An investigation on heat transfer to the implant-bone interface due to abutment preparation with high-speed cutting instruments.

Excessive heat generation at the implant-bone interface may cause irreversible bone damage and loss of osseointegration. The effect of heat generation in vitro at the implant surface caused by abutment reduction with medium- and extra-fine-grain diamond and tungsten burs in a high-speed dental turbine was examined. Titanium-alloy abutments connected to a titanium-alloy cylindrical implant embedded in an acrylic-resin mandible in a 37 degrees C water bath were reduced horizontally and vertically. Temperature changes were recorded via embedded thermocouples at the cervix and apex of the implant surface. Analysis of variance for repeated measures was used to compare seven treatment groups. Thirty seconds of continuous cutting with standard turbine coolant caused a mean temperature increase of 1 degrees C with a maximum of 2 degrees C. Similar tungsten cutting caused a mean increase of 2 degrees C with a maximum of 4.7 degrees C, significantly higher than diamond reduction. Additional air-water spray for continuous tungsten cutting had no significant effect, while intermittent cutting for 15-second increments reduced the temperature increase by 75%. Thus, abutment reduction with medium-grit diamonds using intermittent pressure and normal turbine coolant is unlikely to cause an interface-temperature increase sufficient to cause irreversible bone damage and compromise osseointegration.

An investigation of heat transfer to the implant-bone interface related to exothermic heat generation during setting of autopolymerizing acrylic resins applied directly to an implant abutment.

Excessive heat generation at the implant-bone interface may cause bone damage and compromise osseointegration. Autopolymerizing acrylic resins are commonly used intraorally to join impression copings and suprastructure components for soldering. The effect of heat generation at the implant surface related to the exothermic setting reaction of autopolymerizing acrylic resins applied to an attached abutment was examined in vitro. Two brands of autopolymerizing acrylic resin, Duralay and GC Pattern Resin, were compared. Acrylic resin was applied to a titanium alloy abutment connected to a titanium alloy cylindric implant in varying controlled volumes, with both bulk application and brush paint-on techniques. The implant was embedded in an acrylic resin mandible in a 37 degrees C water bath. Temperature changes were recorded via embedded thermocouples at the cervical and apical of the implant surface. Analysis of variance for repeated measures was used to compare treatment groups. A mean maximum increase in temperature of 4 to 5 degrees C was seen at the implant cervical for both materials, with a maximum temperature increase of 6 degrees C. No difference between Duralay and GC Pattern Resin was seen, except for bulk application to medium-sized copper bands at the implant cervical (P < .05). No difference between the bulk and brush techniques was seen for all options, except for GC, where bulk application to medium-sized copper bands produced higher temperatures than the brush technique (P < .05). Spray coolant reduced temperatures for bulk application of both Duralay and GC (P < .05).

Removable partial denture with a lateral rotational path of insertion.

A removable partial denture with a lateral path of insertion is useful when unsightly facial clasps are objectional to the patient. Rounded rest seat preparations allow extensions of the minor connector to rotate laterally into embrasure undercuts, providing retention. Guiding planes on the contralateral side ensure a different path of withdrawal from the retentive elements. A Kennedy Class IV arch with a long edentulous span is used to illustrate the denture design.

Splinting osseointegrated implants and natural teeth in rehabilitation of partially edentulous patients. Part I: laboratory and clinical studies.

A significant clinical consideration in the restoration of partial edentulism with implant and tooth-supported prostheses is whether implants and natural teeth abutments should be splinted, and if so, in what manner. This article presents a review of laboratory and clinical studies related to splinting. Stress analysis studies reveal high stress concentration around the implant neck when rigidly connected to teeth. This was not borne out in in vivo studies in short-span bridges. While stress absorbing elements have been advocated to redistribute and reduce stress concentration away from the implant neck where bone resorption is often seen, finite element analysis and photo-elastic studies demonstrate that such stress absorbing elements may be effective only when their resiliency is in the same order of magnitude as the periodontal ligament. Clinical studies reporting life table statistics in combined implant and tooth restorations do not show adverse effects of splinting teeth to implants. These studies, however, are mostly short-term reports on survival with results that are as yet inconclusive. The issue of connecting with rigid or non-rigid connectors remains unresolved with a growing body of information favouring retrievable short-span rigid connection to non-mobile teeth. Root intrusion is a potential clinical hazard of non-rigid connection.

Splinting osseointegrated implants and natural teeth in rehabilitation of partially edentulous patients. Part II: principles and applications.

Lone standing splinted implant segments are accepted as optimal. However, in the treatment of partial edentulism, clinical reality often predicates the consideration of splinting teeth and implants due to variables of tooth/implant location and available bone support. This article presents a review on biomechanical aspects of splinting teeth and some considerations of splinting teeth and implants. A proposed classification of splinting applicable to both teeth and implants is presented as well as a discussion of the clinical aspects of splinting illustrated with clinical cases.

Accuracy of three polyvinyl siloxane putty-wash impression techniques.

STATEMENT OF PROBLEM: There is much discussion in the dental literature concerning the effect of the impression technique on the accuracy of cast restorations. PURPOSE: This study assessed the accuracy of 3 putty-wash impression techniques using the same impression material (polyvinyl siloxane) in a laboratory model. MATERIAL AND METHODS: The 3 putty-wash impression techniques used were (1) 1-step (putty and wash impression materials used simultaneously); (2) 2-step with 2-mm relief (putty first as a preliminary impression to create 2-mm wash space with prefabricated copings. In the second step, the wash stage was carried out); and (3) 2-step technique with a polyethylene spacer (plastic spacer used with the putty impression first and then the wash stage). For each technique, 15 impressions were made of a stainless steel master model that contained 3 complete crown abutment preparations, which were used as the positive control. Accuracy was assessed by measuring 6 dimensions (intraabutment and interabutment) on stone dies poured from impressions of the master model. RESULTS: One-way analysis of variance showed statistically significant differences among the 3 putty-wash impression techniques, for all intraabutment and interabutment measurements (P <.001). Overall discrepancies of the 2-step technique with 2-mm relief putty-wash impression technique were significantly smaller than that in the 1-step and polyethylene putty-wash impression techniques. CONCLUSION: The polyvinyl siloxane 2-step, 2-mm, relief putty-wash impression technique was the most accurate for fabricating stone dies.

Composite-veneered amalgam restorations.

A procedure is described for the construction of composite resin veneers for large amalgam restorations. The resulting restoration combines the physical qualities of amalgam with the esthetic benefits of composite resins. Among the 14 restorations that have been studied for 2 years, none failed mechanically and minor surface discolorations have been satisfactorily corrected by polishing.

Surface roughness of tooth shoulder preparations created by rotary instrumentation, hand planing, and ultrasonic oscillation.

A dentinal shoulder with a smooth surface is necessary to ensure accurate adaptation of a porcelain crown. The surface roughness of dentinal shoulders prepared with different instruments was investigated in this in vitro study. Sixty shoulders, 1 mm wide, were prepared with coarse grit diamonds in extracted formalin-stored teeth. Of these 60 shoulders 20 were further refined with fine grit, and 20 more shoulders were refined with super-fine grit diamonds. The surface roughness (Ra) of the dentinal shoulders was recorded after each procedure. Thirty surfaces were further finished and refined with a hand chisel, and the other 30 surfaces were finished with a flat-ended diamond tip held in an ultrasonic generating device; the Ra was then recorded. These shoulder preparations were examined under a scanning electron microscope. The Ra of the dentinal shoulders prepared by the ends of the different grit diamonds was not significantly different (p > 0.05). Hand planing did not improve the Ra, and ultrasonic planing significantly increased the Ra (p < 0.05). Scanning electron micrographs revealed no apparent qualitative differences between surface roughness of the shoulders prepared by the diamonds or by the hand-planed surface. However, deeper scratches were evident at ultrasonically planed surfaces.

Modalities of treatment for the combination syndrome.

A series of destructive changes occurring in the jaws of patients wearing a complete maxillary denture opposed by a mandibular distal extension removable partial denture have been described as the combination syndrome. However, the syndrome does not occur in all patients. Those patients who have not developed signs of the combination syndrome and whose mandibular anterior teeth are well preserved and not overerupted may be treated conservatively with a mandibular removable partial denture. A properly designed removable partial denture that distributes occlusal stresses over hard and soft tissues minimizes the risk of developing the combination syndrome. Nevertheless, the overdenture seems to provide a more predictable prognosis, especially for patients who already have the combination syndrome or whose mandibular anterior teeth are structurally or periodontally compromised or overerupted. The treatment modality is determined by the apparent potential of the patient to develop the combination syndrome and by the condition of the remaining mandibular anterior teeth.

The influence of surface loading and irradiation time during curing on mechanical properties of a composite.

PURPOSE: The aim of this study was to determine the influence of different surface loadings during curing with various irradiation times on hardness and diametral tensile strength of a light-cured composite. MATERIAL AND METHODS: A mold was fabricated to allow loading during curing of cylindrical specimens of a composite. Four surface loadings of 0, 0.35, 0.87, and 1.73 MPa and four irradiation times of 20, 40, 60, and 180 seconds were used (n = 15). Each specimen was subjected to a microhardness test and to a diametral tensile strength test. RESULTS: Surface loading during curing affected both hardness and strength properties, whereas irradiation time influenced only the hardness of the material. Both parameters gained between 15% and 20% improvement when the material was loaded with 0.87 MPa surface pressure and cured by 60-second irradiation time. Higher loading or longer irradiation times did not improve these properties. CONCLUSION: Loading composite during curing improves its mechanical properties, probably through decreasing flaws and air voids of the material.

The linear accuracy of impressions and stone dies as affected by the thickness of the impression margin.

This study compared the dimensional accuracy of impressions and dies made from a metal model simulating prepared abutments and having gingival sulci of varying widths. Measurements of the abutments, impressions, and stone dies were made using a travelling microscope, and the number of defects in each impression was recorded. The impressions and dies made from abutments with narrower sulci showed greater distortions. Analysis of variance and the Fisher PLSD post hoc test indicated significant differences between the group having a sulcular width of 0.08 mm and the groups having larger sulcular widths for the impressions and for the dies (P < .05). The large coefficient of variation occurring groups having 0.08-, 0.13-, and 0.18-mm sulcular widths demonstrated the difficulty of consistently obtaining good impressions of abutments having such narrow sulcular widths. Between 50% and 90% of abutment impressions having sulcular widths of 0.08 and 0.13 mm had defects.

Posterior bite collapse--revisited.

Although there are different definitions of posterior bite collapse, only the classical definition of Amsterdam provides a definite diagnosis and treatment plan. This situation entails a subtle loss of the occlusal vertical dimension with resultant flaring of the maxillary incisors. Other causes for flaring, such as derangements of form and functions of lips and tongue, bruxism, habits, as well as the presence of advanced periodontal disease or malocclusions, should be ruled out before the diagnosis of posterior bite collapse can be made. The complexity of differential diagnosis is illustrated with three case reports.

The effect of marginal thickness on the distortion of different impression materials.

An impression of the margins of a prepared tooth and adjacent gingival sulcus must be of sufficient thickness to withstand distortion and tearing when the impression is removed from the mouth. The purpose of this study was to compare the dimensional accuracy of Elite, Examix, and Express polyvinyl siloxanes; Permadyne polyether; and Permlastic polysulfide elastomeric impression materials. These materials were used to make impressions of a metal model that simulated prepared abutments with gingival sulci of various widths. A traveling microscope was used to measure the abutments and impression widths, and the number of defects in each impression was recorded. Between 70% and 100% of the abutment impressions with sulcular widths of 0.05 mm exhibited defects, which prevented accurate measurements in this group. Express material demonstrated a high number of defects in the 0.10 and 0.16 mm sulcular width groups. No great difference in average maximum distortion values or coefficients of variation (CV) were detected among the materials used to make impressions of abutments with sulcular width groups of 0.2 to 0.4 mm. For the sulci of 0.16 mm and less, Examix and Permiastic materials exhibited distortion and a CV comparable to the impressions of the wider sulcular groups, whereas Elite and Permadyne showed greater distortions and CVs. The differences were not statistically significant (analysis of variance) because of the larger CV among the groups. The larger coefficient of variation in the 0.1 and 0.16 mm sulcular width groups demonstrated inconsistencies in obtaining good impressions of abutments with such narrow sulcular widths.

The closure of the gingival crevice following gingival retraction for impression making.

Scant attention has been paid to the effectiveness of chemomechanical displacement of the gingiva prior to impression making for fixed partial dentures. The closure of the gingival crevice following removal of medicated retraction cord was observed using a miniature video camera. Sulcular widths were measured at time intervals at the midbuccal and transitional line angle areas. The closure rate of the transitional line angle area was significantly faster than that of the mid-buccal area during the first 90 s. An average sulcular width of 0.2 mm was reached at the transitional line angle after less than 30 s.

The effect of displacement time on gingival crevice width.

The authors investigated the length of time medicated displacement cord should remain in the gingival crevice prior to impression making. A silk cord (Deknatel) was placed into the sulcus and was not removed during the study. Medicated cords (Hemodent on Ultrapak #1) were placed into the gingival sulcus for 2, 4, 6, and 8 minutes. Following cord removal, closure of the sulcus was recorded at intervals using a miniature video camera. Crevicular widths were measured at the midbuccal and transitional line angle areas. At both the midbuccal and transitional line angle areas, gingival crevices displaced for 2 minutes were significantly smaller at 20 seconds (P < .05) than crevices following displacement for 4, 6, and 8 minutes. No significant difference in crevicular width was found at any time period after cord removal for crevices displaced for 4, 6, and 8 minutes. At the transitional line angle, crevicular widths were significantly smaller than at the midbuccal at 20 seconds for all times and remained so up to 180 seconds. To achieve a crevicular width of 0.2 mm, cord should remain in the gingival crevice for an optimum time of 4 minutes prior to impression making when using the materials evaluated in this study.

Effect of different cooling rates on fracture toughness and microhardness of a glazed alumina reinforced porcelain.

Dental porcelain has superior esthetics but may be subject to fracture during mastication. Residual compressive stresses on the porcelain surface after cooling enhance resistance of porcelain to crack initiation, as quantified by its fracture toughness (Kc). The effect of different cooling rates on Kc and hardness of a glazed porcelain reinforced with approximately 2% aluminum oxide was examined in 45 porcelain disks that were divided into three groups. After final glaze firing, one group was cooled rapidly, the second was cooled at a medium rate, and the third was cooled slowly. Fracture toughness was determined with a microindentation procedure. The mean Kc recorded for rapidly cooled porcelain (1.74 +/- 0.09 MN/m3/2), for medium-cooled porcelain (1.41 +/- 0.07 MN/m3/2), and for slow-cooled porcelain (1.29 +/- 0.07 MN/m3/2) was statistically different (p < 0.001, analysis of variance and Bonferroni post hoc test). No statistically significant differences in Vickers hardness values were recorded when porcelain was cooled at different rates (530 to 540) (analysis of variance). The faster cooling rate of a glazed alumina reinforced porcelain resulted in greater fracture toughness but had no effect on hardness.

Effect of glaze thickness on the fracture toughness and hardness of alumina-reinforced porcelain.

STATEMENT OF PROBLEM: Although porcelain is the most esthetic restorative material available, it is subject to fracture during function. Glazing reduces the size of flaws in the surface of the porcelain and increases its resistance to crack propagation, but the optimum thickness of this glazed layer has not been determined. PURPOSE: This study compared the fracture toughness (Kc ) and Vickers hardness number (VHN) of an alumina-reinforced porcelain at different thicknesses of glaze. MATERIAL AND METHODS: Disks of feldspathic porcelain reinforced with 2% aluminum oxide were prepared and glazed for 0, 30, 60, 90, and 120 seconds. Fracture toughness and Vickers microhardness were determined with a microindentation technique. Thickness of the glazed layers was measured with a SEM. RESULTS: Mean Vickers hardness number and fracture toughness values both decreased significantly with glazing times from 0 to 60 seconds, and increased significantly with glazing times from 60 to 120 seconds (P <.001, ANOVA). SEM examination revealed an increase in glazed layer thickness with increased glazing time. CONCLUSIONS: Minimal and maximum thicknesses of glaze layers on alumina-reinforced porcelain resulted in a surface that was harder and more resistant to fracture than moderate glaze thicknesses.

Manual closing torque in five implant abutment systems: an in vitro comparative study.

STATEMENT OF PURPOSE: A significant percentage of abutment/implant (A/I) assemblies tend to unscrew on functional loading. PURPOSE: This in vitro study evaluated the maximum closing torque generated manually for comparison with recommended closing torque values in 5 implant systems. METHODS: Closing torque generated by 9 operators with 5 manual torque drivers was measured and compared by using a mannequin and torque gauge assembly. RESULTS: Closing torque values were found to be significantly different between operators and between implant systems (P <.0001). Mean closing torque values of 9 operators performing 5 closures for 5 systems ranged from 7 to 14.6 N/cm for habitual closures and from 9.4 to 19.9 N/cm for maximum closures. CONCLUSIONS: The results demonstrated that maximum manual closure did not approach recommended closing torque in any of the system measured. Significant interoperator and intraoperator variability was found in the closing torque with manual drivers, and the driver diameter and grip were probably an important feature in the generation of high closing torque.