Topographical and crystalline change on surface by sandblasting improve flexural and shear bond strength of niobia-modified yttria-stabilized tetragonal zirconia polycrystal.

This study aimed to investigate the effects of sandblasting on the physical properties and bond strength of two types of translucent zirconia: niobium-oxide-containing yttria-stabilized tetragonal zirconia polycrystals ((Y, Nb)-TZP) and 5 mol% yttria-partially stabilized zirconia (5Y-PSZ). Fully sintered disc specimens were either sandblasted with 125 µm alumina particles or left as-sintered. Surface roughness, crystal phase compositions, and surface morphology were explored. Biaxial flexural strength (n=10) and shear bond strength (SBS) (n=12) were evaluated, including thermocycling conditions. Results indicated a decrease in flexural strength of 5Y-PSZ from 601 to 303 MPa upon sandblasting, while (Y, Nb)-TZP improved from 458 to 544 MPa. Both materials significantly increased SBS after sandblasting (p<0.001). After thermocycling, (Y, Nb)-TZP maintained superior SBS (14.3 MPa) compared to 5Y-PSZ (11.3 MPa) (p<0.001). The study concludes that (Y, Nb)-TZP is preferable for sandblasting applications, particularly for achieving durable bonding without compromising flexural strength.

Biological effects of gamma-ray sterilization on 3 mol% yttria-stabilized tetragonal zirconia polycrystal: An in vitro study.

STATEMENT OF PROBLEM: Selecting the sterilization method is important because sterilization can alter the surface chemistry of implant materials, including zirconia, and influence their cellular biocompatibility. Studies on the biological effects of sterilization on implant materials are lacking. PURPOSE: The purpose of this in vitro study was to evaluate the biocompatibility of gamma-ray irradiated 3 mol% yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP) compared with unirradiated titanium, 3Y-TZP, and pure gold. MATERIAL AND METHODS: Disk-shaped specimens each of commercially pure grade 4 titanium, 3Y-TZP, gamma-rayed 3Y-TZP, and pure gold were prepared and evaluated for osteogenic potential by using a clonal murine cell line of immature osteoblasts derived from mice (MC3T3-E1 cells). The surface topography (n=3), chemical analysis of the disks (n=3), and cell morphology cultured on these surfaces were examined using scanning electron microscopy, confocal laser scanning microscopy, and energy dispersive spectroscopy. Cellular biocompatibility was analyzed for 1 and 3 days after seeding. Cell adhesion and spreading were evaluated using confocal laser scanning microscopy (n=3). Cell proliferation was evaluated using methyl thiazolyl tetrazolium assay (n=3). Kruskal-Wallis and Bonferroni corrections were used to evaluate the statistical significance of the intergroup differences (α=.05). RESULTS: Gamma-ray sterilization of 3Y-TZP showed significantly higher surface roughness compared with titanium and gold (P<.002). On day 1, the proliferation and adhesion of MC3T3-E1 cells cultured on gamma-rayed 3Y-TZP were significantly higher than those cultured on gold (P<.05); however, cell spreading was significantly lower than that of titanium on days 1 and 3 (P<.05). On day 3, cell proliferation of gamma-rayed 3Y-TZP was significantly lower than that of unirradiated 3Y-TZP (P<.05). Cell adhesion of gamma-rayed 3Y-TZP was slightly lower than that of zirconia and titanium but without significant difference (P>.05). CONCLUSIONS: Gamma-rayed zirconia exhibited increased surface roughness compared with titanium and significantly decreased bioactivity compared with titanium and zirconia. The use of gamma-ray sterilization on zirconia is not promising regarding biocompatibility, and the effect of this sterilization method on implant materials warrants further investigation.

Antibacterial activity and biocompatibility of silver coating via aerosol deposition on titanium and zirconia surfaces.

PURPOSE: The purpose of this in vitro study was to investigate the antibacterial effect and biocompatibility of silver coatings via aerosol deposition on titanium and zirconia surfaces. METHODS: The surfaces of titanium and zirconia specimens were polished and coated with silver via aerosol deposition. After silver coating, the elemental composition, surface roughness and amount of silver released from the coated surfaces were measured. The bacterial growth on the silver-coated surfaces was investigated via crystal violet assay after incubation with Streptococcus gordonii for 24 h, Fusobacterium nucleatum for 72 h and Porphyromonas gingivalis for 48 h. Human gingival fibroblasts and mouse preosteoblasts were also cultured on the silver-coated specimens to examine the biocompatibility of the coating. RESULTS: After silver coating via aerosol deposition, the surface roughness increased significantly, and the released silver ranged from 0.067 to 0.110 ppm. The tested bacteria formed significantly less biofilm on the silver-coated titanium surfaces than on the uncoated titanium surfaces. In contrast, biofilm formation on the silver-coated zirconia surfaces was greater than that on the uncoated zirconia surfaces. Human gingival fibroblasts and mouse preosteoblasts proliferated on the silver-coated surfaces without significant differences from the uncoated surfaces. CONCLUSIONS: Silver coating via aerosol deposition provided an antibacterial effect against oral bacteria on titanium surfaces, whereas it promoted more bacterial growth on zirconia surfaces. The proliferation of fibroblasts and osteoblasts was not significantly affected by the silver coating on both titanium and zirconia surfaces.

Measurement of proximal contact of single crowns to assess interproximal relief: A pilot study.

Background: It is common for dental technicians to adjust the proximal surface of adjacent teeth on casts when fabricating single crowns. However, whether the accuracy of the proximal contact is affected if this step is eliminated is unclear. Objective: To evaluate the accuracy of the proximal contact of single crowns for mandibular first molars fabricated from four different restorative materials, without adjustment of the proximal surface of the adjacent teeth by the laboratory/dental technician. Methods: This study was in vitro; all the clinical procedures were conducted on a dentoform. The mandibular first molar tooth on the dentoform was prepared using diamond burs and a high speed handpiece. Twenty single crowns were fabricated, five for each group (monolithic zirconia, lithium disilicate, metal ceramic, and cast gold). No proximal surface adjacent to the definitive crowns was adjusted for tight contact in the dental laboratory. Both the qualitative analyses, using dental floss and shimstock, and the quantitative analyses, using a stereo microscope, were performed to evaluate the accuracy of the proximal contact of the restoration with the adjacent teeth. In the quantitative analysis, one-way analysis of variance was used to compare mean values at a significance level of 0.05. Results: In quantitative analysis, the differences between the proximal contact tightness of the four groups was not statistically significant (P = 0.802 for mesial contacts, P = 0.354 for distal contacts). In qualitative analysis, in most crowns, dental floss passed through the contact with tight resistance and only one film of shimstock could be inserted between the adjacent teeth and the restoration. However, one specimen from the cast gold crown had open contact. Conclusions: Even without proximal surface adjustment of the adjacent teeth during the crown fabrication process, adequate proximal contact tightness between the restoration and adjacent teeth could be achieved.

Comparison between bone-implant interfaces of microtopographically modified zirconia and titanium implants.

The aim of this study was to investigate the surface characteristics and evaluate the bone-implant interfaces of injection molded zirconia implants with or without surface treatment and compare them with those of conventional titanium implants. Four different zirconia and titanium implant groups (n = 14 for each group) were prepared: injection-molded zirconia implants without surface treatment (IM ZrO2); injection-molded zirconia implants with surface treatment via sandblasting (IM ZrO2-S); turned titanium implants (Ti-turned); and titanium implants with surface treatments via sandblasting with large-grit particles and acid-etching (Ti-SLA). Scanning electron microscopy, confocal laser scanning microscopy, and energy dispersive spectroscopy were used to assess the surface characteristics of the implant specimens. Eight rabbits were used, and four implants from each group were placed into the tibiae of each rabbit. Bone-to-implant contact (BIC) and bone area (BA) were measured to evaluate the bone response after 10-day and 28-day healing periods. One-way analysis of variance with Tukey's pairwise comparison was used to find any significant differences. The significance level was set at α = 0.05. Surface physical analysis showed that Ti-SLA had the highest surface roughness, followed by IM ZrO2-S, IM ZrO2, and Ti-turned. There were no statistically significant differences (p > 0.05) in BIC and BA among the different groups according to the histomorphometric analysis. This study suggests that injection-molded zirconia implants are reliable and predictable alternatives to titanium implants for future clinical applications.

Color and surface stainability of additively and subtractively manufactured interim restorative materials against mouth rinses.

STATEMENT OF PROBLEM: Interim restorations are often used along with mouth rinses during the healing period following surgical procedures. However, evidence regarding the color and surface properties of digitally fabricated interim restorations after oral rinsing is lacking. PURPOSE: The purpose of this in vitro study was to evaluate whether different mouth rinses could affect the color and surface roughness of milled and printed interim restorations after simulated oral rinsing. MATERIAL AND METHODS: Disk-shaped specimens (Ø15×2 mm; N=180) were fabricated by using conventional (Jet Tooth Shade), milled (Yamahachi PMMA Disk), and printed (NextDent C&B) resin materials. All resin specimens were divided into 3 different groups according to the rinsing material: distilled water, whitening mouth rinse (Listerine Healthy White), and conventional mouth rinse (Listerine Cool Mint). The specimens were further allocated into short- and long-term subgroups, and oral rinsing simulation was performed (n=10). Short-term rinsing simulated the conditions in a usual interim restoration period, and long-term rinsing was performed to evaluate the properties of the interim materials. The color differences (CIEDE2000, ΔE00) between the baseline and each time point were determined by using a spectrophotometer. The surface roughness of the tested specimens was measured by using a confocal laser scanning microscope. Kruskal-Wallis and Friedman tests with nonparametric pairwise comparisons were used to analyze the data (α=.05). RESULTS: On simulation of a 6-month use of the mouth rinse, the color change in the milled resin did not differ from that in the conventional resin (P>.334), but the printed resin showed a significantly greater color change than the other resins (P<.007). The greatest color change with the printed resin was observed when a conventional mouth rinse was used. However, all color changes were below a perceptible threshold of 1.30. When daily rinsing for 14 years was simulated, all resin groups showed a perceptible color change when conventional mouth rinse was used, and the printed resin showed the greatest median ±interquartile range ΔE00 (2.24 ±0.2). In both short- and long-term simulations, the printed resin rinsed with the conventional mouth rinse showed significantly greater roughness than that rinsed with distilled water (P<.009). CONCLUSIONS: The printed resin showed higher stainability than the conventional resin, and the color change was greatest with the conventional mouth rinse. However, in 6 months of daily mouth rinse simulation, all the tested resin materials exhibited imperceptible color change and clinically acceptable surface roughness.

Comparison of three-dimensional digital analyses and two-dimensional histomorphometric analyses of the bone-implant interface.

Histological analysis is considered to be the gold standard method of evaluating osseointegration around a bone-implant. However, this method requires invasive specimen preparation and is capable of representing only one plane. By comparison, micro-computed tomography (µCT) is a fast and convenient method that offers three-dimensional information but is hampered by problems related to resolution and artifacts, making it a supplementary method for osseointegration analysis. To verify the reliability of µCT for osseointegration evaluation, this animal model study compared bone-to-implant contact (BIC) ratios obtained by the gold standard histomorphometric method with those obtained by the µCT method, using a rabbit tibia implant model. A sandblasted, large-grit, acid-etched (SLA) implant and a machined surface implant were inserted into each tibia of two rabbits (giving eight implants in total). Bone-implant specimens were analyzed using µCT with a spiral scan technique (SkyScan 1275) and histological sections were prepared thereafter. Three-dimensional (3D) reconstructed µCT data and four two-dimensional (2D) µCT sections, including one section corresponding to the histologic section and three additional sections rotated 45°, 90°, and 135°, were used to calculate the BIC ratio. The Pearson's test was used for correlation analysis at a significance level of 0.05. The histomorphometric BIC and the 2D-µCT BIC showed strong correlation (r = 0.762, P = 0.046), whereas the histomorphometric BIC and 3D-µCT BIC did not (r = -0.375, P = 0.385). However, the mean BIC value of three or four 2D-µCT sections showed a strong correlation with the 3D-µCT BIC (three sections: r = 0.781, P = 0.038; four sections: r = 0.804, P = 0.029). The results of this animal model study indicate that µCT can be used to complement the histomorphometric method in bone-implant interface analyses. With the limitations of this study, 3D-µCT analysis may even have a superior aspect in that it eliminates random variables that arise as a consequence of the selected cutting direction.

Platelet-rich plasma alone is unable to trigger contact osteogenesis on titanium implant surfaces.

PURPOSE: Osseointegration consists of bidirectional bone formation around modified implant surfaces by contact osteogenesis and distance osteogenesis. This study tested whether contact osteogenesis on the surface of a modified titanium (Ti) implant is stimulated by cytokines in the blood. METHODS: In the first two types of experiments, sandblasted, large-grit, acid-etched Ti implants and turned Ti tubes were inserted into rabbit tibiae. To exclude the influence of distance osteogenesis, the tubes were inserted into the tibiae, and implants were placed inside the tubes. In a third type of experiment, the implants and tubes were inserted into the rabbit tibiae, and platelet-rich plasma (PRP) or recombinant human bone morphogenetic protein-2 (rhBMP-2) was applied topically. Four weeks after implantation, undecalcified specimens were prepared for histomorphometry. Bone-to-implant contact (BIC) and bone area per tissue (BA) were measured, and the data were analysed using one-way ANOVA at a significance level of 0.05. RESULTS: When the response of bone to Ti tubes with implants was compared to that without implants (first experiment), little bone formation was found inside the tubes. The mean BIC of implant specimens inside the tubes was 21.41 ± 13.81% in a second experiment that evaluated bone responses to implants with or without Ti tubes. This mean BIC value was significantly lower than that in the implant-only group (without tubes) (47.32 ± 12.09%, P = 0.030). The third experiment showed that rhBMP-2 significantly increased contact osteogenesis on the implant surface, whereas PRP had no effect (mean BIC: 66.53 ± 14.06% vs. 16.34 ± 15.98%, P = 0.004). CONCLUSIONS: Platelet-rich plasma alone is unable to trigger contact osteogenesis on the modified titanium implant surface.

Three interfaces of the dental implant system and their clinical effects on hard and soft tissues.

Anatomically, the human tooth has structures both embedded within and forming part of the exterior surface of the human body. When a tooth is lost, it is often replaced by a dental implant, to facilitate the chewing of food and for esthetic purposes. For successful substitution of the lost tooth, hard tissue should be integrated into the implant surface. The microtopography and chemistry of the implant surface have been explored with the aim of enhancing osseointegration. Additionally, clinical implant success is dependent on ensuring that a barrier, comprising strong gingival attachment to an abutment, does not allow the infiltration of oral bacteria into the bone-integrated surface. Epithelial and connective tissue cells respond to the abutment surface, depending on its surface characteristics and the materials from which it is made. In particular, the biomechanics of the implant-abutment connection structure (i.e., the biomechanics of the interface between implant and abutment surfaces, and the screw mechanics of the implant-abutment assembly) are critical for both the soft tissue seal and hard tissue integration. Herein, we discuss the clinical importance of these three interfaces: bone-implant, gingiva-abutment, and implant-abutment.

Analysis of surface characteristics of (Y, Nb)-TZP after finishing and polishing.

PURPOSE: This in vitro study aimed to evaluate the surface characteristics of a full veneer crown fabricated chairside (CS) from a (Y, Nb)-TZP zirconia block in response to conventional zirconia grinding and polishing. MATERIALS AND METHODS: Zirconia crowns (n = 40) were first prepared and divided into two groups of materials: Labside (LS) and CS, after which each specimen went through a five-step grinding and polishing procedure. Following each surface treatment, surface characteristics were analyzed using confocal laser microscopy (CLSM), average surface roughness (Ra) values were processed from the profile data through Gaussian filtering, and X-ray diffraction pattern analysis was performed to evaluate the monoclinic (M) phase content. Then, a representative specimen was selected for field-emission scanning electron microscopy (FE-SEM), followed by a final analysis of the roughness and X-ray diffraction of the specimens using the independent t-test and repeated measures analysis of variance (RM-ANOVA). RESULTS: In every group, polishing significantly reduced the Ra values (P < .001). There was no significant difference in Ra between the polished state CS and LS. Furthermore, CLSM and FE-SEM investigations revealed that even though grain exposure was visible in CS specimens throughout the as-delivered and ground states, the exposure was reduced after polishing. Moreover, while no phase transformation was visible in the LS, phase transformation was visible in CS after every surface treatment, with the M phase content of the CS group showing a significant reduction after polishing (P < .001). CONCLUSION: Within the limits of this study, clinically acceptable level of surface finishing of (Y, Nb)-TZP can be achieved after conventional zirconia polishing sequence.

Bone Response to Conventional Titanium Implants and New Zirconia Implants Produced by Additive Manufacturing.

The aim of the present study was to evaluate the in vivo bone response to an additively manufactured zirconia surface compared to osseointegration into titanium (Ti) surfaces. Scanning electron microscopy, confocal laser scanning microscopy, and electron spectroscopy for chemical analysis were performed to assess the surface characteristics of implant specimens. For the in vivo evaluation, eight Ti implants and eight 3D-printed zirconia implants were used. The surface of four Ti implants was sandblasted, large-grit, and acid-etched (Ti-SLA group), while those of the other four Ti implants were left untreated (Ti-turned group). The zirconia implants had no further surface modification. Implants were placed into the tibiae of four rabbits; two received the Ti-SLA and zirconia implants and the other two received Ti-turned and zirconia implants. The experimental animals were sacrificed after four weeks of surgery, and the undecalcified microscopic slides were prepared. The bone-implant interface was analyzed by histomorphometry to evaluate the bone response. The degree of surface roughness showed that Ti-SLA was the highest, followed by zirconia and Ti-turned surfaces. The 3D-printed zirconia surface showed similar bone-to-implant contact to the Ti-turned surface, and Ti-SLA had the most bone-to-implant contact. The additively manufactured zirconia implant surface is biocompatible with respect to osseointegration compared to the commercially pure Ti surface.

Wear of 3D printed and CAD/CAM milled interim resin materials after chewing simulation.

PURPOSE: The purpose of this in vitro study was to investigate the wear resistance and surface roughness of three interim resin materials, which were subjected to chewing simulation. MATERIALS AND METHODS: Three interim resin materials were evaluated: (1) three-dimensional (3D) printed (digital light processing type), (2) computer-aided design and computer-aided manufacturing (CAD/CAM) milled, and (3) conventional polymethyl methacrylate interim resin materials. A total of 48 substrate specimens were prepared. The specimens were divided into two subgroups and subjected to 30,000 or 60,000 cycles of chewing simulation (n = 8). The wear volume loss and surface roughness of the materials were compared. Statistical analysis was performed using one-way analysis of variance and Tukey's post-hoc test (α=.05). RESULTS: The mean ± standard deviation values of wear volume loss (in mm3) against the metal abrader after 60,000 cycles were 0.10 ± 0.01 for the 3D printed resin, 0.21 ± 0.02 for the milled resin, and 0.44 ± 0.01 for the conventional resin. Statistically significant differences among volume losses were found in the order of 3D printed, milled, and conventional interim materials (P<.001). After 60,000 cycles of simulated chewing, the mean surface roughness (Ra; µm) values for 3D printed, milled, and conventional materials were 0.59 ± 0.06, 1.27 ± 0.49, and 1.64 ± 0.44, respectively. A significant difference was found in the Ra value between 3D printed and conventional materials (P=.01). CONCLUSION: The interim restorative materials for additive and subtractive manufacturing digital technologies exhibited less wear volume loss than the conventional interim resin. The 3D printed interim restorative material showed a smoother surface than the conventional interim material after simulated chewing.

Clinical Feasibility of Fully Sintered (Y, Nb)-TZP for CAD-CAM Single-Unit Restoration: A Pilot Study.

Fifteen participants (9 male, 6 female) received a total of 15 monolithic single restorations made from fully sintered (Y, Nb)-TZP (tetragonal zirconia polycrystal) block. The restorations were clinically evaluated for survival, success rate, and periodontal probing depths 6 months after the insertion of the restorations. Esthetic, functional, and biological evaluations were also performed over a 6-month follow-up period. The survival and success rates of the single-unit restorations were 100%. The periodontal probing depth values ranged from 1 to 3 mm. No complications with regard to functional and biological properties were observed after 6 months. The postoperative sensitivity was only a transient phenomenon. The fully sintered (Y, Nb)-TZP single-unit restoration showed highly acceptable quality with successful clinical performance over 6 months.

Special Issue: Dental Implant Materials 2019.

The Special Issue, "Dental Implant Materials 2019", has tried to introduce recent developments in material science and implant dentistry with biologic and clinical aspects [...].

Influence of Connections and Surfaces of Dental Implants on Marginal Bone Loss: A Retrospective Study Over 7 to 19 Years.

PURPOSE: This retrospective study compared the long-term outcomes of dental implants according to type of connection and surface. MATERIALS AND METHODS: Multiunit restorations were classified as follows: an external connection with a turned surface, an external connection with an anodized surface, or an internal connection with a fluoride-modified surface. Patients who were followed up for longer than 7 years after implant loading were included in the study. Cumulative implant survival rates and the amounts of marginal bone loss were calculated by reviewing dental records and radiographs. Only implants that survived until the last follow-up visit were included in the analysis of marginal bone loss. Statistical analyses were performed to detect between-group differences at the significance level of .05. RESULTS: Sixty-nine patients with 261 bone-level implants were included. The average follow-up duration was 15.2 years in the external turned group, 10.6 years in the external anodized group, and 9.9 years in the internal fluoride-modified group. There was no significant between-group difference in the cumulative survival rate (P = .439) despite eight implant failures (six in the external turned group and two in the internal fluoride-modified group). The mean (SD) marginal bone loss values at the last follow-up were 0.47 mm (0.67), 0.87 mm (1.07), and 0.23 mm (0.58) in the external turned, external anodized, and internal fluoride-modified groups, respectively. After adjusting for follow-up duration, there was significantly less marginal bone loss in the external turned group than in the external anodized group (P < .001) and in the internal fluoride-modified group than in the external anodized group (P < .001). No significant difference in marginal bone loss was found between the external turned and internal fluoride-modified groups (P = .44). CONCLUSION: The implant-abutment connection structure is an important contributor to the maintenance of the level of marginal bone surrounding the implant. Implant surface characteristics are another contributor to marginal bone resorption.

Effect of Yttria Content on the Translucency and Masking Ability of Yttria-Stabilized Tetragonal Zirconia Polycrystal.

Translucent zirconia, manufactured by increasing the yttria content, offers improved translucency, but may have a negative effect on esthetic outcomes under clinical conditions such as discolored abutment because of the reflection of the underlying color. The purpose of this in vitro study was to compare the translucency parameter and masking ability of 3 mol % yttria-stabilized tetragonal zirconia polycrystal (3Y-TZP (Katana HT)), 4Y-ZP (Katana STML), and 5Y-ZP (Katana UTML) with those of lithium disilicate (Rosetta SM). Zirconia and lithium disilicate specimens of 10 mm diameters and 0.8 and 1.5 mm thicknesses were fabricated. Their CIE L*a*b* values (L*, brightness; a*, red-green value; b*, yellow-blue value) were measured at the center of the specimens against black and white backgrounds using a spectrophotometer, and translucency parameter (TP) values were determined. The microstructure of the specimens was observed using scanning electron microscopy. Four cylindrical backgrounds of different shades were prepared. The zirconia and lithium disilicate specimens were placed on the backgrounds without any intervening medium. CIE L*a*b* values were obtained, and the color difference value (ΔE) was calculated. Thresholds for acceptability and perceptibility were assumed as ΔE = 5.5 and ΔE = 2.6, respectively, to evaluate masking ability. Data were compared using one-way analysis of variance and post-hoc was performed using Scheffe's test (α = 0.05). In zirconia specimens, the TP value increased as the yttria content increased from 3 mol %, through 4 mol % to 5 mol %, and all zirconia specimens showed lower TP values than lithium disilicate specimens did. All zirconia specimens showed optimal masking ability against a normal dentin shade (ND3) and acceptable masking ability against titanium at a minimum thickness of 1.5 mm. However, no zirconia specimen could mask severely discolored dentin (ND9), regardless of thickness. The decrease in zirconia thickness from 1.5 to 0.8 mm significantly increased translucency. Monolithic Y-TZP ceramics could mask a normal dentin background but could not mask severely discolored dentin at either 0.8 or 1.5 mm thicknesses.

Ceramic Materials and Technologies Applied to Digital Works in Implant-Supported Restorative Dentistry.

Computer-aided design and manufacturing technology has been closely associated with implant-supported restoration. The digital system employed for prosthodontic restorations comprises data acquisition, processing, and manufacturing using subtractive or additive methods. As digital implantology has developed, optical scanning, computer-based digital algorithms, fabricating techniques, and numerical control skills have all rapidly improved in terms of their accuracy, which has resulted in the development of new ceramic materials with advanced esthetics and durability for clinical application. This study reviews the application of digital technology in implant-supported dental restoration and explores two globally utilized ceramic restorative materials: Yttria-stabilized tetragonal zirconia polycrystalline and lithium disilicate glass ceramics.

Eleven-year follow-up of reconstruction with autogenous iliac bone graft and implant-supported fixed complete denture for severe maxillary atrophy: A case report.

RATIONALE: The iliac bone graft procedure is one of the treatment options for individuals with extremely resorbed alveolar bones. An autogenous block bone graft can allow the use of an implant-supported fixed dental prosthesis, rather than conventional removable dentures, by completely edentulous patients. However, the iliac bone graft technique is an invasive procedure and should be carefully selected based on its long-term clinical results. This case report describes 11-year long-term outcomes for implant-supported complete denture on the grafted iliac bone. PATIENT CONCERNS: A 68-year-old Asian man was referred for oral rehabilitation with fixed dental prostheses. The patient had been unsatisfied with his removable dental prostheses in masticatory performance. DIAGNOSIS: Radiographical examination revealed severely atrophied maxilla. INTERVENTIONS: The atrophied maxilla was reconstructed with an iliac block bone graft, after which an implant-supported fixed complete denture was placed. OUTCOMES: During 11 years of follow-up, several prosthetic and mechanical complications were encountered. Nevertheless, no biological complications were observed. Marginal bone levels around the implants were well-maintained on the radiographs after 11 years of prosthetic use. LESSONS: Iliac bone graft can be chosen as a predictable treatment option that allows patients with extremely atrophic maxilla to use a fixed dental prosthesis instead of a removable denture.

A laminin-211-derived bioactive peptide promotes the osseointegration of a sandblasted, large-grit, acid-etched titanium implant.

Early implant loading is very important for reducing the duration of missing teeth in human patients. The laminin-derived peptide, DLTIDDSYWYRI motif (Ln2-P3), accelerates bone healing. Therefore, to investigate the hypothesis that Ln2-P3 increases the bone response to sandblasted, large-grit, acid-etched (SLA) titanium implants, the effect of the Ln2-P3 peptide on the osseointegration of SLA titanium implants was evaluated in vitro and in vivo. Human osteoblast-like cells were cultured on untreated, scrambled peptide (SP)-treated, and Ln2-P3-treated SLA titanium discs, and the cellular responses of these cells were evaluated. The Ln2-P3 treatment augmented osteoblast attachment and spreading, alkaline phosphatase activity, and the expression of osteogenic marker genes. Furthermore, the untreated and Ln2-P3-treated SLA titanium implants were inserted into the tibiae of rabbits for 9 and 11 days. Compared with the untreated implants, the Ln2-P3-treated implants showed a significantly higher bone-to-implant contact ratio at Day 9 after implantation and an increased bone area. The Ln2-P3 treatment of the SLA titanium implant surface augmented osteoblastic activity and accelerated peri-implant bone formation at the bone-implant interface. Overall, these results indicated that compared with the SLA titanium surface alone, the Ln2-P3 peptide-treated SLA titanium surface enhances initial osseointegration, thereby facilitating earlier implant loading.

Biological Responses to the Transitional Area of Dental Implants: Material- and Structure-Dependent Responses of Peri-Implant Tissue to Abutments.

The stability of peri-implant tissue is essential for the long-term success of dental implants. Although various types of implant connections are used, little is known about the effects of the physical mechanisms of dental implants on the stability of peri-implant tissue. This review summarizes the relevant literature to establish guidelines regarding the effects of connection type between abutments and implants in soft and hard tissues. Soft tissue seals can affect soft tissue around implants. In external connections, micromobility between the abutment and the hex component of the implant, resulting from machining tolerance, can destroy the soft tissue seal, potentially leading to microbial invasion. Internal friction connection implants induce strain on the surrounding bone via implant wall expansion that translates into masticatory force. This strain is advantageous because it increases the amount and quality of peri-implant bone. The comparison of internal and external connections, the two most commonly used connection types, reveals that internal friction has a positive influence on both soft and hard tissues.