Accuracy of Impression Techniques for Impants. Part 2-Comparison of Splinting Techniques

Purpose: The aim of this study was to compare splinting techniques for impression copings of osseointegrated implants with different angulations.Materials and Methods: Replicas (N = 24) of a metal matrix (control) containing two implants at 90 degrees and 65 degrees in relation to the horizontal surface were obtained by using four impression techniques: Technique 1 (T1), direct technique with square copings without union in open trays; Technique 2 (T2), square copings splinted with dental floss and autopolymerizing acrylic resin; Technique 3 (T3), square copings splinted with dental floss and autopolymerizing acrylic resin, sectioned and splinted again with autopolymerizing acrylic resin; Technique 4 (T4), square copings splinted with prefabricated acrylic resin bar. The impression material was polyether. The replicas were individually scanned to capture the images, which were assessed in a graphic computation program. The program allowed the angulation between the bases of the replicas and the reading screws to be measured. The images of the replicas were compared with the matrix image (control), and the differences in angulations from the control image were calculated. The analysis of variance and the Tukey test for comparisons (p < 0.05) were used for statistical analysis.Results: All groups showed significant differences in the implant angulations in comparison with the control group (p < 0.05). Group T1 showed the highest difference (1.019 degrees) followed by groups T2 (0.747 degrees), T3 (0.516 degrees), and T4 (0.325 degrees), which showed the lowest angular alteration compared to the control group. There were significant differences between inclined and straight implants in all the groups, except in group T4.Conclusions: Based on the results, the splinting of pick-up impression copings is indicated for osseointegrated implant impressions. The square copings splinted with a prefabricated acrylic resin bar presented the best results among the pick-up impression techniques evaluated in this study.

Prosthetic transfer impression accuracy evaluation for osseointegrated implants

Purpose: The objective of this study was to evaluate and compare 3 impression techniques for osseointegrated implant transfer procedures.Materials and Methods: (1) Group Splinted with Acrylic Resin (SAR), impression with square copings splinted with prefabricated autopolymerizing acrylic resin bar; (2) Group Splinted with Light-Curing Resin (SLR), impression, with square copings splinted with prefabricated light-curing composite resin bar; (3). Group Independent Air-abraded (IAA), impression with independent square coping aluminum oxide air-abraded. Impression procedures were performed with polyether material, and the data obtained was compared with a control group. These were characterized by metal matrix (MM) measurement values of the implants inclination positions at 90 and 05 degrees in relation to the matrix surface. Readings of analogs and implant inclinations were assessed randomly through graphic computation AutoCAD software. Experimental groups angular deviation with MM were submitted to analysis of variance and means were compared through Tukey's test (P < 0.05).Results: There was no statistical significant difference between SAR and SLR experimental groups and MM for vertical and angulated implants. Group IAA presented a statistically significant difference for angulated implants.Conclusion: It was concluded within the limitations of this study, that SAR and SLR produced more accurate casts than IAA technique, which presented inferior results.

The Effect of Splint Material Rigidity in Implant Impression Techniques

Purpose This in vitro study compared the dimensional accuracy of two impression techniques Duralay splinted impression copings (D) and metal splinted impression copings (M) for implant supported pros theses Materials and Methods A master cast with four parallel implant abutment analogs and a passive framework were fabricated Vinyl polysiloxane impression material was used for all impressions with a metal stock tray Two groups (D and M) were tested (n = 5) The measurement method employed was just one titanium screw tightened to the framework Each group s measurements were analyzed using software that received the images of a video camera coupled to a stereomicroscope at X100 magnification The results were analyzed statistically (t test) Results The mean values of abutment/framework interface gaps were master cast = 32 mu m (SD 2), group D = 165 mu m (SD 60), and group M = 69 mu m (SD 36) There was a statistically significant difference between the D and M groups (P <= 001) Conclusion Under the limitations of this study, it could be suggested that a more accurate working cast can be fabricated using metal splinted impression copings INT J ORAL MAXILLOFAC IMPLANTS 2010 25 1153-1158

Comparison of impression techniques and materials for implant-supported prosthesis

Purpose: To investigate, in vitro, the dimensional accuracy of two impression techniques (squared impression copings and squared impression copings sandblasted and coated with impression adhesive) made of vinyl polysiloxane and polyether impression materials. Materials and Methods: A master cast (control group) with four parallel implant abutment analogs, a passive framework, and a custom aluminum tray was fabricated. Four groups (n = 5 each group) were tested: squared Impregum (SI), squared Express (SE), sandblasted adhesive squared Impregum (ASI), and sandblasted adhesive squared Express (ASE). The measurement method employed was just one titanium screw tightened to the framework. A stereomicroscope was used to evaluate the fit of the framework by measuring the size of the gap between the abutment and the framework. The results were analyzed statistically. Results: The mean values for the abutment/framework interface gaps were: master cast, 31.63 mu m (SD 2.16); SI, 38.03 mu m (SD 9.29); ASI, 46.80 mu m (SD 8.47); SE, 151.21 mu m (SD 22.79); and ASE, 136.59 mu m (SD 29.80). No significant difference was detected between the SI or ASI techniques and the master cast. No significant difference was detected between the SE and ASE techniques. Conclusion: Within the limitations of this study, it can be concluded that Impregum Soft medium consistency was the best impression material and the impression technique did not influence the accuracy of the stone casts. INT J ORAL MAXILLOFAC IMPLANTS 2010;25:771-776

Evaluation of Different Methods of Optical Impression Making on the Marginal Gap of Onlays Created with CEREC 3D

Objectives: This study evaluated the marginal gaps on several surfaces of onlays created with the Cerec 3D system using one intraoral and two extraoral optical impression methods. Methods: A human molar (#19) was mounted with its adjacent teeth on a typodont (Frasaco) and prepared for a MODL onlay. The typodont was assembled in the mannequin head in order to simulate clinical conditions. The same operator took 36 individual optical impressions using a CEREC 3D camera. For group 1 (IP), a thin layer of titanium dioxide powder (CEREC powder-VITA) was applied directly onto the surface of the preparation for imaging (n=12). For group 2 (EP), a sectional impression was taken with hydrocolloid Identic Syringable (Dux Dental), a die made with polyvinylsiloxane KwikkModel Scan (R-dental Dentalerzeugnisse GmbH) and powdered with titanium dioxide for imaging (n=12). For group 3 (ES), a sectional impression was taken with PVS and a sectional stock tray, a die fabricated in stone (Diamond die- HI-TEC Dental Products) and the die being imaged without powdering (n=12). One operator designed and machined the onlays in Vita Blocks Mark II for Cerec (VITA) using a CEREC 3D. The marginal gaps (pm) were measured with an optical microscope (50x) at 12 points, three on each surface of the MODL. The results were analyzed by two-way ANOVA/Tukey's (p=0.05). Results: The overall mean marginal gaps (mu m) for the three methods were: IP=111.6 (+/- 34.0); EP=161.4 (+/- 37.6) and ES=116.8 (+/- 42.3). IP and ES were equal, but both were significantly less than EP. The pooled mean marginal gaps (mu m) for the occlusal = 110.5 (+/- 39) and lingual = 111.5 (+/- 30.5) surfaces were equivalent and significantly less than the distal = 136.5 (+/- 42.5) and mesial = 161.1 (+/- 43.3). Conclusion: The marginal gap of CEREC 3D onlay restorations was not different when the optical impression was taken intraorally vs extraorally using a stone cast that does not require powdering. The lingual and occlusal surfaces showed the lowest gaps.

Avaliação da performance da inspeção visual, sondagem, radiografia interproximal, separação dental e laser de fluorescência no diagnóstico de lesões cariosas proximais

Pós-graduação em Odontologia - FOA

MODIFIED INDEXING TECHNIQUE FOR THE IMMEDIATE INTERIM RESTORATION OF A DENTAL IMPLANT

Because of the functional and esthetic requirements of patients, different techniques have been proposed to reduce the time between dental implant placement and interim restoration fabrication. This article describes a modified indexing technique by using a surgical template for open-tray impression and definitive cast development during immediate loading procedures. This technique does not use a complete impression of the oral cavity and, therefore, is more comfortable, less time consuming, and less expensive. It also allows the fabrication of interim restorations with the optimal shape for developing an adequate emergence profile.

Effect of the association between the tray and impression techniques on angulated implants using the All-on-Four system

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

Evaluation of fluid transport processes in dental enamel. Methods to assess the relevance of enamel permeability in caries prevention and etching treatments.

This thesis evaluated in vivo and in vitro enamel permeability in different physiological and clinical conditions by means of SEM inspection of replicas of enamel surface obtained from polyvinyl siloxane impressions subsequently later cast in polyether impression ma-terial. This technique, not invasive and risk-free, allows the evaluation of fluid outflow from enamel surface and is able to detect the presence of small quantities of fluid, visu-alized as droplets. Fluid outflow on enamel surface represents enamel permeability. This property has a paramount importance in enamel physiolgy and pathology although its ef-fective role in adhesion, caries pathogenesis and prevention today is still not fully under-stood. The aim of the studies proposed was to evaluate enamel permeability changes in differ-ent conditions and to correlate the findings with the actual knowledge about enamel physiology, caries pathogenesis, fluoride and etchinhg treatments. To obtain confirmed data the replica technique has been supported by others specific techniques such as Ra-man and IR spectroscopy and EDX analysis. The first study carried out visualized fluid movement through dental enamel in vivo con-firmed that enamel is a permeable substrate and demonstrated that age and enamel per-meability are closely related. Examined samples from subjects of different ages showed a decreasing number and size of droplets with increasing age: freshly erupted permanent teeth showed many droplets covering the entire enamel surface. Droplets in permanent teeth were prominent along enamel perikymata. These results obtained through SEM inspection of replicas allowed innovative remarks in enamel physiology. An analogous testing has been developed for evaluation of enamel permeability in primary enamel. The results of this second study showed that primary enamel revealed a substantive permeability with droplets covering the entire enamel sur-face without any specific localization accordingly with histological features, without changes during aging signs of post-eruptive maturation. These results confirmed clinical data that showed a higher caries susceptibility for primary enamel and suggested a strong relationship between this one and enamel permeability. Topical fluoride application represents the gold standard for caries prevention although the mechanism of cariostatic effect of fluoride still needs to be clarified. The effects of topical fluoride application on enamel permeability were evaluated. Particularly two dif-ferent treatments (NaF and APF), with different pH, were examined. The major product of topical fluoride application was the deposition of CaF2-like globules. Replicas inspec-tion before and after both treatments at different times intervals and after specific addi-tional clinical interventions showed that such globule formed in vivo could be removed by professional toothbrushing, sonically and chemically by KOH. The results obtained in relation to enamel permeability showed that fluoride treatments temporarily reduced enamel water permeability when CaF2-like globules were removed. The in vivo perma-nence of decreased enamel permeability after CaF2 globules removal has been demon-strated for 1 h for NaF treated teeth and for at least 7 days for APF treated teeth. Important clinical consideration moved from these results. In fact the caries-preventing action of fluoride application may be due, in part, to its ability to decrease enamel water permeability and CaF2 like-globules seem to be indirectly involved in enamel protection over time maintaining low permeability. Others results obtained by metallographic microscope and SEM/EDX analyses of or-thodontic resins fluoride releasing and not demonstrated the relevance of topical fluo-ride application in decreasing the demineralization marks and modifying the chemical composition of the enamel in the treated area. These data obtained in both the experiments confirmed the efficacy of fluoride in caries prevention and contribute to clarify its mechanism of action. Adhesive dentistry is the gold standard for caries treatment and tooth rehabilitation and is founded on important chemical and physical principles involving both enamel and dentine substrates. Particularly acid etching of dental enamel enamel has usually employed in bonding pro-cedures increasing microscopic roughness. Different acids have been tested in the litera-ture suggesting several etching procedures. The acid-induced structural transformations in enamel after different etching treatments by means of Raman and IR spectroscopy analysis were evaluated and these findings were correlated with enamel permeability. Conventional etching with 37% phosphoric acid gel (H3PO4) for 30 s and etching with 15 % HCl for 120 s were investigated. Raman and IR spectroscopy showed that the treatment with both hydrochloric and phosphoric acids induced a decrease in the carbonate content of the enamel apatite. At the same time, both acids induced the formation of HPO42- ions. After H3PO4 treatment the bands due to the organic component of enamel decreased in intensity, while in-creased after HCl treatment. Replicas of H3PO4 treated enamel showed a strongly reduced permeability while replicas of HCl 15% treated samples showed a maintained permeability. A decrease of the enamel organic component, as resulted after H3PO4 treatment, involves a decrease in enamel permeability, while the increase of the organic matter (achieved by HCl treat-ment) still maintains enamel permeability. These results suggested a correlation between the amount of the organic matter, enamel permeability and caries. The results of the different studies carried out in this thesis contributed to clarify and improve the knowledge about enamel properties with important rebounds in theoretical and clinical aspects of Dentistry.

Design of removable partial dentures: a survey of dental laboratories in Greece

The aim of this study was to compare data on design and fabrication methods of removable partial dentures (RPDs) in two major cities in Greece. A questionnaire was sent to 150 randomly selected dental technicians. The participation rate was 79.3%. The anterior palatal strap, the lingual bar, and the Roach-type clasp arm designs were preferred. Half of the RPDs fabricated were retained using precision attachments. Differences between the two cities were observed in types of major maxillary connectors used, types of attachments and impression materials used, as well as the design of distal-extension RPDs. Postdoctoral education was found to have an impact on RPD fabrication. Despite the differences observed, design and fabrication of RPDs followed commonly used principles.

Marginal fit of cemented and screw-retained crowns incorporated on the Straumann (ITI) Dental Implant System: an in vitro study

AIM: The aim of this study was to assess the marginal fit of crowns on the Straumann (ITI) Dental Implant System with special consideration of different casting dental materials. MATERIAL AND METHODS: Sixty porcelain-fused-to-metal crowns were fabricated: 18 crowns on standard cone abutments with an impression cylinder, partially prefabricated analogs, no coping and screw-retained (A); 18 crowns on solid abutments without an impression device, no analogs, no coping and cemented (B); and 18 crowns on solid abutments using an impression transfer cap, an analog with a shoulder, no coping and cemented (C). In each group, six crowns were made on epoxy mastercasts (Bluestar), six on synthetic plaster (Moldasynt) and six on super hard stone (Fujirock). Six additional crowns were fabricated with the transversal screw retention system onto the Octa system with impression transfer caps, metal analogs, gold copings and screw-retained (D). Impregum was used as impression material. Crowns of B and C were cemented with KetacCem. Crowns of A and D were fixed with an occlusal screw torqued at 15 N cm. Crowns were embedded, cut and polished. Under a light microscope using a magnification of x 100, the distance between the crown margin (CM) and the shoulder (marginal gap, MG) and the distance between the CM and the end of the shoulder (crown length, CL) was measured. RESULTS: MGs were 15.4+/-13.2 microm (A), 21.2+/-23.1 microm (B), 11+/-12.1 microm (C) and 10.4+/-9.3 microm (D). No statistically significantly differences using either of the casting materials were observed. CLs were -21.3+/-24.8 microm (A), 3+/-28.9 microm (B), 0.5+/-22 microm (C) and 0.1+/-15.8 microm (D). Crowns were shorter on synthetic casting materials compared with stone casts (P<0.005). CONCLUSIONS: CMs fit precisely with both cemented and screw-retained versions as well as when using no, partial or full analogs.

Deflection of conventional versus nondeflecting dental needles in vitro.

Deflection of conventional and newly introduced nondeflecting dental local anesthetic needles were compared in vitro by radiographic examination of the course of the needles in a hydrocolloid impression material. Results indicated significantly less deflection of the new needles when compared to a variety of conventional needles. Controlled clinical trials will be required to test the significance of this finding.

In Vitro Implant Impression Accuracy Using a New Photopolymerizing SDR Splinting Material

PURPOSE The study aims to evaluate three-dimensionally (3D) the accuracy of implant impressions using a new resin splinting material, "Smart Dentin Replacement" (SDR). MATERIALS AND METHODS A titanium model of an edentulous mandible with six implant analogues was used as a master model and its dimensions measured with a coordinate measuring machine. Before the total 60 impressions were taken (open tray, screw-retained abutments, vinyl polysiloxane), they were divided in four groups: A (test): copings pick-up splinted with dental floss and fotopolymerizing SDR; B (test): see A, additionally sectioned and splinted again with SDR; C (control): copings pick-up splinted with dental floss and autopolymerizing Duralay® (Reliance Dental Mfg. Co., Alsip, IL, USA) acrylic resin; and D (control): see C, additionally sectioned and splinted again with Duralay. The impressions were measured directly with an optomechanical coordinate measuring machine and analyzed with a computer-aided design (CAD) geometric modeling software. The Wilcoxon matched-pair signed-rank test was used to compare groups. RESULTS While there was no difference (p = .430) between the mean 3D deviations of the test groups A (17.5 μm) and B (17.4 μm), they both showed statistically significant differences (p < .003) compared with both control groups (C 25.0 μm, D 19.1 μm). CONCLUSIONS Conventional impression techniques for edentulous jaws with multiple implants are highly accurate using the new fotopolymerizing splinting material SDR. Sectioning and rejoining of the SDR splinting had no impact on the impression accuracy.