Tonino Traini

Direct laser metal sintering as a new approach to fabrication of an isoelastic functionally graded material for manufacture of porous titanium dental implants

OBJECTIVES This work focuses on a titanium alloy implants incorporating a gradient of porosity, from the inner core to the outer surface, obtained by laser sintering of metal powder. Surface appearance, microstructure, composition, mechanical properties and fractography were evaluated. METHODS All the specimens were prepared by a selective laser sintering procedure using a Ti-6Al-4V alloy powder with a particle size of 1-10 microm. The morphological and chemical analyses were performed by SEM and energy dispersive X-ray spectroscopy. The flexure strength was determined by a three-point bend test using a universal testing machine. The surface roughness was investigated using a confocal scanning laser microscope. The surface roughness variation was statistically evaluated by use of a Chi square test. A p value of <0.05 was considered statistically significant. RESULTS The original surface microstructure consisted of roughly spherical particles, diameter range 5-50 microm. After exposure to hydrofluoric acid some of these were removed and the microsphere diameter then ranged from 5.1 microm to 26.8 microm. Following an organic acid treatment, particles were replaced by grooves 14.6-152.5 microm in width and 21.4-102.4 microm depth. The metal core consisted of columnar beta grains with alpha and beta laths within the grains. The alloy was composed of 90.08% Ti, 5.67% Al and 4.25% V. The Youngs modulus of the inner core material was 104+/-7.7 GPa; while that of the outer porous material was 77+/-3.5 GPa. The fracture face showed a dimpled appearance typical of ductile fracture. SIGNIFICANCE In conclusion, laser metal sintering proved to be an efficient means of construction of dental implants with a functionally graded material which is better adapted to the elastic properties of the bone. Such implants should minimize stress shielding effects and improve long-term performance.

Scaffold's Surface Geometry Significantly Affects Human Stem Cell Bone Tissue Engineering

In this study, we have observed dental pulp stem cells (SBP‐DPSCs) performances on different scaffolds, such as PLGA 85:15, hydroxyapatite chips (HA) and titanium. Stem cells were challenged with each engineered surface, either in plane cultures or in a rotating apparatus, for a month. Gingival fibroblasts were used as controls. Results showed that stem cells exerted a different response, depending on the different type of textured surface: in fact, microconcavities significantly affected SBP‐DPSC differentiation into osteoblasts, both temporally and quantitatively, with respect to the other textured surfaces. Actually, stem cells challenged with concave surfaces differentiated quicker and showed nuclear polarity, an index of secretion, cellular activity and matrix formation. Moreover, bone‐specific proteins were significantly expressed and the obtained bone tissue was of significant thickness. Thus, cells cultured on the concave textured surface had better cell‐scaffold interactions and were induced to secrete factors that, due to their autocrine effects, quickly lead to osteodifferentiation, bone tissue formation, and vascularization. The worst cell performance was obtained using convex surfaces, due to the scarce cell proliferation on to the scaffold and the poor matrix secretion. In conclusion, this study stresses that for a suitable and successful bone tissue reconstruction the surface texture is of paramount importance. J. Cell. Physiol. 214:166–172, 2008.

Friction of Conventional and Self-Ligating Brackets Using a 10 Bracket Model

The friction generated by various bracket-archwire combinations previously has been studied using in vitro testing models that included only one or three brackets. This study was performed using a specially designed apparatus that included 10 aligned brackets to compare the frictional resistance generated by conventional stainless steel brackets, self-ligating Damon SL II brackets and Time Plus brackets coupled with stainless steel, nickel-titanium and beta-titanium archwires. All brackets had a 0.022-inch slot, and five different sizes of orthodontic wire alloys used. Each bracket-archwire combination was tested 10 times, and each test was performed with a new bracket-wire sample. Time Plus self-ligating brackets generated significantly lower friction than both the Damon SL II self-ligating brackets and Victory brackets. However, the analysis of the various bracket-archwire combinations showed that Damon SL II brackets generated significantly lower friction than the other brackets when tested with round wires and significantly higher friction than Time Plus when tested with rectangular archwires. Beta-titanium archwires generated higher frictional resistances than the other archwires. All brackets showed higher frictional forces as the wire size increased. These findings suggest that the use of an in vitro testing model that includes 10 brackets can give additional interesting information about the frictional force of the various bracket-archwires combinations to the clinician and the research worker.

A new one-step dental flowable composite for orthodontic use: an in vitro bond strength study.

A new flowable composite, Denfil Flow, has shown an acceptable shear bond strength for bonding orthodontic brackets, when used with an intermediate, unfilled, low-viscosity resin. According to the manufacturer, it also shows a good viscosity for use with no preliminary adhesive. This could reduce the total time of bonding procedure while maintaining clinically useful bond strength. The aim of the current research was to assess this property. Eighty extracted human premolars were randomly divided into four equal groups. Stainless steel brackets were bonded to etched enamel using (1) Denfil Flow, (2) a traditional flowable composite (Dyract Flow), (3) Denfil Flow composite resin and an intermediate liquid resin, and (4) Transbond XT adhesive. Debonding was performed with a shearing force. The residual adhesive on the enamel surface was evaluated using the adhesive remnant index. The bond strength of Denfil Flow (34.8 MPa) showed no significant difference with the other control groups and was clinically acceptable. Denfil Flow and Dyract Flow tended to display cohesive failure within the adhesive. Denfil Flow can be used without liquid resin to reduce the bonding procedure time while maintaining acceptable bond strength. Further studies are required to evaluate the enamel surface of the teeth after the same polishing procedure in the four groups.

Stereo imaging and cytocompatibility of a model dental implant surface formed by direct laser fabrication.

Direct laser fabrication (DLF) allows solids with complex geometry to be produced by sintering metal powder particles in a focused laser beam. In this study, 10 Ti6Al4V alloy model dental root implants were obtained by DLF, and surface characterization was carried out using stereo scanning electron microscopy to produce 3D reconstructions. The surfaces were extremely irregular, with approximately 100 microm deep, narrow intercommunicating crevices, shallow depressions and deep, rounded pits of widely variable shape and size, showing ample scope for interlocking with the host bone. Roughness parameters were as follows: R(t), 360.8 microm; R(z), 358.4 microm; R(a), 67.4 microm; and R(q), 78.0 microm. Disc specimens produced by DLF with an identically prepared surface were used for biocompatibility studies with rat calvarial osteoblasts: After 9 days, cells had attached and spread on the DLF surface, spanning across the crevices, and voids. Cell density was similar to that on a commercial rough microtextured surface but lower than on commercial smooth machined and smooth-textured grit-blasted, acid-etched surfaces. Human fibrin clot extension on the DLF surface was slightly improved by inorganic acid etching to increase the microroughness. With further refinements, DLF could be an economical means of manufacturing implants from titanium alloys.

Biologic width and morphologic characteristics of soft tissues around immediately loaded implants: studies performed on human autopsy specimens.

BACKGROUND Esthetics and the health of oral implants are based upon the soft tissue reaction and biologic width (BW). METHODS Twelve dental implants were placed in the maxilla and mandible of a patient who smoked. Permanent standard abutments and temporary restorations were immediately fixed in place during the surgery stage. The definitive restorations were placed 4 months after loading without removal of the original abutments. After 10 months, the patient died, and the implants were removed en block and processed for histology. RESULTS The BW in the maxilla was 6.5 +/- 2.5 mm, whereas in the mandible, it was 4.8 +/- 1.3 mm (P = 0.017). The sulcular epithelium (SE) in the maxilla was 2.7 +/- 0.8 mm, whereas in the mandible, it was 1.7 +/- 0.4 mm (P <0.001). The junctional epithelium (JE) in the maxilla was 1.3 +/- 0.4 mm, whereas in the mandible, it was 1.5 +/- 0.5 mm (P = 0.164). The connective tissue (CT) in the maxilla was 2.5 +/- 1.3 mm, whereas in the mandible, it was 1.6 +/- 0.4 mm (P = 0.006). In the maxillary bone, the BW, SE, and CT were significantly longer than in the mandible, whereas for the JE, no statistically significant difference was observed. CONCLUSION The soft tissue organization around dental implants was different for upper and lower jawbones.

Scanning Electron Microscopy Fractography Analysis of Fractured Hollow Implants

Fracture of the implant is one of the possible complications affecting dental implants; it is a rare event but of great clinical relevance. The aim of the present study was to perform a scanning electron microscopy (SEM) fractography evaluation of 7 International Team for oral Implantology (ITI) hollow implants removed because of fracture. The most common clinical risk factors, such as malocclusion, bruxism, and cantilevers on the prosthesis, were absent. Seven fractured ITI hollow implants were retrieved from 5 patients and were analyzed with the use of SEM. SEM analysis showed typical signs of a cleavage-type fracture. Fractures could be due to an association of multiple factors such as fatigue, inner defects, material electrochemical problems, and tensocorrosion.

Peri-Implant Bone Organization under Immediate Loading Conditions: Collagen Fiber Orientation and Mineral Density Analyses in the Minipig Model

BACKGROUND Mechanical properties of bones are greatly influenced by percentages of organic and mineral constituents. Nevertheless, information about mineralization level on a microscopic scale and collagen fiber organization in peri-implant bone after immediate loading is scarce. PURPOSE The aim of this work was to analyze and compare the degree of mineralization and collagen fiber orientation in alveolar bone (AB) and peri-implant bone of immediately loaded (IL) and unloaded (NL) implants. MATERIALS AND METHODS A total of 25 dental implants of 3.8 mm in diameter and 11 mm in length were used in the present study. In five minipigs, three premolars and the first molar were removed from the left side of the mandible. Three months later, five implants for each animal were inserted. Four implants were loaded immediately with a fixed restoration, while one implant was left unloaded. After a 4-month healing period, all implants were retrieved. Circularly polarized light and scanning electron microscope with backscattered electron imaging were used to analyze both peri-implant and AB retrieved 5 mm from the implant. RESULTS The bone/implant contact ratio (BIC %) was 77.8 +/- 5.9% for the IL implants and 78.0 +/- 5.8% for the NL implants; the difference was not statistically significant (p = 0.554). In the peri-implant bone, the area related to transverse collagen fibers was 112,453 +/- 4,605 pixels for IL implants and 87,256 +/- 2,428 pixels for NL implants. In the AB, the area related to transverse collagen fibers was 172,340 +/- 3,892 pixels. The difference between groups was statistically significant (p < .001). The degree of mineralization of peri-implant bone was 137 +/- 19 gray level for IL implants and 115 +/- 24 gray level for NL implants, while in the AB, the degree of mineralization was 125 +/- 26 gray level. This difference was statistically significant (p < .001). CONCLUSION In this study, it was found that IL and NL implants showed the same degree of osseointegration. The bone matrix around IL implants had a higher quantity of transverse collagen fibers and presented a higher level of mineralization.

Collagen Fiber Orientation Near a Fractured Dental Implant After a 5-Year Loading Period: Case Report

Purpose:Fracture of an implant is one of the possible complications of dental implants. It is a quite rare event but of high clinical relevance. Nevertheless, it represents an important opportunity for evaluating the peri-implant bone-tissue response to implant overloading in human beings. The aim of the present study was a scanning electron microscopy evaluation of a screw-shaped implant retrieved because of fracture and a birefringence analysis of the tissue near the fractured implant. Materials and Methods:There was 1 fractured screw-shaped implant retrieved from a patient with a trephine bur, and it was processed for histology. The specimen was analyzed under both scanning electron microscopy and circularly polarized light microscopy. Results:The scanning electron microscopy fractography analysis showed the typical signs of a fatigue-fracture, with large plastic deformations on the implant. The fracture seemed to start from the internal coil of the implant. Under circularly polarized light microscopy investigation, a bone-implant contact percentage of 81.6% ± 1.5% (mean ± standard deviation) was found. The amount of the transverse collagen fibers was of 68.3%, and the amount of the longitudinal collagen fibers was of 31.7%. The difference was statistically significant for z = 2.247 (P = 0.025). Conclusion:The fracture of the implant was most probably correlated to a fatigue of the material mainly associated to a lesion of the internal coil. The high level of bone-implant contact percentage was correlated to a predominant transverse collagen fiber orientation of the collagen fibers in the peri-implant bone.

A macro- and nanostructure evaluation of a novel dental implant.

Success in implant dentistry also comes from the implant macrodesign and nanostructure of its surface. Titanium implant surface treatments have been shown to enhance osseointegration, maximize bone healing, and bone-to-implant contact for predictable clinical results. The aim of the study, was to evaluate the geometric macrodesign and the surface nanostructure of a novel dental implant full contact covering (FCC) obtained by electrochemical procedures. FCC implants were analyzed by scanning electronic microscope, profilometer, and x-ray photoelectron spectroscopy and compared with commercial sandblasted and sandblasted, large-grit acid-etched dental implants. Sample analysis allowed to distinguish the different implant macrodesigns, the step and the profile of the coils that cover the fixture, and the surface characteristics. FCC implant showed novel macro-characteristic of crestal module, coils, and apical zone compared with sandblasted and sandblasted and acid-etched dental implants. Moreover, the FCC nanostructure surface showed roughness values statistically higher than the 2 other surfaces, with a more homogeneity in a peaks and valleys arrangement. Finally, the x-ray photoelectron spectroscopy analysis detected differences between the examined surfaces, with the presence of several contaminants according to the different treatment procedures. Research on new macrostructures and nano morphology should result in a better qualitative and quantitative osseointegration response, with a predictability of the clinical results and long-term success of the implants.