Valentim Adelino Ricardo Barão

Stability of cp-Ti and Ti-6Al-4V alloy for dental implants as a function of saliva pH - an electrochemical study

OBJECTIVES To investigate the role of different levels of pH of artificial saliva under simulated oral environment on the corrosion behavior of commercially pure titanium (cp-Ti) and Ti-6Al-4V alloy. Special attention is given to understand the changes in corrosion kinetics and surface characterization of Ti by using electrochemical impedance spectroscopy (EIS). MATERIALS AND METHODS Fifty-four Ti disks (15-mm diameter, 2-mm thickness) were divided into six groups (n = 9) as a function of saliva pH (3, 6.5, and 9) and Ti type. Samples were mechanically polished using standard metallographic procedures. Standard electrochemical tests, such as open circuit potential, EIS, and potentiodynamic tests were conducted in a controlled environment. Data were evaluated by two-way ANOVA, Tukey multiple comparison test, and independent t-test (α = 0.05). Ti surfaces were examined using white-light-interferometry microscopy and scanning electron microscopy (SEM). RESULTS Saliva pH level significantly affected the corrosion behavior of both Ti types. At low pH, acceleration of ions exchange between Ti and saliva, and reduction of resistance of Ti surface against corrosion were observed (P < 0.05). Corrosion rate was also significantly increased in acidic medium (P < 0.05). Similar corrosion behavior was observed for both Ti types. The white-light-interferometry images of Ti surfaces show higher surface changes at low pH level. SEM images do not show detectable changes. No pitting corrosion was observed for any group. CONCLUSIONS The pH level of artificial saliva influences the corrosion behavior of cp-Ti and Ti-6Al-4V alloy in that lower pH accelerates the corrosion rate and kinetics. The corrosion products may mitigate the survival rate of dental implants.

The Role of Lipopolysaccharide on the Electrochemical Behavior of Titanium

Lipopolysaccharide (LPS) may induce peri-implantitis and implant failure. However, the role of LPS in titanium (Ti) electrochemical behavior remains unknown. We hypothesized that LPS in saliva with different pHs affects Ti corrosion properties. Thirty-six Ti discs (15 mm × 3 mm) were divided into 12 groups according to saliva pH (3, 6.5, and 9) and Escherichia coli LPS concentration (0, 0.15, 15, and 150 µg/mL). Electrochemical tests, such as open circuit potential, potentiodynamic, and electrochemical impedance spectroscopy, were conducted in a controlled environment. Data were evaluated by Pearson correlation and regression analysis (α = 0.05). LPS and pH affected Ti corrosive behavior. In general, lower pH and higher LPS concentration accelerated Ti corrosion. In the control group, the increase of pH significantly reduced the corrosion rate and increased the capacitance of the double layer. In LPS groups, the decrease of pH significantly increased the corrosion rate of Ti. LPS negatively influenced Ti corrosion behavior. Abbreviations: Cdl, capacitance of double layer; Ecorr, corrosion potential; EIS, electrochemical impedance spectroscopy; Icorr, corrosion current density; Ipass, passivation current density; LPS, lipopolysaccharide; OCP, open circuit potential; Rp, polarization resistance; Ti, titanium.

Biomechanics Studies in Dentistry: Bioengineering Applied in Oral Implantology

The application of engineering knowledge in dentistry has helped the understanding of biomechanics aspects related to osseointegrated implants. Several techniques have been used to evaluate the biomechanical load on implants comprising the use of photoelastic stress analysis, finite element stress analysis, and strain-gauge analysis. Therefore, the purpose of this study was to describe engineering methods used in dentistry to evaluate the biomechanical behavior of osseointegrated implants. Photoelasticity provides good qualitative information on the overall location and concentration of stresses but produces limited quantitative information. The method serves as an important tool for determining the critical stress points in a material and is often used for determining stress concentration factors in irregular geometries. The application of strain-gauge method on dental implants is based on the use of electrical resistance strain gauges and its associated equipment and provides both in vitro and vivo measurements strains under static and dynamic loads. However, strain-gauge method provides only the data regarding strain at the gauge. Finite element analysis can simulate stress using a computer-created model to calculate stress, strain, and displacement. Such analysis has the advantage of allowing several conditions to be changed easily and allows measurement of stress distribution around implants at optional points that are difficult to examine clinically. All the 3 methodologies can be useful to evaluate biomechanical implant behavior close to the clinical condition but the researcher should have enough knowledge in model fabrication (experimental delineation) and results analysis.

Comparison of stress distribution between complete denture and implant-retained overdenture-2D FEA.

The aim of this study was to compare the stress distribution induced by posterior functional loads on conventional complete dentures and implant-retained overdentures with different attachment systems using a two-dimentional Finite Element Analysis (FEA-2D). Three models representative of edentulous mandible were constructed on AutoCAD software; Group A (control), a model of edentulous mandible supporting a complete denture; Group B, a model of edentulous mandible supporting an overdenture over two splinted implants connected with the bar-clip system; Group C, a model of edentulous mandible supporting an overdenture over two unsplinted implants with the O-ring system. Evaluation was conducted on Ansys software, with a vertical force of 100 N applied on the mandibular left first molar. When the stress was evaluated in supporting tissues, groups B (51.0 MPa) and C (52.6 MPa) demonstrated higher stress values than group A (10.1 MPa). Within the limits of this study, it may be concluded that the use of an attachment system increased stress values; furthermore, the use of splinted implants associated with the bar-clip attachment system favoured a lower stress distribution over the supporting tissue than the unsplinted implants with an O-ring abutment to retain the mandibular overdenture.

A comparison of patient satisfaction between treatment with conventional complete dentures and overdentures in the elderly: a literature review

BACKGROUND It has been stated that mandibular overdentures are more satisfactory than conventional dentures, but problems relating to the use of retrospective ratings, lack of control group and sequential provision of treatment may compromise the findings. OBJECTIVE To establish a comparison between treatment with conventional complete dentures and implant-retained overdentures in elderly patients by conducting a literature review. MATERIALS AND METHODS A search of English language peer-review literature was completed using Medline up to 2008 focusing on evidence-based research. Randomised clinical trials (RCTs) and longitudinal prospective studies were favoured in the review, using a general hierarchical classification. Articles that did not focus exclusively on the comparison of patient satisfaction between complete dentures and overdentures were excluded from further evaluation. The last search was conducted in February 2008. Key terms included quality of life, patient satisfaction, edentulism, complete denture and overdenture. RESULTS Among the 90 articles found in the initial search, 27 met the inclusion criteria. This included 18 RCTs and eight prospective and one cohort study. Most of the articles stated superiority of the mandibular implant-retained overdenture therapy over the conventional complete denture regarding patient satisfaction and quality of life. CONCLUSION Even with implant treatment presenting higher patient satisfaction and improvement of quality of life, it was not possible to establish a direct comparison between the studies due to differences in adopted methodologies.

Effect of occlusal splint treatment on the temperature of different muscles in patients with TMD

PURPOSE The aim of this study was to evaluate the effect of occlusal splint treatment on the temperature of masseter (inferior, intermediate and superior), anterior temporal, digastric and trapezius muscles in patients with temporomandibular disorder (TMD). MATERIALS AND METHODS Thirty patients (6 male and 24 female) aged from 16 to 57 years (mean 37.8±11.4 years) were selected. The patients were diagnosed with muscular TMD by clinical examination (application of Research Diagnostic Criteria questionnaire and physical examination). Occlusal splints in acrylic resin were inserted in all patients with a weekly follow-up. The superficial thermography (°C) on the both sides of the muscles was performed using a digital thermometer in a controlled temperature room. This procedure was performed before occlusal splint insertion (patient with pain) and after the completion of the treatment (patient without pain). The data were analyzed by 2-way repeated-measures ANOVA and means were compared by Tukey HSD test (P<.05). RESULTS After occlusal splint treatment a significant increase in temperature was observed in each muscle, both in the right and left sides. When the muscles were compared in the same period (before or after therapy) there was no significant difference among them. CONCLUSION It can be concluded that the use of occlusal splint promoted a significant increase on the muscles temperature. There was symmetry in the temperature of muscles on the right and left sides both before and after the treatment.

Effects of Dextrose and Lipopolysaccharide on the Corrosion Behavior of a Ti-6Al-4V Alloy with a Smooth Surface or Treated with Double-Acid-Etching

Diabetes and infections are associated with a high risk of implant failure. However, the effects of such conditions on the electrochemical stability of titanium materials remain unclear. This study evaluated the corrosion behavior of a Ti-6Al-4V alloy, with a smooth surface or conditioned by double-acid-etching, in simulated body fluid with different concentrations of dextrose and lipopolysaccharide. For the electrochemical assay, the open-circuit-potential, electrochemical impedance spectroscopy, and potentiodynamic test were used. The disc surfaces were characterized by scanning electron microscopy and atomic force microscopy. Their surface roughness and Vickers microhardness were also tested. The quantitative data were analyzed by Pearsons correlation and independent t-tests (α = 0.05). In the corrosion parameters, there was a strong lipopolysaccharide correlation with the Ipass (passivation current density), Cdl (double-layer capacitance), and Rp (polarization resistance) values (p<0.05) for the Ti-6Al-4V alloy with surface treatment by double-acid-etching. The combination of dextrose and lipopolysaccharide was correlated with the Icorr (corrosion current density) and Ipass (p<0.05). The acid-treated groups showed a significant increase in Cdl values and reduced Rp values (p<0.05, t-test). According to the topography, there was an increase in surface roughness (R2 = 0.726, p<0.0001 for the smooth surface; R2 = 0.405, p = 0.036 for the double-acid-etching-treated surface). The microhardness of the smooth Ti-6Al-4V alloy decreased (p<0.05) and that of the treated Ti-6Al-4V alloy increased (p<0.0001). Atomic force microscopy showed changes in the microstructure of the Ti-6Al-4V alloy by increasing the surface thickness mainly in the group associated with dextrose and lipopolysaccharide. The combination of dextrose and lipopolysaccharide affected the corrosion behavior of the Ti-6Al-4V alloy surface treated with double-acid-etching. However, no dose-response corrosion behavior could be observed. These results suggest a greater susceptibility to corrosion of titanium implants in diabetic patients with associated infections.

Effect of unilateral misfit on preload of retention screws of implant-supported prostheses submitted to mechanical cycling

PURPOSE The aim of this study was to evaluate the effect of different levels of unilateral angular misfit on preload maintenance of retention screws of single implant-supported prostheses submitted to mechanical cycling. MATERIALS AND METHODS Premachined UCLA abutments were cast with cobalt-chromium alloy to obtain 48 crowns divided into four groups (n=12). The crowns presented no misfit in Group A (control group) and unilateral misfits of 50 μm, 100 μm and 200 μm in the groups B, C and D, respectively. The crowns were attached to external hexagon implants with a titanium retention screw with torque of 30 N/cm. Oblique loading of 130 N at 2 Hz was applied on each replica, totalizing 5×10⁴ and 1×10⁶ cycles. Detorque values were measured initially and after each cycling period. Data were evaluated by analysis of variance and Tukeys HSD test (p<0.05). RESULTS All groups presented reduced initial detorque values (p<0.05) in comparison to the insertion torque (30±0.5 N/cm) and Group A (25.18 N/cm) exhibited the lowest reduction. After mechanical cycling, all groups presented detorque values from 19.5 N/cm to 22.38 N/cm and the mechanical cycling did not statistically influence the detorque values regardless the misfit level of the replicas. CONCLUSION The unilateral misfit influenced the preload maintenance only before mechanical cycling. The mechanical cycling did not influence the torque reduction.

The Role of Implant/Abutment System on Torque Maintenance of Retention Screws and Vertical Misfit of Implant-Supported Crowns Before and After Mechanical Cycling

PURPOSE This study aimed to evaluate the role of the implant/abutment system on torque maintenance of titanium retention screws and the vertical misfit of screw-retained implant-supported crowns before and after mechanical cycling. MATERIALS AND METHODS Three groups were studied: morse taper implants with conical abutments (MTC group), external-hexagon implants with conical abutments (EHC group), and external-hexagon implants with UCLA abutments (EHU group). Metallic crowns casted in cobalt-chromium alloy were used (n = 10). Retention screws received insertion torque and, after 3 minutes, initial detorque was measured. Crowns were retightened and submitted to cyclic loading testing under oblique loading (30 degrees) of 130 ± 10 N at 2 Hz of frequency, totaling 1 × 106 cycles. After cycling, final detorque was measured. Vertical misfit was measured using a stereomicroscope. Data were analyzed by analysis of variance, Tukey test, and Pearson correlation test (P < .05). RESULTS All detorque values were lower than the insertion torque both before and after mechanical cycling. No statistically significant difference was observed among groups before mechanical cycling. After mechanical cycling, a statistically significantly lower loss of detorque was verified in the MTC group in comparison to the EHC group. Significantly lower vertical misfit values were noted after mechanical cycling but there was no difference among groups. There was no significant correlation between detorque values and vertical misfit. CONCLUSIONS All groups presented a significant decrease of torque before and after mechanical cycling. The morse taper connection promoted the highest torque maintenance. Mechanical cycling reduced the vertical misfit of all groups, although no significant correlation between vertical misfit and torque loss was found.

Implant Platform Switching: Biomechanical Approach Using Two-Dimensional Finite Element Analysis

In implant therapy, a peri-implant bone resorption has been noticed mainly in the first year after prosthesis insertion. This bone remodeling can sometimes jeopardize the outcome of the treatment, especially in areas in which short implants are used and also in aesthetic cases. To avoid this occurrence, the use of platform switching (PS) has been used. This study aimed to evaluate the biomechanical concept of PS with relation to stress distribution using two-dimensional finite element analysis. A regular matching diameter connection of abutment-implant (regular platform group [RPG]) and a PS connection (PS group [PSG]) were simulated by 2 two-dimensional finite element models that reproduced a 2-piece implant system with peri-implant bone tissue. A regular implant (prosthetic platform of 4.1 mm) and a wide implant (prosthetic platform of 5.0 mm) were used to represent the RPG and PSG, respectively, in which a regular prosthetic component of 4.1 mm was connected to represent the crown. A load of 100 N was applied on the models using ANSYS software. The RPG spreads the stress over a wider area in the peri-implant bone tissue (159 MPa) and the implant (1610 MPa), whereas the PSG seems to diminish the stress distribution on bone tissue (34 MPa) and implant (649 MPa). Within the limitation of the study, the PS presented better biomechanical behavior in relation to stress distribution on the implant but especially in the bone tissue (80% less). However, in the crown and retention screw, an increase in stress concentration was observed.