A Case of Anterior Single Tooth Implant with Fractured Zirconia Abutment due to Trauma.

In recent years, a wide variety of materials have been used in dental implant treatment. In selecting the superstructures and abutments to be used it is important to consider their potential effect on the stability and durability of the planned implant. Excessive force applied to an implant during maintenance commonly results in complications, such as fracture of the superstructure or abutment, and loosening or fracture of the screws. This report describes a case of implant treatment for a 23-year-old man with esthetic disturbance due to trauma to the maxillary anterior teeth. The left maxillary central incisor could not be conserved due to this trauma, which had been caused by a traffic accident. After extraction, the tooth was restored with an anterior bridge. The crown of the left maxillary lateral incisor was fractured at the crown margin and, at the patient's request, implant treatment was selected as the restorative treatment for the missing tooth. A thorough preoperative examination was performed using placement simulation software. One titanium screw-type implant was placed in the maxillary left central incisor under local anesthesia. An all-ceramic crown with a zirconia frame was placed as a screw-fixed direct superstructure. At one year postoperatively, however, the superstructure and abutment became detached due to trauma. The fractured zirconia abutment was removed and replaced with a remanufactured abutment and superstructure. The patient has reported no subsequent dental complaint over the last 11 years. In this case, a surface analysis of the fractured zirconia abutment was performed. The scanned images revealed a difference in the fracture surfaces between the tensile and compressive sides, and electron probe microanalysis demonstrated the presence of titanium on the fracture surface. It was inferred that the hard zirconia abutment had scraped the titanium from the internal surface of the implant.

Cyclic Fatigue Properties of Titanium Alloys for Application in Dental Implants.

The present study investigated the cyclic fatigue properties of titanium alloys (Ti-6Al-4V and Ti-6Al-7Nb) as implant materials and compared their properties with those of commercially pure titanium. Ti-6Al-4V and Ti-6Al-7Nb cylinders with diameters of 3.0 mm were examined. The surfaces of the cylinders were roughened by sand blasting with alumina particles and acid etching. Static and cyclic tests were performed according to ISO 14801:2016. The yield force in the static test (YS) was measured in 5 specimens of each alloy using a universal testing machine. The yield force in a cyclic test (YC) was measured in 20 specimens of each alloy using the staircase method, which involved applying a cyclic load at a frequency of 10 Hz for 106 cycles. After the cyclic loading tests, cross-sections of the specimens were examined under an optical microscope. The YS values for Ti-6Al-4V and Ti-6Al-7Nb were 1463 N±93 N and 1405 N±79 N, respectively, and the YC values were 870 N±58 N and 853 N±202 N, respectively. Microscopic observation revealed cracks on the tensile side of some of the specimens, including run outs and failures. The results of this study suggest that the YC values for Ti-6Al-4V and Ti-6Al-7Nb were 40% less than those for YS. The yield force of Grade-4 Cp-Ti significantly decreased after cyclic loading. The YC values for Ti-6Al-4V and Ti-6Al-7Nb were approximately 900 N, which was markedly greater than that for commercially pure, Grade-4 titanium (700 N).

Influence of one-wall remaining coronal tooth with resin abutment and fiber post on static and dynamic fracture resistance.

The objective of this study was to determine the influence of height and thickness of the one wall remaining coronal tooth structure on the fracture resistance of an endodontically treated root with resin abutment build-up using resin composite and fiber-reinforced resin composite post. Static and dynamic fracture tests were performed by placing the remaining tooth wall on the tensile side and applying loads at an angle of 30° from the tooth axis. Superior static fracture resistance was observed when the wall remaining on the tooth had a height and thickness greater than 1.0 mm. The dynamic fatigue test showed high loading capacity or fracture resistance in specimens with large height and thickness. The dynamic fatigue test showed the influence of the remaining tooth structure on fracture resistance clearly. In conclusion, the static and dynamic fracture resistances increased with the height and thickness of the one wall remaining tooth structure.

Effects of 2% sodium fluoride solution on the prevention of streptococcal adhesion to titanium and zirconia surfaces.

Streptococci are associated with dental plaque formation as the early-colonizing bacteria that adhere to titanium (CpTi) and zirconia (TZP) implant abutment surfaces. Effective prevention of peri-implantitis may be possible by removing streptococci as target. This study aimed to evaluate the effects of 2% NaF on the prevention of streptococcal adhesion to CpTi and TZP. After immersion in 2% NaF for 90 min, surface characterization of mirror-polished CpTi and TZP disks were assesed using XPS, EPMA, and SEM. S. sanguinis, S. gordonii, and S. oralis were used as the streptococcal bacterial strains. After 24 h culture, bacterial adhesion was evaluated using an ATP-bioluminescent assay and SEM. In XPS, EPMA, and SEM analyses, fluoride was detected on the CpTi and TZP surfaces after 2% NaF immersion with no signs of localization, and no corrosion on the CpTi disks. Based on the adhesion assay, the adherences of S. sanguinis, S. gordonii, and S. oralis were significantly lower with NaF than without NaF in CpTi (p = 0.005, 0.001, and 0.001, respectively) and TZP (p = 0.003, 0.002, and 0.001). This was also confirmed by SEM. In conclusion, 2% NaF reduced the adhesion of streptococci to the CpTi and TZP surfaces.

Comparison of retentive forces between telescopic crowns made of poly(ether ether ketone) and type 4 gold alloy.

In this study, retentive forces were compared between telescopic crowns (TSC) made with poly(ether ether ketone) (PEEK) using computer-aided design and manufacturing and type 4 gold alloy using the conventional method. The retentive forces of TSCs were evaluated by performing a pull-out test with primary and secondary crowns. Initial retentive force was approximately 12 N for both PEEK and gold alloy TSCs. The retentive force of PEEK TSC was approximately 6.5 N after 10,000 cycles of insertion and removal. The reduction rate in retentive force was smaller for gold alloy TSC. PEEK TSC displayed greater surface roughness on the primary crown compared to the gold alloy TSC. Surface roughness slightly increased at the cervical margin after repetitive insertion and removal. The retentive force of PEEK TSC was smaller than gold alloy TSC, however the retentive force of PEEK TSC was adequate for stabilizing dental prostheses even after 10,000 cycles.

Adhesion of streptococci to titanium and zirconia.

The purpose of this study was to evaluate the adherence of streptococci to disks of titanium (commercially pure titanium: CpTi) and zirconia (tetragonal zirconia polycrystals: TZP). CpTi and yttria-stabilized TZP disks with a mirror-polished surface were used as specimens. The arithmetic mean surface roughness (Ra and Sa) and the surface wettability of the experimental specimens were measured. For analyzing the outermost layer of the experimental specimens, X-ray photoelectron spectroscopy (XPS) analysis was performed. Streptococcus sanguinis, S. gordonii, S. oralis, and S. mutans were used as streptococcal bacterial strains. These bacterial cultures were grown for 24 h on CpTi and TZP. The number of bacterial adhesions was estimated using an ATP-bioluminescent assay, and scanning electron microscope (SEM) observation of the adhered bacterial specimens was performed. No significant differences in surface roughness or wettability were found between CpTi and TZP. In XPS analyses, outermost layer of CpTi included Ti0 and Ti4+, and outermost layer of TZP included Zr4+. In the cell adhesion assay, the adherences of S. sanguinis, S. gordonii, and S. oralis to TZP were significantly lower than those to CpTi (p < 0.05); however, significant difference was not observed for S. mutans among the specimens. The adherence to CpTi and TZP of S. mutans was significantly lower than that of S. sanguinis, S. gordonii, and S. oralis. These results were confirmed by SEM. S. sanguinis, S. gordonii, and S. oralis adhered less to TZP than to CpTi, but the adherence of S. mutans was similar to both surfaces. S. mutans was less adherent compare with the other streptococci tested in those specimens.

Low-temperature degradation of high-strength Y-TZP (yttria-stabilized tetragonal zirconia polycrystal).

The objective of this study was to investigate the low temperature degradation characteristics of 2 types of high strength yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) in order to evaluate its suitability for implant body, implant superstructure or abutment. Disk-shaped conventional Y-TZP (0.25 mass% alumina) subjected to hot isostatic press treatment (HIP-Y-TZP) and Y-TZP/4Al2O3 with additional alumina (4.0 mass%) were mirror-polished. Accelerated aging tests with 134°C for 5 h at 0.2 MPa and 180°C for 5 h at 1.0 MPa were performed using an autoclave. Biaxial flexural strength and crystal phases were evaluated. Strength decreased as the proportion of monoclinic phase increased after accelerated aging treatment for both types of high-strength Y-TZPs. Despite the low alumina content, HIP-Y-TZP showed higher static strength and strength after accelerated aging treatment compared to Y-TZP/4Al2O3. However, both types of Y-TZP had adequate strength to be used as dental restorations even after accelerated aging treatment, therefore, its clinical suitability was considered high.

In vitro evaluation of a removable partial denture framework using multi-directionally forged titanium.

PURPOSE: This study evaluated the availability of multi-directionally forged (MDF) titanium (Ti) as a component of removable partial dentures (RPDs). MDF-Ti remarkably improved the mechanical properties of RPDs due to its ultrafine-grained structure. MATERIALS AND METHODS: The wear resistance, plaque adhesion, and machinability of MDF-Ti were tested. As controls, commercially pure (CP) titanium was used for wear, plaque adhesion, and machinability tests. For wear resistance, the volume losses of the titanium teeth before and after wear tests were evaluated. Plaque adhesion was evaluated by the assay of Streptococcus mutans. In the machinability test, samples were cut and ground by a steel fissure bur and carborundum (SiC) point. An unpaired t-test was employed for the analysis of the significant differences between MDF-Ti and the control in the results for each test. RESULTS: Wear resistance and plaque adherence of MDF-Ti similar to those of CP-Ti (P>.05) were indicated. MDF-Ti exhibited significantly larger volume loss than CP-Ti in all conditions except 100/30,000 g/rpm in machinability tests (P<.05). CONCLUSION: Although the wear resistance and plaque adherence of MDF-Ti were comparable to those of controls, MDF-Ti showed better machinability than did CP-Ti. MDF-Ti could be used as a framework material for RPDs.

Future prospects of zirconia for oral implants -A review.

Zirconia have been applied to dental implants as well as fixed dental prostheses due to their mechanical, esthetic and biocompatible performance. Moreover, they offer an advantage over titanium (Ti) implants, in that there is no risk of discoloration or hypersensitive reaction with allergy. In this review, the durability and tissue-compatibility of zirconia for the oral implants was mainly discussed. Hot isostatic pressing of Y-TZP had higher cyclic fatigue strength than Cp-Ti (Grade-2), leading the sufficient durability. Tissue-compatibility of zirconia; 1) Blast and acid-etching was effective for bone formation with synergetic effect of micro- and nano-topography. 2) Super-hydrophilic treatment, cold plasma in particular, enhanced initial attachment of osteoblast-like cells and oral keratinocytes. 3) Adherence of the periodontopathic bacteria on zirconia was similar to that on Cp-Ti, leading the necessity of surface modification.

The characteristic regulation of gene expression Lbp and Sod3 in peri-implant connective tissue of rats.

The aim of this study was to investigate the characteristic gene expression profile and localization of peri-implant connective tissue (PICT) compared with those of periodontal connective tissue (PCT) and oral mucosal connective tissue (OMCT). Upper first molar of 5-week-old rats were extracted and titanium implant were placed for PICT group. PCT and OMCT were used as control. Laser microdissected connective tissue at 4 weeks used for microarray analysis. The expression and localization of selected genes were confirmed by quantitative real-time PCR (qRT-PCR) and immunohistochemistry. Approximately, 1000 genes of upregulated and downregulated in PICT compared with PCT and OMCT were recognized. Based on the results of microarray analysis and qRT-PCR were demonstrated lipopolysaccharide binding protein (Lbp) as a specific upregulated gene and superoxide dismutase 3 (Sod3) as a specific downregulated gene in PICT. Immunoreaction of LBP and F4/80 as macrophage marker localized to subepithelial and implant facing connective tissue in PICT. SOD3 expression was not observed in PICT, reactive oxygen species, a target of superoxide dismutase, was strongly and locally expressed in all three tissues. Our data suggested that the upregulation of Lbp and downregulation of Sod3 are as characteristic gene expression pattern in PICT.

In vitro wear behavior of restorative resin composites against bovine enamel.

The purpose of this study was to clarify the effects of fabrication method of restorative resin-based composites on its wear using enamel as antagonist teeth. Wear evaluation was performed via two-body wear test using hemispherical samples of restorative resin-based composite (abrader specimen) fabricated through direct restoration method, indirect restoration method, and CAD/CAM, and bovine enamel (substrate specimen). As a result, there was a difference in wear volume between resin-based composite and bovine enamel depending on the fabrication method. Resin composite used for indirect restoration method showed more wear in both the abrader and substrate specimens. Resin composite used for CAD/CAM crowns showed greater wear volume in the abrader specimen. In conclusion, results clarified that fabrication method of restorative resin-based composite has an influence on the wear of the resin composite itself and enamel as antagonist teeth.

Applying intraoral scanner to residual ridge in edentulous regions: in vitro evaluation of inter-operator validity to confirm trueness.

BACKGROUND: The purpose of this study was to investigate the trueness of intraoral scanning of residual ridge in edentulous regions during in vitro evaluation of inter-operator validity. METHODS: Both edentulous maxillary and partially edentulous mandibular models were selected as a simulation model. As reference data, scanning of two models was performed using a dental laboratory scanner (D900, 3Shape A/S). Five dentists used an intraoral scanner (TRIOS 2, 3Shape A/S) five times to capture intraoral scanner data, and the "zig-zag" scanning technique was used. They did not have experience with using intraoral scanners in clinical treatment. The intraoral scanner data was overlapped with the reference data (Dental System, 3Shape A/S). Regarding differences that occurred between the reference and intraoral scanner data, the vertical maximum distance of the difference and the integral value obtained by integrating the total distance were analyzed. RESULTS: In terms of the maximum distances of the difference on the maxillary model, the means of five operators were as follows: premolar region, 0.30 mm; molar region, 0.18 mm; and midline region, 0.18 mm. The integral values were as follows: premolar region, 4.17 mm2; molar region, 6.82 mm2; and midline region, 4.70 mm2. Significant inter-operator differences were observed with regard to the integral values of the distance in the premolar and midline regions and with regard to the maximum distance in the premolar region, respectively. The maximum distances of the difference in the free end saddles on mandibular model were as follows: right side, 0.05 mm; and left side, 0.08 mm. The areas were as follows: right side, 0.78 mm2; and left side, 1.60 mm2. No significant inter-operator differences were observed in either region. CONCLUSIONS: The present study demonstrated satisfactory trueness of intraoral scanning of the residual ridge in edentulous regions during in vitro evaluation of inter-operator validity.

Optical properties and flexural strength of translucent zirconia layered with high-translucent zirconia.

This study investigated the optical properties and flexural strength of translucent TZP layered with high-translucent PSZ using resin cement of various shades. Zirconia specimens (translucent TZP; Zpex and high-translucent PSZ; ZpexSmile) were 13 mm in diameter, layered at thickness ratios of 0.3/0.7, 0.5/0.5, and 0.7/0.3 mm (ZpexSmile/Zpex), and then luted using resin cement of 3 shades. Monolithic specimens of both were used as controls. CIE L*a*b* color coordinates and translucency parameter (TP) were evaluated as optical properties. Biaxial flexural strength was also determined as a mechanical evaluation. The a* and b* values of layered specimens varied depending on the shade of cement. TP values were not affected by shade of cement and thickness ratio. The biaxial flexural strength was intermediate value between both monolithic specimens. The layering method of zirconia with various translucencies using resin cement of different shades can improve color expression while maintaining clinically sufficient flexural strength.

Change in the retentive force of Akers clasp for zirconia crown by repetitive insertion and removal test.

PURPOSE: The objective of this study was to evaluate the suitability of monolithic zirconia crowns (MZC) as abutment teeth of Akers clasps on removable partial dentures (RPD) by determining the change in retentive force after repetitive insertion/removal test. METHODS: MZC and silver palladium copper alloy (Ag-Pd) full-metal crowns (FMC) for the mandibular second premolar were fabricated. Resin patterns of Akers clasps made with a 3D printer were casted with Ag-Pd or cobalt chromium alloy (Co-Cr). Clasp retentive force was measured with combinations of the crown and clasp materials. After measuring the initial retentive force of the clasp, repetitive insertion/removal test was carried out. The surface of the crown before and after the test was observed with an optical microscope and a scanning electron microscope; some specimens were subjected to element analysis by an electron probe microanalyzer. RESULTS: The initial retentive force of the Co-Cr clasp was greater than the Ag-Pd clasp for both MZC and FMC. Clasp retentive force decreased with increasing number of insertion/removal cycles, and least reduction in force was observed for the Ag-Pd clasp on MZC. Wear marks were detected where FMC contacted the clasp. Discoloration of MZC due to wear of the Co-Cr clasp was observed. CONCLUSIONS: When repetitive insertion/removal of the clasp was performed on MZC, retentive force decreased depending on clasp materials. However, the amount of decrease in retentive force was comparable or small compared to conventional FMC. As a result, it was suggested that MZC could be used on abutment tooth for RPD.

Study on bone quality in the human mandible-Alignment of biological apatite crystallites.

The importance of considering bone quality during oral implant treatment is increasingly being recognized. Assessment of bone quality in response to changes in the jaw bone is extremely important when planning treatment. The present study analyzed biological apatite (BAp) crystallites, a bone quality factor, in order to investigate crystallographic anisotropy in dentate and edentulous human mandibles. Using mandibular samples from Japanese adult cadavers, a region of interest was established comprising cortical bone in the central incisors. Samples were classified into five morphological categories based on the extent of bone resorption. Bone mineral density (BMD) was measured and diffraction intensity ratios were calculated using a microbeam X-ray diffraction system. While no differences were observed in BMD, differences were observed in BAp crystallite alignment between the measurement points. In the alveolar region, samples with residual alveolar bone showed strong alignment in the occlusal direction, while samples with marked alveolar bone resorption had preferential alignment in the mesiodistal direction. The present findings suggest that tooth loss and the extent of alveolar bone resorption affects bone quality in the mandible. © 2018 Wiley Periodicals, Inc. J. Biomed. Mater. Res. Part B: 2018. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 838-846, 2019.

Accuracy and retention of denture base fabricated by heat curing and additive manufacturing.

PURPOSE: The aim of the present study was to compare the accuracy and retentive force of an experimental denture base fabricated using additive manufacturing and heat curing. METHODS: A maxillary edentulous jaw model made of silicon was used. The shape data for the working cast and wax pattern of the experimental denture base were obtained using a dental laboratory scanner. Fabrication of the experimental denture bases was performed using heat curing and additive manufacturing. The shape data for the experimental denture bases was captured using an optical scanner. The shapes of the two experimental denture bases were compared with the shape of the working cast. A digital force gauge was used to measure the traction force. Pulling was maintained until the experimental denture base separated from the elastic model. Retention was set as the maximum value for the traction force. In order to compare the retentive force of the two experimental denture bases. RESULTS: The experimental denture base fabricated using additive manufacturing was more accurate than the experimental denture base fabricated using heat curing. The experimental denture base fabricated using additive manufacturing demonstrated greater retentive force than the experimental denture base fabricated using heat curing. CONCLUSIONS: In this study, the experimental denture base fabricated using additive manufacturing was more accurate and obtained greater retentive force than the experimental denture base fabricated using heat curing.

Wear properties of esthetic dental materials against translucent zirconia.

To clarify the influence of translucent tetragonal zirconia polycrystals (TZP) on wear properties of esthetic dental materials, two-body wear test was performed using translucent TZP as abrader specimen, and bovine tooth enamel (BTE), two resin composites including hybrid filler (CRH) and nano filler (CRN), two glass ceramics including leucite reinforced feldspar porcelain (POR) and lithium disilicate (LDC), or translucent TZP as substrate specimen. After the wear test, wear volume were determined from substrate specimen and surface roughness were measured from abrader specimen. In addition, Vickers hardness was measured and surface morphologies were observed after wear test using a scanning electron microscope. The wear volume of the esthetic dental material against translucent TZP was greater in glass ceramics (POR, LDC), smaller in resin composite (CRH, CRN) and BTE, and no wear in translucent TZP. Microstructures of the esthetic dental material may play a crucial role for wear behavior against translucent TZP.

Bone marrow stromal cells from low-turnover osteoporotic mouse model are less sensitive to the osteogenic effects of fluvastatin.

This study aimed to investigate the effects of fluvastatin on the differentiation of bone marrow stromal cells (BMSCs) into osteoblasts in senescence-accelerated mouse prone 6 (SAMP6) compared with that in the normal senescence-accelerated-resistant mouse (SAMR1) model. SAMP strains arose spontaneously from the AKR/J background and display shortened life span and an array of signs of accelerated aging, compared with control SAMR strains. The dose effects of fluvastatin were also evaluated. BMSCs were cultured with/without fluvastatin (0 µM, 0.1 µM, 0.5 µM, and 1.0 µM). WST-1-based colorimetry was performed to evaluate cell proliferation. To evaluate cell differentiation, gene expression levels of bmp2 and runx2 were determined by quantitative reverse transcription polymerase chain reaction (qRT-PCR), and protein expression levels were determined using enzyme-linked immunosorbent assay (BMP2) and immunofluorescence staining (BMP2 and Runx2). Alkaline phosphatase (ALP) activity assay and histochemical detection were determined; the effect of noggin, a BMP-specific antagonist, was examined using ALP histochemical detection. To assess for mature osteogenic marker, gene expression levels of bglap2 were determined by qRT-PCR and mineralization was determined by alizarin red staining. RhoA activity was also examined by Western blotting. In SAMP6, BMP2, Runx2 and Bglap2 mRNA and protein expressions were significantly increased by fluvastatin, and ALP activity was increased by BMP2 action. RhoA activity was also inhibited by fluvastatin. The concentration of fluvastatin sufficient to increase BMP2 and Runx2 expression and ALP activity was 0.5 µM in SAMP6 and 0.1 µM in SAMR1. In conclusion, the present study revealed that fluvastatin promoted BMSC differentiation into osteoblasts by RhoA-BMP2 pathway in SAMP6. BMSCs of SAMP6 are less sensitive to the osteogenic effects of fluvastatin than SAMR1.

Effect of occlusal groove on abutment, crown thickness, and cement-type on fracture load of monolithic zirconia crowns.

The aim of this study was to investigate the effects of occlusal form of abutment, occlusal thickness of monolithic zirconia crowns (MZC), and cement type on the fracture load of MZC. Abutments were prepared with 2 types of occlusal forms: groove-type and flat-type. These were designed so that thickness at the central fissure region of MZC was 0.3, 0.5, or 0.7 mm. Glass ionomer cement and resin cement were used to lute MZC to their corresponding abutment. Fracture load was determined using a universal testing machine. As a result, groove-type abutment had lower fracture load compared to flat-type abutment; however, the decline in strength was smaller when resin cement was used. Additionally, specimens with larger occlusal thickness had greater fracture load regardless of groove or cement-type. The fracture of MZC occurred on the central fissure region of MZC except for 0.7 mm groove-type MZC luted with resin cement.

Influence of grade and surface topography of commercially pure titanium on fatigue properties.

The objective was to investigate the influence of grade and surface topography of commercially pure titanium (Cp-Ti) on fatigue properties evaluated via staircase method. Cp-Ti grades 2 and 4 were roughened by shot blasting and acid etching, and compared with machined specimens. Yield force under static loading for Cp-Ti grades 2 and 4 were 672±51 and 1,088±93 N for machined and 724±99 and 1,118±96 N for roughened group. Yield force under cyclic loading for Cp-Ti grades 2 and 4 decreased 27 and 40% compared to static loading. Cp-Ti grade 4 demonstrated significantly greater decrease in yield force after cyclic loading; however surface topography had no effect.