María-Jesús Suárez-García

Oral health-related quality of life in complete denture wearers depending on their socio-demographic background, prosthetic-related factors and clinical condition

Objectives: To investigate the differences in impact on oral health-related quality of life (OHRQoL) among complete denture wearers depending on their socio-demographic characteristics, prosthetic-related factors and oral status. Study Design: 51 patients aged 50-90 years treated, from 2005 to 2010, with at least one complete denture at the Department of Buccofacial Prostheses of the Complutense University (Madrid) were enrolled in this cross-sectional study. All of the participants answered the Oral Health Impact Profile (OHIP-14sp) questionnaire. The additive scoring method was used. The prevalence of impacts was calculated by using the occasional threshold (OHIP-14sp score≥2). Socio-demographic and prosthetic-related variables were gathered. Patients underwent clinical examination to assess their oral condition. Descriptive probes and Chi-Square tests were run (p≤0.05). Results: The predominant participants’ profile was that of a man with a mean age of 69 years wearing complete dentures in both the maxilla and the mandible. The prevalence of impact was 23.5%, showing an average score of 19±9.8. The most affected domains were “functional limitation” and “physical pain”, followed by “physical disability”. Minor impacts were recorded for the psychological and social subscales (“psychological discomfort”, “psychological disability”, “social disability” and “handicap”). The prosthesis’ location significantly influenced the overall patient satisfaction, the lower dentures being the less comfortable. Having a complete removable denture as antagonist significantly hampered the patient satisfaction. Patients without prosthetic stomatitis and those who need repairing or changing their prostheses, recorded significantly higher OHIP-14sp total scores. Conclusions: The use of conventional complete dentures brings negative impacts in the OHRQoL of elderly patients, mainly in case of lower prostheses that required reparation or substitution, with a removable total denture as antagonist. The prosthetic stomatitis in this study was always associated to other severe illness, which may have influenced the self-perceived discomfort with the prostheses, as those patients were daily medicated with painkillers. Key words:Oral Health Impact Profile (OHIP), oral health-related quality of life (OHRQoL), patient satisfaction, complete denture, elderly patients.

Misfit and microleakage of implant-supported crown copings obtained by laser sintering and casting techniques, luted with glass-ionomer, resin cements and acrylic/urethane-based agents.

OBJECTIVES This study evaluated the marginal misfit and microleakage of cement-retained implant-supported crown copings. METHODS Single crown structures were constructed with: (1) laser-sintered Co-Cr (LS); (2) vacuum-cast Co-Cr (CC) and (3) vacuum-cast Ni-Cr-Ti (CN). Samples of each alloy group were randomly luted in standard fashion onto machined titanium abutments using: (1) GC Fuji PLUS (FP); (2) Clearfil Esthetic Cement (CEC); (3) RelyX Unicem 2 Automix (RXU) and (4) DentoTemp (DT) (n=15 each). After 60 days of water ageing, vertical discrepancy was SEM-measured and cement microleakage was scored using a digital microscope. Misfit data were subjected to two-way ANOVA and Student-Newman-Keuls multiple comparisons tests. Kruskal-Wallis and Dunns tests were run for microleakage analysis (α=0.05). RESULTS Regardless of the cement type, LS samples exhibited the best fit, whilst CC and CN performed equally well. Despite the framework alloy and manufacturing technique, FP and DT provide comparably better fit and greater microleakage scores than did CEC and RXU, which showed no differences. CONCLUSIONS DMLS of Co-Cr may be a reliable alternative to the casting of base metal alloys to obtain well-fitted implant-supported crowns, although all the groups tested were within the clinically acceptable range of vertical discrepancy. No strong correlations were found between misfit and microleakage. Notwithstanding the framework alloy, definitive resin-modified glass-ionomer (FP) and temporary acrylic/urethane-based (DT) cements demonstrated comparably better marginal fit and greater microleakage scores than did 10-methacryloxydecyl-dihydrogen phosphate-based (CEC) and self-adhesive (RXU) dual-cure resin agents.

Clinical evaluation of the incidence of prosthetic complications in implant crowns constructed with UCLA castable abutments. A cohort follow-up study

OBJECTIVES To evaluate the incidence of prosthetic complications in implant-retained crowns made with UCLA castable abutments and to identify possible risk factors with a view to establishing recommendations to help predict the success of such restorations. METHODS A cohort follow-up study was carried out in 71 partially dentate patients rehabilitated with 93 implant-retained single crowns. Data regarding socio-demographic background, anatomical features, implant-, and prosthesis-related variables were recorded. The incidence rate (%), relative risk (RR) and odds ratio (OR) were applied for predictive risk factors. ANOVA and Student t-tests were used to compare quantitative variables, the chi-square test was used to compare proportions and also a logistic regression analysis was performed. The statistical significance was set at α = 0.05. RESULTS Two implants (2.2%) were lost during the first year of function. The incidence of prosthetic complications in the observed mean period (26.2 ± 15.4 months) was 11.9%, consisting of screw loosening (10.8%) and ceramic fracture (1.1%). A higher tendency for prosthetic complications was noticed in posterior mandibular crowns restoring saddles longer than 10 mm with mesiodistal cantilevers longer than 6mm, having natural antagonists, after long-term use (>20 months), with initial torque values superior than 30 Ncm. CONCLUSIONS Screw loosening is the most frequent complication in implant-retained crowns fabricated with UCLA abutments cast in cobalt-chromium. Nevertheless, the connection usually remains stable after retightening the screws. A high survival rate was recorded, and these prostheses may be a suitable treatment option. CLINICAL SIGNIFICANCE Based on the study findings, the risk of prosthetic complications is expected to increase when long-span posterior edentulous areas are rehabilitated with single implant-supported crowns. The antagonist occlusal plane should be restored to prevent torsional forces and overloading. Implant systems with initial torque values less than 30 Ncm should be selected.

Vertical misfit of laser-sintered and vacuum-cast implant-supported crown copings luted with definitive and temporary luting agents.

Objectives. This study aimed to evaluate the vertical discrepancy of implant-supported crown structures constructed with vacuum-casting and Direct Metal Laser Sintering (DMLS) technologies, and luted with different cement types. Study Design. Crown copings were fabricated using: (1) direct metal laser sintered Co-Cr (LS); (2) vacuum-cast Co-Cr (CC); and (3) vacuum-cast Ti (CT). Frameworks were luted onto machined implant abutments under constant seating pressure. Each alloy group was randomly divided into 5 subgroups (n = 10 each) according to the cement system utilized: Subgroup 1 (KC) used resin-modified glass-ionomer Ketac Cem Plus; Subgroup 2 (PF) used Panavia F 2.0 dual-cure resin cement; Subgroup 3 (RXU) used RelyX Unicem 2 Automix self-adhesive dual-cure resin cement; Subgroup 4 (PIC) used acrylic/urethane-based temporary Premier Implant Cement; and Subgroup 5 (DT) used acrylic/urethane-based temporary DentoTemp cement. Vertical misfit was measured by scanning electron microscopy (SEM). Two-way ANOVA and Student-Newman-Keuls tests were run to investigate the effect of alloy/fabrication technique, and cement type on vertical misfit. The statistical significance was set at α = 0.05. Results. The alloy/manufacturing technique and the luting cement affected the vertical discrepancy (p < 0.001). For each cement type, LS samples exhibited the best fit (p < 0.01) whereas CC and CT frames were statistically similar. Within each alloy group, PF and RXU provided comparably greater discrepancies than KC, PIC, and DT, which showed no differences. Conclusions. Laser sintering may be an alternative to vacuum-casting of base metals to obtain passive-fitting implant-supported crown copings. The best marginal adaptation corresponded to laser sintered structures luted with glass-ionomer KC, or temporary PIC or DT cements. The highest discrepancies were recorded for Co-Cr and Ti cast frameworks bonded with PF or RXU resinous agents. All groups were within the clinically acceptable misfit range. Key words:Dental alloy, laser sintering, implant-supported prostheses, vertical discrepancy, vertical misfit.

Effect of electric arc, gas oxygen torch and induction melting techniques on the marginal accuracy of cast base-metal and noble metal-ceramic crowns

OBJECTIVES The aim of this study was to identify the most appropriate alloy composition and melting technique by evaluating the marginal accuracy of cast metal-ceramic crowns. METHODS Seventy standardised stainless-steel abutments were prepared to receive metal-ceramic crowns and were randomly divided into four alloy groups: Group 1: palladium-gold (Pd-Au), Group 2: nickel-chromium-titanium (Ni-Cr-Ti), Group 3: nickel-chromium (Ni-Cr) and Group 4: titanium (Ti). Groups 1, 2 and 3 were in turn subdivided to be melted and cast using: (a) gas oxygen torch and centrifugal casting machine (TC) or (b) induction and centrifugal casting machine (IC). Group 4 was melted and cast using electric arc and vacuum/pressure machine (EV). All of the metal-ceramic crowns were luted with glass-ionomer cement. The marginal fit was measured under an optical microscope before and after cementation using image analysis software. All data was subjected to two-way analysis of variance (ANOVA). Duncans multiple range test was run for post-hoc comparisons. The Students t-test was used to investigate the influence of cementation (α=0.05). RESULTS Uncemented Pd-Au/TC samples achieved the best marginal adaptation, while the worst fit corresponded to the luted Ti/EV crowns. Pd-Au/TC, Ni-Cr and Ti restorations demonstrated significantly increased misfit after cementation. CONCLUSIONS The Ni-Cr-Ti alloy was the most predictable in terms of differences in misfit when either torch or induction was applied before or after cementation. Cemented titanium crowns exceeded the clinically acceptable limit of 120μm. CLINICAL SIGNIFICANCE The combination of alloy composition, melting technique, casting method and luting process influences the vertical seal of cast metal-ceramic crowns. An accurate use of the gas oxygen torch may overcome the results attained with the induction system concerning the marginal adaptation of fixed dental prostheses.

Fracture Load Before and After Veneering Zirconia Posterior Fixed Dental Prostheses.

PURPOSE To evaluate the fracture load of 3-unit zirconia-based posterior fixed dental prostheses (FDPs) before and after veneering the frameworks. MATERIALS AND METHODS Forty standardized stainless-steel master dies were fabricated (height: 5 mm, convergence: 6º, chamfer: 1 mm) and randomly screwed in pairs onto metal bases. The bases were randomly divided into two groups (n = 20 each) according to the zirconia CAD/CAM system used for constructing 3-unit structures for FDPs: group 1 (L): Lava All-ceramic, group 2 (Z): IPS e.max ZirCAD. Half of the zirconia structures per group were randomly selected and veneered, while the remaining half was left unveneered. The specimens were luted in standard fashion onto the stainless steel master dies using conventional glass ionomer cement. All specimens were tested for fracture load (FL). Specimens were subjected to a three-point bending test until fracture by applying an axial compressive load at the central fossa of the pontics with a universal testing machine at a 0.5 mm/min crosshead speed. Wilcoxons rank-sum test and Weibull statistics were used for statistical analysis (α = 0.05). RESULTS L structures recorded significantly higher values of load to fracture than the Z group both before and after veneering. Within each ceramic group, no differences were found between unveneered and veneered frameworks. CONCLUSIONS Although further studies are necessary to corroborate these findings, both zirconia systems could be recommended for restoring posterior teeth on the basis of the fracture load values recorded in this experiment (>1000 N). The veneering procedure did not affect the overall load to fracture in any group.

Fracture load of metal-ceramic, monolithic, and bi-layered zirconia-based posterior fixed dental prostheses after thermo-mechanical cycling

OBJECTIVES This study aims to evaluate the fracture load of differently fabricated 3-unit posterior fixed dental prostheses (FDPs) with an intermediate pontic. METHODS Fifty sets of two stainless-steel abutments were randomly assigned to five groups (n = 10 each) depending on the material and technique used for manufacturing the FDPs: (1) Metal-ceramic (MC, control); (2) Lava Zirconia (LZ, bi-layered); (3) Lava Plus (LM, monolithic); (4) VITA In-Ceram YZ (YZ, bi-layered); and (5) IPS e-max ZirCAD (ZZ, bi-layered). After being luted to the dies, all FDPs were submitted to thermo-mechanical cycling (120,000 masticatory cycles, 50 N; plus 774 thermal cycles of 5 °C/55 °C, dwell time: 30 s). Samples were then subjected to a three-point bending test until fracture in a universal testing machine (cross-head speed: 1 mm/min). Fracture load of the veneering ceramic (VF) and total fracture load (TF) were recorded. Microstructure and failure patterns were assessed. Data was analysed using one-way ANOVA and Tukey HSD post-hoc tests (α = 0.05). RESULTS MC restorations recorded higher VF and TF values than did zirconia FDPs (p = 0.0001), which showed no between-group differences. Within the bi-layered groups, TF was significantly higher than VF. LM pieces registered lower average grain size than did LZ specimens (p = 0.001). Overall, the connector was the weakest part. CONCLUSIONS All of the groups tested could withstand clinical chewing forces in terms of average fracture load. Zirconia-based samples performed similarly to each other, but showed lower mean fracture load values than did metal-ceramic ones. CLINICAL SIGNIFICANCE Monolithic zirconia may be recommendable for solving the chipping problem.