Accuracy of impression and pouring techniques for an implant-supported prosthesis

Purpose: The purpose of this in vitro study was to compare the dimensional accuracy of a stone index and of 3 impression techniques (tapered impression copings, squared impression copings, and squared impression copings splinted with acrylic resin) associated with 3 pouring techniques (conventional, pouring using latex tubes fitted onto analogs, and pouring after joining the analogs with acrylic resin) for implant-supported prostheses. Materials and Methods: A mandibular brass cast with 4 stainless steel implant-abutment analogs, a framework, and 2 aluminum custom trays were fabricated. Polyether impression material was used for all impressions. Ten groups were formed (a control group and 9 test groups formed by combining each pouring technique and impression technique). Five casts were made per group for a total of 50 casts and 200 gap values (1 gap value for each implant-abutment analog). Results: The mean gap value with the index technique was 27.07 mu m. With the conventional pouring technique, the mean gap values were 116.97 mu m for the tapered group, 5784 mu m for the squared group, and 73.17 mu m for the squared splinted group. With pouring using latex tubes, the mean gap values were 65.69 mu m for the tapered group, 38.03 mu m for the squared group, and 82.47 mu m for the squared splinted group. With pouring after joining the analogs with acrylic resin, the mean gap values were 141.12 jum for the tapered group, 74.19 mu m for the squared group, and 104.67 mu m for the squared splinted group. No significant difference was detected among Index, squarellatex techniques, and master cast (P > .05). Conclusions: The most accurate impression technique utilized squared copings. The most accurate pouring technique for making the impression with tapered or squared copings utilized latex tubes. The pouring did not influence the accuracy of the stone casts when using splinted squared impression copings. Either the index technique or the use of squared coping combined with the latex-tube pouring technique are preferred methods for making implant-supported fixed restorations with dimensional accuracy.

Stress distribution in implant-supported prosthesis with external and internal implant-abutment connections

Objective. This study aimed to investigate the stress distribution in screwed implant-supported prostheses with different implant-abutment connections by using a photoelastic analysis. Materials and methods. Four photoelastic models were fabricated in PL-2 resin and divided according to the implant-abutment connection (external hexagon (EH) and Morse taper (MT) implants (3.75 × 11.5 mm)) and the number crowns (single and 3-unit piece). Models were positioned in a circular polariscope and 100-N axial and oblique (45) loading were applied in the occlusal surface of the crowns by using a universal testing machine. The stresses were photographically recorded and qualitatively analyzed using software (Adobe Photoshop). Results. Under axial loading, the MT implants exhibited a lower number of fringes for single-unit crowns than EH implants, whereas for a 3-unit piece the MT implants showed a higher number of fringes vs EH implants. The oblique loading increased the number of fringes for all groups. Conclusion. In conclusion, the MT implant-abutment connection reduced the amount of stress in single-unit crowns, for 3-unit piece crowns the amount of stress was lower using an external hexagon connection. The stress pattern was similar for all groups. Oblique loading promoted a higher stress concentration than axial loading. © Informa Healthcare.

Comparison of different designs of implant-retained overdentures and fixed full-arch implant-supported prosthesis on stress distribution in edentulous mandible - A computed tomography-based three-dimensional finite element analysis

A finite element analysis was used to compare the effect of different designs of implant-retained overdentures and fixed full-arch implant-supported prosthesis on stress distribution in edentulous mandible. Four models of an human mandible were constructed. In the OR (O'ring) group, the mandible was restored with an overdenture retained by four unsplinted implants with O'ring attachment; in the BC (bar-clip) -C and BC groups, the mandibles were restored with overdentures retained by four splinted implants with bar-clip anchor associated or not with two distally placed cantilevers, respectively; in the FD (fixed denture) group, the mandible was restored with a fixed full-arch four-implant-supported prosthesis. Models were supported by the masticatory muscles and temporomandibular joints. A 100-N oblique load was applied on the left first molar. Von Mises (σvM), maximum (σmax) and minimum (σmin) principal stresses (in MPa) analyses were obtained. BC-C group exhibited the highest stress values (σvM=398.8, σmax=580.5 and σmin=-455.2) while FD group showed the lowest one (σvM=128.9, σmax=185.9 and σmin=-172.1). Within overdenture groups, the use of unsplinted implants reduced the stress level in the implant/prosthetic components (59.4% for σvM, 66.2% for σmax and 57.7% for σmin versus BC-C group) and supporting tissues (maximum stress reduction of 72% and 79.5% for σmax, and 15.7% and 85.7% for σmin on the cortical and trabecular bones, respectively). Cortical bone exhibited greater stress concentration than the trabecular bone for all groups. The use of fixed implant dentures and removable dentures retained by unsplinted implants to rehabilitate edentulous mandible reduced the stresses in the periimplant bone tissue, mucosa and implant/prosthetic components. © 2013 Elsevier Ltd.

BIOMECHANICAL BEHAVIOR OF THE SYSTEM PROSTHESIS/DENTAL IMPLANT: ANALYSIS BY THE PHOTOELASTICITY METHOD

One of the main reasons for the failure in dental implant treatments is the overload, which can cause bone resorption and later, the osseointegration loss in the implant. Therefore, the aim of this study was to analyze the tension generated around dental implants in the rehabilitation of three mandible posterior teeth, varying the connection type, the disposal, and the quantity of implants. The photoelasticity method was used in order to accomplish it. Through photoelasticity, the quantity and localization of the tensions around the implants in the different studied groups were compared (three straight line implants, three offset placement implants, two implants with a mesial cantilever, and two implants with a pontic). The results showed that the tension quantity and disposition around the dental implants of the connection external hexagon and internal hexagon were similar in all groups. In the group where the cantilever was used, an increase of the tension around the implant, adjacent to the cantilever, was observed. From the results it is concluded that the type of connection used in this study did not influence the tension quantity and distribution around the implants; however, the prosthetic configuration with the cantilever use, led to an increase of the tension around the implant, adjacent to the cantilever.

An alternative technique for fabrication of frameworks in an immediate loading implant fixed mandibular prosthesis

The oral rehabilitation of edentulous patients with immediate loading has become a safe procedure with high predictability. The success is related to immediate fabrication of a passive fit framework to attach the implants. Based on these considerations, this case report shows an alternative technique for mandibular rehabilitation using implants immediately loaded, where the framework was fabricated using cylinders with internal reinforcement and precast pieces, electrowelding, and conventional welding providing esthetics and function to the patient in a short period of time.

Distal extension removable partial denture with resilient attachment connect to an anterior fixed implant-supported prosthesis: a clinical report

Background: Considering the limited qualitative and quantitative bone in the posterior arch, this modality of prosthetic treatment could provide a positive emotional factor reestablished by immovability of the anterior fixed implant-supported segment. Objective: This clinical report demonstrates the possibility of achieving positive results with a removable partial denture connected to an implant-supported fixed prosthesis associated to an extra resilient attachment. Clinical significance: In cases of posterior mandibular and maxilla atrophy added to the patients desire against the bone graft, this kind of prosthetic treatment has an important place as an alternative.

Effect of veneering material on the deformation suffered by implant-supported fixed prosthesis framework

The aim of this study was to evaluate the deformation suffered by cantilevered implant-supported fixed prostheses frameworks cast in silver-palladium alloy and coated with two occlusal veneering materials: acrylic resin or porcelain. Material and Methods: Two strain gauges were bonded to the inferior surface of the silver-palladium framework and two other were bonded to the occlusal surface of the prosthesis framework covered with ceramic and acrylic resin on each of its two halves. The framework was fixed to a metallic master model and a 35.2 N compression force was applied to the cantilever at 10, 15 and 20 mm from the most distal implant. The measurements of deformation by compression and tension were obtained. The statistical 2-way ANOVA test was used for individual analysis of the experiment variables and the Tukey test was used for the interrelation between all the variables (material and distance of force application). Results: The results showed that both variables had influence on the studied factors (deformation by compression and tension). Conclusion: The ceramic coating provided greater rigidity to the assembly and therefore less distortion compared with the uncoated framework and with the resin-coated framework. The cantilever arm length also influenced the prosthesis rigidity, causing higher deformation the farther the load was applied from the last implant.

Clinical and radiographic evaluation of a polyester prosthesis in dogs with cranial cruciate ligament rupture

Os achados clínicos e radiográficos após reparo intra-articular do ligamento cruzado cranial com prótese de poliéster, utilizando a técnica over-the-top modificada, foram avaliada em seis cães. Sete cirurgias foram realizadas devido ao acometimento bilateral em um dos animais. A avaliação clínica foi realizada ao 3º, 10º e 40º dias de pós-operatório, e a avaliação radiográfica realizada ao 5º e 24º meses após a cirurgia em cinco cães, por meio da qual se confirmou a progressão da doença articular degenerativa. A resolução dos sinais clínicos foi observada entre o 25º e 68º dias após a cirurgia, segundo avaliação realizada pelos proprietários. A função do membro operado foi considerada boa. Dois cães apresentaram desgaste e ruptura da prótese após a cirurgia. Concluiu-se que a prótese de poliéster, da forma como foi implantada neste estudo, não pode ser considerada como substituto satisfatório, uma vez que resultados superiores podem ser obtidos com ténicas menos invasivas e mais simples.

Effect of cantilever length and framework alloy on the stress distribution of mandibular-cantilevered implant-supported prostheses

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Deformation of Implant Abutments After Framework Connection Using Strain Gauges

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Planning for Immediate Loading of Implant-Supported Prostheses: Literature Review

The aim of this study was to present the factors that influence planning for immediate loading of implants through a literature review for treatment success. Research was conducted in the PubMed database including the key words immediate implant loading, implant-supported prostheses, and implant planning for studies published from 2000 to 2011. Forty-eight articles were used in this review to describe the indications and counterindications, presurgical planning, and technologies available for planning of this treatment alternative.

Prosthetic Platforms in Implant Dentistry

The use of implant-supported prosthesis to replace missing teeth became a predictable treatment. Although high success rate has been reported, implant treatment is suitable to complications, failures, and limitations such as peri-implant bone loss after implant loading. Stress evaluation on the bone-abutment-implant interface has been carried out to develop new designs of prosthetic platform and to understand the stress distribution in this interface. Several types of prosthetic platforms are available such as external and internal hexagon, Morse cone connection, and the concept of platform switching. Therefore, this study aimed to critically describe the different options of prosthetic platforms in implant dentistry, by discussing their biomechanical concepts, clinical use, and advantages and disadvantages. It was observed that all types of prosthetic platforms provided high success rate of the implant treatment by following a strict criteria of indication and limitation. In conclusion, a reverse planning of implant treatment is strongly indicated to reduce implant overload, and the use of advanced surgical-prosthetic techniques is required to obtain a long-term success of oral rehabilitations.

Photoelastic Analysis of Stress Distribution in Different Retention Systems for Facial Prosthesis

The aim of this study was to assess the behavior and stress distribution of 3 retention systems associated with implant for facial prosthesis by using the photoelasticity method. A photoelastic model was made from the replica of the orbital region on the left side of a dry skull with two 4-mm implants fixed in the superior orbital region. Three facial prosthetic retention systems were made for this study: O'ring, bar-clip, and magnets. The set (model/retention systems/prosthesis) was placed in a polariscope, and then traction began to be applied to the retention systems. The limit values for removal of the retention system were obtained by tests performed in an EMIC Universal test machine. The results were obtained by observation during the experiments and by photographic record of the stress behavior in the photoelastic model, resulting from the traction of the retention systems. In the magnet system, a lowest formation of fringes was verified both around and between the implants; in the O'ring system, the formation of photoelastic fringes was noted between the implants in the apical region; and in the bar-clip system, there was a greater concentration of colored fringes in the regions between the implants and cervical area. Based on the results obtained, it was concluded that the retention systems produced different stress distribution characteristics that, in general, were concentrated in the area around the implants, and the highest concentration of fringes, in increasing order, occurred ill the retention systems of the magnets, O'ring, and bar-clip.

Rehabilitation of Atrophic Maxilla Using the Combination of Autogenous and Allogeneic Bone Grafts Followed by Protocol-Type Prosthesis

Currently, there are several techniques for the rehabilitation of atrophic maxillary ridges in literature. The grafting procedure using autogenous bone is considered ideal by many researchers, as it shows osteogenic capability and causes no antigenic reaction. However, this type of bone graft has some shortcomings, mainly the restricted availability of donor sites. In recent years, several alternatives have been investigated to supply the disadvantages of autogenous bone grafts. In such studies, allogeneic bone grafts, which are obtained from individuals with different genetic load, but from the same species, have been extensively used. They can be indicated in cases of arthroplasty, surgical knee reconstruction, large bone defects, and in oral and maxillofacial reconstruction. Besides showing great applicability and biocompatibility, this type of bone is available in unlimited quantities. on the other hand, allogeneic bone may have the disadvantage of transmitting infectious diseases. Atrophic maxillae can be treated with bone grafts followed by osseointegrated implants to obtain aesthetic and functional oral rehabilitation. This study aimed to show the viability of allogeneic bone grafting in an atrophic maxilla, followed by oral rehabilitation with dental implant and protocol-type prosthesis within a 3-year follow-up period by means of a clinical case report.

Digital Radiographic Evaluation of the Level of Alveolar Bone Crest in External Hexagon Implants Submitted to 2 Types of Implant Abutments Under Immediate Loading

Purpose: The aim of this study was to evaluate by means of digital radiography the behavior of the alveolar bone crest in external hexagon implants following the use of 2 different types of abutments, one for conventional cemented prosthesis and one for modified cemented prosthesis.Methods: Ten external hexagon implants (platform 4.1) were placed in 5 patients. Initial instrumentation was carried out to obtain primary stability of the temporary prostheses under immediate loading. Each patient received both abutments for conventional and modified cemented prosthesis. Standardized digital periapical radiographies were performed at times T0 (immediately after implant placement) and T1 (4 months after implant placement). A straight line was initially established from the implant platform to the distal and mesial periimplantar marginal bone tissue (immediately in contact with the implant) and measured by digital radiography, using Sidexis version 2.3 (Sirona Dental Systems GmbH, Bensheim, Germany) software. The data were submitted to paired-samples t-test analysis.Results: There was no significant difference between the conventional and modified cemented prosthesis. In both cases, t-test results were within the null hypothesis level.Conclusion: The abutment for the modified cemented prosthesis resulted in no significant radiographic difference of alveolar bone crest height, when compared with the conventional cemented prostheses.