Arndt Happe

Wear at the titanium–titanium and the titanium–zirconia implant–abutment interface: A comparative in vitro study

OBJECTIVE The purpose of this study was to determine and measure the wear of the interface between titanium implants and one-piece zirconia abutments in comparison to titanium abutments. METHODS 6 implants were secured into epoxy resin blocks. The implant interface of these implants and 6 corresponding abutments (group Zr: three one-piece zirconia abutments; group Ti: three titanium abutments) were examined by a microscope and scanning electron micrograph (SEM). Also the implants and the abutments were scanned by 3D-Micro Computer Tomography (CT). The abutments were connected to the implants and cyclically loaded with 1,200,000 cycles at 100N in a two-axis fatigue testing machine. Afterwards, all specimens were unscrewed and the implants and abutments again were scanned by microscope, SEM and CT. The microscope and SEM images were compared, the CT data were superimposed and the wear was calculated by inspection software. The statistical analysis was carried out with an unpaired t-test. RESULTS Abutment fracture or screw loosening was not observed during cyclical loading. Comparing the microscope and SEM images more wear was observed on the implants connected to zirconia abutments. The maximum wear on the implant shoulder calculated by the inspection software was 10.2μm for group Zr, and 0.7μm for group Ti. The influence of the abutment material on the measured wear was statistically significant (p≤0.001; Levene-test). SIGNIFICANCE Titanium implants showed higher wear at the implant interface following cyclic loading when connected to one-piece zirconia implant abutments compared to titanium abutments. The clinical relevance is not clear; hence damage of the internal implant connection could result in prosthetic failures up to the need of implant removal.

Spectrophotometric assessment of peri-implant mucosa after restoration with zirconia abutments veneered with fluorescent ceramic: a controlled, retrospective clinical study

OBJECTIVES The purpose of this study was to investigate the optical appearance of the soft tissue labial to dental implants restored with fluorescent ceramic-veneered zircona abutments. It was hypothesized that the tested abutment design leads to an increased brightness in the marginal peri-implant tissue, which does not differ from that of natural teeth. Moreover, a reduction of the color difference that has been reported from other abutment materials was expected. MATERIALS AND METHODS A total of 12 patients with single titanium implants in the maxillary anterior region were recruited. All implants (N = 12) were restored with zirconia abutments veneered with fluorescent ceramic and full-ceramic crowns. Color measurements of the peri-implant mucosa at the test sites were made of the facial aspect of the teeth using a Spectroshade-spectrophotometer. The gingiva of a contralateral or adjacent natural tooth served as a control. Color data (CIE-L*a*b* color coordinates) were obtained in five incremental areas of 1 × 2 mm in both test and control sites. ∆E-values were calculated from the ΔL*, Δa* and Δb* values for each patient. RESULTS Data acquisition from the test site demonstrated lower mean values of L*, a* and b* than the control site. Statistical significance between the test site and control site was reached in the L* values only in the second of the five incremental areas (P < 0.05, Wilcoxon test). However, discrepancies in a*- and b*-values reached a statistically significant difference in the incremental areas 1, 2 and 4, and in b* in area 5 (P < 0.05, Wilcoxon test). Medians of the ∆E-values in all five increments were found to be higher than the clinical perceptual threshold of 3.7. However, considering the original data, five individual patients did not reach the threshold in increment 1 and 2, two in increment 3 and three in increment 4. None of the patients showed lower ∆E-values than the perceptual threshold of 3.7 in increment 5, which had the largest distance from the gingival margin. CONCLUSION The tested abutment design leads to a peri-implant soft tissue color that, in the critical marginal area, in five of 12 patients did not statistically differ from the tissue of the gingiva of natural teeth. Particularly, the brightness of the peri-implant soft-tissue seemed to be more adapted to the natural situation using a fluorescent abutment design.

Effects of different polishing protocols on the surface roughness of Y-TZP surfaces used for custom-made implant abutments: a controlled morphologic SEM and profilometric pilot study.

STATEMENT OF PROBLEM Limited information is available on how to treat the surface of computer-aided design/computer-aided manufacturing (CAD/CAM)-derived implant abutments made of yttria tetragonal zirconia polycrystal (Y-TZP). PURPOSE The purpose of this study was to assess and compare 4 different standardized polishing protocols of dental zirconia with a standard handpiece and abrasives and to identify a standardized protocol to obtain a surface roughness of Ra=0.2 μm on dental Y-TZP. MATERIAL AND METHODS Forty specimens of Y-TZP were produced and finished with 4 different polishing protocols with standard dental abrasives. Protocol Co used a coarse rubber abrasive, protocol Me used the rubber abrasive of protocol Co plus a medium rubber abrasive, protocol Fi used the polishing sequences of protocol Me plus a fine rubber abrasive, and protocol UF used protocol Me plus ultrafine high-gloss polishing. Ten machined titanium disks served as control (C). Roughness measurement and scanning electron microscopy was performed for each specimen and tested for differences with ANOVA with Bonferroni correction and the Student t test (α=.05). RESULTS In the zirconia groups, Co (Ra 0.29 ±0.38 μm) showed significantly higher Ra values than Me (Ra 0.22 ±0.38 μm; P=.003), Fi (Ra 0.17 ±0.37 μm; P<.001), and UF (Ra 0.07 ±0.06 μm; P<.001). UF showed the significantly lowest Ra values of all zirconia groups (Co and Me: P<.001, Fi: P=.002). Differences between Me and Fi were not significant (P=.116). Comparison of the 4 zirconia surfaces to the control group (C; Ra=0.17 ±0.03) revealed significant differences for Co (P<.001) and UF (P=.006) but not Me (P=1.000) and Fi (P=.055). In comparison with the literature-based optimal roughness of Ra=0.2 μm, significant differences were found for Co, Fi, and UF (P<.05), but not for Me (P=.117). However, the machined titanium surface (C) also showed significantly smoother Ra values than 0.2 μm (P<.05, Student t test). CONCLUSIONS A roughness of Ra=0.2 μm on zirconia can be achieved by following protocol Me, whereas a roughness comparable to machined titanium is present after protocol Fi.

Esthetic outcome of implant-based reconstructions in augmented bone : comparison of autologous and allogeneic bone block grafting with the pink esthetic score (PES)

IntroductionTo determine the esthetic outcome of implant-based reconstructions after autologous and allogeneic bone grafting.MethodsFrom 2003 to 2009, 67 patients underwent alveolar ridge augmentation and were enrolled in the study, 41 meet the inclusion criteria and 31 agreed to take part in the study. Patients were 18-69 years old (mean: 49.3 ± 13.8 years), and predominantly female. Patients received bone block grafts either autologous (n = 48) (AUBB) or allografts (ABB) (n = 19). Implants were inserted 4-7 months (autografts) or 5-6 months (allografts) after bone grafting. The Pink Esthetic Score (PES) as well as radiographic and subjective assessments were employed for the outcome analysis. The PES was assessed twice within one month based on digital photographic images that were randomly rearranged between evaluations by three independent, experienced investigators.ResultsAcross all observations and investigators, the average PES was 7.5 ± 2.6 without differences between implants inserted in auto- and allografted bone, respectively. Patients assessed the allograft procedures as less painful and would have repeated it more often. The intra-rater reliability was excellent (correlation coefficients 0.7-0.9). The inter-observer agreement was lower (correlation coefficients 0.6-0.8).ConclusionsBone grafting with ABB allografts yields equivalent results to autologous grafting, and patients appreciate the omission of bone harvesting. The PES is a reliable method but should be performed by the same individual.

Are endodontically treated incisors reliable abutments for zirconia-based fixed partial dentures in the esthetic zone?

INTRODUCTION This ex vivo pilot study tested the influence of defect extension and quartz-fiber post placement (QFP) on the ex vivo survival rate and fracture resistance of root-treated upper central incisors served as abutments for zirconia 2-unit cantilever fixed partial dentures (2U-FPDs) exposed to 10 years of simulated clinical function. METHODS Human maxillary central incisors were endodontically treated and divided into the following 5 groups (n = 8): (1) access cavity filled with core build-up composite, (2) biproximal class III cavities filled as in group 1, (3) specimens restored as in group 2 with QFP placed, (4) specimens decoronated and core buildup as in group 1, and (5) specimens restored as in group 4 but with QFP as in group 3. On all specimens, 2U-FPDs were placed with dual-curing resin cement. In order to simulate 10 years of clinical function, specimens were exposed to thermal cycling and mechanical loading with subsequent loading to failure. Kaplan-Meier curves were constructed, and log-rank tests were performed. Fracture force and patterns were compared by means of Kruskal-Wallis, Mann-Whitney U (post hoc), and Fisher exact tests, respectively (P = .05). RESULTS For specimens only with an access cavity, it was observed that 25% had catastrophic tooth fractures and the lowest load-to-fracture values. In all other groups, chipping combined with or without debonding occurred. Groups did not differ significantly regarding the survival rate (P = .603) and fracture patterns (P = .633), but they did for fracture load including technical failures (P = .017). CONCLUSIONS After 10 years of simulated clinical function, both defect extension and placement of QFP had no significant influence on survival of root-treated upper central incisors as abutments restored with zirconia-based 2U-FPDs.

Two-stage horizontal bone grafting with the modified shell technique for subsequent implant placement: a case series.

This case series evaluated the graft stability and resorption of a modified shell technique for horizontal ridge augmentation. Autogenous bone shells of 1-mm thickness were fixed with microtitanium screws with the gaps between the shells and ridge filled with autogenous bone chips. In 22 patients, 30 cases were performed to augment 50 regions. Forty-two implants were inserted after a healing period of 5.5 (± 1.0) months. Preoperatively, the mean width of the crest was 2.7 mm (± 0.9), after bone grafting, 6.7 mm (± 0.8), and during implant placement, 5.9 mm (±0.7), and the mean resorption was 0.8 mm (± 0.5) (P < .001). This technique showed promising results. However, due to slight resorption, the ridge should be over contoured.

Dimensional Evaluation of Different Ridge Preservation Techniques: A Randomized Clinical Study

The objective of this study was to quantitatively determine ridge contour changes after different alveolar ridge preservation techniques. An initial total of 40 patients provided a final total of 35 single-gap extraction sites. After tooth removal, the socket was subjected to one of four treatment modalities: placement of a deproteinized bovine bone mineral (DBBM; Endobon) covered with a soft tissue punch from the palate (Tx1); placement of DBBM without soft tissue punch (Tx2); placement of an adsorbable collagen membrane (Osseoguard) covering the DBBM (Tx3); and no additional treatment (control). Silicone impressions were obtained before and 6 months after tooth extraction for quantitative-volumetric evaluation on stone cast models. Bone quality and need for further bone augmentation were also noted. Tx1 and Tx3 resulted in significantly less bucco-oral tissue loss when compared to Tx2 and the control group. Premolar teeth and teeth extracted for traumatic reasons revealed significantly less tissue loss. Using barrier membranes or soft tissue punches in addition to placement of DBBM seems to be advantageous to limit bucco-oral tissue atrophy. The clinical benefit, however, is still questionable.