Do upper third molars provide more accurate age estimation in the adult based on the pulp-to-tooth ratio than lower third molars? A cone-beam CT study.

INTRODUCTION: Age-at-death estimation is an essential part of the identification process of individuals in many forensic dentistry cases where identity of the individual cannot be resolved by visual recognition or other means. Dental age estimation in adults is more of a challenge as most teeth complete their development by the age of 18 years. AIM: This study aims at using the mesio-distal (MD) pulp-to-tooth ratio taken at the cervix of upper third molars (UM3) to estimate age at the time of radiographic imaging. MATERIALS AND METHODS: A set of 135 Cone-beam computed tomography (CBCT) radiographs of UM3s for a random sample of 135 Jordanian adults (65 females, 70 males; age range = 18-63 years, mean age = 34.4 years, SD = 11.2 years) were used. Both pulp and tooth MD diameters were measured at the cervix. MD pulp-to-tooth ratios for UM3s were correlated with age. RESULTS: Statistically significant negative moderate correlation was found between the age of the individual and the cervix MD pulp/tooth ratio (r = -0.516). This indicates that only 26.6% of the variation in age can be explained by the cervix MD pulp-to-tooth ratio. CONCLUSIONS: This study concludes that cervix MD pulp-to-tooth ratio of UM3s, although apparently stronger than that of lower M3s (r = -0.361), is not a sufficiently reliable estimator of age in adults, and this is perhaps attributed to the greater variability in the time line of third molars development.

Abutment screw loosening and bending resistance of external hexagon implant system after lateral cyclic loading.

BACKGROUND: Rigorous efforts to reduce the recurrence of abutment screw loosening in single-tooth implant restorations have recently been made. However, the behavior of the implant/abutment joint components with respect to critical bending force is still unclear. PURPOSE: This study investigated the effect of different cyclic loading periods on abutment screw loosening and bending resistance of a single-tooth external hexagon implant system. MATERIAL AND METHODS: Fifteen Brånemark implant assemblies were divided equally into groups A, B, and C. Each assembly consisted of a Brånemark System Mk IV 4 x 10 mm implant (Nobel Biocare AB, Gothenburg, Sweden) mounted in a brass block, a CeraOne 3 mm abutment (Nobel Biocare AB), and an experimental cement-retained superstructure. For groups A and B a cyclic load of 50 N was applied centrally and perpendicular to the long axis of the implant. Targets of 1.0 x 10(6) cycles (40 months of simulated function) and 0.5 x 10(6) cycles (20 months of simulated function) were defined for groups A and B, respectively. Group C (control) was left unloaded for the same loading time period as was group B. Reverse torque was recorded before and after loading, and the difference was calculated. After cyclic loading, specimens were mounted in a testing machine, and the yielding and bending strengths were measured. The data were analyzed with one-way analysis of variance and were compared by means of the Tukey test (p < .05). RESULTS: There were statistically significant differences (p < .001) in the reverse torque difference values of group A ([-5.6 to -3.4] +/- 0.86 Ncm) as compared to those of group B ([-2.4 to -1.6] +/- 0.32 Ncm) and group C ([-0.7 to 0.0] +/- 0.26 Ncm). Likewise, group B showed a significant difference compared to group C (p = .002). On the other hand there was no statistically significant difference in the mean values among the test groups in regard to the yielding and bending strengths (p >.050). CONCLUSION: Within the limitations of this study, long-term fatigue significantly affected the reverse torque values under centric lateral load (p <.001) whereas it had no significant effect on the resistance of the implant/abutment joint to static bending.

Stability of the implant/abutment joint in a single-tooth external-hexagon implant system: clinical and mechanical review.

Rigorous efforts have recently been made to reduce the recurrence of implant/abutment joint failure in single-tooth implant restorations. However, the current knowledge about the stability of implant/abutment joints in an external hexagon implant system is incomplete. We reviewed clinical data regarding single-tooth implant treatment with Brånemark implants, specifically the CeraOne abutment system (Nobel Biocare AB, Göteborg, Sweden). In vitro studies on joint stability were systematically assessed. Bending overload and the presence of misfit at the implant/abutment joint interface are the critical mechanical conditions that can make the joint unstable. Appropriate joint fitness and proper alignment of the implant should be assessed, and occlusal adjustment by narrowing the restoration width and flattening cuspal inclination should be applied to avoid bending moments caused by the lateral component of occlusal forces. Sufficient clinical reports of longer duration that evaluate and verify longer-term success of the newly manufactured joint components were unavailable.