Management of a Damaged Implant for Retention of an Overdenture Prosthesis and Fixed Single Crown: Clinical Reports.

This article demonstrates a method to salvage an implant that has been damaged or is no longer usable because of a fractured screw that cannot be removed. In the first situation the patient had a Locator abutment that fractured during torqueing of the abutment. Despite the attempt to remove the fractured screw, it was not retrievable, and the internal threads of the implant were damaged in the attempt to remove the screw. Rather than removing the implant or covering it and sleeping the implant, a custom cast post was used to restore the implant to function. A second example describes a patient with a fixed implant crown. The implant was damaged during attempts to remove the fractured screw. A custom post was fabricated and cemented, and a new crown was fabricated.

Effect of surface treatments on repair with composite resin of a partially monoclinic phase transformed yttrium-stabilized tetragonal zirconia.

STATEMENT OF PROBLEM: Studies of composite resin repairs of yttrium-tetragonal zirconia polycrystal (Y-TZP) are usually performed in its tetragonal phase, but it may be partially transformed into a monoclinic phase in a clinical fracture. PURPOSE: The purpose of this in vitro study was to evaluate the effect of airborne-particle abrasion (APA) and a bonding agent on the shear bond strength (SBS) between a composite resin and hydrothermally aged Y-TZP. MATERIAL AND METHODS: Specimens (7.0×7.0×1.7 mm, N=112) of Y-TZP Lava were obtained, and 50% were aged in an autoclave at 134°C at 300 kPa for 8 hours. The surfaces were treated with APA 50-µm Al2O3 particles (ALU) or Rocatec Soft (30 µm) (ROC) followed by Clearfil SE Bond Primer (10-methacryloyloxydecyl dihydrogen phosphate [10-MDP]) plus Clearfil porcelain bond activator (3-methacryloxypropyl-trimethoxy silane [3-MPS]) (CLE) or RelyX Ceramic Primer plus a layer of RelyX U100 adhesive-resin cement (REL). Composite resin cylinders were built on the Y-TZP treated surfaces. After thermocycling (6000 cycles, 5°C and 55°C, 30-second dwell time), an SBS test was carried out (n=14). Data were analyzed by 3-way ANOVA and the Tukey honest significant differences test (α=.05). The failure mode was analyzed. RESULTS: The 3-way ANOVA was not significant for aging (P>.05), but the APA (P<.001), bonding agent (P<.001), and their interaction (P<.001) were significant. APA with ALU or ROC did not influence the SBS of the groups bonded with CLE, but the REL APA with ROC provided higher SBS. The failure mode was adhesive for all specimens. CONCLUSIONS: Adhesion was not different on monoclinic partially transformed Y-TZP. The APA with ROC followed by REL was the most effective treatment for repairing Y-TZP.

In Vitro Comparison of the Bond Strength between Ceramic Repair Systems and Ceramic Materials and Evaluation of the Wettability.

PURPOSE: When fracture of an all-ceramic restoration occurs, it can be necessary to repair without removing the restoration. Although there are many studies about the repair of metal-ceramic restorations, there are few about all-ceramic restorations. The aim of this study was to evaluate the shear bond strength between ceramic repair systems and esthetic core materials and to evaluate the wettability of all-ceramic core materials. MATERIALS AND METHODS: Disk-like specimens (N = 90) made of three dental ceramic infrastructure materials (zirconia ceramic, alumina ceramic, glass ceramic) were polished with silicon carbide paper, prepared for bonding (abrasion with 30 µm diamond rotary cutting instrument). Thirty specimens of each infrastructure were obtained. Each infrastructure group was divided into three subgroups; they were bonded using 3 repair systems: Bisco Intraoral Repair Kit, Cimara & Cimara Zircon Repair System, and Clearfil Repair System. After 1200 thermocycles, shear bond strength was measured in a universal testing machine at a 0.5 mm/min crosshead speed. In addition, the contact angle values of the infrastructures after surface treatments were examined for wettability. Data were analyzed by using ANOVA and Tukey post hoc tests. RESULTS: Although there were no significant differences among the repair systems (p > 0.05) in the glass ceramic and zirconia groups, a significant difference was found among the repair systems in alumina infrastructure (p < 0.001). There were no statistically significant differences among the infrastructures (p > 0.05); however, a statistically significant difference was found among the repair systems (p < 0.05). No difference was found among the infrastructures and repair systems in terms of contact angle values. CONCLUSIONS: Cimara & Cimara Zircon Repair System had higher bond strength values than the other repair systems. Although no difference was found among the infrastructures and repair systems, contact wettability angle was decreased by surface treatments compared with polished surfaces.

A minimally invasive approach for a compromised treatment plan.

A primary goal in dentistry is the execution of appropriate treatment plans that are minimally invasive and maintainable. However, it is sometimes necessary to repair existing dental restorations or revise treatment plans to accommodate changes in a patient's condition. In the present case, a patient who was satisfied with a removable partial overdenture lost a critical abutment tooth. A creative, minimally invasive approach enabled the patient to keep his existing partial prosthesis and avoid the need for a full reconstruction or complete denture.

Management of a complication with a fractured zirconia implant abutment in the esthetic zone.

Technical complications in implant prosthetic cases represent a major challenge in dentistry. This case report describes minimally invasive management to recover an implant with a fractured remnant of a zirconia abutment, including provisional rehabilitation during a sequential treatment protocol in the esthetic zone. A patient was treated with a screw-retained one-piece implant-supported reconstruction made of a customized zirconia abutment with direct ceramic veneering in the maxillary right central incisor position. During the prosthetic try-in, a fracture in the apical portion of the abutment was evident. The first rescue attempt led to fracture of the retrieval instrument. Immediately, an individualized wired construction was applied to bond the existing fractured reconstruction to the neighboring teeth to maintain the peri-implant mucosal architecture. Because the implant screw canal was blocked, a customized round bur had to be manufactured and was placed in the implant axis with a specific bracket tool from the service set to protect the interior implant threads. Then, the drills of the service set were guided by the newly created access to remove the fractured remnants. The implant screw was retapped and the area rinsed with chlorhexidine solution. All remnants were removed without the need for surgical intervention. Neither the implant connection nor the bone-to-implant interface was damaged. The stepwise treatment approach with the customized round bur combined with the system-specific drills of the service set saved the blocked implant so that the patient could be successfully rehabilitated with a new implant reconstruction.

Minimally Invasive Long-Term Management of Direct Restorations: the '5 Rs'.

The assessment and operative long-term management of direct restorations is a complex and controversial subject in conservative dentistry. Employing a minimally invasive (MI) approach helps preserve natural tooth structure and maintain endodontic health for as long as possible during the restorative cycle. This paper discusses how minimally invasive techniques may be applied practically to reviewing, resealing, refurbishing, repairing or replacing deteriorating/failed direct coronal restorations (the'5 Rs') and provides an update of contemporary MI clinical procedures. CPD/CLINICAL RELEVANCE: The assessment and long-term clinical management of deteriorating/failing direct restorations is a major component of the general dental practice workload and NHS UK budget expenditure for operative dentistry.

Effectiveness of silica-lasing method on the bond strength of composite resin repair to Ni-Cr alloy.

PURPOSE: The aim of this study was to evaluate the effectiveness of silica-lasing method for improving the composite resin repair of metal ceramic restorations. MATERIALS AND METHODS: Sixty Ni-Cr cylindrical specimens were fabricated. The bonding surface of all specimens was airborne-particle abraded using 50 µm aluminum oxide particles. Specimens were divided into six groups that received the following surface treatments: group 1-airborne-particle abrasion alone (AA); group 2-Nd:YAG laser irradiation (LA); group 3-silica coating (Si-CO); group 4-silica-lasing (metal surface was coated with slurry of opaque porcelain and irradiated by Nd:YAG laser) (Si-LA); group 5-silica-lasing plus etching with HF acid (Si-LA-HF); group 6-CoJet sand lased (CJ-LA). Composite resin was applied on metal surfaces. Specimens were thermocycled and tested in shear mode in a universal testing machine. The shear bond strength values were analyzed using ANOVA and Tukey's tests (α = 0.05). The mode of failure was determined, and two specimens in each group were examined by scanning electron microscopy and wavelength dispersive X-ray spectroscopy. RESULTS: Si-CO showed significantly higher shear bond strength in comparison to other groups (p < 0.001). The shear bond strength values of the LA group were significantly higher than those of the AA group (p < 0.05). No significant difference was found among lased groups (LA, Si-LA, Si-LA-HF, CJ-LA; p > 0.05). The failure mode was 100% adhesive for AA, Si-LA, Si-LA-HF, and CJ-LA. LA and Si-CO groups showed 37.5% and 87.5% cohesive failure, respectively. CONCLUSION: Silica coating of Ni-Cr alloy resulted in higher shear bond strength than those of other surface treatments.

Clinical evaluation of fractured metal-ceramic fixed dental prostheses repaired with indirect technique.

OBJECTIVES: Metal ceramic restorations continue to be widely used in dental practice, as they combine esthetics with superior mechanical properties. However, ceramic materials have the potential to fracture due to their brittle nature. The purpose of this study was to evaluate the clinical survival of fractured metal-ceramic restorations repaired with an indirect technique which uses a new "overlay" metal-ceramic crown that is luted to the existing restoration. METHOD AND MATERIALS: The study population consisted of 92 patients. Only patients with one or more fractured retainers of multipleunit metal-ceramic fixed partial dentures were involved in this study. In all cases there were a bulk fracture of the overlaying ceramic material and exposure of the underlying metal substructure. The remaining retainers of the fixed partial dentures were intact. The total number of fractured retainers was 106. All clinical procedures of the indirect repairs were carried out by a single investigator, according the previously published technique. The patients were examined clinically at 1, 2, 4, 6, and 8 years after placement of the new restorations. The repaired restorations were examined for debonding, fracture rate, and esthetics. Patient acceptance was also recorded. RESULTS: Of the 92 patients re-examined, all were satisfied with the function and the esthetic appearance of their restorations. None of the repaired restorations fractured after 8 years of service, and there were no gingival margin problems of significance. Four restorations debonded during the evaluation period. The overall survival rate was 96.2% after 8 years. CONCLUSION: Repair methodology and materials employed in this study resulted in satisfactory longevity for metal-ceramic dental prostheses. The success rate was 96.2% after 8 years. The retention rate was very good, patient satisfaction was very encouraging, and maintenance of the esthetics was good.

Defective composite restorations--repair or replace?

DATA SOURCES: The Cochrane Oral Health Group's Trials Register, the Cochrane Central Register of Controlled Trials (CENTRAL), Medline, Embase, BIOSIS via Web of Knowledge, Web of Science and Opengrey databases were searched. In addition researchers and experts in the field were contacted to trace unpublished or ongoing studies. No restrictions were placed on the language or date of publication. STUDY SELECTION: Randomised controlled trials (including split-mouth studies), involving replacement and repair of resin composite restorations in adults with a defective molar restoration in a permanent molar or premolar teeth were to be considered. DATA EXTRACTION AND SYNTHESIS: Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. Full papers were obtained for relevant articles and both review authors studied these. The Cochrane Collaboration statistical guidelines were followed for data synthesis. RESULTS: The search strategy retrieved 298 potentially eligible studies, after de-duplication. After examination of the titles and abstracts, full texts of potentially relevant studies were retrieved, but none of the retrieved studies met the inclusion criteria of the review. CONCLUSIONS: There are no published randomised controlled trials relevant to this review question. Therefore there is a need for methodologically sound randomised controlled trials that are reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement (www.consort-statement.org/). Further research also needs to explore qualitatively the views of patients on repairing versus replacement, and investigate themes around pain, anxiety and distress, time and costs.

Replacement versus repair of defective restorations in adults: resin composite.

BACKGROUND: Composite filling materials have been increasingly used for the restoration of posterior teeth in recent years as a tooth-coloured alternative to amalgam. As with any filling material composites have a finite life-span. Traditionally, replacement was the ideal approach to treat defective composite restorations, however, repairing composites offers an alternative more conservative approach to the tooth structure where restorations are partly still serviceable. Repairing the restoration has the potential of taking less time and may sometimes be performed without the use of local anaesthesia hence it may be less distressing for a patient when compared with replacement. OBJECTIVES: To evaluate the effects of replacing (with resin composite) versus repair (with resin composite) in the management of defective resin composite dental restorations in permanent molar and premolar teeth. SEARCH METHODS: For the identification of studies relevant to this review we searched the Cochrane Oral Health Group's Trials Register (to 24 July 2013); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2013, Issue 6); MEDLINE via OVID (1946 to 24 July 2013); EMBASE via OVID (1980 to 24 July 2013); BIOSIS via Web of Knowledge (1969 to 24 July 2013); Web of Science (1945 to 24 July 2013); and OpenGrey (to 24 July 2013). Researchers, experts and organisations known to be involved in this field were contacted in order to trace unpublished or ongoing studies. No restrictions were placed on the language or date of publication when searching the electronic databases. SELECTION CRITERIA: Trials were selected if they met the following criteria: randomised controlled trial (including split-mouth studies), involving replacement and repair of resin composite restorations in adults with a defective molar restoration in a permanent molar or premolar teeth. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed titles and abstracts for each article identified by the searches in order to decide whether the article was likely to be relevant. Full papers were obtained for relevant articles and both review authors studied these. The Cochrane Collaboration statistical guidelines were to be followed for data synthesis. MAIN RESULTS: The search strategy retrieved 298 potentially eligible studies, after de-duplication. After examination of the titles and abstracts, full texts of potentially relevant studies were retrieved but none of the retrieved studies met the inclusion criteria of the review. AUTHORS' CONCLUSIONS: There are no published randomised controlled trials relevant to this review question. There is therefore a need for methodologically sound randomised controlled trials that are reported according to the Consolidated Standards of Reporting Trials (CONSORT) statement (www.consort-statement.org/). Further research also needs to explore qualitatively the views of patients on repairing versus replacement and investigate themes around pain, anxiety and distress, time and costs.

Reparación intraoral de una prótesis parcial fija metal-cerámica de seis unidades con resina compuesta: relato del caso / Repair of a six-unit fixed partial denture metal-ceramics with composite resin: case report

Múltiples son los factores que pueden desencadenar fracturas de porcelana en una prótesis parcial fija metal-cerámica, aunque esta situación no siempre determina un reemplazo. La reparación de porcelana mediante el uso de resina compuesta es una alternativa con ventajas de una fácil manipulación y bajo costo. El objetivo del presente artículo es presentar a la resina compuesta como una opción con resultados considerables en la reparación de prótesis metal-cerámicas fracturadas, con alto compromiso estético. Se presenta un caso clínico de reparación intraoral de una prótesis fija metal-cerámica de seis unidades en el sector anterior superior. El tratamiento realizado incluyó fresado de la superficie de porcelana, aislamiento absoluto, grabado ácido con fluoruro de fosfato acidulado, microarenado con óxido de aluminio, silanización, aplicación del adhesivo convencional y tres tipos de resinas compuestas, resina opaca, microhíbrida y resina de nanorelleno. A los 8 meses se evaluó la adaptación de la reparación mediante un explorador e inspección visual, secando con una jeringa triple donde no se observó signos de percolación alguna. Basado en los resultados se puede considerar a esta combinación de resinas compuestas como una alternativa útil en la reparación de porcelana fracturada.

There are multiple factors that can trigger a fracture of porcelain in a metal-ceramic fixed partial denture, although a replacement is not always required. The porcelain repair using composite resin is an alternative with advantages such as easy handling and low cost. The aim of this paper is to present the composite as an option with significant results in the repair of fractured metal-ceramic prostheses, with a high aesthetic commitment. We report a case of intraoral repair of a six-unit metal-ceramic fixed prosthesis in the anterior superior sector. The treatment provided included milling of the surface of porcelain, absolute isolation, acid etching with acidulated phosphate fluoride, aluminium oxide sandblasting, silanization, conventional adhesive application and three types of composite resins: opaque resin, micro-hybrid resin and nanofilled resin. After 8 months we assessed the adaptation of the repair using a surface explorer and visual inspection, drying with a triple syringe. No signs of seepage were observed. Based on the results, this combination of composite resins can be considered as a useful alternative in the repair of broken porcelain.

Two case reports involving implants and fractured healing caps.

The widespread use of endosseous osseointegrated implants to replace missing natural teeth increases the chances of implant complications and failures, despite the high initial success rate reported in the literature. Implant and healing cap fracture are possible rare complications that can cause significant problems for both clinicians and patients. This article reports on 2 unique cases of implant and healing cap fracture, their possible causes, and how the cases were managed.

A technique to salvage a single implant-supported fixed dental prosthesis having a nonretrievable implant screw fragment.

An implant screw fracture is one of the common problems associated with the implant components. In some situations, it may not be possible to retrieve the fractured implant screws. As a result, clinicians either remove the implant or the implant may need to be covered over with soft tissue. The salvage of an implant with a nonretrievable screw fragment may be highly beneficial to the patients. This report describes a technique to salvage an implant-supported single restoration that has a nonretrievable implant screw fragment.

Retrieval technique for the Branemark Novum protocol: replacement of a lost implant.

In the past, the Branemark Novum protocol for the immediate functional loading of a mandibular fixed implant supported prosthesis provided an effective alternative for select patients. However, the manufacturer has discontinued this design, and only a few selected prosthetic-related replacement components are currently available. This clinical report presents the loss of an implant associated with a discontinued system. To take advantage of all of the preexisting components, it proposes a rescue procedure that allows continuous use of the original fixed restoration during the restoration of the tripod support at the implant level.

Three-dimensional location of the retaining screw axis for a cemented single tooth implant restoration.

Retrievability is a major concern with cemented versus screw-retained implant restorations. This article describes the use of cone beam radiography to help target and create a precise screw access opening for a loosened implant-supported single crown retained by cement to its abutment.

An in vitro comparison of four intra-oral ceramic repair systems.

OBJECTIVES: This study evaluated the effect of different surface conditioning methods on the tensile bond strength (TBS) and integrity of the leucite-reinforced glass ceramic (Cerana(®) inserts)-resin composite interface, using four commercially available ceramic repair systems. METHODS: Two hundred extra-large Cerana(®) inserts were mechanically treated and stored in artificial saliva for 3 weeks and subsequently randomly assigned to one of the following ceramic repair systems (n=40/group): Group 1, Ceramic Repair(®) (Ivoclar Vivadent, Liechtenstein); Group 2, Cimara(®) (Voco, Germany); Group 3, Clearfil Repair(®) (Kuraray, Japan); Group 4, CoJet system(®) (3M ESPE, Germany); and Group 5, no surface conditioning and no adhesive system applied: the control group. Subsequently, resin composite material was added to the substrate surfaces and the ceramic-resin composite specimens were subjected to TBS testing. Representative samples from the test groups were subjected to scanning electron microscopy (SEM) to determine the mode of failure. The data were analysed statistically using a one-way multivariate analysis of variance and Kruskal-Wallis test at a 95% confidence interval level. RESULTS: Surface conditioning with the CoJet(®) system resulted in significantly higher bond strength values (5.2 ± 1.1 MPa) than surface conditioning with the other repair systems (p=0.03). The SEM examination of the failed interfaces revealed that all the specimens examined failed adhesively. SIGNIFICANCE: Whilst highest bond strength values were observed with the CoJet(®) system all tested repair systems resulted in relatively weak TBS values and, as a consequence, these repair systems may be indicated only as interim measures.

[Esthetic evaluation of Cerec 3D anterior crowns].

OBJECTIVE: To observe the short-term effect of clinical application of Cerec 3D anterior crowns. METHODS: A total of 16 patients were restored with 31 Cerec 3D anterior crowns. All restorations were stained before cementation. The evaluation started 1 week after luting. The restorations were examined in accordance with the modified US Public Health Service (USPHS) criteria at baseline and every 6 - 12 months. RESULTS: The observation period of 31 Cerec 3D anterior crowns varied from 8 to 33 months. The mean observation period was 22 months. All restorations scored A or B by modified USPHS standard. And 22 out of 31 restorations scored A for all criteria while 8 restorations scored B in color matching. Slight differences of translucency and chroma could be observed. Between baseline and follow-up examinations, insignificant shift from A-to B-rating occurred. CONCLUSION: Cerec 3D anterior crowns may achieve favorable short-term esthetic effects.