Vincent Bennani

New Ti-Alloys and Surface Modifications to Improve the Mechanical Properties and the Biological Response to Orthopedic and Dental Implants: A Review

Titanium implants are widely used in the orthopedic and dentistry fields for many decades, for joint arthroplasties, spinal and maxillofacial reconstructions, and dental prostheses. However, despite the quite satisfactory survival rates failures still exist. New Ti-alloys and surface treatments have been developed, in an attempt to overcome those failures. This review provides information about new Ti-alloys that provide better mechanical properties to the implants, such as superelasticity, mechanical strength, and corrosion resistance. Furthermore, in vitro and in vivo studies, which investigate the biocompatibility and cytotoxicity of these new biomaterials, are introduced. In addition, data regarding the bioactivity of new surface treatments and surface topographies on Ti-implants is provided. The aim of this paper is to discuss the current trends, advantages, and disadvantages of new titanium-based biomaterials, fabricated to enhance the quality of life of many patients around the world.

A comparison of fit of CNC-milled titanium and zirconia frameworks to implants.

BACKGROUND Computer numeric controlled (CNC) milling was proven to be predictable method to fabricate accurately fitting implant titanium frameworks. However, no data are available regarding the fit of CNC-milled implant zirconia frameworks. PURPOSE To compare the precision of fit of implant frameworks milled from titanium and zirconia and relate it to peri-implant strain development after framework fixation. MATERIALS AND METHODS A partially edentulous epoxy resin models received two Branemark implants in the areas of the lower left second premolar and second molar. From this model, 10 identical frameworks were fabricated by mean of CNC milling. Half of them were made from titanium and the other half from zirconia. Strain gauges were mounted close to the implants to qualitatively and quantitatively assess strain development as a result of framework fitting. In addition, the fit of the framework implant interface was measured using an optical microscope, when only one screw was tightened (passive fit) and when all screws were tightened (vertical fit). The data was statistically analyzed using the Mann-Whitney test. RESULTS All frameworks produced measurable amounts of peri-implant strain. The zirconia frameworks produced significantly less strain than titanium. Combining the qualitative and quantitative information indicates that the implants were under vertical displacement rather than horizontal. The vertical fit was similar for zirconia (3.7 µm) and titanium (3.6 µm) frameworks; however, the zirconia frameworks exhibited a significantly finer passive fit (5.5 µm) than titanium frameworks (13.6 µm). CONCLUSIONS CNC milling produced zirconia and titanium frameworks with high accuracy. The difference between the two materials in terms of fit is expected to be of minimal clinical significance. The strain developed around the implants was more related to the framework fit rather than framework material.

A novel in vitro approach to assess the fit of implant frameworks

OBJECTIVE To introduce a new strain gauge approach to assess the fit of fixed implant frameworks. MATERIALS AND METHODS A partially edentulous epoxy resin mandible model received two Straumann implants in the area of the lower left second premolar and second molar. The model was used to fabricate four zirconia and four identical cobalt-chromium alloy frameworks using a laboratory computer-aided design/computer-aided manufacturing (CAD/CAM) system. A total of four linear strain gauges were then bonded around each implant on the peri-implant structure (mesial, distal, buccal, and lingual). The experimental part was composed of two phases: qualitative and quantitative. For the qualitative assessment, the model was verified by recording the response of each strain gauge while applying a near-constant force of known directions on each implant. For the quantitative phase, the frameworks were attached on the implants and the screws were torqued to 15 N cm. RESULTS In the qualitative phase, the strain gauge response to every force direction was recorded. After attaching the frameworks, all frameworks produced measurable strains, but with different strain patterns. Upon correlating the two phases, the zirconia frameworks were found to be slightly smaller than the inter-implant distance, whereas the cobalt-chromium alloy frameworks tended to be slightly larger than the inter-implant distance. CONCLUSIONS The proposed technique is not only valid for detecting implant framework misfit but also for determining the form of inaccuracies. Model verification is an essential informative step to aid the interpretation of the pattern of framework distortion.

Strain Distribution in a Kennedy Class I Implant Assisted Removable Partial Denture under Various Loading Conditions

Purpose. This in vitro study investigates how unilateral and bilateral occlusal loads are transferred to an implant assisted removable partial denture (IARPD). Materials and Methods. A duplicate model of a Kennedy class I edentulous mandibular arch was made and then a conventional removable partial denture (RPD) fabricated. Two Straumann implants were placed in the second molar region, and the prosthesis was modified to accommodate implant retained ball attachments. Strain gages were incorporated into the fitting surface of both the framework and acrylic to measure microstrain (μStrain). The IARPD was loaded to 120Ns unilaterally and bilaterally in three different loading positions. Statistical analysis was carried out using SPSS version 18.0 (SPSS, Inc., Chicago, IL, USA) with an alpha level of 0.05 to compare the maximum μStrain values of the different loading conditions. Results. During unilateral and bilateral loading the maximum μStrain was predominantly observed in a buccal direction. As the load was moved anteriorly the μStrain increased in the mesial area. Unilateral loading resulted in a twisting of the structure and generated a strain mismatch between the metal and acrylic surfaces. Conclusions. Unilateral loading created lateral and vertical displacement of the IARPD. The curvature of the dental arch resulted in a twisting action which intensified as the unilateral load was moved anteriorly.

A comparison of pressure generated by cordless gingival displacement techniques

STATEMENT OF PROBLEM Handling properties of cordless gingival displacement materials is not well understood, resulting in incorrect use. Insufficient displacement of the gingival margin may result in a poor impression. PURPOSE This study investigated the pressure generated by a cordless displacement paste with respect to different techniques. MATERIAL AND METHODS Two chambers with dimensions of 5 × 5 × 2 mm were made from Type IV stone and silicone material to simulate a rigid and elastic environment. A pressure gage was embedded into the wall of the chamber, and a paste material (Expasyl) was injected into the different chambers. The final pressures generated by the Expasyl were recorded by Chart 5 software and Power Lab system. This was repeated by using a displacement cord (KnitTrax) as a control for the study. The different loading methods for the Expasyl material were compared with 1-way ANOVA (α=.05). RESULTS The mean pressure generated during placement of the Expasyl paste material in the silicone chamber was 143 kPa, which is significantly lower (P=.001) than the pressure generated by the KnitTrax cord (5396 kPa). Manipulating Expasyl after placement resulted in a pressure reduction of 73% in the stone chamber and 29% in the silicone chamber. CONCLUSIONS Pressure generated by Expasyl is minimal compared to the cord system. Pressure is generated during the injection of the Expasyl, and subsequent manipulation reduced the final pressure. Handheld and motorized delivery guns produce similar pressure, but the motorized gun was found to have a more constant pressure delivery.

The Effect of Ultrasonic Instruments on the Quality of Preparation Margins and Bonding to Dentin

STATEMENT OF THE PROBLEM Ultrasonic instruments have recently been developed for finishing crown preparations. They are successful in accessing difficult areas on the preparation margin, but their effects on the dentin surface and on bond strength are contradictory. PURPOSE The aim was to evaluate the condition of crown preparation margins finished using new ultrasonic instruments and to assess their effects on dentin bond strength. METHODS Characteristics of tooth surfaces prepared using two different ultrasonic protocols were compared; Perfect Margin Shoulder (PMS) (PMS 3, Satelec, Merignac, France) 1, 2, and 3 (complete finishing) versus PMS 1 and 2 (partial finishing). They were assessed using scanning electron microscopy (SEM) and surface roughness analysis. Bonding of composite resin to dentin surfaces prepared with the complete PMS kit was compared with dentin surfaces prepared with finishing diamond burs, using micro-tensile testing. RESULTS SEM images revealed a clear difference between the two preparation sequences (PMS 1, 2 versus PMS 1, 2, and 3). Surfaces finished using the PMS tips 1, 2, and 3 appeared continuous, even, and smooth compared with PMS tips 1 and 2 only. The additional use of the PMS 3 uncoated tip enhanced smear layer removal. There was no significant difference when comparing the surface roughness obtained with the PMS 1, 2, and 3 protocol with the PMS 1 and 2 only (p > 0.05). Micro-tensile bond strength was not significantly different between the surfaces prepared with the ultrasonic instruments and the surfaces prepared with the diamond burs (p > 0.05). CONCLUSION The use of the complete PMS finishing kit (PMS 1, 2, and 3) produced better quality finishing lines than PMS 1 and 2. The use of ultrasonic instruments to prepare dentin resulted in comparable bond strengths to the use of diamond burs. CLINICAL SIGNIFICANCE The extremely precise preparation margin possible with ultrasonic instruments improves the quality and accuracy of crown preparations, which may lead to better impressions and closer adaptation of restorations. The complete set of three Perfect Margin Shoulder instruments is recommended, which can produce comparable bond strengths to preparations with rotary instruments.

Finite element analysis of an implant-assisted removable partial denture during bilateral loading: Occlusal rests position

STATEMENT OF PROBLEM When implants are incorporated into an existing partial removable dental prosthesis, the acrylic resin base can fracture. It is therefore essential to study the mechanical behavior of partial removable dental prostheses by using stress and deformation analysis. PURPOSE The purpose of this study was to analyze the effect of the occlusal rest position on the implant-assisted partial removable dental prosthesis by finite element analysis. MATERIAL AND METHODS A Faro Arm scan was used to extract the geometrical data of a human partially edentulous mandible. A standard plus regular neck (4.8×12 mm) implant and titanium matrix, tooth roots, and periodontal ligaments were modeled by using a combination of reverse engineering in Rapidform XOR2 and solid modeling with the Solid Works CAD program. The model incorporated a partial removable dental prosthesis and was loaded with standard bilateral forces. A uniform pressure was applied on the occlusal surface so as to generate an equivalent net force of 120 N for both the left and right prosthesis. The finite element analysis program ANSYS Workbench was used to analyze the stress and strain distributions in the implant-assisted partial removable dental prosthesis. RESULTS Maximum stresses were significantly high for the metal framework compared to the acrylic resin surface, and these stresses were different for the mesial and distal arm designs. The maximum stress in the metal framework for the mesial arm design was 614.9 MPa, and it was 796.4 MPa for the distal arm design. The corresponding stresses in the acrylic resin surface were 10.6 and 8.6 MPa. CONCLUSIONS Within the limitation of this study, it was found that moving the position of the occlusal rest from the mesial to distal side of the abutment teeth improved the stress distribution in the metal framework and acrylic resin denture base structures.

Finite Element Analysis of an Implant-Assisted Removable Partial Denture

PURPOSE This study analyzes the effects of loading a Kennedy class I implant-assisted removable partial denture (IARPD) using finite element analysis (FEA). Standard RPDs are not originally designed to accommodate a posterior implant load point. The null hypothesis is that the introduction of posteriorly placed implants into an RPD has no effect on the load distribution. MATERIALS AND METHODS A Faro Arm scan was used to extract the geometrical data of a human partially edentulous mandible. A standard plus regular neck (4.8 × 12 mm) Straumann® implant and titanium matrix, tooth roots, and periodontal ligaments were modeled using a combination of reverse engineering in Rapidform XOR2 and solid modeling in Solidworks 2008 FEA program. The model incorporated an RPD and was loaded with a bilateral force of 120 N. ANSYS Workbench 11.0 was used to analyze deformation in the IARPD and elastic strain in the metal framework. RESULTS FEA identified that the metal framework developed high strain patterns on the major and minor connectors, and the acrylic was subjected to deformation, which could lead to acrylic fractures. The ideal position of the neutral axis was calculated to be 0.75 mm above the ridge. CONCLUSION A potentially destructive mismatch of strain distribution was identified between the acrylic and metal framework, which could be a factor in the failure of the acrylic. The metal framework showed high strain patterns on the major and minor connectors around the teeth, while the implant components transferred the load directly to the acrylic.

Comparison of pressure generated by cordless gingival displacement materials.

STATEMENT OF PROBLEM Because pressure generated by a displacement cord may traumatize the gingiva, cordless gingival displacement materials are available to the clinician as atraumatic alternatives. However, whether the pressures produced by the different systems are equivalent is unclear. PURPOSE The purpose of this study was to investigate the pressures generated by 4 different cordless gingival displacement materials. MATERIAL AND METHODS A chamber with a dimension of 5 × 5 × 2 mm was made from Type IV stone and silicone material to simulate a rigid and elastic environment. A pressure gauge was embedded into the wall of the chamber, and 4 materials (Expasyl, Expasyl New, 3M ESPE Astringent Retraction Paste, and Magic FoamCord) were injected into the chamber. The maximum and postinjection pressures were recorded with Chart 5 software and the Power Lab system. The pressures generated by the different materials were compared with a post hoc Mann-Whitney U test (α=.05). RESULTS The median postinjection pressures generated by Expasyl (142.2 kPa) and Expasyl New (127.6 kPa) were significantly greater than the pressures generated by 3M ESPE Astringent Retraction Paste (58.8 kPa) and Magic Foam Cord (32.8 kPa). Expasyl generated a maximum pressure of 317.4 kPa and Expasyl New of 296.6 kPa during injection, whereas 3M ESPE Astringent Retraction Paste generated 111.0 kPa, and Magic Foam Cord generated 17.8 kPa. CONCLUSIONS All cordless systems produced atraumatic pressures, with Expasyl New and Expasyl generating the highest pressures and, therefore, can be considered the most effective material.

Ultrasonic margin preparation for fixed prosthodontics: a pilot study.

PURPOSE   Atraumatic, oscillating ultrasonic instruments have recently been developed for prosthodontic margin finishing. This in vitro observational pilot study aimed to compare the condition of crown preparation margins finished using new ultrasonic instruments with margins finished with conventional rotary instruments. METHODS   Two extracted human canine teeth were prepared for crowns. A split-tooth model was used to refine the margins: half of the margin was finished with conventional rotary instruments, the other with ultrasonic instruments. The profiles of the margins were observed using scanning electron microscopy, and a quantitative comparison of surface roughness was obtained using surface roughness analysis software. RESULTS   The margins finished with the ultrasonic instruments exhibited a better-defined axial wall/margin angle and a smoother marginal surface. Rotary instruments produced a sharper and more continuous external line angle. Two-dimensional surface roughness analysis showed that the margins produced with the ultrasonic instruments were approximately half as rough as the margins prepared with the conventional rotary instruments. CONCLUSION   The ultrasonic instruments produce margins in better condition than the current standard and appear to have some practical advantages. CLINICAL SIGNIFICANCE Preparations for fixed prosthodontics finished with these ultrasonic instruments created better-defined margins, which could result in more successful prostheses.