A systematic review of the performance of ceramic and metal implant abutments supporting fixed implant reconstructions

OBJECTIVES: The objective of this systematic review was to assess the 5-year survival rates and incidences of complications associated with ceramic abutments and to compare them with those of metal abutments. METHODS: An electronic Medline search complemented by manual searching was conducted to identify randomized-controlled clinical trials, and prospective and retrospective studies providing information on ceramic and metal abutments with a mean follow-up time of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data abstraction was performed independently by three reviewers. Failure rates were analyzed using standard and random-effects Poisson regression models to obtain summary estimates of 5-year survival proportions. RESULTS: Twenty-nine clinical and 22 laboratory studies were selected from an initial yield of 7136 titles and data were extracted. The estimated 5-year survival rate of ceramic abutments was 99.1% [95% confidence interval (CI): 93.8-99.9%] and 97.4% (95% CI: 96-98.3%) for metal abutments. The estimated cumulative incidence of technical complications after 5 years was 6.9% (95% CI: 3.5-13.4%) for ceramic abutments and 15.9% (95% CI: 11.6-21.5%) for metal abutments. Abutment screw loosening was the most frequent technical problem, occurring at an estimated cumulative incidence after 5 years of 5.1% (95% CI: 3.3-7.7%). All-ceramic crowns supported by ceramic abutments exhibited similar annual fracture rates as metal-ceramic crowns supported by metal abutments. The cumulative incidence of biological complications after 5 years was estimated at 5.2% (95% CI: 0.4-52%) for ceramic and 7.7% (95% CI: 4.7-12.5%) for metal abutments. Esthetic complications tended to be more frequent at metal abutments. A meta-analysis of the laboratory data was impossible due to the non-standardized test methods of the studies included. CONCLUSION: The 5-year survival rates estimated from annual failure rates appeared to be similar for ceramic and metal abutments. The information included in this review did not provide evidence for differences of the technical and biological outcomes of ceramic and metal abutments. However, the information for ceramic abutments was limited in the number of studies and abutments analyzed as well as the accrued follow-up time. Standardized methods for the analysis of abutment strength are needed.

Estudio del proceso de fabricación de la industria cerámica

[ES]Mediante este trabajo se tiene como objetivo el análisis energético del proceso de fabricación de productos cerámicos, así como un análisis y valoración de posibles mejoras. El trabajo se basará en una descripción del proceso, analizando todos los elementos que intervienen en él, desde las materias primas hasta los equipos. Aunque se hará una descripción de todos los productos cerámicos que existen en el mercado, este trabajo se focalizará en los productos de construcción y menaje, puesto que son los que mayor producción tienen dentro del estado español. Por último se indicarán una serie de propuestas de mejora, junto con un presupuesto para cuantificar éstas.

Efeito da temperatura de secagem de dois tipos de silano e da supressão ou redução do tempo de condicionamento com ácido hidrofluorídrico na resistência de união entre uma cerâmica de dissilicato de lítio e um cimento resinoso

Este estudo avaliou o efeito de diferentes métodos de silanização e aplicação do ácido hidrofluorídrico (HF) sobre a resistência à microtração de uma cerâmica de dissilicato de lítio a um cimento resinoso. Quarenta blocos de IPS e.max Press /Ivoclar Vivadent (5x5x6mm) foram cimentados a blocos de resina Z250/3M ESPE (5x5x6mm) usando o cimento resinoso RelyX ARC/3M ESPE de acordo com os seguintes métodos de tratamento superficial: G1: 20s de ácido fluorídrico (HF) + silano não hidrolisado Primer-Activactor/Dentsply (SNH) seco à temperatura ambiente; G2: 20s HF + silano pré-hidrolisado RelyX Ceramic-Primer/3M ESPE (SPH) seco à temperatura ambiente; G3: 10s HF + SNH seco com ar quente (50oC-2min); G4: 10sHF + SPH seco com ar quente (50oC-2min); G5: sem ácido, SNH seco com ar quente (50oC-2min); G6: sem ácido, SPH seco com ar quente (50oC-2min); G7: sem ácido, SNH seco à temperatura ambiente; G8: sem ácido, SPH seco à temperatura ambiente. Antes de cada método de silanização, os blocos cerâmicos receberam acabamento com lixas de carbeto de silício (220-600) e limpeza com ácido fosfórico 37% (1min). A cimentação foi realizada com carga vertical de 1kg por 10min. Os conjuntos de cerâmica/cimento/resina foram armazenados em água destilada (37C) por 24 horas e depois seccionados em máquina de corte Isomet 1000 a fim de obter palitos (n = 40) de 1mm2 de área da seção transversal, que foram submetidos ao teste de microtração em máquina de ensaio universal Emic (v = 0,5mm/min). O modo de fratura foi avaliado em microscópio eletrônico de varredura. A análise estatística foi realizada utilizando ANOVA / Dunnett (p-valor = 0,000). As médias MPa e desvio padrão foram: G1-21,5 (8,9) BC; G2-30,5 (7,2) A; G3-19.4 (9.1) BC; G4-24,0 (9,0) B; G5-8.1 (3.2) D; G6 -18,0 (6,2) C; G7-7.8 (2,6) D; G8-6.3 (2,5) D. Grupos 2, 3, 4 e 6 não tiveram falhas prematuras dos palitos contra os grupos 1, 5, 7 e 8, que apresentaram 2,2; 44,4; 75,6 e 33,3% de perdas prematuras, respectivamente. O teste de correlação foi realizado apresentando significância estatística, com valor de -0,736 (p-valor = 0,000), mostrando que, a medida que o percentual de perda prematura aumenta, a média da MPa diminui. Quanto ao modo de fratura, observou-se 44,97% de falhas do tipo mista, 51,70% de falhas do tipo adesiva, 3,33% de falhas do tipo coesiva do cimento. Quando é realizada a supressão do condicionamento com HF como pré-tratamento da superfície cerâmica IPS e.max Press, a aplicação de silano SPH, associada ao seu tratamento térmico, deve ser o método de silanização recomendado, embora os valores mais elevados de resistência de união tenham sido os obtidos quando utilizado o condicionamento com HF por 20s. Quando é realizada a redução do tempo de condicionamento com HF para 10s, a aplicação do silano (SPH ou SNH) deve ser sempre associada ao seu tratamento térmico. O SNH só deve ser usado se as superfícies das cerâmicas IPS e.max Press forem tratadas com HF.

Avaliação dos tipos de reabilitações fixas dento-suportadas em dentes anteriores

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

Reabilitação fixa aparafusada Vs. reabilitação fixa cimentada

Projeto de Pós-Graduação/Dissertação apresentado à Universidade Fernando Pessoa como parte dos requisitos para obtenção do grau de Mestre em Medicina Dentária

COLOR STABILITY OF DENTAL CERAMICS SUBMITTED TO ARTIFICIAL ACCELERATED AGING AFTER REPEATED FIRINGS

Statement of problem. Color stability is an important factor to ensure the long-term clinical success of ceramic restorations. There is a lack of information on how color is affected by fabrication procedures, such as the number of firings. Purpose. The purpose of this study was to evaluate the effects that the number of firings and type of substrate have on the color stability of dental ceramic submitted to artificial accelerated aging. Material and methods. Sixty specimens were fabricated: 30 metal ceramic (Verabond II + IPS d.SIGN) and 30 all-ceramic (IPS d.SIGN). Specimens were divided into 3 groups (n=10), and submitted to 2, 3, or 4 firings (+/- 900 degrees C), respectively, according to the manufacturer`s instructions. Color readings were obtained with a spectro photometer before and after artificial accelerated aging, and L*, a*, and b* coordinates and total color variation (Delta E) were analyzed (2-way ANOVA, Bonferroni, (alpha=05). Results. For metal ceramic specimens, differences for the L* coordinates were significant (P<.05) only for the group submitted to 3 firings. With respect to the all-ceramic specimens, smaller L* coordinates were obtained for greater a* and b* coordinates, indicating that the greater the number of firings, the darker and more reddish/yellowish the specimen. All Delta E values, for all groups, were below 1.0. All-ceramic specimens submitted to 3 and 4 firings presented Delta E means differing statistically (P<.05) from those of the metal ceramic group. Conclusions. The type of substrate and number of firings affected the color stability of the ceramic material tested. Artificial accelerated aging did not produce perceptible color stability changes (Delta E<1.0). (J Prosthet Dent 2009-101:13-18)

Recovering the function and esthetics of fractured teeth using several restorative cosmetic approaches. Three clinical cases

The teeth most commonly affected by trauma are the maxillary central incisors. The most frequent types of traumatic dental injuries to permanent teeth are enamel fractures, enamel and dentine fractures, and enamel and dentine fractures with pulp involvement. This article describes three clinical cases with different levels of traumatized maxillary incisors and several cosmetic approaches for recovery of the esthetics and the masticatory function, as well as the social/psychological aspects of treatment. All cases involved young adult men. The three clinical cases involve dentin and enamel fractures, dentin and enamel fractures with pulp exposure, and dentin and enamel fractures with pulp exposure associated with root fracture. The cosmetic treatments used to resolve fractures were direct composite resin by layering technique, indirect all-ceramic restorations (laminate veneer and ceramic crowns over the teeth), and immediate implant after extraction followed by immediate loading (ceramic abutments with ceramic crown over implant). In all three cases, excellent functional and esthetic results were achieved by use of these treatment modalities. The patients were very satisfied with the results.

Evaluation of thermal compatibility between core and veneer dental ceramics using shear bond strength test and contact angle measurement

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Surface degradation of glass ceramics after exposure to acidulated phosphate fluoride

Objective: This study evaluated the surface degradation effect of acidulated phosphate fluoride (APF) gel exposure on the glassy matrix ceramics as a function of time. Material and methods: Disc-shaped ceramic specimens (N = 120, 10/per ceramic material) were prepared in stainless steel molds (inner diameter: 5 mm, height: 2 mm) using 6 dental ceramics: 3 indicated for ceramic-fused-to-metal (Vita Omega 900, Carmen and Vita Titankeramik), 2 for all-ceramic (Vitadur Alpha and Finesse (R) Low Fusing) and 1 for both types of restorations (IPS d. SIGN). The specimens were wet ground finished, ultrasonically cleaned and auto-glazed. All specimens were subjected to calculation of percentage of mass loss, surface roughness analysis and topographical description by scanning electron microscopy (SEM) before (0 min) and after exposure to 1.23 % APF gel for 4 min and 60 min representing short-and long-term etching effect, respectively. The data were analyzed using two-way ANOVA with repeated measures and Tukey` s test (alpha=0.05). Results: Significant effect of the type of the ceramics (p=0.0000, p=0.0031) and exposure time (p=0.0000) was observed in both surface roughness and percentage of mass loss values, respectively. The interaction factor between both parameters was also significant for both parameters (p=0.0904, p=0.0258). Both 4 min (0.44 +/- 0.1-0.81 +/- 0.2 mu m) and 60 min (0.66 +/- 0.1 - 1.04 +/- 0.3 mu m) APF gel exposure created significantly more surface roughness for all groups when compared to the control groups (0.33 +/- 0.2-0.68 +/- 0.2 mu m) (p<0.05). There were no significant differences in percentage of mass loss between the ceramics at 4 min (p>0.05) but at 60 min exposure, IPS d. SIGN showed the highest percentage of mass loss (0.1151 +/- 0.11). The mean surface roughness for Vita Titankeramik (0.84 +/- 0.2 mu m) and Finesse (R) Low Fusing (0.74.+/- 0.2 mu m) was significantly higher than those of the other ceramics (0.59 +/- 0.1 mu m - 0.49 +/- 0.1 mu m) and Vita Titankeramik (p<0.05) regardless of the exposure time. A positive correlation was found between surface roughness and percentage of mass loss for all ceramic materials [(r=0.518 (Vitadur Alpha), r=0.405 (Vita Omega 900), r=0.580 (Carmen), r=0.687 (IPS d. SIGN), r=0.442 (Finesse (R) Low Fusing), r=0.572 (Vita Titankeramik), Pearson's correlation coefficient)]. The qualitative SEM analysis showed evidence of corrosive attack on all of ceramics at varying degrees. Conclusions: The ceramics indicated for either metal-ceramic or all-ceramic restorations were all vulnerable to surface texture changes and mass loss after short-term and long-term APF gel exposure.

Functional and esthetic rehabilitation with In-Ceram alumina and zirconia system: A multidisciplinary approach

The development of all-ceramic systems following metalceramics restorations allowed simulation of natural dentition due to favorable esthetics and resistance. In-Ceram is an alternative when esthetics is primordial as well as resistance required in rehabilitation. However, an ideal smile is associated to not only shape, color, texture and translucency but also harmony with gingival tissue. So, the aim of this study is to report a clinical case based on periodontal and fixed partial dentures principles to perform periodontal plastic surgery followed by esthetic rehabilitation. A female patient, 40-year-old, presented complaint about dental esthetics. After clinical and radiographic exams, metal-ceramics crowns (teeth 11, 12, 13, 21, 22 and 23) were considered unsatisfactory due to marginal leakage, color change in gingival tissue associated to metallic margin, and gummy smile. So, a crown lengthening surgery of anterior teeth was performed followed by rehabilitation of superior teeth with In-Ceram single crowns. Clinical significance: The interaction between periodontics and fixed prosthodontic area is the key of an adequated treatment planning which involves gingival smile to provide function and an esthetic condition in association with an esthetic, resistant and predictable material.

Avaliação in vitro da translucidez de dois sistemas cerâmicos metal-free: In-Ceram x Empress 2

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Análise in vitro da estabilidade de cor e rugosidade superficial de braquetes ortodônticos cerâmicos

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

Avaliação da adaptação marginal de restaurações cerâmicas inlay após a cimentação

Pós-graduação em Odontologia Restauradora - ICT

Análise da influência de diferentes tratamentos superficiais de sistemas cerâmicos na resistência de união adesiva

Pós-graduação em Ciências Odontológicas - FOAR

Fratura precoce da porcelana em restaurações com infra-estrutura de zircônia: influência de gradientes térmicos no desenvolvimento e magnitude de tensões residuais e transitórias

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)