Hybrid abutment during prosthetic planning and oral rehabilitation.

INTRODUCTION: The present study aims to describe through a literature review, the characteristics and properties of hybrid abutments, as well as their proper use as a new rehabilitation strategy. EVIDENCE ACQUISITION: A bibliographic search was conducted in the main health databases Pubmed (www.pubmed.gov) and Google Scholar (www.scholar.google.com.br), in which studies published from 2001 to 2020 were collected. Laboratory studies, case reports, systematic and literature reviews were included. Therefore, articles that do not address the characteristics and properties of hybrid abutments were excluded. In addition, studies that did not report the use of hybrid abutments as a new rehabilitation strategy. EVIDENCE SYNTHESIS: According to the inclusion and exclusion criteria, 80 research articles were selected and 20 were excluded, while 25 in vitro, 17 in vivo and 9 in silico studies were reviewed. CONCLUSIONS: The literature demonstrates that hybrid abutments are an excellent alternative in cases of implant-supported rehabilitation, presenting high esthetic results, associated with good soft tissue response, peri implant marginal bone stability and adequate stress distribution during the masticatory loads dissipation.

Durability of staining and glazing on a hybrid ceramics after the three-body wear.

Hybrid ceramic is a promising material for monolithic restorations that could require an individualization through the extrinsic staining to improve aesthetics. Due to the possibilities to treat this ceramic prior to staining, this study evaluated the wear resistance of surface treatments prior to staining and glazing a hybrid ceramic. Thirty-two specimens (Vita Enamic) were divided into 8 groups according to the surface treatment prior to the staining (Polishing: Pol, Acid etching: Ac, Sandblasting with Al2O3: Sd or Self-etching silane: Ses) and glaze application (with: gl or without: gl). The specimens were submitted to the ACTA wear machine simulating the presence of food bolus and antagonist. The wear rate of the stain was determined after 7 intervals of 20,000 cycles, using a profilometer. The surface before and after staining, and after wear were inspected using Scanning Electron Microscopy (SEM). The rates were analyzed using three-way ANOVA and Tukey test. The wear was affected by surface treatment, glaze application and number of cycles (p < 0.001). 100% of the staining was removed after 20,000 cycles for Pol, 40,000 for Pol + gl, 60,000 for Ses + gl, 80,000 for Ac, 100,000 for Sd and Ses, 120,000 for Ac + gl and 140,000 for Sd + gl. SEM showed similar worn surfaces. Sandblasting followed by glaze application was the most durable treatment to maintain the external staining on the hybrid ceramic surface when subjected to three-body wear.

Survival Probability, Weibull Characteristics, Stress Distribution, and Fractographic Analysis of Polymer-Infiltrated Ceramic Network Restorations Cemented on a Chairside Titanium Base: An In Vitro and In Silico Study.

Different techniques are available to manufacture polymer-infiltrated ceramic restorations cemented on a chairside titanium base. To compare the influence of these techniques in the mechanical response, 75 implant-supported crowns were divided in three groups: CME (crown cemented on a mesostructure), a two-piece prosthetic solution consisting of a crown and hybrid abutment; MC (monolithic crown), a one-piece prosthetic solution consisting of a crown; and MP (monolithic crown with perforation), a one-piece prosthetic solution consisting of a crown with a screw access hole. All specimens were stepwise fatigued (50 N in each 20,000 cycles until 1200 N and 350,000 cycles). The failed crowns were inspected under scanning electron microscopy. The finite element method was applied to analyze mechanical behavior under 300 N axial load. Log-Rank (p = 0.17) and Wilcoxon (p = 0.11) tests revealed similar survival probability at 300 and 900 N. Higher stress concentration was observed in the crowns' emergence profiles. The MP and CME techniques showed similar survival and can be applied to manufacture an implant-supported crown. In all groups, the stress concentration associated with fractographic analysis suggests that the region of the emergence profile should always be evaluated due to the high prevalence of failures in this area.

Three-body wear effect on different CAD/CAM ceramics staining durability.

Regardless the materials properties, the vast majority of ceramic restorations could require an individualization through the extrinsic staining to improve aesthetics. This study aimed to compare the staining wear durability of different monolithic ceramics. Specimens of high translucent zirconia (YZHT), zirconia reinforced lithium silicate (ZLS), hybrid ceramic (HC) and feldspathic ceramic (FLD) were divided in five groups according to each material staining technique. The ZLS ceramic was tested with stained prior (ZLS1) and after crystallization (ZLS2). All specimens were extrinsically characterized, i.e. stained, and crystallized or sintered in specific ovens, according to the manufacturer's recommendation. The specimens were submitted to three-body wear tests in ACTA wear machine, simulating the presence of food bolus and antagonist (pH 7, 15 N, 1 Hz). The wear rate of the stain surface was determined after 5 intervals of 200,000 cycles, using a profilometer. The ceramic surface before and after staining, and after wear were inspected by Scanning Electron Microscopy (SEM). The wear rates were analyzed using two-way ANOVA and post-hoc Tukey test. The wear rates of the staining were affected by ceramic and the number of cycles (P < 0.001). 100% of staining was removed after 200,000 cycles for HC, and after 600,000 cycles for YZHT and ZLS1. Staining of ZLS2 and FLD remained on ceramic surface even after 1,000,000 cycles. Furthermore, FLD showed a significant higher staining durability than ZLS2. SEM revealed different surface morphologies for each group with and without staining and after the wear test. Ceramics with fired staining showed higher durability compared to the polymerized one. The feldspar ceramic presented superior staining durability, followed by zirconia reinforced lithium silicate and high translucent zirconia. The conventional two steps staining technique showed improved durability for zirconia reinforced lithium silicate.

Short communication: Influence of retainer configuration and loading direction on the stress distribution of lithium disilicate resin-bonded fixed dental prostheses: 3D finite element analysis.

The present study elucidates the mechanical performance of different designs of resin-bonded fixed dental prostheses made of lithium disilicate simulating masticatory loads of anterior or canine guidance. A three-dimensional model of maxilla was constructed containing central incisor and canine teeth, with edentulous space of the lateral incisor. Three designs of prosthesis were created: retained in central incisor (1-I), retained in canine (1-C) and fixed in both teeth (2-IC). The computational analysis was performed for load in canine and central incisor separately (100N, 45°). The tensile and shear stresses were calculated for the resin-bonded fixed dental prosthesis, bonding surface of each retainer and cement layer using 3D finite element analysis. The 20 highest stress values were analyzed using two-way ANOVA and post-hoc Tukey test, all with α = 5%. The computational analysis showed that 2-retainer resin-bonded fixed dental prosthesis presented the worst prognosis regardless of the mandibular movement. ANOVA showed that Mandibular movement*Retainer interaction influenced on the tensile and shear stresses values (p < 0.01). Higher stresses were observed in the connector region for all groups (13-82.2 MPa; 11-70.2 MPa). In order to reduce the stress concentration in the resin-bonded fixed dental prosthesis and the retainer made of lithium disilicate, the occlusion may serve as the selection criteria of the unitary abutment for better sustainability.

Influence of resin cement rigidity on the stress distribution of resin-bonded fixed partial dentures.

The mechanical properties of the adhesive cement used in resin-bonded fixed partial dentures (RBFPD) can modify the clinical performance of the rehabilitation. The goal of this study was to evaluate the influence of the elastic modulus of different cements on the stress distribution in RBFPD using finite element analysis. For that an anterior 3-unit prosthesis was modeled based in a stereolithography file. The model was meshed with tetrahedral elements and materials considered isotropic, linearly elastic and homogeneous. The force applied to the palatal area of the lateral incisor (pontic) at 45° was 100 N. The cements used presented 7 different elastic modulus (E): 2, 6, 10, 14, 18, 22 or 26 GPa. The total deformation, von-Mises stress and maximum principal stress criteria were used to calculate the results. The lower tensile stress occurred in the cement layer with E = 2 GPa [25.6 (canine) and 16.32 MPa (incisor)]. For the prosthesis, the model with the lower tensile stress [287 (canine) and 248 MPa (incisor)] occurred when the cement presented E = 26 GPa. In this way, the stress concentration may have its magnitude modified depending on the stiffness of the cement. Since more flexible cements concentrate less tensile stress in its structure, but allow an increased displacement of the prosthesis, which is friable and rigid and ends up concentrating more tensile stress at its connector. In that way the clinician should avoid the use of adhesive cement with lower elastic modulus due to it increases the stress concentration in the ceramic.

Mechanical behavior of Class I cavities restored by different material combinations under loading and polymerization shrinkage stress. A 3D-FEA study.

PURPOSE: To examine the influence of different bulk and block composite and flowable and glass-ionomer material combinations in a multi-layer technique and in a unique technique, in deep Class I dental restorations. METHODS: 3D CAD of the sound tooth were built-up from a CT scan dataset using reverse engineering techniques. Four restored tooth models with Class I cavity were virtually created from a CAD model of a sound tooth. 3D-finite element (FE) models were created and analyzed starting from CAD models. Model A with flowable resin composite restoring the lower layer and bulk-fill resin composite restoring the upper layer, model B with glass-ionomer cement (GIC) restoring the lower layer and bulk-fill resin composite restoring the upper layer, model C with block composite as the only restoring material and model D with bulk-fill resin composite as the only restoring material. Polymerization shrinkage was simulated with the thermal expansion approach. Physiologic masticatory loads were applied in combination with shrinkage effect. Nodal displacements on the lower surfaces of FE models were constrained in all directions. Static linear analyses were carried out. The maximum normal stress criterion was used to assess the influence of each factor. RESULTS: Considering direct restoring techniques, models A, B and D exhibited a high stress gradient at the tooth/restorative material interface. Models A and D showed a similar stress trend along the cavity wall where a similar stress trend was recorded in the dentin and enamel. Model B showed a similar stress trend along enamel/restoration interface but a very low stress gradient along the dentin/restoration interface. Model C with a restoring block composite material showed a better response, with the lowest stress gradient at the dentin, filling block composite and enamel sides. CLINICAL SIGNIFICANCE: Bulk resin-based composite materials applied in a multilayer technique to deep and large Class I cavities produced adverse stress distributions versus block resin composite. Polymerization shrinkage and loading determined high stress levels in deep Class I cavities with bulk multi-layer restorations, while its impact on adhesion in block composite restorations was insignificant.

Influence of restoration thickness on the stress distribution of ultrathin ceramic onlay rehabilitating canine guidance: a 3D-finite element analysis.

BACKGROUND: The rehabilitation of canine guidance can be performed with adhesive indirect materials, but can the restoration thickness be reduced without mechanical disadvantages? Thus the goal of this study was to analyze the stress of upper canines which received different thicknesses of ceramic fragments for the rehabilitation of the canine guidance using finite element analysis. METHODS: A superior canine was modeled using a computer aided design software. The dental tissues were individually shaped containing enamel, dentin and periodontal ligament. The following three different ceramic fragment thicknesses were then implemented: 0.3, 0.7 and 1.5 mm. Lithium disilicate was chosen as the ceramic material. The solid geometries were exported to the analysis software. The materials were considered isotropic, homogeneous and linear. The set was submitted to efforts in the incisal third in the palatine face to analyze maximal principal stress, mimicking mandibular lateral movement. The applied load was 100N, and the fixation region was on the medullary bone. RESULTS: For restoration, the thinner the ceramic, the higher the stress concentration was; while for the adhesive surface of teeth, the thicker the ceramic, the higher the stress concentration. CONCLUSIONS: The smaller the ceramic thickness was, the lower stress concentration showed at the adhesive interface, while the stress concentration was higher on the restoration intaglio surface.