Effect of Different Sintering Procedures on Marginal and Internal Fit, Color, and Fracture Load of Monolithic Zirconia Fixed Partial Prosthesis.

AIM: The aim of this in vitro study is to investigate the effects of different sintering procedures on the fit, color parameters, and fracture load of monolithic fixed partial prosthesis. MATERIALS AND METHODS: Metal model was scanned and fixed partial prosthesis was designed. Groups were created by fabricating fixed partial prosthesis by using four different sinterization procedures (Prettau-Standard (PST), Prettau-Slow (PSL), Ice-Speed (IS), Ice-Standard (IST), n=10). PST-PSL (Group P, N=20) and IS-IST (Group I, N=20) were colored with different coloring liquids. The marginal and internal fit were measured using the silicone replica method. CIELAB values of the samples were measured using a spectrophotometer. Then, for each sample, the die was obtained from polymethyl methacrylate. The specimens were cemented into dies and tested in a universal testing machine for fracture load. One-way ANOVA were performed to assess the effect of the sintering procedure on the marginal and internal fit, fracture load, and ∆E00, ∆L', ∆C', and ∆H' values of fixed partial prosthesis. RESULTS: PSL and PST groups showed significantly smaller internal and marginal fit compared to the IS group. Additionally, IST group internal fit values were significantly higher than Prettau groups. Sintering time reduction led to a decrease in ∆E00 values. Fracture loads values were not statistically significantly affected by the different sintering procedures in both brands. CONCLUSION: Different sintering procedures did not have a clinically significant effect on fit and fracture load. Different sintering procedures were found to have an impact on the color change of monolithic zirconia restorations.

Recycling selective laser melting alloy powder on cobalt chromium-to-ceramic bond strength.

STATEMENT OF PROBLEM: Reusing the powder in selective laser melting machines after multiple cycles is a cost-effective procedure for dental laboratories. However, information on the metal-ceramic bond strength of the framework fabricated by using recycled powder is lacking. PURPOSE: The purpose of this in vitro study was to investigate how the bonding agent and repeated alloy powder reuse affected the metal-ceramic bond strength of cobalt chromium frameworks fabricated by using selective laser melting. MATERIAL AND METHODS: Four square and 40-bar-shaped cobalt chromium frameworks were fabricated by selective laser melting. Half were produced by using virgin alloy powder (Group V; nsquare=2, nbar=20), and half with 30-times reused powder (Group R; nsquare=2, nbar=20). The particle size of each powder was measured by using scanning electron microscopy, and its phase composition was characterized by using radiograph diffraction. Each group was divided into 2 subgroups (Group W [Wash Opaque] and Group N [NP-Bond]) according to the brand of bonding agent used. After ceramic application, the metal-ceramic bond strengths were evaluated by using 3-point bend tests. The bonding agents' chemical composition was analyzed by using radiograph fluorescence. Bond strength data were analyzed by using a 2-way analysis of variance (α=.05). RESULTS: Mean ±standard deviation bond strengths did not differ significantly (P>.05) between Groups V (31.25 ±4.65) and R (30.88 ±4.78). Group W (35.34 ±1.78) had significantly higher bond strength than Group N (26.80 ±1.74; P<.001). Radiograph diffraction analysis found that the phase composition of all powders was similar. The bonding agent in Group W contained cerium, whereas, that in Group N did not. CONCLUSIONS: Metal-ceramic bond strength was unaffected by alloy powder reuse. However, the bonding agent brand may affect the bond strength of cobalt chromium frameworks fabricated by using selective laser melting.

Effect of sintering procedures on optical properties, chemical composition, and grain size of monolithic zirconia ceramic at different thicknesses after hydrothermal aging: An in vitro study.

Aim: The purpose of the present study was to examine the optical properties, chemical composition, and grain size (GS) of monolithic zirconia (MZ) ceramic at different thicknesses sintered using different procedures after hydrothermal aging. Settings and Design: An in vitro study. Materials and Methods: Forty MZ discs (0.5-mm thickness [Group-0.5] and 1-mm thickness [Group-1]; 12 mm diameter) were milled and divided according to standard (Group-ST) and speed (Group-SP) sintering procedures. All specimens were hydrothermally aged at 134°C after sintering. Translucency (TP), opalescence (OP), and fluorescence (ΔEabFNx01-FL) parameters were calculated using the color coordinates (LFNx01, aFNx01, bFNx01, respectively) of the discs. The chemical composition and the GS of the specimens were characterized using X-ray fluorescence spectroscopy and a scanning electron microscopy, respectively. Statistical Analysis Used: TPs and ΔEabFNx01-FLs were analyzed using independent samples t-tests and Mann-Whitney U-tests while a two-way analysis of variance (ANOVA) was used for OPs. Results: Group-1 showed significantly lower TP than Group-0.5 (P < 0.001) but a significantly higher OP (P = 0.014). Group-SP showed significantly higher OP (P = 0.00003) and ΔEabFNx01-FL (P = 0.0026) values than Group-ST without considering the thickness. Group-SP (0.29 ± 0.119 µm) had a smaller GS than Group-ST (0.306 ± 0.142 µm). Compared to Group-ST, Group-SP had a lower percentage of Y2O3 and a higher percentage of Al2O3. Conclusion: The effect of the sintering procedure on TP and OP of MZ was not perceived by the naked eye. The speed sintering procedure may increase Δ EFNx01ab-FL of MZ to higher values than natural teeth when compared with standard sintering. The speed sintering may cause minor changes in GS and the chemical composition of MZ.

The Assessment of Different Gingival Management Materials for Immediate Implant Treatment in the Esthetic Zone: A Clinical and Biochemical Study.

PURPOSE: To observe the effect of different prosthetic materials (polymethyl methacrylate [PMMA] and flowable composite [FC]) on marginal bone loss, pink esthetic score (PES), and cytokine levels (receptor activator of nuclear factor kappa-Β ligand [RANKL] and osteoprotegerin [OPG]). MATERIALS AND METHODS: A total of 46 patients (31 women, 15 men) were treated with immediate implant therapy after tooth extraction. For standardization, only the maxillary premolar tooth of each patient was restored, and also, both of the adjacent teeth were present in the dental arch. Provisional crowns were prepared before the surgery on patient models with two different materials (24 PMMA, 22 FC). Following the surgical procedure, provisional crowns were adjusted on polyetheretherketone (PEEK) abutments as nonfunctional in centric and eccentric movements. After the surgery, patients were evaluated monthly for 3 months. At each follow-up, periapical radiography was obtained by the parallel technique, and peri-implant crevicular fluid (PICF) was collected. Pink esthetic scoring was done. MBL was calculated for the mesial and distal sides separately. Cytokine levels were analyzed from PICF. Statistical analyses (Shapiro-Wilk, Mann-Whitney U, independent-samples t test, Wilcoxon t test, paired-samples t test, and Friedman two-way analysis of variance with Bonferroni correction) were completed (α = .05). RESULTS: PES was increased significantly within groups (P < .01). However, there was no statistically significant difference between groups. According to the Mann-Whitney U test, no significant difference was found for the MBL (P > .05). When the RANKL/OPG values were evaluated within the group by using the Friedmann two-way analysis of variance test, no significant difference was found (P > .05). CONCLUSION: Similar pink esthetics, cytokine levels, and bone loss can be achieved using a protocol including immediate implants, particle grafts, soft tissue graft, PEEK abutments, and provisional restorations fabricated using PMMA and FC.

Does abutment preparation affect abutment screw joint stability? An in vitro study.

STATEMENT OF PROBLEM: Whether preparation of an implant abutment decreases the stability of the abutment screw joint is unclear. PURPOSE: The purpose of this in vitro study was to evaluate the effect of the abutment preparation in laboratory conditions on the reverse torque value (RTV) of the abutment screw. MATERIAL AND METHODS: Sixty implants, implant analogs, and abutments obtained from 2 different manufacturers were used in the present study and divided into 2 groups (groups B and N) according to the manufacturer. Each group was then divided into 3 subgroups (n=10) according to the remaining wall thickness (control, 0.4 mm, 0.6 mm). All abutments were tightened to analogs with 15 Ncm, and standardized preparation was made with a custom-designed copy-milling system. All abutments were tightened to the implants with 30 Ncm, and then, the abutment screws were removed and RTVs were recorded. Subgroups were analyzed by using 1-way ANOVA (α=.05), and the independent-sample t test was used to compare groups. Relationships between categorical variables were analyzed by chi-square tests. One abutment screw from each subgroup was randomly selected and analyzed by using a scanning electron microscope. RESULTS: A statistically significant difference was found between RTVs of different manufacturers (group B=28.2 ±1.2 Ncm, group N=25.9 ±1.4 Ncm; P<.005). In group N, there was a significant difference among subgroups, control (26.7 ±1.4 Ncm), and 0.6-mm wall thickness (24.8 ±0.8 Ncm) (P<.05). A statistically significant relationship was found between preparation and RTV for the NucleOSS only (P<.05) and between manufacturer and RTV (P<.001). Scanning electron microscopy evaluations identified different screw head and thread designs. CONCLUSIONS: The abutment screw joint stability of the BioHorizons implant was not affected by abutment preparation.

Evaluation of marginal adaptation in three-unit frameworks fabricated with conventional and powder-free digital impression techniques.

PURPOSE: The purpose of this in vitro study was to evaluate the marginal misfits of three-unit frameworks fabricated with conventional and digital impressions techniques. MATERIALS AND METHODS: Thirty brass canine and second premolar abutment preparations were fabricated by using a computer numerical control machine and were randomly divided into 3 groups (n=10) as follows: conventional impression group (Group Ci), Cerec Omnicam (Group Cdi), and 3shape TRIOS-3 (Group Tdi) digital impression groups. The laser-sintered metal frameworks were designed and fabricated with conventional and digital impressions. The marginal adaptation was assessed with a stereomicroscope at ×30 magnification. The data were analyzed with 1-way analysis of variances (ANOVAs) and the independent simple t tests. RESULTS: A statistically significant difference was found between the frameworks fabricated by conventional methods and those fabricated by digital impression methods. Multiple comparison results revealed that the frameworks in Group Ci (average, 98.8 ± 16.43 µm; canine, 93.59 ± 16.82 µm; premolar, 104.10 ± 15.02 µm) had larger marginal misfit values than those in Group Cdi (average, 63.78 ± 14.05 µm; canine, 62.73 ± 13.71 µm; premolar, 64.84 ± 15.06 µm) and Group Tdi (average, 65.14 ± 18.05 µm; canine, 70.64 ± 19.02 µm; premolar, 59.64 ± 16.10 µm) (P=.000 for average; P=.001 for canine; P<.001 for premolar). No statistical difference was found between the marginal misfits of canine and premolar abutment teeth within the same groups (P>.05). CONCLUSION: The three-unit frameworks fabricated with digital impression techniques showed better marginal fit compared to conventional impression techniques. All marginal misfit values were clinically acceptable.

Production of a Piece of Custom-Made Abutment Screwdriver: Technique and Case Report.

Crown fractures, framework fractures, and abutment screw loosening or screw fracture are examples of mechanical implant failures. Abutment screw loosening is a serious problem that can result in abutment screw fractures. This clinical report describes the production method of a custom-made abutment screwdriver piece for a patient with abutment screw loosening.

Effect of repeated ceramic firings on the marginal and internal adaptation of metal-ceramic restorations fabricated with different CAD-CAM technologies.

STATEMENT OF PROBLEM: The use of computer-aided design and computer-aided manufacturing (CAD-CAM) for metal-ceramic restorations has increased with advances in the technology. However, little is known about the marginal and internal adaptation of restorations fabricated using laser sintering (LS) and soft milling (SM). Moreover, the effects of repeated ceramic firings on the marginal and internal adaptation of metal-ceramic restorations fabricated with LS and SM is also unknown. PURPOSE: The purpose of this in vitro study was to investigate the effects of repeated ceramic firings on the marginal and internal adaptation of metal-ceramic copings fabricated using the lost wax (LW), LS, and SM techniques. MATERIAL AND METHODS: Ten LW, 10 LS, and 10 SM cobalt-chromium (Co-Cr) copings were fabricated for an artificial tooth (Frasaco GmbH). After the application of veneering ceramic (VITA VMK Master; VITA Zahnfabrik), the marginal and internal discrepancies of these copings were measured with a silicone indicator paste and a stereomicroscope at ×100 magnification after the first, second, and third clinical simulated ceramic firing cycles. Repeated measures 2-way ANOVA and the Fisher LSD post hoc test were used to evaluate differences in marginal and internal discrepancies (α=.05). RESULTS: Neither fabrication protocol nor repeated ceramic firings had any statistically significant effect on internal discrepancy values (P>.05). Marginal discrepancy values were also statistically unaffected by repeated ceramic firings (P>.05); however, the fabrication protocol had a significant effect on marginal discrepancy values (P<.001), with LW resulting in higher marginal discrepancy values than LS or SM (P<.05). Marginal discrepancy values did not vary between LS and SM (P>.05). CONCLUSIONS: All groups demonstrated clinically acceptable marginal adaptation after repeated ceramic firing cycles; however, the LS and SM groups demonstrated better marginal adaptation than that of LW group and may be appropriate clinical alternatives to LW.

In Vitro Comparison of the Bond Strength between Ceramic Repair Systems and Ceramic Materials and Evaluation of the Wettability.

PURPOSE: When fracture of an all-ceramic restoration occurs, it can be necessary to repair without removing the restoration. Although there are many studies about the repair of metal-ceramic restorations, there are few about all-ceramic restorations. The aim of this study was to evaluate the shear bond strength between ceramic repair systems and esthetic core materials and to evaluate the wettability of all-ceramic core materials. MATERIALS AND METHODS: Disk-like specimens (N = 90) made of three dental ceramic infrastructure materials (zirconia ceramic, alumina ceramic, glass ceramic) were polished with silicon carbide paper, prepared for bonding (abrasion with 30 µm diamond rotary cutting instrument). Thirty specimens of each infrastructure were obtained. Each infrastructure group was divided into three subgroups; they were bonded using 3 repair systems: Bisco Intraoral Repair Kit, Cimara & Cimara Zircon Repair System, and Clearfil Repair System. After 1200 thermocycles, shear bond strength was measured in a universal testing machine at a 0.5 mm/min crosshead speed. In addition, the contact angle values of the infrastructures after surface treatments were examined for wettability. Data were analyzed by using ANOVA and Tukey post hoc tests. RESULTS: Although there were no significant differences among the repair systems (p > 0.05) in the glass ceramic and zirconia groups, a significant difference was found among the repair systems in alumina infrastructure (p < 0.001). There were no statistically significant differences among the infrastructures (p > 0.05); however, a statistically significant difference was found among the repair systems (p < 0.05). No difference was found among the infrastructures and repair systems in terms of contact angle values. CONCLUSIONS: Cimara & Cimara Zircon Repair System had higher bond strength values than the other repair systems. Although no difference was found among the infrastructures and repair systems, contact wettability angle was decreased by surface treatments compared with polished surfaces.

Effect of digital impressions and production protocols on the adaptation of zirconia copings.

STATEMENT OF PROBLEM: Proper marginal, axial, and occlusal adaptation of dental restorations is essential for their long-term success. Production protocols including digital impression systems have been developed, but little information is available on the adaptation of zirconia restorations produced via them. PURPOSE: The purpose of this in vitro study was to compare the effects of digital impression protocols on the marginal, axial, and occlusal adaptation of zirconia copings. MATERIAL AND METHODS: Thirty extracted human maxillary premolar teeth without caries or defects were used. The teeth were prepared for zirconia crowns and randomly divided into 3 groups. Zirconia copings were designed at a thickness of 0.5 mm with 30 µm of simulated die spacer starting 1 mm from the margin of preparations. They were produced using computer-aided design-computer-aided manufacture (CAD-CAM) protocol with a conventional impression (group Cn) and 2 different production protocols with digital impressions (group C) and group Tr. The marginal, axial, and occlusal discrepancies of these copings were measured using the silicone replica technique with stereomicroscopy at ×50 magnification, and the data were analyzed with 1-way ANOVAs (α=.05). RESULTS: The mean marginal discrepancy values were 85.6 µm for group Cn, 58.7 µm for group C, and 47.7 µm for the Tr group. Significant differences were found among the production protocols in marginal, axial, and occlusal discrepancies (P<.05). Copings fabricated with the aid of digital impressions had significantly fewer marginal discrepancies than those of group Cn (P<.05). Group Tr exhibited the lowest marginal discrepancy, whereas groups Cn and C demonstrated similar axial adaptations (P>.05), and group Tr revealed the lowest axial discrepancy (P<.05). With regard to the occlusal discrepancy evaluation, group Tr had the lowest discrepancy. However, no significant differences was found between groups C and Cn (P>.05). CONCLUSIONS: The copings produced with the aid of digital impression systems exhibited better marginal and occlusal adaptation than those of the copings produced with the aid of conventional impression.

Accuracy of torque-limiting devices: A comparative evaluation.

STATEMENT OF PROBLEM: To prevent the loosening of implant screws, clinicians should be aware of the output torque values needed to achieve the desired preload. Accurate torque-control devices are crucial in this regard; however, little information is currently available comparing the accuracy of mechanical with that of electronic torque-control devices. PURPOSE: The purpose of this in vitro study was to identify and compare the accuracy of different types of torque-control devices. MATERIAL AND METHODS: Devices from 5 different dental implant manufacturers were evaluated, including 2 spring-type (Straumann, Implance) mechanical devices (MTLD), 2 friction-type (Biohorizons, Dyna) MTLDs, and 1 (Megagen) electronic torque-control device (ETLD). For each manufacturer, 5 devices were tested 5 times with a digital torque tester, and the average for each device was calculated and recorded. The percentage of absolute deviations from the target torque values (PERDEV) were calculated and compared by using 1-way ANOVA. A 1-sample t test was used to evaluate the ability of each device to achieve its target torque value within a 95% confidence interval for the true population mean of measured values (α=.05 for all statistical analyses). RESULTS: One-way ANOVAs revealed statistically significant differences among torque-control devices (P<.001). ETLD showed higher PERDEVs (28.33 ±9.53) than MTLDs (P<.05), whereas PERDEVS of friction-type (7.56 ±3.64) and spring-type (10.85 ±4.11) MTLDs did not differ significantly. In addition, devices produced by Megagen had a significantly higher (P<.05) PERDEV (28.33 ±9.53) other devices, whereas no differences were found in devices manufactured by Biohorizons (7.31 ±5.34), Dyna (7.82 ±1.08), Implance (8.43 ±4.77), and Straumann (13.26 ±0.79). However, 1-sample t tests showed none of the torque-control devices evaluated in this study were capable of achieving their target torque values (P<.05). CONCLUSIONS: Within the limitations of this in vitro study, MTLDs were shown to be significantly more accurate than ETLDs. However, none of the torque-control devices evaluated were able to meet their target torque values successfully.

In vitro evaluation of marginal, axial, and occlusal discrepancies in metal ceramic restorations produced with new technologies.

STATEMENT OF PROBLEM: Marginal and axial discrepancies of metal ceramic restorations are key to their long-term success. Little information is available for metal ceramic restorations fabricated with soft metal milling and laser sintering technologies. PURPOSE: The purpose of this in vitro study was to compare the marginal, axial, and occlusal discrepancies in single-unit metal ceramic restorations fabricated with new production techniques with those in a single-unit restoration fabricated using a conventional technique. MATERIAL AND METHODS: After the artificial tooth was prepared, impressions were made, and 40 dies were obtained. Dies were randomly divided into 4 groups (n=10). Cobalt-chromium (Co-Cr) cast (C), hard metal milled (HM), laser sintered (LS), and soft metal milled (SM) copings were fabricated. Marginal, axial, and occlusal discrepancies of these copings were measured using the silicone replica technique before and after the application of veneering ceramic. Data were analyzed with repeated measurements 2-way ANOVAs and Bonferroni post hoc tests (α=.05). RESULTS: Significant differences were found in the increase of marginal discrepancy after the application of veneering ceramic in the LS group (P=.016). However, no significant differences in marginal discrepancy were found whether veneering ceramic was applied to copings before or after in the other groups (P>.05). With regard to marginal and occlusal discrepancies, significant differences were found among the production techniques (P<.001 and P<.05, respectively). No significant differences in axial discrepancies were found among the groups (P>.05). CONCLUSION: This in vitro study showed that metal ceramic restorations produced with HM and newly introduced SM techniques exhibited better marginal adaptations than those produced with the LS or C technique.

Clinical Outcomes After Immediate and Late Implant Loading for a Single Missing Tooth in the Anterior Maxilla.

PURPOSE: This study compared the clinical outcomes of 1-year follow-up of immediate and late implant loading after implant restoration of a single tooth in the anterior maxilla. MATERIALS AND METHODS: Thirty-three patients with missing teeth in the anterior maxilla were included in this study (18 immediate loading and 15 late loading). Standard periapical radiographs were obtained to evaluate the vertical bone loss around the implant. For both implant groups, periimplant parameters (probing depth, gingival bleeding index, gingival index (GI), modified plaque index, width of keratinized gingiva) were evaluated. RESULTS: There were no significant differences in bone loss, the widths of keratinized gingiva, the GI, and modified plaque index between the immediate implant loading and late implant loading groups (P > 0.05). A significant difference in the probing depth was observed between these groups at the initial and 1-month evaluations (P < 0.05). Significant differences in bleeding indices between these groups were observed at months 3 and 6 (P < 0.05). CONCLUSIONS: When selecting appropriate patients (adequate primary stability, patient compliance with the surgeon's recommendations), immediate implant loading may be an alternative method to late loading protocol for replacement of a missing tooth in anterior maxilla.

Effects of Ozone Therapy on the Early Healing Period of Deepithelialized Gingival Grafts: A Randomized Placebo-Controlled Clinical Trial.

BACKGROUND: This study evaluates the effects of ozone therapy (OT) on the early healing period of deepithelialized gingival grafts (DGG) placed for non-root coverage gingival augmentation by laser Doppler flowmetry (LDF). METHODS: Thirty-three patients were assigned to study groups: 1) test: DGG + OT; or 2) control group: DGG alone. Thirty patients completed the study. Ozone was applied on DGGs placed in the recipient bed and donor site immediately after surgery and at days 1 and 3 post-surgery. Blood perfusion in the recipient site was measured by LDF on the day of surgery and at 1, 2, 3, 6, 8, 10, and 13 days after surgery. Quality of life (assessed by the Oral Health Impact Profile-14) and pain at donor/recipient sites (assessed by visual analog scale) were also investigated. RESULTS: Increase in blood perfusion units in the test group was significantly higher than control group at 1, 2, 3, 6, and 8 days post-surgery (P <0.001). Significant differences occurred between test and control groups in terms of visual analog scale values during the first week post-surgery for both donor and recipient sites (P <0.05). The ozone-treated group showed significantly higher quality of life than control group on postoperative day 6 (P = 0.002). CONCLUSIONS: OT enhanced blood perfusion units in the first postoperative week. This outcome is also consistent with improvement in wound healing, accompanied by an increase in quality of life and decrease in postoperative pain in the test group.

Effect of fluid contamination on reverse torque values in bone-level implants.

INTRODUCTION: Screw loosening is one of the most common mechanical complications within the prosthetic components of dental implants. Clinicians must know if reverse torque values (RTVs) are affected by contamination of the implant abutment screw hole with either blood, saliva or chlorhexidine. METHODS: Forty implants were divided into 4 groups (n = 10). Implants were embedded in epoxy resin and placed in a digital torque meter. Screw holes of 30 implants were contaminated with either chlorhexidine (CG), fresh human saliva (SG), or blood (BG), and the remaining noncontaminated screws served as a control group (NC). Abutment screws were tightened using a hand-held torque meter (25 N·cm). Thermocycling (1500 cycles) was performed, and abutment detorque values were calculated using the digital torque meter. RESULTS: RTVs were lower than insertion torque values for all groups. According to Tukey HSD Test, blood contamination of abutment screws resulted in significantly lower RTVs (18.950 ± 2.641 N·cm) when compared with controls. CONCLUSIONS: Blood contamination of abutment screw holes was shown to significantly decrease RTVs. Blood contamination may result in greater loosening of implant screws in clinical practice.