Clinical performance and risk factors of all-ceramic screw-retained implant crowns in the posterior region based on a retrospective investigation.

OBJECTIVES: Clinical data on all-ceramic screw-retained implant crowns (SICs) luted on titanium base abutments (TBAs) over more than 3 years are sparse. This study aimed to evaluate the clinical performance and potential risk factors for these restorations. MATERIALS AND METHODS: Analysis took place based on the medical patient-records of three dental offices. Implant survival and prosthetic complications over time were evaluated. The study included SICs in premolar and molar regions made from monolithic lithium disilicate ceramic (M_LiDi) or veneered zirconia (V_ZiO) luted on a TBA documented over an observation time of at least 3 years. Survival and complication rates were calculated and compared by a log-rank test. Cox-Regressions were used to check potential predictors for the survival (p < .05). RESULTS: Six hundred and one crowns out of 371 patients met the inclusion criteria and follow-up period was between 3.0 and 12.9 (mean: 6.4 (SD: 2.1)) years. Over time, six implants had to be removed and 16 restorations had to be refabricated. The estimated survival rates over 10 years were 93.5% for M_LiDi and 95.9% for V_ZiO and did not differ significantly among each other (p = .80). However, V_ZiO showed significantly higher complication rates (p = .003). Material selection, sex, age, and implant diameter did not affect the survival of investigated SICs but crown height influences significantly the survival rate (hazard ratio, HR = 1.26 (95%CI: 1.08, 1.49); p = .043). CONCLUSIONS: Screw-retained SICs luted on TBAs that were fabricated from monolithic lithium disilicate ceramic or veneered zirconia showed reliable and similar survival rates. Increasing crown heights reduced survival over the years.

A prospective, randomized, controlled, multicenter evaluation of extraction socket preservation comparing two bovine xenografts: clinical and histologic outcomes.

The aim of this prospective, randomized, controlled, multicenter study was to evaluate and compare the histologic and histomorphometric aspects of extraction sockets grafted with two commercially available bovine bone xenografts: Endobon (test group) and Bio-Oss (control group). The study was designed to ensure that baseline variables between groups were as similar as possible to allow for a direct comparison of graft healing characteristics. Thirty-eight patients contributed 62 augmented extraction sites to the study. All sites were grafted with one type of bovine bone mineral and covered with a resorbable collagen membrane for 6 months of healing prior to implant placement surgery. The histologic outcomes between the two treatment groups are similar, with de novo bone (mean ± SD) for the test group at 28.5% ± 20% and for the control group, 31.4% ± 18%. Histologic specimens also include membrane remnants. All but two implants integrated successfully after 1 year of follow-up. This investigation provides support for the efficacy of bovine bone xenograft for socket preservation when subsequent implant placement is planned.

The Randomized Shortened Dental Arch study (RaSDA): design and protocol.

BACKGROUND: Various treatment options for the prosthetic treatment of jaws where all molars are lost are under discussion. Besides the placement of implants, two main treatment types can be distinguished: replacement of the missing molars with removable dental prostheses and non-replacement of the molars, i.e. preservation of the shortened dental arch. Evidence is lacking regarding the long-term outcome and the clinical performance of these approaches. High treatment costs and the long time required for the treatment impede respective clinical trials. METHODS/DESIGN: This 14-center randomized controlled investigator-initiated trial is ongoing. Last patient out will be in 2010. Patients over 35 years of age with all molars missing in one jaw and with at least both canines and one premolar left on each side were eligible. One group received a treatment with removable dental prostheses for molar replacement (treatment A). The other group received a treatment limited to the replacement of all missing anterior and premolar teeth using fixed bridges (treatment B). A pilot trial with 32 patients was carried out. Two hundred and fifteen patients were enrolled in the main trial where 109 patients were randomized for treatment A and 106 for treatment B. The primary outcome measure is further tooth loss during the 5-year follow-up. The secondary outcome measures encompassed clinical, technical and subjective variables. The study is funded by the Deutsche Forschungsgemeinschaft (German Research Foundation, DFG WA 831/2-1, 2-2, 2-3, 2-4, 2-5). DISCUSSION: The particular value of this trial is the adaptation of common design components to the very specific features of complex dental prosthetic treatments. The pilot trial proved to be indispensable because it led to a number of adjustments in the study protocol that considerably improved the practicability. The expected results are of high clinical relevance and will show the efficacy of two common treatment approaches in terms of oral health. An array of secondary outcome measures will deliver valuable supplementary information. If the results can be implemented in the clinical practice, the daily dental care should strongly profit thereof. TRIAL REGISTRATION: The trial is registered at ClinicalTrials.gov under ISRCTN68590603 (pilot trial) and ISRCTN97265367 (main trial).

Influence of preparation angle on marginal and internal fit of CAD/CAM-fabricated zirconia crown copings.

OBJECTIVE: To evaluate the effect of different preparation angles on the marginal and internal fit of zirconia single-crown copings. METHOD AND MATERIALS: Three ivorine maxillary right first molars were prepared with preparation angles of 4, 8, and 12 degrees. Impressions were made of each abutment tooth to obtain 20 specimens per group. The copings were manufactured by a CAD/CAM system and milled from semi-sintered zirconia blanks. After sintering, 10 copings were randomly chosen from each group and adapted by a dental technician. All 60 copings were cemented with glass ionomer on the master casts. After embedding, all specimens were cross-sectioned. Both marginal and internal fit were evaluated under an optical microscope. A 1-way analysis of variance (ANOVA) and a nonparametric test (Mann-Whitney U) were used to compare data (a = .05). RESULTS: The 4-degree copings showed a mean marginal gap of 91 microm (+/- 15) before and 67 microm (+/- 8) after adaptation; the 8-degree group exhibited a mean marginal gap of 82 microm (+/- 13) before and 67 microm (+/- 11) after adaptation; the 12-degree specimens showed 50 microm (+/- 6) before and 46 microm (+/- 6) after adaptation. Adaptation led to a significant improvement of specimens from the 4-degree and 8-degree groups, while no statistical difference could be observed among 12-degree specimens before and after adaptation. CONCLUSION: The highest marginal gaps were found in the 4- and 8-degree groups. In the group with 12-degree preparation angle, additional adaptation did not improve the fit and can be considered unnecessary under the conditions of this study.

Marginal and internal fits of fixed dental prostheses zirconia retainers.

OBJECTIVES: CAM (computer-aided manufacturing) and CAD (computer-aided design)/CAM systems facilitate the use of zirconia substructure materials for all-ceramic fixed partial dentures. This in vitro study compared the precision of fit of frameworks milled from semi-sintered zirconia blocks that were designed and machined with two CAD/CAM and one CAM system. METHODS: Three-unit posterior fixed dental prostheses (FDP) (n=10) were fabricated for standardized dies by: a milling center CAD/CAM system (Etkon), a laboratory CAD/CAM system (Cerec InLab), and a laboratory CAM system (Cercon). After adaptation by a dental technician, the FDP were cemented on definitive dies, embedded and sectioned. The marginal and internal fits were measured under an optical microscope at 50x magnification. A one-way analysis of variance (ANOVA) was used to compare data (alpha=0.05). RESULTS: The mean (S.D.) for the marginal fit and internal fit adaptation were: 29.1 microm (14.0) and 62.7 microm (18.9) for the milling center system, 56.6 microm (19.6) and 73.5 microm (20.6) for the laboratory CAD/CAM system, and 81.4 microm (20.3) and 119.2 microm (37.5) for the laboratory CAM system. One-way ANOVA showed significant differences between systems for marginal fit (P<0.001) and internal fit (P<0.001). SIGNIFICANCE: All systems showed marginal gaps below 120 microm and were therefore considered clinically acceptable. The CAD/CAM systems were more precise than the CAM system.

Long-term clinical performance of resin-bonded fixed partial dentures with retentive preparation geometry in anterior and posterior areas.

PURPOSE: The aim of this prospective clinical evaluation was to show the long-term clinical behavior of resin-bonded fixed partial dentures (RBFPD) with a retentive, minimally invasive preparation design. MATERIALS AND METHODS: Since 1985, 232 RBFPDs with a retentive preparation design were placed under controlled clinical conditions. In 2005 and 2006, 84 fixed partial dentures could be re-evaluated. Using Kaplan-Meier analysis, the survival rate was determined. The probability of survival was calculated with several risk factors: location (anterior/posterior, maxilla/mandible), metal alloy of the framework (titanium/CoCr), number of pontics, and number of supporting teeth. RESULTS: A total of 12 failures was observed and resulted in a survival rate of 77% after 10 years. However, only 4 catastrophic failures occurred. In such cases, the restoration was lost, or could not be re-bonded or repaired (survival rate 88% after 10 years). RBFPDs made of a titanium alloy exhibited a statistically significantly higher survival rate than RBFPDs made of a nonprecious CoCr alloy in terms of all failures. Only slight but not statistically significant differences between the covariates maxilla, mandible, anterior/posterior region, number of pontics, and number of abutment teeth were observed. CONCLUSION: Within the limitations of this study, RBFPDs seem to be a reliable restorative alternative to conventional short-span fixed dental prostheses.

Effect of preparation design on the fracture resistance of zirconia crown copings.

The aim of this in vitro study was to evaluate the effects of different preparation designs on the fracture resistance of single-crown zirconia frameworks. To this end, maxillary molar dies of CrCo alloy were fabricated with five different preparation designs: shoulderless, slight and pronounced deep chamfer, beveled and non-beveled shoulder. Ten zirconia copings with a wall thickness of 0.4 mm were fabricated for each type of preparation. After cementation by glass ionomer cement, they were loaded until fracture. There were significant differences in the breaking load of the experimental groups (ANOVA, p < 0.01). The shoulder preparation had a mean breaking load of 2286 N, the shoulderless preparation 2041 N, the beveled shoulder 1722 N, the pronounced deep chamfer 1752 N, and the slight chamfer 1624 N. Based on the results of this study, a shoulder preparation is highly recommended whenever possible. Moreover, for endodontically treated teeth that are structurally compromised or which have anatomically limited areas, the slight chamfer preparation is an optimal recommendation.

Removal of bacterial endotoxin from root surface with Er:YAG laser.

PURPOSE: To determine the potential of 2.94 microm Er:YAG laser radiation to remove bacterial endotoxin from root surfaces. MATERIALS AND METHODS: 40 extracted teeth were divided into four groups of 10 samples each. A 16 mm2 area of the root surface on each sample was inoculated with an aliquot of 7 microl of a lipopolysaccharide suspension at a concentration of 50 IU/ml. LPS was derived from a non-oral Escherichia coli strain (E. coli 055:B5). Source of laser radiation was an Er:YAG laser emitting pulsed infrared radiation at a wavelength of 2.94 microm, with a pulse duration of 250 micros, and a pulse repetition rate of 15 pps. Three specimen groups were irradiated with 105 laser pulses at a radiation energy of 60 mJ, 100 mJ and 140 mJ. One specimen group was untreated (control). The LPS concentration with each sample was determined using a chromogenic, quantitative Limulus-amoebocyte-lysate assay. Statistical analysis was ANOVA and Scheffé-test. RESULTS: Mean LPS yield from the untreated control samples was 50.1 (+/- 35.9) IU/ml. Following laser irradiation the average LPS on the root surfaces was 19.86 (+/- 14.4) IU/ml at 60 mJ, 12.86 (+/- 8.1) IU/ml at 100 mJ and 8.58 (+/- 4.9) IU/ml at 140 mJ.

Antimicrobial effects of 2.94 microm Er:YAG laser radiation on root surfaces: an in vitro study.

OBJECTIVES: This in vitro study investigated the antimicrobial effects of 2.94 microm Er:YAG laser radiation on root surfaces. MATERIALS AND METHODS: The study used 125 extracted teeth which were divided into 2 groups (A, B) of 40 teeth and 3 groups of 15 teeth (C, D, E). A defined and similarly-sized area of the root surface was inoculated with an aliquot of 7 microl of a bacterial suspension of Escherichia coli (ATCC 25922), Staphylococcus aureus (ATCC 25923), Actinobacillus actinomycetemcomitans (ATCC 43719), Eikenella corrodens (ATCC 51724), or Peptostreptococcus micros (ATCC 33270). Subsequently, the samples from each group were further divided into subgroups which have been irradiated either with 55, 75, and 105 (group A, B) or 55 and 75 (group C, D, E) laser pulses. 1 subgroup of each group was left untreated as control. The source of laser radiation was an Er:YAG laser emitting pulsed infrared radiation at a wavelength of 2.94 microm. The number of bacteria was determined using the surface spread plate technique. The statistical analysis was performed using ANOVA followed by the Scheffé-test. RESULTS: Depending on the number of laser pulses the bacterial load in the E. coli group was reduced by the Er:YAG laser radiation after exposure to 105 laser pulses to 5.5% of the initial count and that in the Staph. aureus group to 15.1%. The number of bacteria in case of A. actinomytemcomitans was reduced to 8.3%, in case of E. corrodens to 3.0% and in case of P. micros to 22.0% after application of 75 laser pulses. CONCLUSION: Besides the selective removal of plaque and calculus, the 2.94 microm Er:YAG laser radiation causes reduction in bacteria on root surfaces.