Peter Schärer

Sinus elevation procedures in the resorbed posterior maxilla. Comparison of the crestal and lateral approaches.

OBJECTIVES The purpose of this study was to compare three different methods for sinus elevation: (1) the lateral antrostomy as a two-step procedure, (2) the lateral antrostomy as a one-step procedure, and (3) the osteotome technique with a crestal approach. Indication criteria were defined, based on the residual bone height measured from computed tomography scans, for the sake of applying the appropriate technique. STUDY In 30 patients designated for implant treatment in the resorbed posterior maxilla, 79 implants were placed in combination with a bone-grafting material for sinus augmentation. The final bone heights were measured from panoramic radiographs or post-operative computed tomography scans. RESULTS The success rate for the osteotome technique was 95% during the 30-month study period; no failures occurred in any site treated with a lateral antrostomy. The gain in bone height was comparable for the one-step (median = 10 mm) and two-step (median = 12.7 mm) lateral antrostomies. These sites exhibited a significantly greater increase in bone height (p < 0.001) than did the sites in which the osteotome technique was applied (mean = 3.5 mm). The histologic sections showed both bone apposition in intimate contact with the bone-grafting material particles and initial signs of its remodeling. CONCLUSIONS The results indicate that the osteotome technique can be recommended when more than 6 mm of residual bone height is present and an increase of about 3 to 4 mm is expected. In cases of more advanced resorption a one-step or two-step lateral antrostomy has to be performed.

Soft tissue correction of a single-tooth pontic space: a comparative quantitative volume assessment.

STATEMENT OF PROBLEM Various augmentation procedures are recommended for the correction of localized alveolar ridge defects. However, no study has quantitatively evaluated the results of these procedures to date. PURPOSE This study compared 2 soft tissue augmentation surgeries commonly used to alter contours of single-tooth pontic space by quantifying 3-dimensional volume changes with the optical projection Moiré method at 1 and 3.5 months after surgery. MATERIAL AND METHODS Twenty-four patients required surgery. Each patient had a localized alveolar ridge defect, corresponding to a mesial-distal width of 1 single tooth. The defect of 12 patients was corrected with a subepithelial connective tissue graft; the remaining 12 patients were treated by receiving a free full-thickness gingival graft, which included epithelium and connective tissue with fatty tissue. Six unoperated defects of 6 patients formed the control group. For each defect, an impression was made before treatment, at 1 and 3.5 months after surgery to measure the volume changes on the dental casts with a validated projection Moiré system. Volume change was assessed relative to the preoperative dimension at the buccal and crestal aspects of the single-tooth pontic space. RESULTS At 3.5 months postsurgery, mean volumetric gain for the connective tissue group with 159 mm(3) (SD +/- 80) was significantly greater (P =.027) than for free full-thickness gingival graft group with 104 mm(3) (SD +/- 31). CONCLUSION The applied projection Moiré method proved its applicability in assessing 3-dimensional volume changes of pontic spaces with a single-tooth width. Volumetric assessment after 1 and 3.5 months revealed significantly greater volume gain with the subepithelial connective tissue graft in comparison to the free full-thickness gingival graft.

Factors influencing metal-resin tensile bond strength to filled composites

This study evaluated the effect of metal surface conditioning, application of a silicon layer, water storage, and resin filling on tensile bond strength of a metal-resin system using three experimental composites (un-, micro-, and macrofilled) having the same self-curing resin composed of Bis-GMA and TEGDMA (2:1 wt%). Test specimens were prepared by bonding the resin between pairs of Ni-Cr-Be alloy cast disks (diameter, 8 mm) previously subjected to heat treatments simulating porcelain firing procedures. A specially constructed apparatus facilitated the absolutely parallel alignment and orientation of the disk faces to each other, maintaining a constant resin thickness of 100 microns. Before being bonded, the sand-blasted metal surfaces were either electrolytically etched and/or silicoated. Prior to being tested, assemblies were stored in water at 37 degrees C for one and 30 days. Thereafter, the specimens were processed in a universal testing machine at a cross-head speed of 2 mm/min until failure. Bond strengths ranged from 4.2 to 20.5 MPa. Data were analyzed by ANOVA with a factorial design (conf. level = 99%). The results showed that: (i) bond strength was increased when the metal was silicoated, (ii) the combination of sandblasting/silicoating produced the best values, and (iii) the 30-day water storage combined with silicoating enhanced the strength of the bond. The resin filling had no significant effect, indicating that neither its presence nor type affects bonding strengths to metal.

Corrosion considerations in the brazing repair of cobalt-based partial dentures

Cobalt-based alloys (Co-Cr-Mo) are usually used in dentistry as frameworks for removable partial dentures. In their basic form these structures function successfully. However, modifications or repairs of the frameworks may reduce their resistance to corrosion and, as a consequence, may provoke biologic reactions in the soft tissues. These reactions may be the result of different types of alloys that contact each other and, in the presence of saliva (based on potential differences), produce a galvanic cell. In this study, a clinical situation after repair of a removable partial denture was examined. The metallographic study of the prosthesis revealed a brazed zone where a gold braze was joining the Co-Cr-Mo framework with a Co-Cr-Ni type alloy (without Mo). The latter revealed signs of corrosion. Various electrochemical parameters (Ecorr, Ecouple, icorr, icouple) of these alloys were analyzed in the laboratory. The Co-Cr-Ni alloy had the lowest nobility and underwent galvanic corrosion in a galvanic couple with gold braze.