BIOMECHANICAL ANALYSIS OF THE STRESSES GENERATED BY DIFFERENT DISOCCLUSION PATTERNS IN AN IMPLANT-SUPPORTED MANDIBULAR COMPLETE DENTURE

Objectives:

This study evaluated by three-dimensional finite element analysis the tensions generated by different disocclusion patterns (canine guide and bilateral balanced occlusion) in an implant-supported mandibular complete denture.

Material and Methods:

A three-dimensional model of implant-supported mandibular complete denture was fabricated according to the Brånemark protocol. A 5-element 3.75 x 13-mm screw-shape dental implant system was modeled for this study. The implants were located in the intermental foramen region with 3-mm-high prosthetic components joined by a nickel-chromium framework with 12-mm bilateral cantilever covered by acrylic resin and 12 acrylic denture teeth. SolidWorks^® software was used before and after processing the simulations. The mechanical properties of the components were inserted in the model and a 15 N load was established in fixed points, in each one of the simulations. Data were collected in the entire nickel-chromium framework. The results were displayed three-dimensionally as color graphic scales.

Results:

The canine guide generated greater tensions in the region of the first implant, while the bilateral balanced occlusion generated great tensions in the entire metallic framework. The maximum tension found in the simulation of the bilateral balanced occlusion was 3.22 fold higher than the one found in the simulation of the disocclusion in canine guide.

Conclusion:

The pattern of disocclusion in canine guide is the ideal for implant-supported mandibular complete denture.     

Effect of cement washout on loosening of abutment screws and vice versa in screw- and cement- retained implant-supported dental prosthesis

PURPOSE

The purpose of this study was to examine the abutment screw stability of screw- and cement-retained implant-supported dental prosthesis (SCP) after simulated cement washout as well as the stability of SCP cements after complete loosening of abutment screws.

MATERIALS AND METHODS

Thirty-six titanium CAD/CAM-made implant prostheses were fabricated on two implants placed in the resin models. Each prosthesis is a two-unit SCP: one screw-retained and the other cemented. After evaluating the passive fit of each prosthesis, all implant prostheses were randomly divided into 3 groups: screwed and cemented SCP (Control), screwed and noncemented SCP (Group 1), unscrewed and cemented SCP (Group 2). Each prosthesis in Control and Group 1 was screwed and/or cemented, and the preloading reverse torque value (RTV) was evaluated. SCP in Group 2 was screwed and cemented, and then unscrewed (RTV=0) after the cement was set. After cyclic loading was applied, the postloading RTV was measured. RTV loss and decementation ratios were calculated for statistical analysis.

RESULTS

There was no significant difference in RTV loss ratio between Control and Group 1 (P=.16). No decemented prosthesis was found among Control and Group 2.

CONCLUSION

Within the limits of this in vitro study, the stabilities of SCP abutment screws and cement were not significantly changed after simulated cement washout or screw loosening.     

Effect of axial loads on implant-supported partial fixed prostheses by strain gauge analysis

Objectives

The present study used strain gauge analysis to perform an in vitro evaluation of the effect of axial loading on 3 elements of implant-supported partial fixed prostheses, varying the type of prosthetic cylinder and the loading points.

Material and methods

Three internal hexagon implants were linearly embedded in a polyurethane block. Microunit abutments were connected to the implants applying a torque of 20 Ncm, and prefabricated Co-Cr cylinders and plastic prosthetic cylinders were screwed onto the abutments, which received standard patterns cast in Co-Cr alloy (n=5). Four strain gauges (SG) were bonded onto the surface of the block tangentially to the implants, SG 01 mesially to implant 1, SG 02 and SG 03 mesially and distally to implant 2, respectively, and SG 04 distally to implant 3. Each metallic structure was screwed onto the abutments with a 10 Ncm torque and an axial load of 30 kg was applied at five predetermined points (A, B, C, D, E). The data obtained from the strain gauge analyses were analyzed statistically by RM ANOVA and Tukey''s test, with a level of significance of p<0.05.

Results

There was a significant difference for the loading point (p=0.0001), with point B generating the smallest microdeformation (239.49 με) and point D the highest (442.77 με). No significant difference was found for the cylinder type (p=0.748).

Conclusions

It was concluded that the type of cylinder did not affect in the magnitude of microdeformation, but the axial loading location influenced this magnitude.     

EFFECT OF PONTIC FRAMEWORK DESIGN ON THE FRACTURE RESISTANCE OF IMPLANT-SUPPORTED ALL-CERAMIC FIXED PARTIAL DENTURES

Objective:

The purpose of this study was to compare the fracture resistance of implant-supported all-ceramic fixed partial dentures, which have three different pontic designs.

Material and Methods:

Two implants were placed in a metal model simulating mandibular left second premolar and mandibular left second molar. Thirty standardized 3-unit all-ceramic fixed partial dentures with biconvex, convex or concave pontic designs were fabricated using IPS e.max system (n=10). Afterwards, specimens were centrally loaded on the pontics until failure with a universal testing machine. Results were analyzed by Kruskal-Wallis and Mann-Whitney U tests at 5% significance level.

Results:

The fracture resistance values of all-ceramic fixed partial dentures designed with biconvex, convex or concave pontics were 349.71, 438.20 and 300.78 N, respectively. There were no statistically significant differences between the fracture resistances of the groups (p>0.05), except for convex and concave groups (p<0.05 and p=0.009, respectively).

Conclusions:

Convex design showed the best mechanical properties as demonstrated by the high values of fracture resistance.     

Evaluation of biogeneric design techniques with CEREC CAD/CAM system

PURPOSE

The aim of this study was to evaluate occlusal contacts generated by 3 different biogeneric design modes (individual (BI), copy (BC), reference (BR)) of CEREC software and to assess the designs subjectively.

MATERIALS AND METHODS

Ten pairs of maxillary and mandibular casts were obtained from full dentate individuals. Gypsum cast contacts were quantified with articulating paper and digital impressions were taken. Then, all ceramic crown preparation was performed on the left first molar teeth and digital impressions of prepared teeth were made. BI, BC, and BR crowns were designed. Occlusal images of designs including occlusal contacts were superimposed on the gypsum cast images and corresponding contacts were determined. Three designs were evaluated by the students.

RESULTS

The results of the study revealed that there was significant difference among the number of contacts of gypsum cast and digital models (P<.05). The comparison of the percentage of virtual contacts of three crown designs which were identical to the contacts of original gypsum cast revealed that BI and BR designs showed significantly higher percentages of identical contacts compared with BC design (P<.05). Subjective assessment revealed that students generally found BI designs and BR designs natural regarding naturalness of fissure morphology and cusp shape and cusp tip position. For general occlusal morphology, student groups generally found BI design "too strong" or "perfect", BC design "too weak", and BR design "perfect".

CONCLUSION

On a prepared tooth, three different biogeneric design modes of a CAD/CAM software reveals different crown designs regarding occlusal contacts and morphology.     

Flexural strengths of implant-supported zirconia based bridges in posterior regions

PURPOSE

Impact forces in implant supported FDP (fixed dental prosthesis) are higher than that of tooth supported FDPs and the compositions used in frameworks also has a paramount role for biomechanical reasons. The aim of this study was to evaluate the flexural strength of two different zirconia frameworks.

MATERIALS AND METHODS

Two implant abutments with 3.8 mm and 4.5 mm platform were used as premolar and molar. They were mounted vertically in an acrylic resin block. A model with steel retainers and removable abutments was fabricated by milling machine; and 10 FDP frameworks were fabricated for each Biodenta and Cercon systems. All samples were thermo-cycled for 2000 times in 5-55℃ temperature and embedded in 37℃ artificial saliva for one week. The flexural test was done by a rod with 2 mm ending diameter which was applied to the multi-electromechanical machine. The force was inserted until observing fracture. The collected data were analyzed with SPSS software ver.15, using Weibull modulus and independent t-test with the level of significance at α=.05.

RESULTS

The mean load bearing capacity values were higher in Biodenta but with no significant differences (P>.05). The Biodenta frameworks showed higher load bearing capacity (F₀=1700) than Cercon frameworks (F₀=1520) but the reliability (m) was higher in Cercon (m=7.5).

CONCLUSION

There was no significant difference between flexural strengths of both zirconia based framework systems; and both Biodenta and Cercon systems are capable to withstand biting force (even parafunctions) in posterior implant-supported bridges with no significant differences.     

Evaluation of dental panoramic radiographic findings in edentulous jaws: A retrospective study of 743 patients "Radiographic features in edentulous jaws"

PURPOSE

The aim of this study was to determine the frequency of significant panoramic radiographic findings and eventual treatment requirements before conventional or implant supported prosthetic treatment in asymptomatic edentulous patients.

MATERIALS AND METHODS

A total of 743 asymptomatic edentulous patients were retrospectively evaluated using a digital panoramic system. We analyzed the radiographic findings, including impacted teeth, retained root fragments, foreign bodies, severe atrophy of the posterior maxillary alveolar bone, mucous retention cysts, soft tissue calcifications and radiopaque-radiolucent conditions.

RESULTS

Four-hundred-eighty-seven (65.6%) patients had no radiographic finding. A total of 331 radiographic findings were detected in 256 (34%) patients. In 52.9% (n=175) of these conditions, surgical treatment was required before application of implant-supported fixed prosthesis. However, before application of conventional removable prosthesis surgical treatment was required for 6% (n=20) of these conditions.

CONCLUSION

The edentulous patients who will have implant placement for implant-supported fixed prosthesis can frequently require additional surgical procedures to eliminate pathological conditions.     

Does the number of implants have any relation with peri-implant disease?

Objective

The aim of this study was to evaluate the relationship between the number of pillar implants of implant-supported fixed prostheses and the prevalence of periimplant disease.

Material and Methods

Clinical and radiographic data were obtained for the evaluation. The sample consisted of 32 patients with implant-supported fixed prostheses in function for at least one year. A total of 161 implants were evaluated. Two groups were formed according to the number of implants: G1) ≤5 implants and G2) >5 implants. Data collection included modified plaque index (MPi), bleeding on probing (BOP), probing depth (PD), width of keratinized mucosa (KM) and radiographic bone loss (BL). Clinical and radiographic data were grouped for each implant in order to conduct the diagnosis of mucositis or peri-implantitis.

Results

Clinical parameters were compared between groups using Student''s t test for numeric variables (KM, PD and BL) and Mann-Whitney test for categorical variables (MPi and BOP). KM and BL showed statistically significant differences between both groups (p<0.001). Implants from G1 – 19 (20.43%) – compared with G2 – 26 (38.24%) – showed statistically significant differences regarding the prevalence of peri-implantitis (p=0.0210).

Conclusion

It seems that more than 5 implants in total fixed rehabilitations increase bone loss and consequently the prevalence of implants with periimplantitis. Notwithstanding, the number of implants does not have any influence on the prevalence of mucositis.     

Load-bearing capacity of screw-retained CAD/CAM-produced titanium implant frameworks (I-Bridge?2) before and after cyclic mechanical loading

Implant-supported screw-retained fixed dental prostheses (FDPs) produced by CAD/ CAM have been introduced in recent years for the rehabilitation of partial or total endentulous jaws. However, there is a lack of data about the long-term mechanical characteristics.

Objective

The aim of this study was to investigate the failure mode and the influence of extended cyclic mechanical loading on the load-bearing capacity of these frameworks.

Material and Methods

Ten five-unit FDP frameworks simulating a free-end situation in the mandibular jaw were manufactured according to the I-Bridge^®2-concept (I-Bridge^®2, Biomain AB, Helsingborg, Sweden) and each was screw-retained on three differently angulated Astra Tech implants (30º buccal angulation/0º angulation/30º lingual angulation). One half of the specimens was tested for static load-bearing capacity without any further treatment (control), whereas the other half underwent five million cycles of mechanical loading with 100 N as the upper load limit (test). All specimens were loaded until failure in a universal testing machine with an occlusal force applied at the pontics. Load-displacement curves were recorded and the failure mode was macro- and microscopically analyzed. The statistical analysis was performed using a t-test (p=0.05).

Results

All the specimens survived cyclic mechanical loading and no obvious failure could be observed. Due to the cyclic mechanical loading, the load-bearing capacity decreased from 8,496 N±196 N (control) to 7,592 N±901 N (test). The cyclic mechanical loading did not significantly influence the load-bearing capacity (p=0.060). The failure mode was almost identical in all specimens: large deformations of the framework at the implant connection area were obvious.

Conclusion

The load-bearing capacity of the I-Bridge^®2 frameworks is much higher than the clinically relevant occlusal forces, even with considerably angulated implants. However, the performance under functional loading in vivo depends on additional aspects. Further studies are needed to address these aspects.     

Chromatic stability of acrylic resins of artificial eyes submitted to accelerated aging and polishing

Esthetics and durability of materials used to fabricate artificial eyes has been an important eissue since artificial eyes are essential to restore esthetics and function, protect the remaining tissues and help with patients'' psychological therapy. However, these materials are submitted to degrading effects of environmental agents on the physical properties of the acrylic resin.

Objective

This study assessed the color stability of acrylic resins used to fabricate sclera in three basic shades (N1, N2 and N3) when subjected to accelerated aging, mechanical and chemical polishing.

Material and methods

Specimens of each resin were fabricated and submitted to mechanical and chemical polishing. Chromatic analysis was performed before and after accelerated aging through ultraviolet reflection spectrophotometry.

Results

All specimens revealed color alteration following polishing and accelerated aging. The resins presented statistically significant chromatic alteration (p<0.01) between the periods of 252 and 1008 h.

Conclusions

Both polishing methods presented no significant difference between the values of color derivatives of resins.     

Maintenance requirements of implant-supported fixed prostheses opposed by implant-supported fixed prostheses, natural teeth, or complete dentures: A 5-year retrospective study.

Purpose

The purpose of this study was to compare the maintenance requirements of implant-supported fixed prostheses with cantilever arms in edentulous jaws when opposed by fixed prostheses of similar design, by natural teeth, or by complete dentures.

Materials and Methods

The maintenance requirements for the 5-year follow-up period were obtained by examining the dental records of 37 people. Six were provided with fixed prostheses in both arches, 22 with a fixed prosthesis in the mandible opposed by a complete denture, and 9 with a fixed prosthesis opposed by natural teeth. Everyone was treated with Nobel Biocare implants using standard implant and prosthetic protocols.

Results

The denture teeth and acrylic resin were repaired on 44 occasions in the group with implants in both jaws, on 14 occasions in the group with implants opposed by natural teeth, and twice in the group in which the implants were opposed by a complete denture. The group with implants in both jaws was more likely to fracture the gold-alloy framework, which occurred on six occasions. The group with implants in both jaws was significantly different from the other two groups in relation to higher incidence of fracture of the teeth and gold-alloy framework.

Conclusion

The maintenance requirements of implant-supported fixed prostheses with cantilever arms opposed by fixed prostheses of similar design were much greater than when opposed by natural teeth or complete dentures.     

Prosthetic misfit of implant-supported prosthesis obtained by an alternative section method

PURPOSE

Adequate passive-fitting of one-piece cast 3-element implant-supported frameworks is hard to achieve. This short communication aims to present an alternative method for section of one-piece cast frameworks and for casting implant-supported frameworks.

MATERIALS AND METHODS

Three-unit implant-supported nickel-chromium (Ni-Cr) frameworks were tested for vertical misfit (n = 6). The frameworks were cast as one-piece (Group A) and later transversally sectioned through a diagonal axis (Group B) and compared to frameworks that were cast diagonally separated (Group C). All separated frameworks were laser welded. Only one side of the frameworks was screwed.

RESULTS

The results on the tightened side were significantly lower in Group C (6.43 ± 3.24 µm) when compared to Groups A (16.50 ± 7.55 µm) and B (16.27 ± 1.71 µm) (P<.05). On the opposite side, the diagonal section of the one-piece castings for laser welding showed significant improvement in the levels of misfit of the frameworks (Group A, 58.66±14.30 µm; Group B, 39.48±12.03 µm; Group C, 23.13±8.24 µm) (P<.05).

CONCLUSION

Casting diagonally sectioned frameworks lowers the misfit levels. Lower misfit levels for the frameworks can be achieved by diagonally sectioning one-piece frameworks.     

Bond strength between acrylic resin and maxillofacial silicone

The development of implant dentistry improved the possibilities of rehabilitation with maxillofacial prosthesis. However, clinically it is difficult to bond the silicone to the attachment system.

Objectives

This study aimed to evaluate the effect of an adhesive system on the bond strength between acrylic resin and facial silicone.

Material and Methods

A total of 120 samples were fabricated with auto-polymerized acrylic resin and MDX 4-4210 facial silicone. Both materials were bonded through mechanical retentions and/or application of primers (DC 1205 primer and Sofreliner primer S) and adhesive (Silastic Medical Adhesive Type A) or not (control group). Samples were divided into 12 groups according to the method used to attach the silicone to the acrylic resin. All samples were subjected to a T-peel test in a universal testing machine. Failures were classified as adhesive, cohesive or mixed. The data were evaluated by the analysis of variance (ANOVA) and the Tukey''s HSD test (α=.05).

Results

The highest bond strength values (5.95 N/mm; 3.07 N/mm; 4.75 N/mm) were recorded for the samples that received a Sofreliner primer application. These values were significantly higher when the samples had no scratches and did not receive the application of Silastic Medical Adhesive Type A.

Conclusions

The most common type of failure was adhesive. The use of Sofreliner primer increased the bond strength between the auto-polymerized acrylic resin and the Silastic MDX 4-4210 facial silicone.     

Stress analysis of a fixed implant-supported denture by the finite element method (FEM) when varying the number of teeth used as abutments

Objectives

In some clinical situations, dentists come across partially edentulous patients, and it might be necessary to connect teeth to implants. The aim of this study was to evaluate a metal-ceramic fixed tooth/implant-supported denture with a straight segment, located in the posterior region of the maxilla, when varying the number of teeth used as abutments.

Materials and Methods

A three-element fixed denture composed of one tooth and one implant (Model 1), and a four-element fixed denture composed of two teeth and one implant (Model 2) were modeled. A 100 N load was applied, distributed uniformly on the entire set, simulating functional mastication, for further analysis of the SEQV (Von Mises) principal stresses, which were compared with the flow limit of the materials.

Results

In a quantitative analysis, it may be observed that in the denture with one tooth, the maximum SEQV stress was 47.84 MPa, whereas for the denture with two teeth the maximum SEQV stress was 35.82 MPa, both located in the region between the pontic and the tooth.

Conclusion

Lower stresses were observed in the denture with an additional tooth. Based on the flow limit of the materials, porcelain showed values below the limit of functional mastication.     

The influence of various core designs on stress distribution in the veneered zirconia crown: a finite element analysis study

PURPOSE

The purpose of this study was to evaluate various core designs on stress distribution within zirconia crowns.

MATERIALS AND METHODS

Three-dimensional finite element models, representing mandibular molars, comprising a prepared tooth, cement layer, zirconia core, and veneer porcelain were designed by computer software. The shoulder (1 mm in width) variations in core were incremental increases of 1 mm, 2 mm and 3 mm in proximal and lingual height, and buccal height respectively. To simulate masticatory force, loads of 280 N were applied from three directions (vertical, at a 45° angle, and horizontal). To simulate maximum bite force, a load of 700 N was applied vertically to the crowns. Maximum principal stress (MPS) was determined for each model, loading condition, and position.

RESULTS

In the maximum bite force simulation test, the MPSs on all crowns observed around the shoulder region and loading points. The compressive stresses were located in the shoulder region of the veneer-zirconia interface and at the occlusal region. In the test simulating masticatory force, the MPS was concentrated around the loading points, and the compressive stresses were located at the 3 mm height lingual shoulder region, when the load was applied horizontally. MPS increased in the shoulder region as the shoulder height increased.

CONCLUSION

This study suggested that reinforced shoulder play an essential role in the success of the zirconia restoration, and veneer fracture due to occlusal loading can be prevented by proper core design, such as shoulder.     

Effect of the number of abutments on biomechanics of Branemark prosthesis with straight and tilted distal implants

Objective

This study aimed to evaluate the bending moments, and compressive and tensile forces in implant-supported prostheses with three, four or five abutments.

Material and Methods

Ten Pd-Ag frameworks were tested over two master models with: 1) parallel vertical implants, and 2) tilted distal implants. Strain gauges were fixed on the abutments of each master model to measure the deformation when a static load of 50 N was applied on the cantilever (15 mm). The deformation values were measured when the metallic frameworks were tested over three, four or five abutments, and transformed into force and bending moment values. Data were analyzed by ANOVA and Tukey’s test for multiple comparisons at 5% level of significance.

Results

Abutment #1 (adjacent to the cantilever) had the highest values of force and sagittal bending moment for all tests with three, four or five abutments. Independently from the number of abutments, axial force in abutment #1 was higher in the vertical model than in the tilted model. Total moment was higher with three abutments than with four or five abutments. Independently from the inclination of implants, the mean force with four or five abutments was lower than that with three abutments.

Conclusion

The results suggest that in the set-ups with four or five abutments tilted distal implants reduced axial force and did not increase bending moments.     

Importance of a distal proximal contact on load transfer by implant-supported single adjacent crowns in posterior region of the mandible: a photoelastic study

Objective

This study aimed to evaluate the importance of a distal proximal contact on the load transfer to the posterior region of the mandible by non-splinted adjacent implant-supported crowns using photoelastic stress analysis.

Material and Methods

A rectangular model (68x30x15 mm) was made of polymethylmethacrylate resin to simulate half of the mandibular arch. One model was completed with resin replicas representing the first premolar and second molar and with two 3.75 mm dia.x11 mm internal hexagon threaded implants replacing the second premolar and first molar. The other model was manufactured in the same way but without the second molar. Both models were duplicated using photoelastic resin. The roots of the teeth replicas were covered with a layer of polyether impression material to simulate the periodontal ligament. Two different vertical loads were applied to the crowns as follows: 1 - single static point load alternately applied to the crowns replacing the second premolar and first molar (50 N); 2 - simultaneous static point loads applied to both of the crowns replacing the second premolar and first molar (100 N). The resulting isochromatic fringe pattern in the photoelastic model was monitored and photographed.

Results

All loading conditions studied showed that the presence of the second molar has changed the load transmission and the pattern of stresses.

Conclusion

Results showed that the presence of a second molar proximal contact can help minimize the stresses around the implants.     

In vitro evaluation of an alternative method to bond molar tubes

Despite the advances in bonding materials, many clinicians today still prefer to place bands on molar teeth. Molar bonding procedures need improvement to be widely accepted clinically.

Objective

The purpose of this study was to evaluate the shear bond strength when an additional adhesive layer was applied on the occlusal tooth/tube interface to provide reinforcement to molar tubes.

Material and methods

Sixty third molars were selected and allocated to the 3 groups: group 1 received a conventional direct bond followed by the application of an additional layer of adhesive on the occlusal tooth/tube interface, group 2 received a conventional direct bond, and group 3 received a conventional direct bond and an additional cure time of 10 s. The specimens were debonded in a universal testing machine. The results were analyzed statistically by ANOVA and Tukey’s test (α=0.05).

Results

Group 1 had a significantly higher (p<0.05) shear bond strength compared to groups 2 and 3. No difference was detected between groups 2 and 3 (p>0.05).

Conclusions

The present in vitro findings indicate that the application of an additional layer of adhesive on the tooth/tube interface increased the shear bond strength of the bonded molar tubes.     

Relationship between squamous cell carcinoma of the tongue and the position of dental prosthesis

PURPOSE

Squamous cell carcinoma (SCC) of the tongue has a relatively high incidence of all oral cancers. Some studies have reported a relationship between intraoral dental prosthesis and SCC of the tongue; however, this relationship remains controversial. The purpose of this study was to investigate the relationship between SCC of the tongue and the positional aspects of dental prosthesis using a retrospective analysis.

MATERIALS AND METHODS

A total of 439 patients with SCC of the tongue were diagnosed and treated in the Department of Oral and Maxillofacial Surgery, Seoul National University Dental Hospital. Patients were treated over a 12.5-year period ranging from January 1, 2001 to June 30, 2013. Statistical analysis was performed to examine potential differences between the groups.

RESULTS

The number of patients with a crown and/or a bridge (134, 63.5%) was significantly different than the number of patients without a prosthesis (77, 36.5%). Even after accounting for different types of prostheses such as crowns, bridges, and dentures, no significant differences were observed between the position of the prosthesis and the location of the SCC of the tongue, with significance defined as a P-value less than .05 by the Pearson-Chi square test.

CONCLUSION

Patients with crowns and/or bridges exhibited more frequent SCC of the tongue compared with patients without these prosthesis. These data support the hypothesis that mechanical trauma and galvanic phenomena play a role in the etiology of SCC of the tongue.