How can excess residual cement be reduced in implant-supported restorations?: An in vitro study.

OBJECTIVE: The aim of this study was to investigate the effect of different cements and cementation techniques used in implant-supported restorations and the application of various vent modifications and extraoral replica techniques on the amount of overflowing cement in cemented systems. MATERIALS AND METHODS: In this study, three different abutment designs were used as fully closed, occlusal vented, and occlusal + proximal vented. An extraoral replica was produced by milling the CAD/CAM ceramic block. The number of groups with and without replicas was determined as six (n = 10). For the cementation procedures, three different cements were tested: dual-cure resin, eugenol-free zinc oxide, and polycarboxylate cements. Cobalt-chromium superstructures to be cemented to the implant analog-abutment complex were produced by direct metal laser sintering method. Twenty-four hours after the cementation process, residual cement were measered with Micro-CT. In comparisons between groups, ANOVA test was used for normally distributed variables and Kruskall-Wallis H test was used for non-normally distributed variables at a significance level of p < 0.05. RESULTS: The difference in residual cement volumes between the groups in terms of both cementation techniques (whether or not to use an extraoral replica and different vent desings) and cement types was found to be statistically significant (p < 0.05). There was significantly less residual cement in all groups that used extraoral replicas than those that did not. As for the cement types, the most residual cement occurred in the resin cement. CONCLUSION: The use of extraoral replicas and vent designs on the abutment significantly reduces the amount of residual cement. Regardless of the cementation technique, the type of cement used affects the amount of excess cement. CLINICAL RELEVANCE: To reduce residual cement, both the type of cement and the cementation technique used must be considered.

Effect of different preparation finishing procedures on the marginal and internal fit of CAD-CAM-produced restorations: A microcomputed tomography evaluation.

STATEMENT OF PROBLEM: Accurate fit is an important factor for the longevity of computer-aided design and computer-aided manufacturing (CAD-CAM) ceramic restorations. Few studies have compared how restoration finishing procedures affect the marginal and internal fit of these restorations by using microcomputed tomography (µCT). PURPOSE: The purpose of this in vitro study was to evaluate the preparations with different surface finishing procedures for the fit of CAD-CAM restorations by using µCT. MATERIAL AND METHODS: A total of 28 anatomic contour monolithic feldspathic ceramic crowns were produced for 4 typodont teeth prepared according to the different surface finishing procedures (n=7). The generated experimental groups were finishing with extra-coarse (181 µm) diamond rotary instruments (EC), finishing with fine (40 µm) diamond rotary instruments after extra-coarse diamond rotary instruments (F), finishing with very fine (20 µm) diamond rotary instruments after extra-coarse and fine diamond rotary instruments (VF), and finishing with extra-coarse, fine, and very fine diamond rotary instruments followed by polishing rubber points (P). µCT scans were obtained to measure the gaps between the typodont teeth and the crowns. Reference points such as the margin, chamfer (the deepest point), cusp tips, and central fossa were determined, and 196 measurements were made. Data were analyzed by using 2-way analyses of variance and the Tukey HSD test (α=.05). RESULTS: The highest gap values in all sections were observed in the finishing with extra-coarse (181 µm) diamond rotary instruments group. The lowest gap value in the marginal point was observed in the P group (P<.05). In total, the gap values of the reference points were in the order of margin, chamfer, cusp, and central fossa. CONCLUSIONS: µCT evaluation showed that tooth preparation finishing procedure with finer grit rotary instruments yielded better marginal fit for monolithic feldspathic CAD-CAM restorations. The internal gap values of all groups were also in the range of clinically acceptable values, important for mechanical properties.

Comparison of two different digital occlusal analysis methods.

OBJECTIVES: The aim of this study is to compare the sensitivity of T-Scan digital occlusal analysis system and the occlusal analysis mode of the CEREC Omnicam system, which is mainly used for design/production, using the data recorded at the maximum intercuspal position. MATERIALS AND METHODS: Occlusal recordings were obtained from healthy 20 females and 20 males aged 18-25 at the maximum intercuspal position. Records were saved as.jpeg format and transferred to Adobe Photoshop CS6 program. Blue, green, and red colors (shown by the same color codes in both systems) representing light, intense, and tight contacts, respectively, were evaluated in terms of the pixel counts. For statistical comparison, the differences between the systems independent sample T test and, between the genders, one sample T test were used (α = 0.05). RESULTS: The total numbers of pixels of all colors which are evaluated with T-Scan and CEREC Omnicam in females were 31,296.6 and 15,745, respectively, and in males 39,812.3 and 17,462, respectively. In both systems, the blue contact area is the most seen. For all colors tested, T-Scan recorded more contact than those of CEREC Omnicam in both genders and statistically significant difference was found between two systems for all colors. In both systems, recorded contacts are significantly higher in men than in women. Compared with women, 27% more contact area was recorded in men with T-Scan and 11% more with CEREC Omnicam was obtained. CONCLUSIONS: While T-Scan was found sensitive even in the diagnosis of light contacts, the CEREC Omnicam was found sensitive only in the diagnosis of tight contacts. CLINICAL RELEVANCE: Although both T-Scan and CEREC Omnicam are effective in occlusal analysis, T-Scan's sensitivity was found to be higher. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT04798729.

Efficiency of Concentrated Growth Factor in the Surgical Treatment of Multiple Adjacent Papillary Losses: A Randomized, Controlled, Examiner-Blinded Clinical Trial Using CAD/CAM.

This study aimed to create papilla with concentrated growth factor (CGF) in cases in which the interdental papilla was not able to fill the interproximal space (IPS) due to physiologic factors. A three-dimensional digital model of this space with the digital impression obtained from direct intraoral scanning of IPS was created. This study aimed to evaluate the efficacy of CGF in the regeneration of multiple adjacent papillary losses (MAPL), with the change in the IPS area calculated on intraorally scanned images obtained with digital impressions. This study included 160 teeth from 40 patients with 120 papillary losses. Patients were randomly allocated to the test group (TG) (n = 20), with 60 MAPL (three adjacent, lost interdental papillae per patient) receiving minimally invasive surgery with CGF, or the control group (CG) (n = 20), with 60 MAPL without surgery. A total of 480 images were uploaded to a software. The patients' age, gender, Plaque Index, bleeding on probing, and mean probing pocket depth values were evaluated. Papillary area (PA) were calculated between the two central, lateral-central, and lateral-canine teeth at baseline and posttreatment periods of 3, 6, and 12 months in both groups. Papillary filling percentage, keratinized-gingiva width, papillary thickness, thrombocyte, count and mean platelet volume were recorded in TG. Considering the variables in TG and CG, there was no difference in terms of age, gender, and periodontal parameters (P > .05). PA at 3, 6, and 12 months showed statistically significant differences from baseline values in TG (P < .001) but not in CG (P > .05). In TG, a moderate positive correlation was found between the midline papillary thickness and the 3-, 6-, and 12-month filling percentages (r: 0.506, P = .023; r: 0.509, P = .022; and r: 0.515, P = .02, respectively), and a high positive correlation was determined between thrombocyte count and the 6- and 12-month filling percentages (r: 0.733, P < .001; and r: 0.744, P < .001, respectively). CGF provided papillary regeneration in the treatment of MAPL and supported three-dimensional structure of the regenerated interdental papilla throughout 1 year.

An examination of the 2-year results obtained from hyaluronic acid filler injection for interdental papilla losses.

OBJECTIVE: The aim of this study was to compare and evaluate the clinical results obtained in the maxilla and mandible by taking digital impressions following application of hyaluronic acid fillers for the reconstruction of multiple papillary losses. METHOD AND MATERIALS: Evaluation was made of a total of 200 papilla spaces in 20 patients applied with hyaluronic acid filler injection to consecutive papillae regions in both arches symmetrically. The area of the interdental space and the percentage change in the area value over time was calculated separately for each papilla space by taking digital impressions before the application of hyaluronic acid and at 3, 12, and 24 months after the application. RESULTS: A significant improvement was determined in the area values of both arches at 3, 12, and 24 months compared to the baseline values. In the percentage change at 24 months, irrespective of whether the mandible or maxilla, the highest filling percentage of all the spaces was between the canine and lateral incisors. When the 24-month filling percentages were compared between the maxillae and mandibles, the most significant difference was between the central teeth. CONCLUSION: The results showed that success was obtained in both arches with hyaluronic acid filler injection applied for reconstruction of multiple papilla losses; because the filling percentages in the maxilla at 3 months and 12 months were greater than those in the mandible, it can be suggested that results can be obtained more quickly and at a higher level in the maxilla.

Fracture resistance of monolithic and veneered all-ceramic four-unit posterior fixed dental prostheses after artificial aging.

This study compared the fracture resistance of monolithic and veneered all-ceramic four-unit posterior fixed dental prostheses (FDPs) generated by computer-aided design/computer-aided manufacturing (CAD/CAM) after aging in a mastication simulator. Four-unit FDPs were designed from six different all-ceramic systems: 1) monolithic lithium disilicate (M-E), 2) monolithic zirconia (M-TZI), 3) veneered zirconia by conventional layering (V-L), 4) veneered zirconia by lithium disilicate pressing (V-P), 5) veneered zirconia by lithium disilicate fusing (CAD-F-E), and 6) veneered zirconia by feldspathic ceramic cementing (CAD-C-CB). The specimens were divided into control and aging groups (n = 10 per group). The aging process included both thermocycling and mechanical loading and was followed by fracture resistance testing. All specimens in the M-E, M-TZI, and V-L groups survived; however, all specimens in the V-P group were fractured during artificial aging. The highest fracture resistance values were observed in the M-TZI group. According to the fracture resistance test, connector fractures were the most frequent type of failure. M-TZI and M-E FDPs revealed no failures during aging and showed higher fracture resistance than the veneered groups. Among the veneered zirconia framework groups, V-L FDPs showed the highest success rate during aging, while the fracture resistance was similar among all the veneered zirconia groups.

The Effect of Porcelain Firing on Electrochemical Behavior of a Dental Alloy in Hydrogen Peroxide.

PURPOSE: The aim of this study was to evaluate changes in electrochemical corrosion properties of porcelain firing simulated nickel-chromium dental casting alloy exposed to a 10% hydrogen peroxide bleaching agent. MATERIALS AND METHODS: The electrochemical corrosion behavior of a Ni-Cr alloy was evaluated by cyclic polarization test in the aerated electrolyte (pH = 6.5). Test groups were produced in as-cast (group 1, control group) and simulated porcelain firing (group 2: heat-treated/mean value; group 3: heat-treated/cycle) conditions. Scanning electron microscopy (SEM) was also used to examine the alloy surfaces before and after the corrosion test. RESULTS: The ranking of the groups with respect to Ecorr and Icorr was as follows: 1, 2, 3 and 3, 1, 2, respectively. Group 3 exhibited the greatest and group 2 displayed the least corrosion tendencies. An increase in corrosion rates was observed after heat treatment/cycle state. Post-corrosion SEM photographs were also consistent with the test results. CONCLUSION: Within the parameters of this study, a single heat treatment is insufficient to cause upheaval in corrosion behavior of a Ni-Cr alloy subjected to 10% hydrogen peroxide.

Evaluation of biogeneric design techniques with CEREC CAD/CAM system.

PURPOSE: The aim of this study was to evaluate occlusal contacts generated by 3 different biogeneric design modes (individual (BI), copy (BC), reference (BR)) of CEREC software and to assess the designs subjectively. MATERIALS AND METHODS: Ten pairs of maxillary and mandibular casts were obtained from full dentate individuals. Gypsum cast contacts were quantified with articulating paper and digital impressions were taken. Then, all ceramic crown preparation was performed on the left first molar teeth and digital impressions of prepared teeth were made. BI, BC, and BR crowns were designed. Occlusal images of designs including occlusal contacts were superimposed on the gypsum cast images and corresponding contacts were determined. Three designs were evaluated by the students. RESULTS: The results of the study revealed that there was significant difference among the number of contacts of gypsum cast and digital models (P<.05). The comparison of the percentage of virtual contacts of three crown designs which were identical to the contacts of original gypsum cast revealed that BI and BR designs showed significantly higher percentages of identical contacts compared with BC design (P<.05). Subjective assessment revealed that students generally found BI designs and BR designs natural regarding naturalness of fissure morphology and cusp shape and cusp tip position. For general occlusal morphology, student groups generally found BI design "too strong" or "perfect", BC design "too weak", and BR design "perfect". CONCLUSION: On a prepared tooth, three different biogeneric design modes of a CAD/CAM software reveals different crown designs regarding occlusal contacts and morphology.

Do surface treatments affect the optical properties of ceramic veneers?

STATEMENT OF PROBLEM: Surface treatments may affect the optical properties of ceramic veneers before cementation. PURPOSE: The purpose of this study was to evaluate whether various surface treatments affect the optical properties of different types of ceramic veneers. MATERIAL AND METHODS: Disk-shaped ceramic veneers (N=280) were prepared from the IPS e.max Press, e.max CAD, Empress Esthetic, e.max Ceram, and Inline ceramic systems with 0.5-mm and 1.0-mm thicknesses. The ceramics were divided into 4 groups: no surface treatments; etched with hydrofluoric acid; airborne-particle abraded with 30-µm Al2O3; and irradiated with erbium:yttrium-aluminum-garnet laser. A translucent shade of resin was chosen for cementation. Color parameters were examined with a colorimeter. Statistical analyses were done with 3-way ANOVA and the Bonferroni test (P=.05). RESULTS: Significant interactions were noted between the surface treatments, ceramic type, and thickness for ΔE values (P=.01), and no significant interactions were noted for L* (P=.773), a* (P=.984), and b* (P=.998). The greatest color change occurred after airborne-particle abrasion with 0.5-mm-thick e.max Press (2.9 ΔE). Significant differences in ΔE values were found among the hydrofluoric acid, airborne-particle abrasion, and laser groups for 0.5-mm-thick ceramics, except IPS Inline, and among the hydrofluoric acid, airborne-particle abrasion, and laser groups for 1.0-mm-thick ceramics, except Empress Esthetic ceramics. CONCLUSIONS: The color change of the ceramics increased after the surface treatments, particularly as the ceramics became thinner.

Effects of pH and elevated glucose levels on the electrochemical behavior of dental implants.

Implant failure is more likely to occur in persons with medically compromising systemic conditions, such as diabetes related to high blood glucose levels and inflammatory diseases related to pH levels lower than those in healthy people. The aim of this study was to investigate the effects of lower pH level and simulated- hyperglycemia on implant corrosion as these effects are critical to biocompatibility and osseointegration. The electrochemical corrosion properties of titanium implants were studied in four different solutions: Ringer's physiological solution at pH = 7.0 and pH = 5.5 and Ringer's physiological solution containing 15 mM dextrose at pH = 7 and pH = 5.5. Corrosion behaviors of dental implants were determined by cyclic polarization test and electrochemical impedance spectroscopy. Surface alterations were studied using a scanning electron microscope. All test electrolytes led to apparent differences in corrosion behavior of the implants. The implants under conditions of test exhibited statistically significant increases in I(corr) from 0.2372 to 1.007 µAcm(-2), corrosion rates from 1.904 to 8.085 mpy, and a decrease in polarization resistances from 304 to 74 Ω. Implants in dextrose-containing solutions were more prone to corrosion than those in Ringer's solutions alone. Increasing the acidity also yielded greater corrosion rates for the dextrose-containing solutions and the solutions without dextrose.

Electrochemical corrosion and surface analyses of a ni-cr alloy in bleaching agents.

PURPOSE: The aim of this study was to evaluate the corrosion behavior of a Ni-Cr dental casting alloy subjected to 10% hydrogen peroxide (HP) and 10% carbamide peroxide (CP) bleaching solutions and to determine the composition of the surface oxide layer formed on the alloy specimens. MATERIALS AND METHODS: Ten cylindrical specimens (4 mm in diameter × 25 mm in height) were cast from a Ni-Cr alloy (Wiron 99) and divided into two groups (n = 5). A potentiodynamic polarization test was used to compare the corrosion rates of specimens in HP and CP (pH = 6.5). Before cyclic polarization tests, all alloy specimens were allowed to reach a steady open circuit potential (Ecorr ) for a period of 1 hour. Then tests were initiated at 100 mV versus standard calomel electrode (SCE) below Ecorr and scanned at a rate of 1 mV/s in the anodic direction until reaching 1000 mV over the Ecorr value. The scan then was reversed back to the Ecorr of the specimens. The open circuit potentials (Ecorr ) and the current densities (Icorr ) were determined using the anodic Tafel regions extrapolating from the curves. Differences in Ecorr and Icorr were determined using one-way ANOVA (α = 0.05). In addition, corrosion rates were calculated from these curves. Before and after polarization tests, a scanning electron microscope (SEM) examination accompanied by energy dispersive X-ray spectroscopy (EDS) was used to analyze the surface morphology. The surface characterization of the passive film formed on alloy specimens was also performed by using X-ray photoelectron spectroscopy (XPS). RESULTS: In this study, bleaching agents had an effect on the anodic process for two groups. Although no statistical difference was identified between the groups for both corrosion parameters, results indicated that the effect of CP on the corrosion behavior was less than that of HP. These results agreed with the SEM observations. XPS data showed that oxide layers formed on all groups contained mainly Cr2 O3 , NiO, and MoO3 , and the amounts of oxides formed on CP-treated specimens were higher than HP treated ones. Also, molybdenum rates were increased with CP application compared to HP. CONCLUSIONS: The comparison of the effects of the two bleaching agents at 10% showed that the alloy suffered less corrosion with CP than HP. This result was also confirmed by the SEM and XPS data. The presence of Mo on the oxide layer affected the oxide layer, leading to lower corrosion rates.

Surface characterization of passive film and elemental release analysis of a Ni-Cr alloy during bleaching, part I: effects of different bleaching agents.

The aim of this study was to evaluate the elemental release from a Ni-Cr dental casting alloy subjected to 10% hydrogen peroxide (HP) or 10% carbamide peroxide (CP) solutions and to determine the composition of surface oxide layer formed on alloy samples. Cylinder-shaped 15 specimens were cast from a Ni-Cr alloy and divided into three groups (n = 5). Samples were exposed either to phosphate-buffer solution, HP, or CP for 30 days, and total mass and individual elements (Ni, Cr, Mo) released into solutions were measured by means of atomic absorption spectrometry. Before and after elemental release measurements, a scanning electron microscope (SEM) accompanied by energy dispersive spectroscopy (EDS) (SEM/EDS) was used to analyze the surface morphology, and surface characterization of passive film formed on alloy samples was also performed by using X-ray photoelectron spectroscopy (XPS). The presence of bleaching agents induced the mass released compared to control group (4.9 µg/cm(2)); this effect was recorded in both HP (171.2 µg/cm(2)) and CP (59.7 µg/cm(2)). XPS data showed that Cr and Ni levels in oxide layers formed on HP group were higher, Mo level was lower than those of CP group.

Prosthetic rehabilitation of hypophosphatasia: a case report.

Hypophosphatasia is a congenital disease characterized by deficiency of serum and tissue non-specific alkaline phosphatase activity. The disease occurs due to mutations in the liver/bone/kidney alkaline phosphatase gene. Six clinical forms of hypophosphatasia are recognized. Systemic symptoms of the disease are respiratory complications, premature craniosynostosis, widespread demineralization and rachitic changes in the metaphases, stress fractures, chondrocalcinosis and osteoarthropathy. Characteristic dental symptoms are premature deciduous teeth loss, premature exfoliation of fully rooted primary teeth, severe dental caries and alveolar bone loss. This clinical report describes the prosthetic rehabilitation of a twenty two year-old Turkish female patient with hypophosphatasia.