Photoelastic Analysis of Cemented or Screwed Implant-Supported Prostheses With Different Prostheses Connections

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

The Effect of Mechanical Cycling and Different Misfit Levels on Vicker's Microhardness of Retention Screws for Single Implant-Supported Prostheses

Purpose: The aim of this study was to evaluate the effect of mechanical cycling and different misfit levels on Vicker's microhardness of retention screws for single implant-supported prostheses.Materials and Methods: Premachined UCLA abutments were cast with cobalt-chromium alloy to obtain 48 crowns divided into four groups (n = 12). The crowns presented no misfit in group A (control group) and unilateral misfits of 50 mu m, 100 mu m, and 200 mu m in groups B, C, and D, respectively. The crowns were screwed to external hexagon implants with titanium retention screws (torque of 30 N/cm), and the sets were submitted to three different periods of mechanical cycling: 2 x 10(4), 5 x 10(4), and 1 x 10(6) cycles. Screw microhardness values were measured before and after each cycling period. Data were evaluated by two-way ANOVA and Tukey's test (p < 0.05).Results: Mechanical cycling statistically reduced microhardness values of retention screws regardless of cycling periods and groups. In groups A, B, and C, initial microhardness values were statistically different from final microhardness values (p < 0.05). There was no statistically significant difference for initial screw microhardness values (p > 0.05) among the groups; however, when the groups were compared after mechanical cycling, a statistically significant difference was observed between groups B and D (p < 0.05).Conclusions: Mechanical cycling reduced the Vicker's microhardness values of the retention screws of all groups. The crowns with the highest misfit level presented the highest Vicker's microhardness values.

Effect of Misfit on Preload Maintenance of Retention Screws of Implant-Supported Prostheses

The aim of this study was to evaluate the effect of unilateral misfit at different levels on a crown-implant-retention screw system of implant-supported crowns. Hexagon castable UCLA abutments were cast in Co-Cr alloy to fabricate 48 metallic crowns divided into four groups (n = 12). Group A: crowns did not present misfit; Groups B, C and D: crowns were fabricated with unilateral misfit of 50, 100, and 200 mu m, respectively. The crowns were attached by titanium retention screw with 30 N/cm to external hexagonal osseointegrated implants embedded in acrylic resin. After 2 min, the retention screw of each replica was submitted to detorque evaluation by an analogic torque gauge. Three retention screws were used to perform detorque evaluation at each replica and the procedure was repeated twice with each screw. Each group was submitted to 72 detorque measurements. Data were evaluated by ANOVA and Tukey test (P < 0.05). All groups exhibited significant decrease (P < 0.05) in preload and the lowest decrease occurred in Group A. Groups B, C, and D were statistically significant different from Group A (P < 0.05), but there was no statistically significant difference between Groups B and D (P > 0.05). Crowns with unilateral misfit presented higher preload decrease than crowns completely fitted to osseointegrated implants.

Straight and Offset Implant Placement under Axial and Nonaxial Loads in Implant-Supported Prostheses: Strain Gauge Analysis

Purpose: The aim of this in vitro study was to quantify strain development during axial and nonaxial loading using strain gauge analysis for three-element implant-supported FPDs, varying the arrangement of implants: straight line (L) and offset (O). Materials and Methods: Three Morse taper implants arranged in a straight line and three implants arranged in an offset configuration were inserted into two polyurethane blocks. Microunit abutments were screwed onto the implants, applying a 20 Ncm torque. Plastic copings were screwed onto the abutments, which received standard wax patterns cast in Co-Cr alloy (n = 10). Four strain gauges were bonded onto the surface of each block tangential to the implants. The occlusal screws of the superstructure were tightened onto microunit abutments using 10 Ncm and then axial and nonaxial loading of 30 Kg was applied for 10 seconds on the center of each implant and at 1 and 2 mm from the implants, totaling nine load application points. The microdeformations determined at the nine points were recorded by four strain gauges, and the same procedure was performed for all of the frameworks. Three loadings were made per load application point. The magnitude of microstrain on each strain gauge was recorded in units of microstrain (mu). The data were analyzed statistically by two-way ANOVA and Tukey's test (p < 0.05). Results: The configuration factor was statistically significant (p= 0.0004), but the load factor (p= 0.2420) and the interaction between the two factors were not significant (p= 0.5494). Tukey's test revealed differences between axial offset (mu) (183.2 +/- 93.64) and axial straight line (285.3 +/- 61.04) and differences between nonaxial 1 mm offset (201.0 +/- 50.24) and nonaxial 1 mm straight line (315.8 +/- 59.28). Conclusion: There was evidence that offset placement is capable of reducing the strain around an implant. In addition, the type of loading, axial force or nonaxial, did not have an influence until 2 mm.

Photoelastic stress analysis of splinted and unitary implant-supported prostheses

The aim of this study was to evaluate the effects that splinting and different lengths of implants have on the stress distribution in implant-supported prostheses by photoelastic analysis. A total of five photoelastic resin models were made with different proposed situations, and 400 load applications were performed for the analysis. Compared with the unitary prosthesis, the splinted implant-supported prosthesis acted favorably in the distribution of stresses and strains to the implant (p < 0.001). The increase in length was a significant factor in the stress distribution (p < 0.05) and, ultimately, the overall reduction in stress. It was concluded that the splinted implant-supported prosthesis behaved better biomechanically compared with the unitary prosthesis.

Three-dimensional finite element analysis of anterior single implant-supported prostheses with different bone anchorages

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Esthetics in implant-supported prostheses: a literature review

Esthetics is important for success of implant-supported prostheses. This study aimed to review esthetics concepts for implant treatment. Research in the PubMed database included studies published from 1995 to 2010 with the keywords implant esthetics, implant-supported prostheses, and esthetics. Forty-five studies were evaluated regarding the presurgical planning, surgical phase, and temporary and final restoration phases. It was concluded that esthetics in implant-supported prostheses results from a multidisciplinary approach from planning until insertion of the final restoration.

Influence of prosthesis type and retention mechanism on complications with fixed implant-supported prostheses: a systematic review applying multivariate analyses

PURPOSE To identify the influence of fixed prosthesis type on biologic and technical complication rates in the context of screw versus cement retention. Furthermore, a multivariate analysis was conducted to determine which factors, when considered together, influence the complication and failure rates of fixed implant-supported prostheses. MATERIALS AND METHODS Electronic searches of MEDLINE (PubMed), EMBASE, and the Cochrane Library were conducted. Selected inclusion and exclusion criteria were used to limit the search. Data were analyzed statistically with simple and multivariate random-effects Poisson regressions. RESULTS Seventy-three articles qualified for inclusion in the study. Screw-retained prostheses showed a tendency toward and significantly more technical complications than cemented prostheses with single crowns and fixed partial prostheses, respectively. Resin chipping and ceramic veneer chipping had high mean event rates, at 10.04 and 8.95 per 100 years, respectively, for full-arch screwed prostheses. For "all fixed prostheses" (prosthesis type not reported or not known), significantly fewer biologic and technical complications were seen with screw retention. Multivariate analysis revealed a significantly greater incidence of technical complications with cemented prostheses. Full-arch prostheses, cantilevered prostheses, and "all fixed prostheses" had significantly higher complication rates than single crowns. A significantly greater incidence of technical and biologic complications was seen with cemented prostheses. CONCLUSION Screw-retained fixed partial prostheses demonstrated a significantly higher rate of technical complications and screw-retained full-arch prostheses demonstrated a notably high rate of veneer chipping. When "all fixed prostheses" were considered, significantly higher rates of technical and biologic complications were seen for cement-retained prostheses. Multivariate Poisson regression analysis failed to show a significant difference between screw- and cement-retained prostheses with respect to the incidence of failure but demonstrated a higher rate of technical and biologic complications for cement-retained prostheses. The incidence of technical complications was more dependent upon prosthesis and retention type than prosthesis or abutment material.

Avaliação da desadaptação das selas de próteses parciais removíveis após 1 a 5 anos de uso

The non-adaptation of the removable partial prosthesis (RPP) base to fibromucosal tissue is caused by resorption of residual ridges (RRR). The onset of bone resorption, which occurs after tooth extraction and continues throughout life, is accelerated by local or systemic factors. Aim: Assess the degree of non-adaptation of removable partial prosthesis saddles and the factors that influence it. Methodology: A sectional study was conducted with 81 patients using RPP who had their prostheses installed between 2003 and 2007 (1 to 5 years of use) at the Faculty of Dentistry of the Universidade Federal do Rio Grande do Norte (UFRN). After anamnese and clinical examination, a cast was made with polyether-based material, using the base of the prosthesis to make the impression. The base of the saddle was loaded with the casting material and positioned in the mouth, applying pressure on the supports. After polymerization, the material was removed from the saddle and measurements were taken at 3 different points using a pachymeter. Results: The non-adaptation of the saddle increased significantly with years of use (p = 0.005). The tooth-tissue supported prostheses obtained higher mean non-adaptation values than those of tooth supported prostheses (p < 0.001). Flaccid mucosa showed the worst non-adaptation results, which were statistically different from resilient mucosa (p < 0.001). The greater the extension of the saddle, the greater the non-adaptation (p < 0.001). The natural tooth antagonistic arch yielded better results than did RPP and total prosthesis (p < 0.001). Saddle non-adaptation at the free end was less near the pillar tooth and greater in the more posterior region (p < 0.001). When adaptation of the supports to the niches was poor, greater saddle non-adaptation occurred than when it was good or fair (p < 0.001). Saddles located in the posterior region of the arch had greater non-adaptation than those in the anterior region (p = 0.023). Conclusion: The mean non-adaptation of the saddle to the residual ridges was 0.27 mm. It can be concluded that, even with the use of RPP, bone height reduction was slight within the 1-5-year period of use. The following are factors that influence adaptation of the RPP saddle base: years of use, age, force transmission path to the alveolar bone, location of the toothless area, antagonistic arch, type of mucosa, adaptation of supports to the niche and extension of the saddle

Resolução estética associando prótese sobre implante e prótese convencional na região anterior

The combination of several methods for solving aesthetics in a clinical case can be a complicating factor. The diagnosis and planning of the event held in conjunction with the dental technician expand the possibilities of success. The present case illustrates the aesthetic resolution through the association of implant- and tooth-supported prostheses using metal free ceramic systems. A 38-year old male patient presented with a complex smile. After diagnosis and treatment planning, two ceramic crowns were made, one on tooth 11 and one on the implant region 21, along with a laminated porcelain veneer on the region of 12. Aesthetic needs of the patient are predictable only with a sound diagnosis.

A Systematic Review of the Clinical Performance of Tooth-Retained and Implant-Retained Double Crown Prostheses with a Follow-Up of ≥3 Years

Purpose: The objective of this review was to systematically screen the literature for data related to the survival and complication rates observed with dental or implant double crown abutments and removable prostheses under functional loading for at least 3 years. Materials and Methods: A systematic review of the dental literature from January 1966 to December 2009 was performed in electronic databases (PubMed and Embase) as well as by an extensive hand search to investigate the clinical outcomes of double crown reconstructions. Results: From the total of 2412 titles retrieved from the search, 65 were selected for full-text review. Subsequently, 17 papers were included for data extraction. An estimation of the cumulative survival and complication rates was not feasible due to the lack of detailed information. Tooth survival rates for telescopic abutment teeth ranged from 82.5% to 96.5% after an observation period of 3.4 to 6 years, and for tooth-supported double crown retained dentures from 66.7% to 98.6% after an observation period of 6 to 10 years. The survival rates of implants were between 97.9% and 100% and for telescopic-retained removable dental prostheses with two mandibular implants, 100% after 3.0 and 10.4 years. The major biological complications affecting the tooth abutments were gingival inflammation, periodontal disease, and caries. The most frequent technical complications were loss of cementation and loss of facings. Conclusions: The main findings of this review are: (I) double crown tooth abutments and dentures demonstrated a wide range of survival rates. (II) Implant-supported mandibular overdentures demonstrated a favorable long-term prognosis. (III) A greater need for prosthetic maintenance is required for both tooth-supported and implant-supported reconstructions. (IV) Future areas of research would involve designing appropriate longitudinal studies for comparisons of survival and complication rates of different reconstruction designs.

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.

Quality of reporting of clinical studies to assess and compare performance of implant-supported restorations

The objective of this analysis was to assess and compare the 5- and 10-year survival of different types of tooth-supported and implant-supported fixed dental prostheses (FDPs) and single crowns (SCs), and to describe the incidence of biological and technical complications with emphasis on quality of reporting.

Validation of an experimental polyurethane model for biomechanical studies on implant-supported prosthesis: compression tests

OBJECTIVES: The complexity and heterogeneity of human bone, as well as ethical issues, most always hinder the performance of clinical trials. Thus, in vitro studies become an important source of information for the understanding of biomechanical events on implant-supported prostheses, although study results cannot be considered reliable unless validation studies are conducted. The purpose of this work was to validate an artificial experimental model based on its modulus of elasticity, to simulate the performance of human bone in vivo in biomechanical studies of implant-supported prostheses. MATERIAL AND METHODS: In this study, fast-curing polyurethane (F16 polyurethane, Axson) was used to build 40 specimens that were divided into five groups. The following reagent ratios (part A/part B) were used: Group A (0.5/1.0), Group B (0.8/1.0), Group C (1.0/1.0), Group D (1.2/1.0), and Group E (1.5/1.0). A universal testing machine (Kratos model K - 2000 MP) was used to measure modulus of elasticity values by compression. RESULTS: Mean modulus of elasticity values were: Group A - 389.72 MPa, Group B - 529.19 MPa, Group C - 571.11 MPa, Group D - 470.35 MPa, Group E - 437.36 MPa. CONCLUSION: The best mechanical characteristics and modulus of elasticity value comparable to that of human trabecular bone were obtained when A/B ratio was 1:1.