In vitro damping and strain distribution for implant-supported crowns using 5 different CAD-CAM crowns and 3 different luting cements.

STATEMENT OF PROBLEM: Dental implants are particularly susceptible to occlusal overloading because, unlike natural teeth, they lack a periodontal ligament to help absorb occlusal forces. However, studies evaluating the impact of different crown and luting materials on the damping behavior and strain distribution of implant-supported crowns are lacking. PURPOSE: The purpose of this in vitro study was to investigate the damping behavior and strain distribution of peri-implant bone associated with 5 different CAD-CAM implant-supported crowns and 3 luting materials. MATERIAL AND METHODS: A titanium implant was embedded in a plastic tube with epoxy resin and 5 different crown materials (polymethyl methacrylate, resin-infiltrated ceramic, lithium disilicate, titanium, and zirconia) luted to prosthetic abutments with 3 different luting materials (zinc oxide non-eugenol cement, zinc phosphate cement, and adhesive resin cement) and an uncemented condition were tested (n=5). Strain gauges were attached at the crestal and apical levels of the implant model. All specimens were load tested from 0 to 200 N. Slopes of load/time, microstrain/time, and time required to reach the maximum load were examined to represent the damping behavior. Absolute maximum strain (AMS) and its occurrence level were examined to represent the strain distribution. Two-way ANOVA, followed by the Tukey HSD test, were used for statistical analysis (α=.05). RESULTS: All slopes and times to reach the maximum load in each crown material were statistically similar (P>.05), except for the polymethyl methacrylate group, which showed less steepness in all slopes and more time required to reach the maximum load significantly (P<.05). Both the polymethyl methacrylate group (224.5 ±30.2) and the titanium group (224.0 ±24.3) exhibited significantly higher AMS at the crestal level compared with the resin-infiltrated ceramic group (210.6 ±5.0) (P<.05). The lithium disilicate (218.1 ±15.0) and zirconia groups (217.3 ±14.8) demonstrated comparable AMS values with the others (P>.05). The uncemented group demonstrated steeper slopes and less time required to reach the maximum load compared with the adhesive resin group (P<.05), while slopes and times of the zinc phosphate and zinc oxide non-eugenol groups were comparable (P>.05). The uncemented group (242.7 ±25.3) exhibited significantly higher AMS at the crestal level than the other groups (P<.05). CONCLUSIONS: The crown material significantly affected the damping behavior of peri-implant bone, unlike the luting material. Polymethyl methacrylate with a high damping behavior exhibited high strain at the crestal level. In contrast, resin-modified ceramic with a moderate damping behavior exhibited low strain at the crestal level. Strain at the crestal level could be effectively reduced by approximately 13% through cementation.

Effect of thermocycling on the retentive force of the retentive inserts in three denture attachments and their water absorption ability.

This study aimed to evaluate the thermocycling effect on the retentive force of 3 different retentive inserts in 3 denture attachments (Blue, Pink, Clear retentive inserts in LOCATOR; Blue, Pink, Clear retentive inserts in LOCATOR R-Tx; and White, Yellow, Green retentive inserts in Novaloc) (n=10). Maximum retentive force of each retentive insert was evaluated at baseline, 7-day water storage, and after 5,000-, and 10,000- cycle thermocycling. The water absorption percentage of the retentive inserts was also determined. Comparing between baseline and 7-day water storage, the retentive forces of the LOCATOR and LOCATOR R-Tx groups were significantly reduced (p<0.05), while the retentive force of the Novaloc group was significantly increased (p<0.05). Comparing between 7-day water storage and 10,000-cycle thermocycling, the retentive force of most retentive inserts remained unchanged (p>0.05). The water absorption percentage of the LOCATOR and LOCATOR R-Tx groups was significantly greater than that of the Novaloc group (p<0.05).

Effect of Restoration Design on the Removal Torque Loss of Implant-supported Crowns after Cyclic Loading.

AIM: To compare the removal torque loss (RTL) percentage of screw-retained, cement-retained, and combined screw- and cement-retained implant-supported crowns after cyclic loading and measure the impact of cyclic loading on removal torque. MATERIALS AND METHODS: Thirty-two dental implants (4.0 × 10 mm) in resin blocks and abutments were divided into four groups (n = 8) based on restoration design: combined screw- and cement-retained group (SC), two cement-retained groups: cemented with adhesive resin cement (AR) (Panavia V5) or provisional cement (PR) (RelyX Temp NE), and screw-retained one-piece titanium group (TI). Removal torques were measured in Newton-centimeter (Ncm) before and after 500,000-cycle cyclic loading with forces ranging from 20 to 200 N at 15 Hz. The RTL percentage in each group was calculated. The paired t-test was used to detect the difference between pre-loading (RT1) and post-loading removal torque (RT2) in each group and 1-way ANOVA was used to detect the difference of RTL percentage between groups. RESULTS: The post-loading removal torques in all groups were significantly lower than their pre-loading removal torques (p < 0.001). The 1-way ANOVA test found no significant difference in the RTL% between the study groups. The PR group exhibited the lower RTL% (30.74 ± 7.3%), followed by the TI (30.78 ± 5.6%), AR (32.12 ± 2.5%), and SC (35.71 ± 5.1%) groups. CONCLUSION: Combined screw- and cement-retained restorations exhibited similar RTL compared with other restoration designs, and cyclic loading significantly affected the removal torque. CLINICAL SIGNIFICANCE: Combined screw- and cement-retained restorations can be utilized in single-tooth situations, offering a comparable impact on screw joint stability while providing benefit of retrievability. Cyclic loading significantly influences joint stability, periodic checkup for screw loosening is recommended. How to cite this article: Jongsiri S, Arksornnukit M, Homsiang W, et al. Effect of Restoration Design on the Removal Torque Loss of Implant-supported Crowns after Cyclic Loading. J Contemp Dent Pract 2023;24(12):951-956.

Brushing effect on the retentive force of retentive inserts in three denture attachments: An in vitro study.

STATEMENT OF PROBLEM: Daily denture brushing results in wear on implant-retained overdenture attachments. However, studies on the remaining denture attachment retention after brushing are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the retentive force of the retentive inserts in 3 denture attachments after brushing with different media. MATERIAL AND METHODS: Three retentive insert types in 3 denture attachments (LOCATOR, LOCATOR R-Tx, and Novaloc) were tested. Three abutments and 20 metal housings of each denture attachment were separately embedded into individual acrylic resin blocks, and 20 retentive inserts of each retentive type in each denture attachment were placed in the metal housing. The blocks embedded with a metal housing of each denture attachment were divided into 2 brushing media groups (n=10), mounted on a brushing machine, and brushed with deionized water (DI) or toothpaste slurry (TP). After 0, 10 000, and 20 000 brushing cycles, the block specimens were mounted on a universal testing machine, and the retentive force was evaluated by pulling the blocks apart until complete separation. The maximum retentive force was measured 5 times and averaged. The evaluated retentive insert was removed and replaced with a new retentive insert. The specimen blocks were subjected to another brushing test with the same protocol. Representative specimens of each group were examined with scanning electron microscopy. The retentive force of each retentive insert type in each denture attachment was analyzed by 2-way repeated measures ANOVA, followed by the Bonferroni test (α=.05). RESULTS: The retentive force of each LOCATOR and LOCATOR R-Tx retentive insert demonstrated significant differences in the interaction between brushing media and brushing cycles (P<.05). Between baseline and 20 000 brushing cycles with DI, the retentive force of the LOCATOR and LOCATOR R-Tx retentive inserts decreased significantly (P<.05). Between baseline and 20 000 brushing cycles with TP, the retentive force of the LOCATOR retentive inserts increased significantly (P<.05), while the retentive force of the LOCATOR R-Tx retentive inserts was statistically similar (P>.05). The retentive force of the Novaloc retentive inserts demonstrated significant differences only for brushing cycles (P<.05). The Novaloc retentive inserts decreased in average retentive force over time. CONCLUSIONS: After brushing with deionized water, the retentive forces of the LOCATOR, LOCATOR R-Tx, and Novaloc retentive inserts decreased, while, after brushing with toothpaste, the retentive force of the retentive inserts increased in the LOCATOR group, was unchanged in the LOCATOR R-Tx group, and decreased in the Novaloc group.

Effect of zinc oxide nanoparticles incorporated into tissue conditioner on antifungal, physical, and mechanical properties.

This study evaluated the antifungal, physical, and mechanical properties of tissue conditioner incorporated with different amounts of zinc oxide nanoparticles (ZnOnps) at different storage times (0, 7, and 14 days). Specimens of 0, 5, 10, 15 wt% ZnOnps, or 15 wt% nystatin incorporated into tissue conditioner were fabricated (control, 5Zn, 10Zn, 15Zn, and Nys). The direct contact test (n=6) was performed to evaluate the antifungal effect against C. albicans suspension. The penetration depth (n=6) and tensile bond strength (n=8) were evaluated following ISO 13139. The 15Zn significantly reduced C. albicans cell number compared with control at all storage times (p<0.001). The penetration depths and tensile bond strengths of the 5Zn, 10Zn, 15Zn, and Nys were not significantly different compared with control at all storage times (p>0.05). In conclusion, the 15Zn provides antifungal effect up to 14 days without adverse effects on penetration depth and tensile bond strength.

Pressure transmission area and maximum pressure transmission of different thermoplastic resin denture base materials under impact load.

PURPOSES: The purposes of the present study were to examine the pressure transmission area and maximum pressure transmission of thermoplastic resin denture base materials under an impact load, and to evaluate the modulus of elasticity and nanohardness of thermoplastic resin denture base. METHODS: Three injection-molded thermoplastic resin denture base materials [polycarbonate (Basis PC), ethylene propylene (Duraflex), and polyamide (Valplast)] and one conventional heat-polymerized acrylic resin (PMMA, SR Triplex Hot) denture base, all with a mandibular first molar acrylic resin denture tooth set in were evaluated (n=6). Pressure transmission area and maximum pressure transmission of the specimens under an impact load were observed by using pressure-sensitive sheets. The modulus of elasticity and nanohardness of each denture base (n=10) were measured on 15×15×15×3mm3 specimen by using an ultramicroindentation system. The pressure transmission area, modulus of elasticity, and nanohardness data were statistically analyzed with 1-way ANOVA, followed by Tamhane or Tukey HSD post hoc test (α=.05). The maximum pressure transmission data were statistically analyzed with Kruskal-Wallis H test, followed by Mann-Whitney U test (α=.05). RESULTS: Polymethyl methacrylate showed significantly larger pressure transmission area and higher maximum pressure transmission than the other groups (P<.001). Significant differences were found in modulus of elasticity and nanohardness among the four types of denture bases (P<.001). CONCLUSIONS: Pressure transmission area and maximum pressure transmission varied among the thermoplastic resin denture base materials. Differences in the modulus of elasticity and nanohardness of each type of denture base were demonstrated.

Antifungal, optical, and mechanical properties of polymethylmethacrylate material incorporated with silanized zinc oxide nanoparticles.

BACKGROUND: Fungal infected denture, which is typically composed of polymethylmethacrylate (PMMA), is a common problem for a denture wearer, especially an elderly patient with limited manual dexterity. Therefore, increasing the antifungal effect of denture by incorporating surface modification nanoparticles into the PMMA, while retaining its mechanical properties, is of interest. AIM OF THE STUDY: This study aimed to evaluate antifungal, optical, and mechanical properties of heat-cured PMMA incorporated with different amounts of zinc oxide nanoparticles (ZnOnps) with or without methacryloxypropyltrimethoxysilane modification. MATERIALS AND METHODS: Specimens made from heat-cured PMMA containing 1.25, 2.5, and 5% (w/w) nonsilanized (Nosi) or silanized (Si) ZnOnps were evaluated. Specimens without filler served as control. The fungal assay was performed placing a Candida albicans suspension on the PMMA surface for 2 h, then Sabouraud Dextrose Broth was added, and growth after 24 h was determined by counting colony forming units on agar plates. A spectrophotometer was used to measure the color in L* (brightness), a* (red-green), b* (yellow-blue) and opacity of the experimental groups. Flexural strength and flexural modulus were determined using a three-point bending test on universal testing machine after 37°C water storage for 48 h and 1 month. RESULTS: The antifungal, optical, and mechanical properties of the PMMA incorporated with ZnOnps changed depending on the amount. With the same amount of ZnOnps, the silanized groups demonstrated a greater reduction in C. albicans compared with the Nosi groups. The color difference (ΔE) and opacity of the Nosi groups were greater compared with the Si groups. The flexural strength of the Si groups, except for the 1.25% group, was significantly greater compared with the Nosi groups. CONCLUSION: PMMA incorporated with Si ZnOnps, particularly with 2.5% Si ZnOnps, had a greater antifungal effect, less color differences, and opacity compared with Nosi ZnOnps, while retaining its mechanical properties.

The pH effect of solvent in silanization on fluoride released and mechanical properties of heat-cured acrylic resin containing fluoride-releasing filler.

This study aimed to evaluate the effect of an acidic-adjusted pH of solvent in silanization on the amount of fluoride released and mechanical properties of heat-cured acrylic resin containing a silanized fluoride-releasing filler. The experimental groups were divided into 4 groups; non-silanized, acidic-adjusted pH, non-adjusted pH, and no filler as control. For fluoride measurement, each specimen was placed in deionized water which was changed every day for 7 days, every week for 7 weeks and measured. The flexural strength and flexural modulus were evaluated after aging for 48 h, 1, and 2 months. Two-way ANOVA indicated significant differences among groups, storage times, and its interaction in fluoride measurement and flexural modulus. For flexural strength, there was significant difference only among groups. Acidic-adjusted pH of solvent in silanization enhanced the amount of fluoride released from acrylic resin, while non-adjusted pH of solvent exhibited better flexural strength of acrylic resin.

Toothbrushing alters the surface roughness and gloss of composite resin CAD/CAM blocks.

This study investigated the surface roughness and gloss of composite resin CAD/CAM blocks after toothbrushing. Five composite resin blocks (Block HC, Cerasmart, Gradia Block, KZR-CAD Hybrid Resin Block, and Lava Ultimate), one hybrid ceramic (Vita Enamic), one feldspar ceramic (Vitablocs Mark II), one PMMA block (Telio CAD), and one conventional composite resin (Filtek Z350 XT) were evaluated. Surface roughness (Ra) and gloss were determined for each group of materials (n=6) after silicon carbide paper (P4000) grinding, 10k, 20k, and 40k toothbrushing cycles. One-way repeated measures ANOVA indicated significant differences in the Ra and gloss of each material except for the Ra of GRA. After 40k toothbrushing cycles, the Ra of BLO and TEL showed significant increases, while CER, KZR, ULT, and Z350 showed significant decreases. GRA, ENA, and VIT maintained their Ra. All of the materials tested, except CER, demonstrated significant decreases in gloss after 40k toothbrushing cycles.

Polishing and toothbrushing alters the surface roughness and gloss of composite resins.

This study aimed to investigate the surface roughness and gloss of composite resins after using two polishing systems and toothbrushing. Six composite resins (Durafill VS, Filtek Z250, Filtek Z350 XT, Kalore, Venus Diamond, and Venus Pearl) were evaluated after polishing with two polishing systems (Sof-Lex, Venus Supra) and after toothbrushing up to 40,000 cycles. Surface roughness (Ra) and gloss were determined for each composite resin group (n=6) after silicon carbide paper grinding, polishing, and toothbrushing. Two-way ANOVA indicated significant differences in both Ra and gloss between measuring stages for the composite resins tested, except Venus Pearl, which showed significant differences only in gloss. After polishing, the Filtek Z350 XT, Kalore, and Venus Diamond showed significant increases in Ra, while all composite resin groups except the Filtek Z350 XT and Durafill VS with Sof-Lex showed increases in gloss. After toothbrushing, all composite resin demonstrated increases in Ra and decreases in gloss.

Fracture resistance of endodontically treated teeth using fiber post with an elastic modulus similar to dentin.

This study investigated the effect of fiber reinforced composite resin (FRC) post lengths, ferrule, and full coverage metal crown on fracture resistance of endodontically treated teeth (ETT) using an experimental FRC post with the similar elastic modulus of dentin (11.5 GPa). ETT was restored according to 1 of 7 combinations of FRC post length (10, 5, 2.5, 0 mm), ferrule (0, 2 mm), and with/without metal crown (n=6). An oblique compressive load was applied on the restored teeth using a universal testing machine. Fracture loads were evaluated with 1-way ANOVA and Tukey HSD test (p<0.05). Compared with tooth preparation only, the fracture loads of ETT restored with composite resin and different post lengths were not significantly different. The group with the ferrule with metal crown showed significantly greater fracture resistance than the others.