Effect of Titanium Hardness on the Integrity and Stress Concentration of External Hexagon Dental Implants

ABSTRACT: The aim of this study was to evaluate the influence of overtorque on integrity, strength and stress on external hexagonal implants (EH), with two different grades (N=10): conventional (C), grade 4; and modified (M), grade 4 with thermal treatment. The dimensions of EH were 3.75 x 13 mm; the specimens were fixed and submitted to SEM analysis and image acquisition. The abutment was then retained with 70 N/cm, re-analyzed by SEM, and a second image was obtained. The images were analyzed by Image J software (1.44o- NIH, USA) for dimensional variations measurement on surface of the hexagonal area. The finite element method was applied with a similar compliance to calculate the resultant stress (MPa) during the torque. Results were statistically analyzed with t-student test (5 %). The dimensional accuracy of M (0.22 mm2) was statistically significant (p<0.05). Minimum principal stress and von-Mises stress of C (-19.95 MPa, -19.94 MPa), were lower than M values (-55.83 MPa, -55.96 MPa), respectively. However, the M group showed lower deformation than C group. Therefore, more rigid titanium alloy is a promising alternative to avoid plastic deformation of prosthetic connec tions even concentrating higher stress magnitude on its structure.

RESUMEN: El objetivo de este estudio fue evaluar la influencia del sobrepar en la integridad, la fuerza y la tensión en los implantes hexagonales externos (EH), con dos grados diferentes (N = 10): convencional (C), grado 4; y modificado (M), grado 4 con tratamiento térmico. Las dimensiones de EH eran 3,75 de diámetro x 13 mm de longitud; las muestras se fijaron y se sometieron a análisis SEM y adquisición de imágenes. A continuación, el pilar se retuvo con 70 N / cm, se volvió a analizar por SEM y se obtuvo una segunda imagen. Las imágenes se analizaron con el software Image J (1.44o-NIH, EE. UU.) Para medir las variaciones dimensionales en la superficie superior del área hexagonal, que fue causada por un par excesivo. El método de los elementos finitos se aplicó con un cumplimiento similar para calcular la tensión resultante (MPa) durante el par. Los resultados se analizaron estadísticamente con la prueba t-student (5 %). La precisión dimensional de M (0,22 mm2) fue estadísticamente significativa (p <0,05). La tensión principal mínima y la tensión de von-Mises de C (-19,95 MPa, -19,94 MPa), fueron inferiores a los valores de M (-55,83 MPa, -55,96 MPa), respectivamente. Sin embargo, el hexágono del grupo M mostró menor deformación que el grupo C. Por lo tanto, la aleación de titanio más rígida es una alternativa prometedora para evitar la deformación plástica de las conexiones protésicas incluso concentrando una mayor magnitud de tensión en su estructura.

Mechanical Behavior of Different Restorative Materials and Onlay Preparation Designs in Endodontically Treated Molars.

This study evaluated the effect of the combination of three different onlay preparation designs and two restorative materials on the stress distribution, using 3D-finite element analysis. Six models of first lower molars were created according to three preparation designs: non-retentive (nRET), traditional with occlusal isthmus reduction (IST), and traditional without occlusal isthmus reduction (wIST); and according to two restorative materials: lithium-disilicate (LD) and nanoceramic resin (NR). A 600 N axial load was applied at the central fossa. All solids were considered isotropic, homogeneous, and linearly elastic. A static linear analysis was performed, and the Maximum Principal Stress (MPS) criteria were used to evaluate the results and compare the stress in MPa on the restoration, cement layer, and tooth structure (enamel and dentin). A novel statistical approach was used for quantitative analysis of the finite element analysis results. On restoration and cement layer, nRET showed a more homogeneous stress distribution, while the highest stress peaks were calculated for LD onlays (restoration: 69-110; cement layer: 10.2-13.3). On the tooth structure, the material had more influence, with better results for LD (27-38). It can be concluded that nRET design showed the best mechanical behavior compared to IST and wIST, with LD being more advantageous for tooth structure and NR for the restoration and cement layer.

Newer vs. older CAD/CAM burs: Influence of bur experience on the fatigue behavior of adhesively cemented simplified lithium-disilicate glass-ceramic restorations.

This study evaluated the effect of the CAD/CAM burs experience (newer vs older as consequence of the milling sequence) on fatigue failure load (FFL), number of cycles for failure (CFF), and survival rates of lithium disilicate glass-ceramic simplified restorations adhesively cemented to a dentin analogue substrate. Three sets of CAD/CAM burs were used to mill disc-shaped ceramic specimens (1 bur set - 18 milled discs with 10 mm diameter and 1.5 mm thickness), considering the bur experience as a result of the milling sequence to compose the study groups: G1-6 - discs obtained from the 1st to 6th milling of each bur set; G7-12 - specimens from the 7th to 12th milling; G13-18 - discs from the 13th to 18th. Discs of dentin analogue (G10, 10 mm diameter and 2.0 mm thickness) were made to serve as substrate (base material) and randomly assigned into pairs with the respective ceramic discs. Then, the ceramic discs were adhesively cemented onto the dentin analogue substrate, composing a three-layer specimen that mimics a monolithic restoration of a posterior tooth. Specimens were tested under stepwise fatigue approach: frequency = 20 Hz, 5000 cycles at maximum load of 400 N to accommodate the testing assembly, followed by incremental steps of 200 N with initial load ranging from 10 to 1000 N, to a maximum of 20,000 cycles/each step, until the occurrence of failure (radial crack). FFL and CFF were recorded at the end of the testing and subjected to statistical analysis. Supplementary roughness analysis of the milled surface was performed (n = 18) using a contact profilometer. Residual stress after milling and acid etching were accessed via X-ray Diffractometry analysis. FFL and CFF were not affected by increase on bur experience (no statistical differences among groups), despite that, it affected both Ra and Rz parameters (G1-6 had the smoothest surface). The residual stress concentration was negligible (milling did not induce residual stress concentration). It is concluded that the fatigue behavior of adhesively cemented lithium-disilicate glass-ceramic restorations was not influenced by CAD/CAM bur experience (newer vs older as consequence of the milling sequence), and so the residual stress concentration induced by milling was negligible.

Fracture of Zirconia Abutment with Metallic Insertion on Anterior Single Titanium Implant with Internal Hexagon: Retrieval Analysis of a Failure.

This case report presents a retrieval analysis of a screw-retained one-piece restoration with the veneering ceramic fired directly onto the zirconia abutment that fractured during insertion. A patient who experienced root fracture of a maxillary left central incisor received a titanium implant on the same day as extraction. After delayed implant loading, a two-piece zirconia abutment with metallic insertion was customized. Upon installation, a horizontal fracture of the crown just above the metallic portion was detected. The retrieval analysis of a fractured zirconia abutment showed crack formation and diffusion of glaze material that expanded the crack line during firing.

Failure Probability of Three Designs of Zirconia Crowns.

This study used a two-parameter Weibull analysis for evaluation of the lifespan of fully or partially porcelain-/glaze-veneered zirconia crowns after fatigue test. A sample of 60 first molars were selected and prepared for full-coverage crowns with three different designs (n = 20): traditional (crowns with zirconia framework covered with feldspathic porcelain), modified (crowns partially covered with veneering porcelain), and monolithic (full-contour zirconia crowns). All specimens were treated with a glaze layer. Specimens were subjected to mechanical cycling (100 N, 3 Hz) with a piston with a hemispherical tip (Ø = 6 mm) until the specimens failed or up to 2 × 106 cycles. Every 500,000 cycles, the fatigue tests were interrupted and stereomicroscopy (10×) was used to inspect the specimens for damage. The authors performed Weibull analysis of interval data to calculate the number of failures in each interval. The types and numbers of failures according to the groups were: cracking (13 traditional, 6 modified) and chipping (4 traditional) of the feldspathic porcelain, followed by delamination (1 traditional) at the veneer/core interface and debonding (2 monolithic) at the cementation interface. Weibull parameters (ß, scale; η, shape), with a two-sided confidence interval of 95%, were: traditional-1.25 and 0.9 × 106 cycles; modified-0.58 and 11.7 × 106 cycles; and monolithic-1.05 and 16.5 × 106 cycles. Traditional crowns showed greater susceptibility to fatigue, the modified group presented higher propensity to early failures, and the monolithic group showed no susceptibility to fatigue. The modified and monolithic groups presented the highest number of crowns with no failures after the fatigue test. The three crown designs presented significantly different behaviors under fatigue. The modified and monolithic groups presented less probability of failure after 2 × 106 cycles.

Effect of Thickness, Processing Technique and Cooling Rate Protocol on the µTBS of a Bilayer Ceramic System.

PURPOSE: To evaluate the influence of different processing techniques, ceramic thicknesses, and cooling rate protocols on the µTBS of a veneering ceramic to zirconia (Y-TZP). MATERIALS AND METHODS: Eighty Y-TZP ceramic blocks (VITA In-Ceram 2000) with dimensions of 10 x 7 x 5 mm were obtained. The blocks were sintered in a special furnace at 1500° for 2 h, wet ground, and divided into 8 groups according to the factors "processing technique" (P: pressed/veneering ceramic PM9; or V: layered/ veneering ceramic VM9), "thickness" (2 mm and 4 mm), and "cooling protocol" (S: slow [10°C/s]; F: fast [50°C/s]). The Y-TZP/veneering ceramic blocks were sectioned to produce non-trimmed bar specimens (bonded area: 1±0.1 mm2), which were submitted to 1200 thermal cycles (5°C and 55°C, 30-s dwell time) and stored for 1 week in distilled water (37°C) before microtensile testing in a universal test machine (EMIC, 1 mm/min). The data in MPa were analyzed statistically using three-way ANOVA and Tukey's test. RESULTS: ANOVA revealed that only the factor processing technique was significant (p=0.015), unlike the factors thickness (p=0.111) and cooling protocol (p=0.202). The majority of the failures were classified as adhesive. CONCLUSION: Layered application of a thin veneering ceramic using a fast cooling rate resulted in improved bonding between veneering ceramic and zirconia.

Bond strengths, degree of conversion of the cement and molecular structure of the adhesive-dentine joint in fibre post restorations.

OBJECTIVES: Because fibre post restorations are influenced by multiple factors such as the types of bonding materials, the dentine region and the time under moist exposure, this study sought to determine the bond strength of endodontic restorations and its relation to the degree of conversion of the cement layer and the molecular structure of the dentine-bonded joints. METHODS: The performance of 2 etch-and-rinse (All-Bond 2 and One-Step Plus) and 2 self-etch (Clearfil SE Bond and Xeno III) adhesives at post spaces regions, after 7 d or 4 m, was evaluated. FRC Postec Plus posts were cemented to the root canal with a dual-cure resin cement (Duo-Link). Transverse sections of the tooth were subjected to push-out testing, to degree-of-conversion measurements and to hybrid layer evaluation through µ-Raman spectroscopy. RESULTS: Coronal bonding was higher than cervical and middle bonding. The hybrid layer was thicker for the etch-and-rinse systems, with thicknesses decreasing towards the middle region. The degree of conversion measured for the 3-step etch-and-rinse group after 4 m was significantly higher than that for the self-etching groups. CONCLUSIONS: Although not totally stable at the adhesive-dentine interface, the 3-step etch-and-rinse adhesive in the coronal dentine provided the best bond strength, degree of conversion of the cement and hybrid layer thickness in post restorations, in both short- and long-term analyses.

Effect of adhesive system type and tooth region on the bond strength to dentin.

PURPOSE: This study evaluated the bond strength of two etch-and-rinse adhesive systems (two- and three-step) and a self-etching system to coronal and root canal dentin. MATERIALS AND METHODS: The root canals of 30 human incisors and canines were instrumented and prepared with burs. The posts used for luting were duplicated with dual resin cement (Duo-link) inside Aestheti Plus #2 molds. Thus, three groups were formed (n = 10) according to the adhesive system employed: All-Bond 2 (TE3) + resin cement post (rcp) + Duo-link (Dl); One-Step Plus (TE2) + rcp + Dl; Tyrian/One-Step Plus (SE) + rcp + Dl. Afterwards, 8 transverse sections (1.5 mm) were cut from 4 mm above the CEJ up to 4 mm short of the root canal apex, comprising coronal and root canal dentin. The sections were submitted to push-out testing in a universal testing machine EMIC (1 mm/min). Bond strength data were analyzed with two-way repeated measures ANOVA and Tukey's test (p < 0.05). RESULTS: The relationship between the adhesives was not the same in the different regions (p < 0.05). Comparison of the means achieved with the adhesives in each region (Tukey; p < 0.05) revealed that TE3 (mean +/- standard deviation: 5.22 +/- 1.70) was higher than TE2 (2.60 +/- 1.74) and SE (1.68 +/- 1.85). CONCLUSION: Under the experimental conditions, better bonding to dentin was achieved using the three-step etch-and-rinse system, especially in the coronal region. Therefore, the traditional etch-and-rinse three-step adhesive system seems to be the best choice for teeth needing adhesive endodontic restorations.