0.553) and AMD (r=-0.497). ZLS with TMA was least reliable, according to Weibull probability. Conclusion Within the limitations of this study, ZLS crowns had lower fracture load values and greater marginal misfit than did LDS crowns, although these values were within acceptable limits.

The substitution of the implant and abutment for their analogs in mechanical studies: In vitro and in silico analysis.

The use of analogs could reduce the cost of mechanical tests involving implant-supported crowns, but it is unclear if it would negatively affect the data accuracy. This study evaluated the substitution of the implant by implants analogs or abutment analogs as a support for crowns in mechanical tests, taking into account stress distribution and fracture load of monolithic lithium disilicate crowns. Thirty lithium disilicate monolithic crowns were randomized into three groups according to the set: Implant+abutment (IA); implant analog+abutment (IAA); abutment analog (AA). The specimens were subjected to mechanical fatigue (106cycles, 200N, 2Hz) and thermal fatigue (104cycles, 5°-55°C). A final compression load was applied and the maximum fracture load was recorded. Data were analyzed using one-way ANOVA (α=0.05). The experiment was validated by finite element analysis and the maximum principal stress was recorded. No statistically significant difference was observed in the mean fracture load among groups (P>0.05). The failure mode was similar for all groups with the origin of crack propagation located at the load point application. Finite element analysis showed similar stress distribution and stress peak values for all groups. The use of implant's or abutment's analog does not influence the fracture load and stress distribution for cemented implant-supported crowns.

Effect of the laser and light-emitting diode (LED) phototherapy on midpalatal suture bone formation after rapid maxilla expansion: a Raman spectroscopy analysis.

The aim of this study was to analyze the effect of laser or light-emitting diode (LED) phototherapy on the bone formation at the midpalatal suture after rapid maxilla expansion. Twenty young adult male rats were divided into four groups with 8 days of experimental time: group 1, no treatment; group 2, expansion; group 3, expansion and laser irradiation; and group 4, expansion and LED irradiation. In groups 3 and 4, light irradiation was in the first, third, and fifth experimental days. In all groups, the expansion was accomplished with a helicoid 0.020" stainless steel orthodontic spring. A diode laser (λ780 nm, 70 mW, spot of 0.04 cm(2), t = 257 s, spatial average energy fluence (SAEF) of 18 J/cm(2)) or a LED (λ850 nm, 150 mW ± 10 mW, spot of 0.5 cm(2), t = 120 s, SAEF of 18 J/cm(2)) were used. The samples were analyzed by Raman spectroscopy carried out at midpalatal suture and at the cortical area close to the suture. Two Raman shifts were analyzed: ∼ 960 (phosphate hydroxyapatite) and ∼ 1,450 cm(-1) (lipids and protein). Data was submitted to statistical analysis. Significant statistical difference (p ≤ 0.05) was found in the hydroxyapatite (CHA) peaks among the expansion group and the expansion and laser or LED groups. The LED group presented higher mean peak values of CHA. No statistical differences were found between the treated groups as for collagen deposition, although LED also presented higher mean peak values. The results of this study using Raman spectral analysis indicate that laser and LED light irradiation improves deposition of CHA in the midpalatal suture after orthopedic expansion.