Influence of toothbrushing methods on tightening torque with healing abutments of different lengths: An in vitro study.

STATEMENT OF PROBLEM: Early tightening torque at the implant-healing abutment interface is a recognized concern in implant treatment. However, little is known regarding the effects of toothbrushing methods on the interface established between the implant and healing abutments of different heights. PURPOSE: The purpose of this in vitro study was to evaluate the effect of different toothbrushing methods on tightening torque for healing abutments of different heights. MATERIAL AND METHODS: A total of 60 implants (Bilimplant; Proimtech) were embedded in epoxy resin blocks. The following 6 test groups were established: healing abutments with manual toothbrush group (Oral B Pro Expert All in one; Oral B) and 4 mm height (MTB-4, (which served as the control); 6 mm height (MTB-6, which served as the control); sonic toothbrush group (Philips Sonicare 3100 Series; Philips Oral Healthcare) and 4 mm height (S-4); 6 mm height (S-6); oscillating/rotating toothbrush group (Oral B Smart 6 6000N; Oral B) and 4 mm height (OR-4) and 6 mm height (OR-6). Each specimen was tightened to 15 Ncm and brushed. The digital torque meter (Cap Torque Tester Series TT01; Mark10) was used to calculate the reverse torque values. RESULTS: The highest torque loss value in the average torque losses in the test groups was 1.3 (OR-6); the lowest was 0.3 (S-4). While a significant difference was found between groups S-4 and S-6 (P=.018), no statistically significant difference was found among the other groups (P>.05). CONCLUSIONS: Torque loss was greater in the healing abutment with a height of 6 mm and with the oscillatory and rotational brushing method.

Effectiveness of surface polishing after debonding of metal brackets from different CAD-CAM materials.

PURPOSE: The purposes of this study were to compare and evaluate the surface texture of different restorative computer-aided design and computer-aided manufacturing (CAD/CAM) materials before bonding and after debonding of metal orthodontic brackets. MATERIALS AND METHODS: A total of 60 rectangular ceramic test specimens (n = 20 in each group) were prepared using feldspathic ceramic blocks (FLD; served as control), hybrid ceramic blocks (HC), and lithium disilicate ceramic blocks (LDC). Surface roughness (Ra) analysis was conducted using a profilometer before bonding the metal brackets. After the debonding and polishing procedures, a second surface roughness analysis was conducted on each specimen. The shear bond strength (SBS) test was applied to each specimen using a universal test machine for debonding the metal brackets. The debonded specimens were examined under a stereomicroscope and scored using a 4-step adhesive remnant index (ARI). The Ra and SBS values and the ARI scores were saved, and the data were analyzed statistically at a significance level of 0.05. One specimen from each group was examined under atomic force microscopy to visualize surface roughness. Furthermore, one specimen from each group was additionally prepared for scanning electron microscopy analysis. RESULTS: Statistically significant differences in SBS measurements were observed between all three groups. The highest SBS values were obtained from the FLD group, the lowest from the LDC group. The HC group showed significantly (P = 0.001) lower Ra values than the LDC and FLD groups after debonding and polishing. No significant differences were observed in the ARI scores between the groups. CONCLUSIONS: Hybrid ceramics could be a suitable alternative for fixed restorations in adult patients receiving subsequent treatments with fixed orthodontic appliances.

Evaluation of the flexural strength of metal frameworks fabricated by sintering-based computer-aided manufacturing methods.

STATEMENT OF PROBLEM: Sintering-based computer-aided metal manufacturing strategies have been proposed as an alternative to hard metal milling. While these fabrication methods have been evaluated in terms of marginal and internal discrepancies and bond strength to porcelain, limited information on metal frameworks is available regarding their flexural yield strength. PURPOSE: The purpose of this in vitro study was to evaluate the flexural yield strength of 3-unit cobalt-chromium (Co-Cr) metal frameworks fabricated by hard metal milling (HMM), presintered soft metal milling (PSMM), and direct metal laser melting (DMLM) with 25-µm and 50-µm layer thicknesses. MATERIAL AND METHODS: Three-unit master metal die models were prepared. A total of 40 metal frameworks (n=10) were fabricated by using HMM (group HM), PSMM (group PSM), and DMLM with 25-µm (group LM25) and 50-µm layer thicknesses (group LM50). Metal frameworks were cemented to the master die and then subjected to a 3-point bend test. The flexural yield force was used to calculate the flexural yield strength. The data were statistically analyzed (α=.05). One metal framework from each group was evaluated with scanning electron microscopy for microstructural analysis. RESULTS: The group LM50 exhibited the lowest significant (P<.001) flexural yield strength values. The group HM exhibited higher flexural yield strength values than the other groups. No significant difference was found between the groups LM25 and PSM (P=.954) or between the groups PSM and HM (P=.111). CONCLUSIONS: The fabrication method significantly affected the flexural yield strength of metal frameworks. Metal frameworks fabricated by DMLM with a 50-µm layer thickness exhibited considerably lower flexural yield strength values.

Effect of layer thickness on the flexural strength of multiple-unit laser-sintered metal frameworks.

STATEMENT OF PROBLEM: Laser sintering devices have been increasingly used to fabricate the metal frameworks of metal-ceramic restorations. In the fabrication process, the sintering layer thickness is an important parameter; however, information on how it may affect the flexural strength of metal frameworks remains limited. PURPOSE: The purpose of this in vitro study was to evaluate the flexural strength of 3-unit and 4-unit cobalt-chromium (Co-Cr) metal frameworks laser sintered with 20-µm, 30-µm, and 40-µm layer thicknesses. MATERIAL AND METHODS: Three-unit and 4-unit master metal die models with premolar and molar abutments were prepared through direct metal laser sintering (DMLS). A total of 40 metal frameworks (n=10 for each metal die model) were fabricated by the lost-wax technique (group C, served as the control group) and through DMLS with 20-µm, 30-µm, and 40-µm layer thickness (experimental groups LS20, LS30, and LS40, respectively). Each metal framework was cemented to a master die with a polyvinyl siloxane impression material and then subjected to a 3-point bend test at a crosshead speed of 1 mm/min. The yield force of each metal framework was used to calculate the flexural strength. Data were statistically analyzed by using 1-way ANOVA followed by a Tukey honestly significant difference (HSD) test and an independent-samples t test (α=.05) The microstructure of the fracture surface was evaluated by scanning electron microscopy. RESULTS: Group C reported the lowest mean flexural strength (P<.05), whereas group LS20 reported the highest mean flexural strength, although no significant difference (P>.05) in flexural strength was observed among the DMLS groups. The 3-unit metal frameworks exhibited a statistically significant higher mean flexural strength than the 4-unit metal frameworks (P<.05). CONCLUSIONS: The sintering layer thickness did not significantly affect the flexural strength of the laser-sintered metal frameworks. However, the DMLS groups reported a higher mean flexural strength than the cast group.

Evaluation of marginal discrepancy in metal frameworks fabricated by sintering-based computer-aided manufacturing methods.

PURPOSE: The aim of this in vitro study was to evaluate the effect of sintering procedures on marginal discrepancies of fixed partial metal frameworks fabricated using different sintering-based computer-aided design and computer/aided manufacturing (CAD/CAM) techniques. MATERIALS AND METHODS: Forty resin die models of prepared premolar and molar abutment teeth were fabricated using a three-dimensional (3D) printer and divided into four groups (n = 10) according to the fabrication method of metal frameworks used: HM (via hard milling), SM (via soft metal milling), L25 (via direct metal laser melting [DMLM] with a 25 µm layer thickness), and L50 (via direct DMLM with a 50 µm layer thickness). After the metal frameworks were fabricated and cemented, five vertical marginal discrepancy measurements were recorded in each site (i.e., buccal, facing the pontic, lingual, and facing away from the pontic) of both abutment teeth under a stereomicroscope (×40). Data were statistically analyzed at a significance level of 0.05. RESULTS: No statistically significant differences (P>.05) were found among the four axial sites of metal frameworks fabricated by sintering-based CAD/CAM techniques. The HM and L25 groups showed significantly (P<.001) lower marginal discrepancy values than the SM and L50 groups. CONCLUSION: Marginal discrepancy in the sites facing the pontic was not influenced by the type of sintering procedure. All fabrication methods exhibited clinically acceptable results in terms of marginal discrepancies.

Digital evaluation of laser scanning speed effects on the intaglio surface adaptation of laser-sintered metal frameworks.

STATEMENT OF PROBLEM: Laser sintering has several processing parameters, typically under the control of dental laboratory technicians. Laser scan speed is an important parameter, which has a significant effect on manufacturing time but may also affect the adaptation of restorations. However, limited information is available regarding its impact. PURPOSE: The purpose of this in vitro study was to evaluate the intaglio surface adaptation of laser-sintered cobalt-chromium single-crown frameworks sintered at laser scanning speeds of 1, 3, and 6 m/s. MATERIAL AND METHODS: A master bronze metal die was prepared and scanned by using a laboratory scanner to fabricate the metal frameworks for 4 groups (n=10). In group C, the frameworks were fabricated by using the lost-wax method (control). In group L1, L3, and L6, the frameworks were fabricated by using direct metal laser melting (DMLM) at laser scanning speeds of 1, 3, and 6 m/s. After fabrication, 3 scanning data sets were used to evaluate the intaglio surface adaptation: the master die, the intaglio surface of each metal framework, and each metal framework seated on the master die. The intaglio surface adaptation of the metal frameworks was evaluated by using a metrology software program. The data were statistically analyzed by using a 1-way ANOVA, the Tukey honestly significant difference test, and the Tamhane T2 test (α=.05). RESULTS: The highest mean intaglio surface discrepancy value was obtained from group L6, and this was significantly different from the other 3 groups (P<.001). No significant intaglio surface discrepancy differences were found among the other groups. CONCLUSION: The amount of intaglio surface discrepancy increased when the laser scanning speed reached 6 m/s.

Evaluation of the light transmission of chairside polymer infiltrated hybrid ceramics in different shades and thicknesses.

BACKGROUND:: This in vitro study aimed to evaluate the amount of polymerizing light passing through hybrid ceramic specimens in different shades and thicknesses. METHODS:: Rectangular-shaped feldspathic ceramic computer aided design and computer aided manufacturing (CAD-CAM) blocks and translucent and high translucent polymer infiltrated hybrid ceramic CAD-CAM blocks in four different shades (1M1, 1M2, 2M2, and 3M2) were sectioned in four different thicknesses (0.8, 1.5, 2, and 3 mm), and a total of 48 groups ( n = 10) were obtained. Feldspathic ceramic specimens served as the control group. The light transmission of each ceramic specimen was measured three times by using a light-emitting diode and a radiometer. Data were statistically analyzed by using univariate analysis of variance (ANOVA) followed by one-way ANOVA, Tukey honest significant difference, and Tamhane T2 tests (α = 0.05). RESULTS:: Translucent polymer infiltrated hybrid ceramic specimens exhibited significantly ( p < 0.001) lower light transmission values than high translucent polymer infiltrated hybrid ceramic and feldspathic ceramic specimens, whereas feldspathic ceramic specimens exhibited significantly ( p < 0.001) higher light transmission than translucent and high translucent polymer infiltrated hybrid ceramic specimens. The amount of light transmission significantly ( p < 0.05) decreased when the shade value decreased and the thickness increased. CONCLUSIONS:: Polymer infiltrated hybrid ceramic specimens showed lower light transmission values than feldspathic ceramic specimens, and the amount of light transmission was affected by the ceramic shade and thickness.

The effect of layer thickness on the porcelain bond strength of laser-sintered metal frameworks.

STATEMENT OF PROBLEM: Laser sintering has become a common manufacturing technique in the fabrication of metal-ceramic restorations. The layer thickness of the sintering process may affect the surface morphology and hence the porcelain bond strength. However, limited information is available on the effect of layer thickness on porcelain bond strength. PURPOSE: The purpose of this in vitro study was to evaluate the porcelain bond strength of direct metal laser-melted (DMLM) cobalt-chromium (Co-Cr) metal frameworks sintered with 25-µm and 50-µm layer thicknesses. MATERIAL AND METHODS: Thirty metal frameworks (n=10) were fabricated by using the lost-wax technique (group C [control]), DMLM with a 25-µm layer thickness (group L25), and DMLM with a 50-µm layer thickness (group L50) according to the International Organization for Standardization (ISO) 9693-1. The surface roughness of 1 metal specimen from each group was analyzed by atomic force microscopy. After porcelain firing, a 3-point bend test was applied to each metal-ceramic specimen as in ISO 9693-1. In addition, 1 metal framework from each group was prepared and examined by scanning electron microscopy to evaluate surface morphology. Data were analyzed statistically by using 1-way analysis of variance and the Tukey honestly significant difference tests (α=.05). RESULTS: Group C and group L25 showed significantly higher (P<.001) mean porcelain bond strength values than group L50, and no significant bond strength difference was found between groups C and L25. All groups generally exhibited an adhesive type of failure. CONCLUSIONS: The results indicate that layer thickness may affect the porcelain bond strength of DMLM metal frameworks.

Effect of layer thickness on the marginal and internal adaptation of laser-sintered metal frameworks.

STATEMENT OF PROBLEM: Laser sintering is commonly used for fabricating metal-ceramic restorations. The layer thickness of the sintering process may affect restoration adaptation. However, limited information is available regarding its impact. PURPOSE: The purpose of this in vitro study was to compare the marginal and internal adaptation of laser-sintered cobalt-chromium single crown frameworks sintered with layer thicknesses of 25 and 50 µm. MATERIAL AND METHODS: Thirty resin dies that represented prepared single molar abutment teeth were prepared by using a 3-dimensional printer and were divided into 3 groups (n=10) according to the method used for fabricating metal frameworks: group C, metal frameworks fabricated by using the lost-wax method (control); group L25, metal frameworks fabricated by using direct metal laser melting with a layer thickness of 25 µm; and group L50, metal frameworks fabricated by using direct metal laser melting with a layer thickness of 50 µm. After fabricating the metal frameworks, 15 vertical marginal discrepancy measurements were made in each axial region (mesial, distal, buccal, and lingual) using a stereomicroscope. Next, all the specimens were sectioned from the midline, and 5 internal discrepancy measurements were made in each internal region (inner marginal, axial, and occlusal). The data were analyzed statistically by using 1-way ANOVA, the Tukey honestly significant difference, and Tamhane T2 tests (α=.05). RESULTS: The highest marginal and internal discrepancy values were obtained for metal frameworks in group C, and these values were significantly different (P<.001) from those obtained for metal frameworks in the other 2 groups. No significant difference was observed in the marginal and internal discrepancy values of metal frameworks in groups L25 and L50. CONCLUSIONS: These results indicate that layer thickness does not affect the adaptation of laser-sintered metal frameworks, yet both sintering parameters yielded significantly lower mean marginal discrepancy values than the cast group.

Evaluation of marginal fit of single implant-supported metal-ceramic crowns prepared by using presintered metal blocks.

STATEMENT OF PROBLEM: Recently, presintered metal blocks for nonprecious and precious metal implant-supported restorations have gained popularity in computer-aided design and computer-aided manufacturing (CAD-CAM) systems. However, few studies have evaluated the marginal discrepancy of implant-supported restorations made with these new alloy systems. PURPOSE: The purpose of this in vitro study was to compare the milling-sintering method with the lost-wax and milling methods in terms of the marginal fit of implant-supported metal-ceramic restorations. MATERIAL AND METHODS: Thirty implant abutments screwed to implant analogs were embedded into acrylic resin to investigate marginal fit and then divided according to fabrication methods into the following 3 groups (n=10): lost-wax (LW; control group), milling (M), and milling-sintering (MS). Porcelain material was applied to all specimens after completion of the fabrication process. Subsequently, all specimens were cemented to implant abutments for the measurement of marginal discrepancies. Twelve marginal discrepancy measurements were recorded on each implant abutment by using a stereomicroscope. The arithmetic mean of these 12 measurements was considered the mean marginal discrepancy value of each abutment. Data were statistically analyzed by using 1-way ANOVA and Tukey honest significant difference tests (α=.05). RESULTS: The lowest mean marginal discrepancy values (81 ±2 µm) were observed in the M group, which was significantly different (P<.001) from the other methods. The highest mean marginal discrepancy values (99 ±2 µm) were observed in the MS group. CONCLUSIONS: The results revealed that restorations prepared by the milling-sintering method provided clinically acceptable results (<120 µm); however, this new technique was not found to be as precise as the milling method in terms of marginal fit.

Effect of different restorative crown and customized abutment materials on stress distribution in single implants and peripheral bone: A three-dimensional finite element analysis study.

STATEMENT OF PROBLEM: In recent years, the use of resin-matrix ceramics and polyetheretherketone (PEEK) abutments has been suggested to absorb excessive stresses on dental implants. However, only a few studies have evaluated the effect of these materials on stress distribution in implants and peripheral bone structure. PURPOSE: The purpose of this finite element analysis was to evaluate the biomechanical behaviors of resin-matrix ceramics and PEEK customized abutments in terms of stress distribution in implants and peripheral bone. MATERIAL AND METHODS: Three-dimensional (3D) models of a bone-level implant system and a titanium base abutment were created by using the standard tessellation language (STL) data of original implant components. An anatomic customized abutment and a maxillary right second premolar crown were then modeled over the titanium base abutment. A bone block representing the maxillary right premolar area was created, and the implant was placed in the bone block with 100% osseointegration. Six different models were created according to combinations of restoration materials (translucent zirconia [TZI], lithium disilicate glass ceramic [IPS], polymer-infiltrated hybrid ceramic [VTE]), and customized abutment materials (PEEK and zirconia). In each model, the implants were loaded vertically (200 N) and obliquely (100 N). The stress distribution in the crown, implant, and abutments was evaluated through the von Mises stress analysis, and the stress distribution in the peripheral bone was examined through the maximum and minimum principal stress analyses. RESULTS: The oblique load resulted in high stress values in the implant components, restorative crown, and cortical bone. Low stress values were observed in the VTE crowns. Zirconia customized abutments exhibited higher stress values than PEEK customized abutments. The stress distributions in the implant and peripheral bone were similar in all models. CONCLUSIONS: Changes in restoration and customized abutment material did not affect stress distribution in the implant and peripheral bone.

An Alternative Prosthetic Approach for Rehabilitation of Two Edentulous Maxillectomy Patients: Clinical Report.

Obturator prosthesis is a common treatment method for maxillectomy patients for maintaining their oronasal separation and resuming their social lives. After tumor resection, the remaining anatomical structures have a significant effect on prosthesis retention. The present study describes the rehabilitation of two maxillectomy patients after cancer surgery using a prosthesis consisting of a denture and a special retentive obturator that is positioned in the anatomical undercuts of the nasal cavity. These patients have undergone total and subtotal maxillectomy surgery after the diagnosis of squamous cell carcinoma. The systemic and local health status of the total maxillectomy patient was not suitable for zygomatic implant surgery. Only one osseointegrated dental implant was placed into the left maxillary tuberosity area in the subtotal maxillectomy patient. In addition, the quality, vertical height, and horizontal width of the remaining bone structures in the maxilla limited the use of osseointegrated dental implants. Mechanical prosthesis retention was provided using a multiunit retentive mechanism composed of an orthodontic forsus fatigue resistant device (OFFRD), two Herbst appliances, and an acrylic piece associated with healthy keratinized mucosa. The OFFRD could easily apply a consistent force and push the acrylic pieces toward the retentive undercut under the control of the two Herbst appliances. Two OFFRD units in different directions were designed for the total maxillectomy patient, while only one OFFRD unit was placed on the opposite side of the osseointegrated implant in the subtotal maxillectomy patient. A sufficient retention was obtained for both patients. The patients were satisfied, and no major complications were observed in periodic controls.

Comparison of porcelain bond strength of different metal frameworks prepared by using conventional and recently introduced fabrication methods.

STATEMENT OF PROBLEM: Most studies evaluating dental laser sintering systems have focused on the marginal accuracy of the restorations. However, the bond strength at the metal-ceramic interface is another important factor that affects the survival of restorations, and currently, few studies focus on this aspect. PURPOSE: The purpose of this in vitro study was to compare the porcelain bond strength of cobalt-chromium (Co-Cr) metal frameworks prepared by using the conventional lost-wax technique, milling, direct metal laser sintering (DMLS), and laser cusing, a direct process powder-bed system. MATERIAL AND METHODS: A total of 96 metal frameworks (n=24 in each group) were prepared by using conventional lost-wax (group C), milling (group M), DMLS (group LS), and direct process powder-bed (group LC) methods according to International Organization for Standardization standard ISO 9693-1. After porcelain application, a 3-point bend test was applied to each specimen by using a universal testing machine. Data were statistically analyzed using 1-way ANOVA and Tukey honest significant difference tests (α=.05). Failure types at the metal-ceramic interfaces were examined using stereomicroscopy. Additionally, 1 specimen from each group was prepared for scanning electron microscopy analysis to evaluate the surface topography of metal frameworks. RESULTS: The mean bond strength was 38.08 ±3.82 MPa for group C, 39.29 ±3.51 MPa for group M, 40.73 ±3.58 MPa for group LS, and 41.24 ±3.75 MPa for group LC. Statistically significant differences were observed among the 4 groups (P=.016). All groups, except for LS, exhibited adhesive and mixed type bond failure. CONCLUSIONS: Both of the laser sintering methods were found to be successful in terms of metal-ceramic bond strength.

Influence of porcelain firing and cementation on the marginal adaptation of metal-ceramic restorations prepared by different methods.

STATEMENT OF PROBLEM: Marginal adaptation plays an important role in the survival of metal-ceramic restorations. Porcelain firings and cementation may affect the adaptation of restorations. Moreover, conventional casting procedures and casting imperfections may cause deteriorations in the marginal adaptation of metal-ceramic restorations. PURPOSE: The purpose of this in vitro study was to compare the marginal adaptation after fabrication of the framework, porcelain application, and cementation of metal-ceramic restorations prepared by using the conventional lost-wax technique, milling, direct metal laser sintering (DMLS), and LaserCUSING, a direct process powder-bed system. Alterations in the marginal adaptation of the metal frameworks during the fabrication stages and the precision of fabrication methods were evaluated. MATERIAL AND METHODS: Forty-eight metal dies simulating prepared premolar and molar abutment teeth were fabricated to investigate marginal adaptation. They were divided into 4 groups (n=12) according to the fabrication method used (group C serving as the control group: lost-wax method; group M: milling method; group LS: DMLS method; group DP: direct process powder-bed method). Sixty marginal discrepancy measurements were recorded separately on each abutment tooth after fabrication of the framework, porcelain application, and cementation by using a stereomicroscope. Thereafter, each group was divided into 3 subgroups according to the measurements recorded in each fabrication stage: subgroup F (framework), subgroup P (porcelain application), and subgroup C (cementation). Data were statistically analyzed with univariate analysis of variance (followed by 1-way ANOVA and Tamhane T2 test (α=.05). RESULTS: The lowest marginal discrepancy values were observed in restorations prepared by using the direct process powder-bed method, and this was significantly different (P<.001) from the other methods. The highest marginal discrepancy values were recorded after the cementation procedure in all groups. CONCLUSIONS: The results showed that the direct process powder-bed method is quite successful in terms of marginal adaptation. The marginal discrepancy increased after porcelain application and cementation.