Paolo Baldissara

A CAD/CAM-prototyped anatomical condylar prosthesis connected to a custom-made bone plate to support a fibula free flap

This paper describes a new protocol for mandibular reconstruction. Computer-aided design/computer-aided manufacturing (CAD/CAM) technology was used to manufacture custom-made cutting guides for tumor ablation and reconstructive plates to support fibula free flaps. CT scan data from a patient with an odontogenic keratocyst on the left mandibular ramus were elaborated to produce a virtual surgical plan of mandibular osteotomy in safe tissue for complete ramus resection. The CAD/CAM procedure was used to construct a customized surgical device composed of a cutting guide and a titanium reconstructive bone plate. The cutting guide allowed the surgeon to precisely transfer the virtual planned osteotomy into the surgical environment. The bone plate, including a custom-made anatomical condylar prosthesis, was designed using the outer surface of the healthy side of the mandible to obtain an ideal contour and avoid the bone deformities present on the side affected by the tumor. Operation time was reduced in the demolition and reconstruction phases. Functional and aesthetic outcomes allowed patients to immediately recover their usual appearance and functionality. This new protocol for mandibular reconstruction using CAD/CAM to construct custom-made guides and plates may represent a viable way to reproduce the patient’s anatomical contour, give the surgeon better procedural control, and reduce operation time.

Accuracy of fibular sectioning and insertion into a rapid-prototyped bone plate, for mandibular reconstruction using CAD-CAM technology.

Modern techniques of mandibular reconstruction, such as CAD-CAM technology and rapid prototyping, offer new means by which reconstructive surgery can be planned to optimise aesthetic outcomes and prosthetic rehabilitation. The high degree of accuracy afforded by these approaches is principally attributable to high-precision fibular sectioning and insertion of the bone into a customised bone plate. CAD-CAM mandibular reconstruction procedures using vascularised bone free-flap transfers were performed on 10 patients with benign or malignant neoplasms. Five were not treated with the aid of CAD-CAM technology, and served as the control group. Five were scheduled for maxillofacial surgery using surgical cutting guides and customised bone plates. A generalised linear model for linear measures was used to compare the accuracy of reconstruction between the two groups. A difference, even though not significant, in the lateral shift of the mesial and distal positions of the fibular units was evident between groups. CAD-CAM-generated fibular surgical guides afford improved accuracy when used to restore native anatomy, especially in the context of mandibular arch restoration, and both operating room time and related costs are reduced during fibular sectioning.

Effect of particle size on the flexural strength and phase transformation of an airborne-particle abraded yttria-stabilized tetragonal zirconia polycrystal ceramic

STATEMENT OF PROBLEMnBecause airborne-particle abrasion is an efficient method of improving the bond at the zirconia-cement interface, understanding its effect on the strength of yttria-stabilized tetragonal zirconia polycrystal is important.nnnPURPOSEnThe purpose of this study was to evaluate the effect of the particle size used for airborne-particle abrasion on the flexural strength and phase transformation of a commercially available yttria-stabilized tetragonal zirconia polycrystal ceramic.nnnMATERIAL AND METHODSnFor both flexural strength (20.0xa0× 4.0xa0× 1.2 mm) (n=14) and phase transformation (14.0-mm diameterxa0× 1.3-mm thickness) (n=4), the zirconia specimens were made from Lava, and their surfaces were treated in the following ways: as-sintered (control); with 50-μm aluminum oxide (Al2O3) particles; with 120-μm Al2O3 particles; with 250-μm Al2O3 particles; with 30-μm silica-modified Al2O3 particles (Cojet Sand); with 120-μm Al2O3 particles, followed by 110-μm silica-modified Al2O3 particles (Rocatec Plus); and with Rocatec Plus. The phase transformation (%) was assessed by x-ray diffraction analysis. The 3-point flexural strength test was conducted in artificial saliva at 37°C in a mechanical testing machine. The data were analyzed by 1-way ANOVA and the Tukey honestly significant difference post hoc test (α=.05).nnnRESULTSnExcept for the Cojet Sand group, which exhibited statistically similar flexural strength to that of the as-sintered group and for the group abraded with 250-μm Al2O3 particles, which presented the lowest strength, airborne-particle abrasion with the other particle sizes provided the highest values, with no significant difference among them. The as-sintered specimens presented no monoclinic phase. The groups abraded with smaller particles (30 μm and 50 μm) and those treated with the larger ones (110 μm and/or 120 μm particles and 250 μm) exhibited percentages of monoclinic phase that varied from 4% to 5% and from 8.7% to 10%.nnnCONCLUSIONSnExcept for abrasion with Cojet Sand, depending on the particle size, zirconia exhibited an increase or a decrease in its flexural strength. Airborne-particle abrasion promoted phase transformation (tetragonal to monoclinic), and the percentage of monoclinic phase varied according to the particle size.

Efficacy of surface treatments on the bond strength of resin cements to two brands of zirconia ceramic.

PURPOSEnTo compare the shear bond strengths (SBS) of two cements to two Y-TZP ceramics subjected to different surface treatments.nnnMATERIALS AND METHODSnZirconia specimens were made from Lava (n = 36) and IPS e.max ZirCAD (n = 36), and their surfaces were treated as follows: no treatment (control), silica coating with 30-µm silica-modified alumina (Al2O3) particles (CoJet Sand), or coating with liners Lava Ceram for Lava and Intensive ZirLiner for IPS e.max ZirCAD. Composite resin cylinders were bonded to zirconia with Panavia F or RelyX Unicem resin cements. All specimens were thermocycled (6000 cycles at 5°C/55°C) and subjected to SBS testing. Data were analyzed by three-way ANOVA and Tukeys (HSD) post-hoc test (α = 0.05). Failure mode was analyzed by stereomicroscope and SEM.nnnRESULTSnCoJet Sand and liners promoted significantly higher SBS than their control groups, but had similar results to one another. Panavia F provided significantly higher SBS values than RelyX Unicem (p < 0.01) for nontreated zirconia specimens of both brands. When Lava and IPS e.max ZirCAD were abraded with CoJet Sand, RelyX Unicem promoted significantly higher SBS values than Panavia F (p < 0.001). There was no significant difference between the two cements when the zirconia specimens were treated with their respective liners. The nontreated specimens and those treated with CoJet Sand exhibited a high percentage of adhesive and mixed A failures, while the specimens treated with liners presented an increase in mixed A and mixed C failures as well as some cohesive failure in the bulk of Lava Ceram for both cements.nnnCONCLUSIONnCoJet Sand and liners provided the best surface treatment for Lava and IPS e.max ZirCAD. The best surface treatment/cement combinations were CoJet Sand/RelyX Unicem and liner/Panavia F. SBS of Panavia F and RelyX Unicem was not influenced by the zirconia brand.

Clinical outcomes and success rates of quartz fiber post restorations: A retrospective study

STATEMENT OF PROBLEMnCast metal posts and dowels are inherently dark and, when metal-free restorations are used, could impair the definitive esthetic appearance. Quartz fiber posts could represent a reliable choice for restoring abutment teeth.nnnPURPOSEnThe purpose of this study was to evaluate the long-term success rate of teeth restored with quartz fiber posts and fixed dental prostheses (FDPs).nnnMATERIAL AND METHODSnNinety-nine teeth restored with 114 quartz fiber posts and FDPs were evaluated. The evaluation time ranged from 7 months to 9.25 years. The Kaplan-Meier method was used to obtain success curves. The influence of the tooth location, definitive restoration, and failure pattern upon the success function was analyzed with the log-rank test. The Cox regression test was used to evaluate possible predictors among the interactions of the observed parameters.nnnRESULTSnThe success rate of the restorations was 85.86% in a mean period of 5.88 ±1.37 years, with an estimated success probability of 85% at 6.17 years. The statistical analysis identified the factors related to the arch (P=.045) and type of definitive restoration (P=.021) as significantly associated with success. Post debonding was the most frequent failure mode, followed by endodontic failure, with the latter not necessarily being related to the post itself. No root fractures were recorded. Twelve teeth out of the 14 that failed were restored again, bringing the overall survival rate of the teeth to 98%.nnnCONCLUSIONSnThe rehabilitation of abutment teeth with quartz fiber posts can be considered a reliable procedure; however, adhesive techniques and luting materials require improvement.

Effect of surface treatments on the shear bond strength of luting cements to Y-TZP ceramic

STATEMENT OF PROBLEMnBecause zirconia is a glass-free material, alternative surface treatments such as airborne-particle abrasion or silica coating should be used for long-term bonding. However, these surface treatments in combination with different bonding agents and luting cements have not yet been studied.nnnPURPOSEnThe purpose of the study was to evaluate the effect of surface treatments on the shear bond strength (SBS) of luting cements to Y-TZP ceramic.nnnMATERIAL AND METHODSnZirconia disks (N=240) were airborne-particle abraded with the following particles (n=48): 50 μm Al2O3; 120 μm Al2O3; 30 μm silica-coated Al2O3 (Rocatec Soft); 120 μm Al2O3+110 μm silica-coated Al2O3 (Rocatec Plus); and Rocatec Plus. After silanization of the zirconia surface, composite resin disks were bonded with (n=12) RelyX Luting 2; RelyX ARC; RelyX U100; and Panavia F. The bonded specimens were thermocycled (10 000 cycles) and tested for SBS. Failure mode was determined with a stereomicroscope (×20). The morphology and elemental composition of airborne-particle abraded surfaces were evaluated with scanning electron microscopy (×500) and energy-dispersive x-ray spectroscopy (×50).nnnRESULTSnSurface treatments, cements, and their interaction were significant (P<.001). For RelyX ARC, Rocatec Soft and Rocatec Plus provided the highest SBS. In general, surface treatments did not influence the SBS of RelyX U100 and Panavia F. Regardless of the cement, no significant difference was found between 50 μm and 120 μm Al2O3 particles, between Rocatec Soft and Rocatec Plus, or between Rocatec Plus and 120 μm Al2O3 particles+Rocatec Plus. All groups showed adhesive failures. Different particle sizes provided differences in morphological patterns. The elemental composition comprised Al and Al/Si for alumina and silica-abraded zirconia.nnnCONCLUSIONSnParticle size did not influence the SBS of the groups abraded exclusively with alumina or silica-coated particles. RelyX ARC was more surface-treatment dependent than RelyX U100 or Panavia F.

Shear bond strength of veneering porcelain to zirconia after argon plasma treatment.

PURPOSEnThe aim of this study was to investigate if argon plasma cleaning increases the shear bond strength between zirconia and veneering ceramic surfaces.nnnMATERIALS AND METHODSnNinety tablets of densely sintered yttriastabilized tetragonal zirconia polycrystal were divided into three groups according to cleaning treatment (steam cleaning or plasma of Argon for 375 or 750 seconds). Groups were divided into two subgroups according to the application of a ceramic liner (A = liner, B = no liner).nnnRESULTSnWithin subgroup A, argon plasma cleaning significantly decreased shear bond strength. In subgroup B, the plasma treatment increased the shear bond strength, but the differences were not statistically significant. Subgroup A demonstrated lower shear bond strength compared to subgroup B.nnnCONCLUSIONSnArgon plasma cleaning was suggested to improve the bond between ceramic and zirconia surfaces; however, when plasma cleaning was followed by a glassy liner application, the veneering ceramic/zirconia bond was significantly reduced.

Implant Abutment Screw Reverse Torque Values Before and After Plasma Cleaning

This in vitro study analyzed the reverse torque (RevT) of abutment screws following different cleaning treatments. A convenience sample of 50 customized titanium abutment screw complexes was divided into five groups: cleaning by steam (control group), cleaning by Argon plasma (test groups 1 and 2 [with chlorhexidine gel]), and replacement of old screws with new ones (test groups 3 and 4 [with chlorhexidine gel]). Abutments were screwed onto implants and tested for RevT. The RevT of the test groups was significantly higher than that of the control group. No statistically significant difference between test groups was noted except between groups 2 and 3.

A systematic method for predetermined scanning electron microscope analysis in dental science.

Scanning electron microscope evaluation could be criticized if the method adopted to correct for bias is not specified in the study design. Observers can draw conclusions from images unconsciously chosen to best support their research hypotheses, impairing the basic research principle of operators impartiality. In this study, a systematic observation method has been described and verified for repeatability. The number and the observation points on a certain specimen have been predetermined using a scheme along with observation rules previously established in the research protocol. When our instrument is used at an operating magnification between 500x and 1,000x (corresponding to a frame of 250x190 micro and 120x90 micro, respectively), the method allowed 100% repeatable observation frames, with linear frame errors in finding an observation point of 12.5% in length and 16.8% in height. With modifications to accommodate research objective and statistical requirements, the method could be applied to many SEM observation study.

Effect of root canal preparation, type of endodontic post and mechanical cycling on root fracture strength

Objective To evaluate the impact of the type of root canal preparation, intraradicular post and mechanical cycling on the fracture strength of roots. Material and Methods eighty human single rooted teeth were divided into 8 groups according to the instruments used for root canal preparation (manual or rotary instruments), the type of intraradicular post (fiber posts- FRC and cast post and core- CPC) and the use of mechanical cycling (MC) as follows: Manual and FRC; Manual, FRC and MC; Manual and CPC; Manual, CPC and MC; Rotary and FRC; Rotary, FRC and MC; Rotary and CPC; Rotary, CPC and MC. The filling was performed by lateral compactation. All root canals were prepared for a post with a 10 mm length, using the custom #2 bur of the glass fiber post system. For mechanical cycling, the protocol was applied as follows: an angle of incidence of 45°, 37°C, 88 N, 4 Hz, 2 million pulses. All groups were submitted to fracture strength test in a 45° device with 1 mm/ min cross-head speed until failure occurred. Results The 3-way ANOVA showed that the root canal preparation strategy (p<0.03) and post type (p<0.0001) affected the fracture strength results, while mechanical cycling (p=0.29) did not. Conclusion The root canal preparation strategy only influenced the root fracture strength when restoring with a fiber post and mechanical cycling, so it does not seem to be an important factor in this scenario.