Thickness of the buccal bone wall and root angulation in the maxilla and mandible: an approach to cone beam computed tomography

Background: The objective of this paper is to anatomically describe the bone morphology in the maxillary and mandibular tooth areas, which might help in planning post-extraction implants. Methods: CBCT images (Planmeca ProMax 3D) of 403 teeth (208 upper teeth and 195 lower teeth) were obtained from 49 patients referred to the Dental School of Seville from January to December 2014. The thickness of the facial wall was measured at the crest, point A, 4mm below, point B, and at the apex, point C. The second parameter was the angle formed between the dental axis and the axis of the basal bone. Results: A total of 403 teeth were measured. In the maxilla, 89.4% of incisors, 93.94% of canines, 78% of premolars and 70.5% of molars had a buccal bone wall thickness less than the ideal 2mm. In the mandible, 73.5% of incisors, 49% of canines, 64% of premolars and 53% of molars had <1mm buccal bone thickness as measured at point B. The mean angulation in the maxilla was 11.67±6.37° for incisors, 16.88±7.93° for canines, 13.93±8.6° for premolars, and 9.89±4.8° for molars. In the mandible, the mean values were 10.63±8.76° for incisors, 10.98±7.36° for canines, 10.54±5.82° for premolars and 16.19±11.22° for molars. Conclusions: The high incidence of a buccal wall thickness of less than 2mm in over 80% of the assessed sites indicates the need for additional regeneration procedures, and several locations may also require custom abutments to solve the angulation problems for screw-retained crowns

In vitro evaluation of the influence of the cortical bone on the primary stability of two implant systems

Aims: Immediate loading has become a predictable option for treatment, while one of the main requirements for its implementation is obtaining appropriate primary stability in implants. With that aim, conical implants are commercially available, since, according to specialized literature, they provide greater stability. One of the methods to measure implant stability which has evolved to further stages is resonance frequency analysis (RFA). In the present paper we attempt to evaluate the influence of the cortical bone on the primary stability of two implants of similar diameter and length. Study design: 15 fresh cow ribs were selected and six different implant beds were prepared in each. These preparations corresponded to two different implant systems: A Swiss Plus from Zimmer Dental® and an Mk IV from Nobel Biocare®. Two drilling protocols were used for soft bone, hard bone and bone without cortical. After preparing the beds, the implants were placed and implant primary stability was measured with the Osstell® mentor. Results: Higher ISQ (Implant Stability Quotient) values were observed for both implant systems when the cortical bone is maintained than when it is eliminated, the difference being statistically significant in the case of Mk IV implants. Conclusions: The results from this study show the importance of preserving cortical bone during drilling in order to obtain greater primary stability

In vitro evaluation of the type of implant bed preparation with osteotomes in bone type IV and its influence on the stability of two implant systems

Objectives: 1) To evaluate and compare the stability of two types of implants in an animal model after preparing the implant bed with various sequences of osteotomes in bone type IV. 2) To evaluate the hypothesis of whether or not the sequence of using osteotomes influences the primary implant stability.Material and Method: We selected bone from cow ribs, which in its cross section (the most medullar area of the bone) would be equivalent to a type IV human bone. We used fifteen ribs, in which six implant beds were prepared in each rib block using different preparation protocols for seating three conical Swiss Plus SPB implants of 3.7 x 10 mm versus three MK III parallel wall implants of 4 x 10 mm.Three preparations, each with a diameter, were made for the implants, using osteotomes that progressively increased the diameter of the implant bed. In the first preparation, the complete sequence of osteotomes was used; in the second preparation, the last osteotome was left out; and in the third preparation, the implant was placed after only passing through the first osteotome. Once the implants were seated, we proceeded to evaluate the stability (Osstell® ISQ-value). The locations were randomly chosen (by a coin toss).Results and statistical analysis: We performed a statistical analysis of the ISQ values that were obtained during the different preparations carried out for the Mk III and Swiss Plus implants. The average range and standard deviation were calculated. The hypothesis was compared by a two-way variance analysis (type of implant/ different sequences of preparing the implant bed). It was considered significant for a p <0.05. The statistical results obtained for the values of the Mk III implant were significant (p = 0.042).Conclusions: The results of this in vitro study conclude that the tapered shape provides more primary stability to the implant and suggest that a short sequence of osteotomes in bone type IV provide more primary stability than the complete sequence

Differences between the fittings of dental prostheses produced by CAD-CAM and laser sintering processes

Digital dentistry and new techniques for the dental protheses’ suprastructure fabrication have undergone a great evolution in recent years, revolutionizing the quality of dental prostheses. The aim of this work is to determine whether the best horizontal marginal fit is provided by the CAD-CAM technique or by laser sintering. These values have been compared with the traditional casting technique. A total of 30 CAD-CAM models, 30 laser sintering models, and 10 casting models (as control) were fabricated. The structures realized with chromium–cobalt (CrCo) have been made by six different companies, always with the same model. Scanning electron microscopy with a high-precision image analysis system was used, and 10,000 measurements were taken for each model on the gingival (external) and palatal (internal) side. Thus, a total of 1,400,000 images were measured. It was determined that the CAD-CAM technique is the one that allows the best adjustments in the manufacturing methods studied. The laser sintering technique presents less adjustment, showing the presence of porosities and volume contraction defects due to solidification processes and heterogeneities in the chemical composition (coring). The technique with the worst adjustments is the casting technique, containing numerous defects in the suprastructure. The statistical analysis of results reflected the presence of statistically significant gap differences between the three manufacturing methods analyzed (p < 0.05), with the samples manufactured by CAD-CAM and by traditional casting processes being the ones that showed lower and higher values, respectively. No statistically significant differences in fit were observed between the palatal and gingival fit values, regardless of the manufacturing method used. No statistically significant differences in adjustment between the different manufacturing centers were found, regardless of the process used.Peer ReviewedPostprint (published version

Job satisfaction and depression in the Spanish Society of Periodontology and Research (SEPA) members, and their relation to the burnout syndrome. Creation of a structural model

Objective: This study is aimed at getting to know the existing relationship between the dimensions of the burnout syndrome and job satisfaction, on one hand, and depressive feelings on the other through the creation of a structural model aimed at relating all these concepts on a sample of Spanish periodontists. Study design: The initial sample comprised 284 individuals, who represented 20% of the members of the Spanish Society of Periodontology and Research (www.SEPA.es). These individuals were chosen randomly by means of stratified sampling with proportional affixation by their autonomous community of residence. All participants were sent by post the MBI, CET and job-satisfaction questionnaires. The software package used for data analysis was LISREL v. 8.7 by checking models of structural equations so as to prove the proposed model?s adjustment. Results: The total number of answered questionnaires was 170 (59.85%). A positive relation was observed between emotional tiredness and depersonalization and depression. However, this dimension correlated negatively with job satisfaction and self-realization. Conclusions: The obtained results show that, in this sample of periodontists, job satisfaction acts as a modulator in the transition from emotional tiredness to depressio

Resonance frequency analysis-reliability in third generation instruments : Osstell mentor ®

Few studies assess repeatability and reproducibility in registers of resonance frequency analysis (a value of dental implant stability). Objective: Few studies assess repeatability and reproducibility in resonance frequency analyses (implant stability evaluation). This study is aimed at assessing reliability (repeatabilty and reproducibility) in the Osstell Mentor® system using the intraclass correlation coefficient (ICC) as the statistical method. Study Design: ISQ measurements of RFA were carried out by means of the Osstell Mentor ® instrument in 58 implants in 19 patients. Six measurements were performed on each implant by means of two different Smart-Pegs (I and II). Three consecutive measurements were registered with each transducer. Results: Average ISQ varied from 72.43 to 72.60 and 73.26 in the first, second and third measurements, respectively with the SamrtPeg I and from 72.98 to 73.26 and 73.74 in the first, second and third measurements, respectively with the SamrtPeg II . Exactly equal values were observed in 10.43 and 12.1% of the cases with Smart-Pegs I and II, respectively. The intraclass correlation coefficient was 0.96 and 0.96 for Smart Pegs I and II, respectively. Repeatability and reproducibility was 0.97 for both Smart-Pegs I and II. Conclusions: The RFA system contributed by Osstell Mentor ® renders almost perfect reproducibility and repeatability, as proven by statistical analysis carried out by means of ICC with 95% confidence level. This instrument contributes highly reliable RFA measurements in dental implants

Corrosion Behavior of Titanium Dental Implants with Implantoplasty

The procedure generally used to remove bacterial biofilm adhering to the surface of titanium on dental implants is implantoplasty. This treatment is based on the machining of the titanium surface to remove bacterial plaque. In this study, we used 60 grade 4 titanium implants and performed the implantoplasty protocol. Using X-ray diffraction, we determined the stresses accumulated in each of the as-received, machined and debris implants. The resistance to corrosion in open circuit and potentiodynamically in physiological medium has been determined, and the corrosion potentials and intensities have been determined. Tests have been carried out to determine ion release by ICP-MS at different immersion times. The results show that the corrosion resistance and the release of titanium ions into the medium are related to the accumulated energy or the degree of deformation. The titanium debris exhibit compressive residual stresses of −202 MPa, the implant treated with implantoplasty −120 MPa, and as-received −77 MPa, with their corrosion behavior resulting in corrosion rates of 0.501, 0.77, and 0.444 mm/year, respectively. Debris is the material with the worst corrosion resistance and the one that releases the most titanium ions to the physiological medium (15.3 ppb after 21 days vs. 7 ppb for as-received samples). Pitting has been observed on the surface of the debris released into the physiological environment. This behavior should be taken into account by clinicians for the good long-term behavior of implants with implantoplasty

In Vitro Study of Preload Loss in Different Implant Abutment Connection Designs

The stability and integrity of the abutment-implant connection, by means of a screw, is fallible from the moment the prosthetic elements are joined and is dependent on the applied preload, wear of the components and function. One of the main causes of screw loosening is the loss of preload. The loosening of the screw-abutment can cause complications such as screw fracture, marginal gap, peri-implantitis, bacterial microleakage, loosening of the crown and discomfort of the patient. It is also reported that loosening of the screw/abutment may lead to a failure of osseointegration. It is necessary to evaluate and quantify, with in vitro studies, the torque loss before and after loading in the different connections. Aim: evaluate the influence of implant- abutment connection design in torque maintenance after single tightening, multiple tightening and multiple tightening followed by mechanical cycling. Materials and Methods: 180 Klockner implants divided in 4 groups: 15 SK2 external connection, 25 Ncm tightening torque; 15 KL external connection, 30 Ncm tightening torque; 15 Vega internal connection, 25 Ncm tightening torque; 15 Essential internal connection, 30 Ncm tightening torque. In each group removal torque values (RTV) were evaluated with a digital torque meter, in 3 distinct phases: after one single tightening, 10 multiple tightenings and 10 multiple tightenings and cyclic loading (500 N × 1000 cycles). Results: After one single tightening, and for all connections, RTV were lower than those of insertion, but only for Essential and Vega internal connections this result was statistically significant. After multiple tightening, RTV were significantly lower in all connections. After repeated tightening followed by cyclic loading, mean RTV were significantly lower, when compared to insertion torque. The multiple tightening technique resulted in higher RTV than the single tightening technique, except for Vega implant. The multiple tightening followed by cyclic load, compared to the other phases, was the one that generated the lowest RTV, for all connections. Conclusions: The connection design, in our study, did not seem to influence the maintenance of preload. Loading influenced the loss of preload, in the sense that significantly decreased the removal torque values. The multiple re-tightening technique resulted in higher removal torque values than the single tightening technique. Clinically, our results recommend to retighten retaining screws, a few minutes after insertion

Benefits of Residual Aluminum Oxide for Sand Blasting Titanium Dental Implants: Osseointegration and Bactericidal Effects

Objectives. The purpose of this work was to determine the influence of residual alumina after sand blasting treatment in titanium dental implants. This paper studied the effect of alumina on physico-chemical surface properties, such as: surface wettability, surface energy. Osseointegration and bacteria adhesion were determined in order to determine the effect of the abrasive particles. Materials and Methods. Three surfaces were studied: (1) as-received, (2) rough surface with residual alumina from sand blasting on the surface and (3) with the same roughness but without residual alumina. Roughness was determined by white light interferometer microscopy. Surface wettability was evaluated with a contact angle video-based system and the surface free energy by means of Owens and Wendt equation. Scanning electron microscopy equipped with microanalysis was used to study the morphology and determine the chemical composition of the surfaces. Bacteria (Lactobacillus salivarius and Streptococcus sanguinis) were cultured in each surface. In total, 110 dental implants were placed into the bone of eight minipigs in order to compare the osseointegration. The percentage of bone-to-implant contact was determined after 4 and 6 weeks of implantation with histometric analysis. Results. The surfaces with residual alumina presented a lower surface free energy than clean surfaces. The in vivo studies demonstrated that the residual alumina accelerated bone tissue growth at different implantation times, in relation to clean dental implants. In addition, residual alumina showed a bactericidal effect by decreasing the quantity of bacteria adhering to the titanium. Conclusions. It is possible to verify the benefits that the alumina (percentages around 8% in weight) produces on the surface of titanium dental implants. Clinical relevance. Clinicians should be aware of the benefits of sand-blasted alumina due to the physico-chemical surface changes demonstrated in in vivo tests

Influence of the CAD-CAM Systems on the Marginal Accuracy and Mechanical Properties of Dental Restorations

The aim of this study was to compare the quality of different computer-assisted-design and computer assisted manufacturing systems (CAD-CAM) generated by only one scanner, focusing on vertical fit discrepancies and the mechanical properties. A master model was obtained from a real clinical situation: the replacement of an absent (pontic) tooth, with the construction of a fixed partial denture on natural abutments with three elements. Nine scans were performed by each tested and 36 copies were designed using a dental CAD-CAM software (Exocad). The frameworks were manufactured using three-axis and five-axis, with the same batch of the chrome-cobalt (CrCo) alloy. The frameworks were not cemented. A focus ion beam-high resolution scanning electron microscope (FIB-HRSEM) allowed us to obtain the vertical gap measurements in five points for each specimen. Roughness parameters were measured using white light interferometry (WLI). The samples were mechanically characterized by means of flexural tests. A servo-hydraulic testing machine was used with a cross-head rate of 1 mm/min. One-way ANOVA statistical analysis was performed to determine whether the vertical discrepancies and mechanical properties were significantly different between each group (significance level p < 0.05). The overall mean marginal gap values ranged: from 92.38 ± 19.24 µm to 19.46 ± 10.20 µm, for the samples produced by three-axis and five-axis machines, respectively. Roughness was lower in the five-axis machine than the three-axis one, and as a consequence, the surface quality was better when the five-axis machine was used. These results revealed a statistically significant difference (p < 0.005) in the mean marginal gap between the CAD-CAM systems studied. The flexural strength for these restorations range from 6500 to 7000 N, and does not present any statistical differences’ significance between two CAD-CAM systems studied. This contribution suggests that the number of axes improves vertical fit and surface quality due to the lower roughness. These claims show some discrepancies with other studies