Comparative evaluation of the effect of impression materials and trays on the accuracy of angulated implants impressions

Vinyl Polyether Siloxane is a newly introduced impression material and studies on that is scarce. Implant insertion in posterior mandible might be angulated due to anatomical considerations. The purpose of this study was to compare the dimensional and angular accuracy of impressions using full-arch versus sectional tray and Vinyl Polysiloxane versus Vinyl Polyether Siloxane in angulated implants. Four implants were placed in dental areas #19, #21, #28 and #30 of a Kennedy class I mandibular acrylic model with 30° lingual angulation. Twenty sectional and 20 full-arch open trays were made on the primary cast. Impressions were taken using Vinyl Polysiloxane and Vinyl Polyether Siloxane (n=10 in 4 groups); and were poured with type IV dental stone. The coordinate measuring machine was used to measure displacements in the X, Y and Z axes and rotational discrepancies of implants. The data were analyzed using SPSS 22 and two-way ANOVA. Type of tray had no significant effect on the dimensional and angular accuracy of impressions (p >0.05). Type of impression material significantly affected linear displacement (?r) (P 0.05). Vinyl Polysiloxane yielded more accurate impressions of angulated implants

Radiographic Evaluation of Implant Impression Component Misfit

Statement of Problem: Radiographs are commonly used to detect misfit of implant components, but various factors including implant connection and component opacity could affect this decision.Purpose: The purpose of this study was to evaluate the diagnostic capability of senior students and experienced dentists on the adaptation of implant and impression coping in different vertical and horizontal angled radiographs.Materials and Methods: The implant and the impression coping were attached to each other; once without any gap and once with a gap of 0.5 mm. Totally, 40 digital X-rays were taken with vertical inclinations of 0, 5, 10, 15, 20, 25, 30 degrees in positive and negative directions, and the rest were horizontally inclined with the same values. Forty senior students and twenty experienced dentists observed the radiographs. Their diagnoses were compared with the real status of components.Results: No significant difference was observed between the performance of students and experts (P=0.74). Statistical T-test analysis revealed that the directions (inclinations toward the implants or the impression copings) does not result in any significant difference in diagnoses of students (P=0.29) and dentists (P= 0.15). Nevertheless, general linear model showed the radiograph angulations had a significant impact on the diagnoses of students (P=0.003) and dentists (P<.001). Youden factor revealed that there was not a consistent trend regarding sensitivity and specificity of vertically angled radiographs; however, sensitivity and in particular, specificity decreased as a result of horizontal angle inclination.Conclusion: Increasing vertical angulations of the radiographs for diagnosing the adaptation of implant components is likely to reduce diagnostic capability of clinicians, even experienced ones. Specificity is more affected than sensitivity in both horizontally and vertically angled radiographs. 

Fully Digital versus Conventional Workflows for Fabricating Posterior Three-Unit Implant-Supported Reconstructions: A Prospective Crossover Clinical Trial.

This study assessed the clinical variables influencing the success of three-unit implant-supported fixed dental prostheses (ISFDPs) fabricated using either fully digital or conventional workflows. The clinical trial evaluated 10 patients requiring three-unit ISFDPs in the posterior mandible. Maxillomandibular relation records, and digital and conventional impressions were obtained from each patient using an intraoral scanner (IoS) and polyvinylsiloxane (PVS), and the frameworks were fabricated using zirconia and cobalt-chromium, respectively. A 2 µm accuracy scanner scanned the conventional master casts and standard reference models. The stereolithography (STL) files of the digital and conventional impressions were superimposed on the standard model file, and the accuracy was calculated with the best-fit algorithm. The framework adaptation and passivity were assessed using the one-screw and screw resistance tests. The time required for occlusal adjustment of both types of reconstructions, including the duration of the whole treatment, was recorded. The aesthetic appearance of ISFDPs was rated by each patient and clinician using a self-administered visual analogue scale questionnaire and the FDI World Dental Federation aesthetic parameters, respectively. The sample size was based on the power calculation, and alpha was set at 0.05 for the statistical analyses. The impression accuracy, framework adaptation and passivity, and reconstructions aesthetics did not significantly differ between the digital and conventional approaches. The total fabrication time was significantly shorter using the digital workflow. Within the limitations of this clinical study, the fully digital workflow can be used for the fabrication of ISFDPs with a clinical outcome comparable to that of the conventional workflow

Effect of lateral oblique cyclic loading on microleakage and screw loosening of implants with different connections

Background. The implant connection type might affect microleakage and screw loosening in two-piece implants. The aim of this study was to measure microleakage and screw loosening of two connections of Noble Biocare implant system before and after cyclic loading. Methods. Twelve samples were categorized into two groups: external hexagon (Branemark) and internal hexagon connection (Noble Active) and two implants as controls. The abutments were tightened to a 35 Ncm torque. Initial torque loss (ITL) was measured five minutes after retightening the abutment, using a digital torque wrench. The samples were covered with putty material to the abutment‒implant junction. Customized metal crowns with 45° inclinations were placed on the abutments and cyclic loading was performed accordingly. Thereafter, the secondary torque loss (STL) was measured. Microleakage test was also performed. Data were analyzed with Mann-Whitney and Wilcoxon tests (α=0.05). Results. There were no statistically significant differences between the two phases of gamma counting between and within two groups (P>0.05). However, STL after cyclic loading was less than ITL in both groups (P=0.042). Conclusion. Connection type and cyclic loading had no significant effect on microleakage. Furthermore, the internal connection had less TL as compared to the external connection. In addition, the STLs were less than ITLs in both groups

Full Mouth Reconstruction of a Bruxer with Severely Worn Dentition: A Clinical Report

Tooth wear is attributed to several factors many of which often remain unidentified. Management of tooth wear is challenging in preventive and restorative dentistry. Correct assessment of occlusal vertical dimension, interocclusal rest space, and centric relation records are critical for successful treatment. In order to evaluate different treatment modalities and select the treatment of choice some information can be obtained from study casts and diagnostic wax-up. In order to achieve a predictable and desirable result, a systematic approach may be helpful. This paper describes the full mouth rehabilitation of a 36-year-old bruxer with severely worn dentition and other dental problems such as unfavorable restorations. A diagnostic work-up was performed and provisional restorations were made; then, they were clinically evaluated and adjusted based on the criteria dictating esthetics, phonetics, and vertical dimension. After endodontic therapy, clinical crown lengthening was performed. Two short implants were inserted in the posterior mandible. Custom-cast dowel cores and metal-ceramic restorations were fabricated and a full occlusal splint was used to protect the restorations. We ensured stable contacts on all teeth with equal intensity in centric relation and anterior guidance in accord with functional jaw movements

Full Arch All-on-4 Fixed Implant-Supported Prostheses with 8.5 Years of Follow-Up: A Case Report

Typically, full arch reconstruction of edentulous ridges requires five to 10 dental implants; however, some patients demanding fixed implant-supported prostheses are not able to medically or economically afford complex bone grafts and/or a greater number of implants. These situations could pivot the treatment plan toward the All-on-4 protocol. Nevertheless, due to less implant support in this treatment option, mechanical and biological complications might arise. This article describes the treatment of a fully edentulous patient with two types of fixed implant-supported prostheses on four dental implants along with the following complication

Accuracy of implant transfer and surface detail reproduction with polyether and polyvinyl siloxane using closed-tray impression technique

Background and Aims: Making accurate impressions of prepared teeth when they are adjacent to dental implants is of great importance. In these situations, disregarding the selection of appropriate impression material and technique, not only can affect accuracy of transferring of the 3-dimentional spatial status of implant, but also can jeopardize the accurate recording of tooth. In the present study, the accuracy of two impression materials with taper impression copings for recording implant position and surface details was evaluated.   Materials and Methods: One metal reference model with 2 implants (Implantium) and a preparation of three grooves on a tooth according to ADA no. 19 standard was fabricated. 10 medium- consistency polyEther (PE) impressions using custom trays and 10 polyVinyl Siloxane (PVS) putty wash impressions using prefabricated trays with conical impression coping were made. Impressions were poured with ADA type IV stone. A Coordinate Measuring Machine (CMM) evaluated x, y and angular displacement of the implant analog heads and also accuracy of groove reproduction were measured using a Video Measuring Machine (VMM). These measurements were compared to the ones from reference model. Data were analyzed using one-way ANOVA and T-test.   Results: Putty wash PVS had less linear discrepancy compared with reference model (P > 0.001). There was no significant difference in the surface detail reproduction (P = 0.15).   Conclusion: Putty wash PVS had better results for linear displacement compared with medium consistency PE. There was no significant difference in surface detail reproduction between the two impression materials

Effects of Immediate and Delayed Loading on the Outcomes of All-on-4 Treatment: A Prospective Study

Objectives: The purpose of this study was to compare the outcomes of immediate and delayed rehabilitation of edentulous jaws by means of two straight and two tilted implants after one year of function. Materials and Methods: Thirty consecutive patients (16 males, 14 females) were enrolled in this study. Two anterior straight and two posterior tilted implants were placed in each patient. According to the implant insertion torque and the need for bone grafting, implants were loaded immediately (at 72 hours) or delayed (after four months) using a fixed metal resin prosthesis. Results: One axial implant failed in the delayed group after one year of loading, resulting in cumulative implant survival rate of 99.3%. The mean marginal bone loss was 0.84mm. No significant difference was found between axial and tilted implants in the two groups (P>0.05) Conclusions: Based on the results, immediate or delayed fabrication of final prosthesis on two tilted and two axial implants did not result in significant differences in survival rates or marginal bone loss.

Accuracy of implant transfer with open-tray and closed-tray impression techniques and surface detail reproduction of the tooth during impression

Background and Aims: Accurate recording of implant location is required to achieve passive fit and have the implants without stress concentration. The aim of this in-vitro study was to evaluate the dimensional and angular accuracy of open-tray and closed-tray impression techniques using polyether impression material and also to assess the surface detail reproduction of the tooth while impression making.Materials and Methods: One reference metal model with 2 implants (Implantium) on the position of the maxillary second premolar and first molar and one molar tooth for evaluation of surface details was prepared. 27 polyether impressions of these models were made (9 using open-tray, 9 using closed-tray techniques and 9 were made just of the surface of the teeth without any implants). Impressions were poured with ADA type IV stone. Coordinate Measuring Machine was used for measuring the dimensional accuracy and video measuring machine for surface detail reproduction. All of these measurements were compared with the measurements on the reference model. Data were analyzed by and compared by T-test and One-way ANOVA.Results: There was a significant statistical difference between open-tray and closed-tray techniques (P<0.001). There was no significant difference in the surface detail reproduction of open-tray and Closed-tray techniques and impression making with or without the implants (P>0.05).Conclusion: The accuracy of open-tray impression technique was more than closed-tray technique. The surface detail reproduction of the tooth was not affected by impression technique

Comparative evaluation of different surfaces fit of digitally fabricated cobalt-chromium copings in two depth of finish lines

Background and Aims: Despite the increasing application of intra-oral scanners, the effect of finish line position on gingival margins adaptation is still discussed. The purpose of this clinical study was to evaluate the fitness of cobalt-chromium copings obtained from intraoral scanning in two depth of finish lines. Materials and Methods: Thirty teeth prepared for single premolar metal-ceramic crowns were included. Fifteen teeth had supragingival and fifteen had sub-gingival finish lines. Digital impressions were made using an intraoral scanner (Trios-3shape). Computer-aided design and computer-aided manufacture (CAD/CAM) cobalt-chromium copings were fabricated from the scan files. The copings were evaluated intraorally and after adjustments, the internal and marginal discrepancy were measured using silicone replicas and a stereomicroscopy. Internal and marginal discrepancies were analyzed using the Multivariate test (P<0.05). Results: The mean internal and marginal gap were 52.1 and 56.27μ, for supragingival group and 49.72 and 62.98μ for subgingival group, respectively. The evaluation of finish line position showed no significant effect on obtained results (P>0.05). Conclusion: CAD/CAM chrome-cobalt copings fabricated by digital impressions provided acceptable marginal and internal precision. However, the finish line position had no significant effect on the internal and marginal adaptation