Sebastian Spintzyk

UV-A and UV-C light induced hydrophilization of dental implants.

OBJECTIVESnWettability is increasingly considered to be an important factor determining biological responses to implant materials. In this context, the purpose of this study was to compare the dynamic wettability of dental implants made from different bulk materials and modified by different surface modifications, and to analyze the respective changes of wettability upon irradiating these implants by UV-A or UV-C light.nnnMETHODSnFour original screw-type implants were investigated: One grit-blasted/acid-etched and one anodically oxidized titanium, one zirconia and one polyetheretherketone implant. Additionally, experimental, screwless, machined titanium cylinders were included in the study. Part of that cylinders and of blasted/etched implants were further modified by a magnetron-sputtered photocatalytic anatase thin film. Scanning electron microscopy was used to investigate the surface micro- and nanostructures. Samples were treated by UV-A (382nm, 25mWcm(-2)) and UV-C (260nm, 15mWcm(-2)) for entire 40min, respectively, and their wettability was quantified by dynamic contact angle (CA) analysis from multi-loop Wilhelmy experiments.nnnRESULTSnAll implants are characterized by submicron- and nanosized surface features. Unexposed implants were hydrophobic (CA>90°). Upon UV-A, solely the implants with anatase coating became superhydrophilic (CA<5°). Upon UV-C, the blasted/etched implants turned superhydrophilic, the anodized titanium and the zirconia implants were considerably (CA=34° and 27°, respectively) and the PEEK implants slightly (CA=79°) hydrophilized.nnnSIGNIFICANCEnThe wettability of implant surfaces can be improved by UV irradiation. The efficiency of UV-A and UV-C irradiation to lower the CA by photocatalysis or photolysis, however, is strongly dependent on the specific material and surface. Thus, attempts to photofunctionalize these surfaces by irradiation is expected to result in a different pattern of bioresponses.

Comparative evaluation of topographical data of dental implant surfaces applying optical interferometry and scanning electron microscopy

OBJECTIVEnComparability of topographical data of implant surfaces in literature is low and their clinical relevance often equivocal. The aim of this study was to investigate the ability of scanning electron microscopy and optical interferometry to assess statistically similar 3-dimensional roughness parameter results and to evaluate these data based on predefined criteria regarded relevant for a favorable biological response.nnnMETHODSnFour different commercial dental screw-type implants (NanoTite Certain Prevail, TiUnite Brånemark Mk III, XiVE S Plus and SLA Standard Plus) were analyzed by stereo scanning electron microscopy and white light interferometry. Surface height, spatial and hybrid roughness parameters (Sa, Sz, Ssk, Sku, Sal, Str, Sdr) were assessed from raw and filtered data (Gaussian 50μm and 5μm cut-off-filters), respectively. Data were statistically compared by one-way ANOVA and Tukey-Kramer post-hoc test. For a clinically relevant interpretation, a categorizing evaluation approach was used based on predefined threshold criteria for each roughness parameter.nnnRESULTSnThe two methods exhibited predominantly statistical differences. Dependent on roughness parameters and filter settings, both methods showed variations in rankings of the implant surfaces and differed in their ability to discriminate the different topographies. Overall, the analyses revealed scale-dependent roughness data. Compared to the pure statistical approach, the categorizing evaluation resulted in much more similarities between the two methods.nnnSIGNIFICANCEnThis study suggests to reconsider current approaches for the topographical evaluation of implant surfaces and to further seek after proper experimental settings. Furthermore, the specific role of different roughness parameters for the bioresponse has to be studied in detail in order to better define clinically relevant, scale-dependent and parameter-specific thresholds and ranges.

Additive Manufacturing: A Comparative Analysis of Dimensional Accuracy and Skin Texture Reproduction of Auricular Prostheses Replicas

PURPOSEnThe use of computer-aided design/computer-aided manufacturing (CAD/CAM) and additive manufacturing in maxillofacial prosthetics has been widely acknowledged. Rapid prototyping can be considered for manufacturing of auricular prostheses. Therefore, so-called prostheses replicas can be fabricated by digital means. The objective of this study was to identify a superior additive manufacturing method to fabricate auricular prosthesis replicas (APRs) within a digital workflow.nnnMATERIALS AND METHODSnAuricles of 23 healthy subjects (mean age of 37.8 years) were measured in vivo with respect to an anthropometrical protocol. Landmarks were volumized with fiducial balls for 3D scanning using a handheld structured light scanner. The 3D CAD dataset was postprocessed, and the same anthropometrical measurements were made in the CAD software with the digital lineal. Each CAD dataset was materialized using fused deposition modeling (FDM), selective laser sintering (SLS), and stereolithography (SL), constituting 53 APR samples. All distances between the landmarks were measured on the APRs. After the determination of the measurement error within the five data groups (in vivo, CAD, FDM, SLS, and SL), the mean values were compared using matched pairs method. To this, the in vivo and CAD dataset were set as references. Finally, the surface structure of the APRs was qualitatively evaluated with stereomicroscopy and profilometry to ascertain the level of skin detail reproduction.nnnRESULTSnThe anthropometrical approach showed drawbacks in measuring the protrusion of the ears helix. The measurement error within all groups of measurements was calculated between 0.20 and 0.28 mm, implying a high reproducibility. The lowest mean differences of 53 produced APRs were found in FDM (0.43%) followed by SLS (0.54%) and SL (0.59%)--compared to in vivo, and again in FDM (0.20%) followed by SL (0.36%) and SLS (0.39%)--compared to CAD. None of these values exceed the threshold of clinical relevance (1.5%); however, the qualitative evaluation revealed slight shortcomings in skin reproduction for all methods: reproduction of skin details exceeding 0.192 mm in depth was feasible.nnnCONCLUSIONnFDM showed the superior dimensional accuracy and best skin surface reproduction. Moreover, digital acquisition and CAD postprocessing seem to play a more important role in the outcome than the additive manufacturing method used.

Direct 3D printing of silicone facial prostheses: A preliminary experience in digital workflow

Direct silicone printing may be applied to the fabrication of maxillofacial prostheses, although its clinical feasibility is unknown. The present clinical report shows an early application of a directly printed silicone prosthesis for the rehabilitation of a nasal defect. Two extraoral scanning systems were used to capture the face and the defect. The virtual construction of the nasal prosthesis was performed with free-form software. Two prostheses were printed in silicone and post-processed by manual sealing and coloring. The clinical outcome was acceptable for an interim prosthesis; however, the marginal adaptation and color match were not satisfactory without further individualization.

Polishability and wear resistance of splint material for oral appliances produced with conventional, subtractive, and additive manufacturing

Occlusal splints to treat bruxism are commonly made from polymethylmethacrylate (PMMA) in a manual workflow (powder-liquid technique). Today digitalization allows a machine-based manufacturing in subtractive (milling) and additive (printing) means using industrial-made PMMA or comparable resins. An in-vitro study should assess the surface finish and screen the wear resistance of conventional and industrial materials. Therefore, a total of 30 specimens made from conventionally PMMA (group C; powder-liquid, Palapress), polycarbonate ingots (group S; innoBlanc splint plus), and light-curing resin (group A; VarseoWax splint) were polished to examine the surface roughness (Ra) by profilometry and further analyzed by SEM. The specimens were loaded with a steatite ball moving 5000 times along 1cm with 5N of surface pressure under constant wetting (artificial saliva). The total height of profile (Pt) was calculated by further profilometry of the specimens. All specimen showed initially comparable Ra values ranging between 0.06 and 0.05µm (SD = 0.01) after polishing. SEM investigations revealed no visual cues for scratches or irregularities in any group. After abrasion test, the comparison of the wear depths, revealed mean Pt values of 111.4µm (SD = 18.5) in C, 85.7µm (SD = 21.5) in S, and 99.1µm (SD = 21.5) in A, whereas the mean of S was statistically different from C (p = 0.025). No signs of abrasion were found on the steatite balls. All materials showed comparable polished surfaces and a similar scale of wear. It remains questionable if the detected statistical differences are of clinical relevance, but indicates the need for tests of novel materials, especially in additive manufacturing.

Influence of Pre-Sintered Zirconia Surface Conditioning on Shear Bond Strength to Resin Cement

This study analyzed the shear bond strength (SBS) of resin composite on zirconia surface to which a specific conditioner was applied before sintering. After sintering of either conditioner-coated or uncoated specimens, both groups were divided into three subgroups by their respective surface modifications (n = 10 per group): no further treatment; etched with hydrofluoric acid; and sandblasted with 50 µm Al2O3 particles. Surfaces were characterized by measuring different surface roughness parameters (e.g., Ra and Rmax) and water contact angles. Half of the specimens underwent thermocycling (10,000 cycles, 5–55 °C) after self-adhesive resin cement build-up. The SBSs were measured using a universal testing machine, and the failure modes were analyzed by microscopy. Data were analyzed by nonparametric and parametric tests followed by post-hoc comparisons (α = 0.05). Conditioner-coated specimens increased both surface roughness and hydrophilicity (p < 0.01). In the non-thermocycled condition, sandblasted surfaces showed higher SBSs than other modifications, irrespective of conditioner application (p < 0.05). Adhesive fractures were commonly observed in the specimens. Thermocycling favored debonding and decreased SBSs. However, conditioner-coated specimens upon sandblasting showed the highest SBS (p < 0.05) and mixed fractures were partially observed. The combination of conditioner application before sintering and sandblasting after sintering showed the highest shear bond strength and indicated improvements concerning the failure mode.

Influence of Different Framework Designs on the Fracture Properties of Ceria-Stabilized Tetragonal Zirconia/Alumina-Based All-Ceramic Crowns

The aim of this study was to evaluate the fracture load and failure mode of all-ceramic crowns with different ceria-stabilized tetragonal zirconia/alumina nanocomposite (Ce-TZP/A) framework designs. Four frameworks (anatomical shape: AS, with a buccal or lingual supporting structure: BS and LS, or buccal and lingual supporting structures: BLS) were fabricated. All frameworks were veneered with porcelain to fabricate all-ceramic crowns followed by cementation to tooth analogs. The fracture load of each crown either without or with pre-loading (1.2 million cycles, 49 N) was measured. The failure mode was classified into partial or complete fracture. Differences were tested for significance (p < 0.05) by a two-way Analysis of Variance (ANOVA), followed by Tukey’s test and by Fisher’s exact test, respectively. Without pre-loading, supporting structures did not influence the fracture load or failure mode. Partial fractures were the most common failure mode. Pre-loading promoted the severity of the failure mode, although the fracture load among the framework designs was not influenced. In the AS group, prefailures were observed during pre-loading, and complete fractures were significantly increased after pre-loading. In contrast, the failure mode of the BLS group remained unchanged, showing only partial fracture even after pre-loading. This Ce-TZP/A framework design, comprised of an anatomical shape with additional buccal and lingual structures, has the potential to reduce the chipping of the veneering porcelain.

Influence of a surface conditioner to pre-sintered zirconia on the biaxial flexural strength and phase transformation

OBJECTIVESnTo assess the influence of a surface conditioner applied to pre-sintered yttria-stabilized tetragonal zirconia polycrystal (Y-TZP) on the biaxial flexural strength and phase transformation.nnnMETHODSnConditioner-coated specimens (12mm diameter×0.8mm thickness) were prepared by application of a slurry conditioner using a brush on pre-sintered Y-TZP discs, followed by sandblasting with 50-μm Al2O3 after sintering (C-SB) or no further treatment (C-NT). The remaining conditioner-free specimens were subjected to sandblasting before sintering (NC-SB) or were maintained without treatment (NC-NT). Surface roughness measurements and scanning electron microscopy (SEM) in conjunction with energy dispersive X-ray spectroscopy (SEM-EDX) were performed for surface characterizations. The phase transformation of Y-TZP was identified by X-ray diffraction (XRD), and the biaxial flexural strength was measured using the piston-on-three-ball test according to ISO 6872:2015. The data were analyzed using nonparametric Kruskal-Wallis tests and Weibull distributions with the maximum likelihood estimation.nnnRESULTSnSandblasting resulted in significantly rougher surfaces, irrespective of conditioner application. Conditioner layers were observed on surfaces in the C-NT and C-SB specimens. Monoclinic contents were present in a very small amount in the C-SB specimens. Both median biaxial flexural and characteristic strengths of all specimens exceeded ISO 6872:2015 requirements (Class 5: >800MPa), except the NC-SB specimens which showed significantly the lowest strength (p<0.001). Although no statistical difference was observed in Weibull modulus among the specimens (p=0.598), the NC-SB specimens showed the highest.nnnSIGNIFICANCEnSurface conditioner application does not affect the biaxial flexural strength and phase stability of Y-TZP and can be considered practical for clinical use.

Fracture resistance and failure modes of polymer infiltrated ceramic endocrown restorations with variations in margin design and occlusal thickness

PURPOSEnThe purpose of this in vitro study was to assess the effect of varying the margin designs and the occlusal thicknesses on the fracture resistance and mode of failures of endodontically treated teeth restored with polymer infiltrated ceramic endocrown restorations.nnnMETHODSnRoot canal treated mandibular molars were divided into four groups (n=8) and were prepared to receive Computer-Aided Design/Computer-Aided Manufacturing (CAD/CAM) fabricated polymer infiltrated ceramic endocrowns (ENAMIC blocks). Group B2 represents teeth prepared with a butt joint design receiving endocrowns with 2mm occlusal thickness and the same for group B3.5 but with 3.5mm occlusal thickness. Group S2 represents teeth prepared with 1mm shoulder finish line receiving endocrowns with 2mm occlusal thickness and the same for group S3.5 but with 3.5mm occlusal thickness. After cementation and thermal aging, fracture resistance test was performed and failure modes were observed.nnnRESULTSnGroup S3.5 showed the highest mean fracture load value (1.27±0.31kN). Endocrowns with shoulder finish line had significantly higher mean fracture resistance values than endocrowns with butt margin (p<0.05). However, the results were not statistically significant regarding the restoration thickness. Evaluation of the fracture modes revealed no statistically significant difference between the modes of failure of tested groups.nnnCONCLUSIONSnFor the restoration of endodontically treated teeth, adding a short axial wall and shoulder finish line can increase the fracture resistance. However, further investigations, especially the fatigue behavior, are needed to ensure this effect applies with small increases of restoration thickness.

Influence of the Conditioning Method for Pre-Sintered Zirconia on the Shear Bond Strength of Bilayered Porcelain/Zirconia

This study evaluated the bond strength of veneering porcelain with an experimental conditioner-coated zirconia. Pre-sintered Y-TZP specimens (n = 44) were divided in two groups based on conditioning type. After sintering, all sample surfaces were sandblasted and layered with veneering porcelain. Additionally, half of the specimens in each group underwent thermal cycling (10,000 cycles, 5–55 °C), and all shear bond strengths were measured. After testing, the failure mode of each fractured specimen was determined. Differences were tested by parametric and Fisher’s exact tests (α = 0.05). The differences in bond strength were not statistically significant. Adhesive fractures were dominantly observed for the non-thermal cycled specimens. After thermal cycling, the conditioner-coated group showed cohesive and mixed fractures (p = 0.0021), whereas the uncoated group showed more adhesive fractures (p = 0.0021). Conditioning of the pre-sintered Y-TZP did not change the shear bond strength of the veneering porcelain, but did improve the failure mode after thermal cycling.