Analysis of mechanical behavior of implant-supported prostheses in the anterior maxilla: analysis by speckle pattern interferometry

The use of implants to rehabilitation of total edentulous, partial edentulous or single tooth is increasing, it is due to the high rate of success that this type of treatment present. The objective of this study was to analyze the mechanical behavior of different positions of two dental implants in a rehabilitation of 4 teeth in the region of maxilla anterior. The groups studied were divided according the positioning of the implants. The Group 1: Internal Hexagonal implant in position of lateral incisors and pontic in region of central incisors; Group 2: Internal Hexagonal implant in position of central incisors and cantilever of the lateral incisors and Group3 - : Internal Hexagonal implants alternate with suspended elements. The Electronic Speckle Pattern Interferometry (ESPI) technique was selected for the mechanical evaluation of the 3 groups performance. The results are shown in interferometric phase maps representing the displacement field of the prosthetic structure.

Use of a Tooth-Implant Supported Bone Distractor in Oral Rehabilitation: Description of a Personalized Technique

Osteodistraction is a clinical reality available for the resolution of bone deficiencies before dental implant placement or in cases where the existing implants are at the wrong position. The objective of this study is to suggest a new possibility for bone distraction, based on tooth-implant bone distractors, in areas were there is the need for extensive alveolar bone recovery, with installed dental implants. This technique presented good results associated with its simplicity and low cost, making it a viable clinical solution for bone tissue augmentation. Although its use is recent, the suggested technique shows the potential to become used widely in attempts to achieve bone-height augmentation, primarily when dental implants are installed and osteointegrated already. (C) 2008 American Association of Oral and Maxillofacial Surgeons

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.

Patients' Expectations of and Satisfaction with Implant-Supported Fixed Partial Dentures and Single Crowns

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

In vitro evaluation of the precision of working casts for implant-supported restoration with multiple abutments

Objective: The purpose of this study was to compare the accuracy of two working cast fabrication techniques using strain-gauge analysis. Methods: Two working cast fabrication methods were evaluated. Based on a master model, 20 working casts were fabricated by means of an indirect impression technique using polyether after splinting the square transfer copings with acrylic resin. Specimens were assigned to 2 groups (n=10): Group A (GA): type IV dental stone was poured around the abutment analogs in the conventional way; Group B (GB), the dental stone was poured in two stages. Spacers were used over the abutment analogs (rubber tubes) and type IV dental stone was poured around the abutment analogs in the conventional way. After the stone had hardened completely, the spacers were removed and more stone was inserted in the spaces created. Six strain-gauges (Excel Ltd.), positioned in a cast bar, which was dimensionally accurate (perfect fit) to the master model, recorded the microstrains generated by each specimen. Data were analyzed statistically by the variance analysis (ANOVA) and Tukey's test (α= 5%). Results: The microstrain values (με) were (mean±SD): GA: 263.7±109.07με, and GB: 193.73±78.83με. Conclusion: There was no statistical difference between the two methods studied.

The Role of Implant/Abutment System on Torque Maintenance of Retention Screws and Vertical Misfit of Implant-Supported Crowns Before and After Mechanical Cycling

Purpose: This study aimed to evaluate the role of the implant/abutment system on torque maintenance of titanium retention screws and the vertical misfit of screw-retained implant-supported crowns before and after mechanical cycling. Materials and Methods: Three groups were studied: morse taper implants with conical abutments (MTC group), external-hexagon implants with conical abutments (EHC group), and external-hexagon implants with UCLA abutments (EHU group). Metallic crowns casted in cobalt-chromium alloy were used (n = 10). Retention screws received insertion torque and, after 3 minutes, initial detorque was measured. Crowns were retightened and submitted to cyclic loading testing under oblique loading (30 degrees) of 130 +/- 10 N at 2 Hz of frequency, totaling 1 x 10(6) cycles. After cycling, final detorque was measured. Vertical misfit was measured using a stereomicroscope. Data were analyzed by analysis of variance, Tukey test, and Pearson correlation test (P < .05). Results: All detorque values were lower than the insertion torque both before and after mechanical cycling. No statistically significant difference was observed among groups before mechanical cycling. After mechanical cycling, a statistically significantly lower loss of detorque was verified in the MTC group in comparison to the EHC group. Significantly lower vertical misfit values were noted after mechanical cycling but there was no difference among groups. There was no significant correlation between detorque values and vertical misfit. Conclusions: All groups presented a significant decrease of torque before and after mechanical cycling. The morse taper connection promoted the highest torque maintenance. Mechanical cycling reduced the vertical misfit of all groups, although no significant correlation between vertical misfit and torque loss was found.

The role of superstructure material on the stress distribution in mandibular full-arch implant-supported fixed dentures. A CT-based 3D-FEA

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

Effect of Abutment Screw Surface Treatment on Reliability of Implant-Supported Crowns

Purpose: To evaluate and compare the reliability of implant-supported single crowns cemented onto abutments retained with coated (C) or noncoated (NC) screws and onto platform-switched abutments with coated screws. Materials and Methods: Fifty-four implants (DT Implant 4-mm Standard Platform, Intra-Lock International) were divided into three groups (n = 18 each) as follows: matching-platform abutments secured with noncoated abutment screws (MNC); matching-platform abutments tightened with coated abutment screws (MC); and switched-platform abutments secured with coated abutment screws (SC). Screws were characterized by scanning electron microscopy and x-ray photoelectron spectroscopy (XPS). The specimens were subjected to step-stress accelerated life testing. Use-level probability Weibull curves and reliability for 100,000 cycles at 200 N and 300 N (90% two-sided confidence intervals) were calculated. Polarized light and scanning electron microscopes were used for fractographic analysis. Results: Scanning electron microscopy revealed differences in surface texture; noncoated screws presented the typical machining grooves texture, whereas coated screws presented a plastically deformed surface layer. XPS revealed the same base components for both screws, with the exception of higher degrees of silicon in the SiO2 form for the coated samples. For 100,000 cycles at 300 N, reliability values were 0.06 (0.01 to 0.16), 0.25 (0.09 to 0.45), and 0.25 (0.08 to 0.45), for MNC, MC, and SC, respectively. The most common failure mechanism for MNC was fracture of the abutment screw, followed by bending, or its fracture, along with fracture of the abutment or implant. Coated abutment screws most commonly fractured along with the abutment, irrespective of abutment type. Conclusion: Reliability was higher for both groups with the coated screw than with the uncoated screw. Failure modes differed between coated and uncoated groups.

Non-linear 3D finite element analysis of full-arch implant-supported fixed dentures

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

Impact of Replacing Conventional Complete Dentures with Implant-Supported Fixed Complete Dentures

The aim of this study was to assess the impact of replacing conventional mandibular complete dentures with implant-supported fixed complete dentures (ISFDs) on the oral health related quality of life (OHOOL) of edentulous patients and on the associated kinesiographic parameters. The patients had their complete dentures replaced by ISFDs and were assessed after 1, 2, 3, 6, and 12 months. An improvement of general OHQOL was observed 2 months after treatment with ISFDs. Kinesiographic recordings revealed significant mandibular vertical and horizontal opening increases and a greater vertical intrusion of the maxillary complete dentures during clenching after the treatment with ISFD.

Repair Technique for Fractured Implant-Supported Metal-Ceramic Restorations: A Clinical Report

The fracture of porcelain structures have been related in either natural dentition or implant-supported restorations. Techniques using a composite resin or indirect methods can be used. This article presents a porcelain fracture on implant-supported metal-ceramic restoration. IPS Empress e.max laminate veneer restoration was used to repair the fracture. With this technique, it was possible to restore aesthetics and function, combined with low cost and patient satisfaction.

Biomechanical influence of crown-to-implant ratio on stress distribution over internal hexagon short implant: 3-D finite element analysis with statistical test

The study of short implants is relevant to the biomechanics of dental implants, and research on crown increase has implications for the daily clinic. The aim of this study was to analyze the biomechanical interactions of a singular implant-supported prosthesis of different crown heights under vertical and oblique force, using the 3-D finite element method. Six 3-D models were designed with Invesalius 3.0, Rhinoceros 3D 4.0, and Solidworks 2010 software. Each model was constructed with a mandibular segment of bone block, including an implant supporting a screwed metal-ceramic crown. The crown height was set at 10, 12.5, and 15 mm. The applied force was 200 N (axial) and 100 N (oblique). We performed an ANOVA statistical test and Tukey tests; p < 0.05 was considered statistically significant. The increase of crown height did not influence the stress distribution on screw prosthetic (p > 0.05) under axial load. However, crown heights of 12.5 and 15 mm caused statistically significant damage to the stress distribution of screws and to the cortical bone (p <0.001) under oblique load. High crown to implant (C/I) ratio harmed microstrain distribution on bone tissue under axial and oblique loads (p < 0.001). Crown increase was a possible deleterious factor to the screws and to the different regions of bone tissue. (C) 2014 Elsevier Ltd. All rights reserved.

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)

Extraoral Implants in the Rehabilitation of Craniofacial Defects: Implant and Prosthesis Survival Rates and Peri-Implant Soft Tissue Evaluation

Purpose: Few reports have evaluated cumulative survival rates of extraoral rehabilitation and peri-implant soft tissue reaction at long-term follow-up. The objective of this study was to evaluate implant and prosthesis survival rates and the soft tissue reactions around the extraoral implants used to support craniofacial prostheses. Materials and Methods: A retrospective study was performed of patients who received implants for craniofacial rehabilitation from 2003 to 2010. Two outcome variables were considered: implant and prosthetic success. The following predictor variables were recorded: gender, age, implant placement location, number and size of implants, irradiation status in the treated field, date of prosthesis delivery, soft tissue response, and date of last follow-up. A statistical model was used to estimate survival rates and associated confidence intervals. We randomly selected 1 implant per patient for analysis. Data were analyzed using the Kaplan-Meier method and log-rank test to compare survival curves. Results: A total of 150 titanium implants were placed in 56 patients. The 2-year overall implant survival rates were 94.1% for auricular implants, 90.9% for nasal implants, 100% for orbital implants, and 100% for complex midfacial implants (P = .585). The implant survival rates were 100% for implants placed in irradiated patients and 94.4% for those placed in nonirradiated patients (P = .324). The 2-year overall prosthesis survival rates were 100% for auricular implants, 90.0% for nasal implants, 92.3% for orbital implants, and 100% for complex midfacial implants (P = .363). The evaluation of the peri-implant soft tissue response showed that 15 patients (26.7%) had a grade 0 soft tissue reaction, 30 (53.5%) had grade 1, 6 (10.7%) had grade 2, and 5 (8.9%) had grade 3. Conclusions: From this study, it was concluded that craniofacial rehabilitation with extraoral implants is a safe, reliable, and predictable method to restore the patient's normal appearance. (C) 2012 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 70:1551-1557, 2012