OBJECTIVES: This study aimed to evaluate potential differences in biofilm accumulation on three different implant surfaces: turned surface (TS), modified surface (MS), and modified surface treated with implantoplasty (IPS), using a within-subject comparison.

MATERIAL AND METHODS: Ten volunteers wore individualized splints containing three titanium implants with different surfaces (TS, MS, and IPS) on each buccal side of the splint. The implant position (anterior, central, and posterior) was randomly assigned among the three implants on each side. Volunteers were instructed to wear the splint for 72 h and to remove it only for eating, drinking, and performing standard oral hygiene; the splint itself was not cleaned. After 72 h, the implants were carefully removed from the splint, and the accumulated biofilm was assessed using a crystal violet assay by measuring intensity/absorbance at 570 nm.

RESULTS: All volunteers reported no deviations from the instructions. The lowest mean amount of biofilm (0.405 ± 0.07) was detected on implants of the IPS group, followed by implants of the MS (0.463 ± 0.06) and TS group (0.467 ± 0.07). A multilevel mixed-effects linear regression analysis confirmed that implants of the IPS group accumulated a significantly lower amount of biofilm than the other surfaces (p < 0.001); however, no significant difference was detected between implants of the TS and MS groups (p = 0.806).

CONCLUSIONS: Implantoplasty can generate a surface significantly less conducive to biofilm accumulation in the short term compared to pristine implants with turned or modified surfaces.

TRIAL REGISTRATION: clinicaltrials.gov identifier: NCT06049121.

OBJECTIVE: The aim of this study was to evaluate the influence of combining primers and cements from two different resin cement systems on the microtensile bond strength (muTBS) between zirconia and human dentin.

MATERIALS AND METHODS: A total of 120 specimens of zirconia cemented to dentin were allocated into eight groups based on cement type (RelyX Ultimate or Panavia V5) and primers (Tooth Primer, Clearfil Ceramic Primer and Scotchbond Universal Adhesive) combinations, applied to dentin or ceramic surfaces. Following artificial aging with 5000 thermocycles, muTBS tests were conducted. Statistical analysis was performed using One-way ANOVA and Tukey's post hoc tests (p </= 0.05), and failure modes were assessed.

RESULTS: The Panavia V5 cement system demonstrated the highest bond strength (19.4 +/- 4.4 MPa), significantly higher than the other groups except when RelyX cement was used with Panavia primers (16.9 +/- 3.7 MPa). Cohesive fractures within the cement layer were the predominant failure mode.

CONCLUSIONS: The combination of primers from different adhesive cement system brands may significantly affect the bonding effectiveness. Therefore, using products from a single product line of the same adhesive cement system, and following the manufacturer's recommendations for indications and use, is crucial for a more predictable clinical outcome.

Aim: This study aimed to evaluate the bond strength of adhesively cemented lithium disilicate restorations to dentin by applying different pretreatments and cleaning methods.

Material and Methods: Twenty-five human posterior teeth were mounted in an acrylic mold, flattened to expose mid-coronal dentin, and divided into five groups based on different pretreatments and cleaning methods prior to adhesive cementation. After cementation, the teeth were sectioned to obtain 1 mm² specimens, yielding 15 specimens in each group that were subjected to aging and thermocycling process, followed by a microtensile bond test and failure mode assessment.

Results: The highest bond strength values were in the control group and in the group that was treated with fluoride and where the temporary cement was removed using pumice, whereas the lowest values were in groups that were cleaned by excavator irrespective of whether they were treated with fluoride or not. However, all groups showed mainly cohesive failure without any statistically significant differences.

Conclusions: To eliminate any possible negative impact of eugenol on adhesion to dentin, surface cleaning by rotational brush and pumice is recommended prior to cementing lithium disilicate restorations.

Introduction

Different materials and restorative concepts have been proposed over the years to restore endodontically treated teeth (ETT). Monolithic ceramic and composite restoration can be lute to the tooh, without the use of a post. However, little is known how the material stiffness and presence of a composite core will affect the survival and failure mode.

The objective of this in-vitro study was to evaluate the fracture strength and failure mode of endodontically treated molars, restored with ceramic or hybrid composite monolithic restoration, in the presence of absence of a composite core.

Materials and Methods

Sixty depulped molars were restored with a lithium-disilicate (e.max CAD) or hybrid composite (Cerasmart) restoration. Both materials were used in a monolithic approach, but with 3 different designs: (a) monolithic endocrown, (b) crown with a separate composite core, and (c) overlay without core buildup or pulpal extension. Ten sound teeth were used as control group. All groups were thermocycled (10,000 cycles), subsequently loaded in a chewing simulator (100,000 cycles) and finally loaded until fracture.

Results

Peak fracture loads and failure modes were registered. No significant differences were seen between the groups in terms of fracture load. Failure modes were statistically significantly different among groups with significant correlation between restoration type and material. (p < 0.001 and p = 0.033, respectively). No group presented significantly higher fracture resistance. Although ceramic crowns and overlays presented the highest repairability, all restored ETT were within the range of the intact tooth' fracture strength.

Conclusion

No restoration presented significant different fracture loads. However, the type of restoration and material choice were correlated to the fracture mode.

OBJECTIVE: To evaluate the clinical outcome of different designs of zirconia dental implants.

DATA: This systematic review adhered to the PRISMA checklist and followed the PICO framework. The protocol is registered in PROSPERO (CRD42022337228).

SOURCES: The search was conducted in March 2023 through four databases (PubMed, Web of Science, Cochrane Library, and Google Scholar) along with a search of references in the related reviews. Three authors reviewed on title, and abstract level and analysed the risk of bias, and all authors reviewed on a full-text level.

STUDY SELECTION: Clinical studies excluding case reports for patients treated with different designs of zirconia dental implants were included. From a total of 2728 titles, 71 full-text studies were screened, and 27 studies were included to assess the risk of bias (ROBINS-I tool) and data extraction. After quality assessment, four studies were included, and the remaining 23 excluded studies were narratively described.

RESULT: The included prospective studies with moderate risk of bias reported success and survival rates of one-piece implants that ranged between 95 and 98.4 % with no difference between different lengths and diameters. The acid-etched roughened surface showed higher clinical outcomes compared to other surface roughness designs.

CONCLUSION: Promising 5-year clinical outcomes were found for one-piece zirconia implants with no difference between different diameters and lengths. Concerning surface roughness, better outcomes were found when using the acid-etched implant surface. However, due to the limited available studies, further high-quality clinical studies comparing zirconia one-piece and two-piece implants with different diameters, lengths, and surface roughness are needed.

CLINICAL SIGNIFICANCE: Based on this systematic review, under suitable clinical situations, the one-piece zirconia implants with diameters of 4.0 mm, 4.5 mm, or 5.5 mm and lengths of 8 mm, 10 mm, 12 mm, or 14 mm have similar promising clinical outcomes. Additionally, the acid-etched roughened implant surface may be preferable.

Purpose: To assess and compare the clinical outcomes of three different types of all-ceramic posterior monolithic tooth-supported crowns. Materials and Methods: A total of 71 patients received 90 all-ceramic crowns randomized to be either high-translucency zirconia (ZC), high-translucency zirconia with a partial buccal veneer (ZC-V), or lithium disilicate glass-ceramic (LDS). All treatments were performed by four general dentists. Choice of material was blinded. Baseline and subsequent annual evaluation were based on modified California Dental Association (CDA) criteria. A questionnaire was used to include patient-reported outcomes and to compare them to the crown quality rating performed by dentists. Results: A total of 66 patients with 84 crowns were examined after 3 years. The survival rate was 98.8%. No crowns fractured during the observation period. One ZC-V crown failed due to loss of retention, and three complications were noted: loss of retention occurred in one ZC crown, and two ZC crowns needed to be endodontically treated. There was no significant difference between the different crowns regarding marginal integrity, surface, or anatomical form. Both patients and examining dentists rated the crowns favorably regarding esthetics, patients more than dentists. Conclusion: Posterior lithium disilicate glass-ceramic crowns and translucent zirconia crowns with or without a partial buccal veneer show excellent and promising clinical outcomes from a short-term perspective. Patients and dentists rate the restorations favorably concerning esthetics and function.

Purpose: To determine the biologic and biomechanical effects of two implant drilling protocols on the cortical bone around implants subjected to immediate loading. Materials and Methods: A total of 48 implants were inserted into the mandibles of six sheep following one of two drilling protocols: undersized preparation (US; n = 24) and nonundersized preparation (NUS; n = 24). Immediately after implant insertion, an abutment was placed on each implant and 36 implants were subjected to 10 sessions of dynamic vertical loads (1,500 cycles, 1 Hz) of 25 N or 50 N. Insertion torque value (ITV) was recorded at implant installation. Resonance frequency analysis (RFA) was measured at implant insertion and at each loading session. Fluorochrome was administered at day 17, and the animals were euthanized after 5 weeks. The removal torque values (RTVs) were measured, and samples underwent histomorphometric, mu CT (microcomputed tomography), and fluorescence image acquisition analyses. The bone volume density (BV/TV), bone-to-implant contact (BIC), bone area fraction occupancy (BAFO), and fluorochrome stained bone surface (MS) were calculated. A linear mixed model analysis was performed, and Pearson paired correlation was calculated. Results: Five implants from the NUS group failed, with a mean ITV of 8.8 Ncm and an RFA value of 57. The mean ITVs for US group and NUS group were 80.5 (+/- 14) Ncm and 45.9 (+/- 25) Ncm, respectively (P < .001). No differences were noted in the RFA values from the time of implant insertion until the end of the study. No differences in RTV, BV/TV, BAFO, or MS were observed between the groups. Intense new bone formation took place in the NUS group implants that were subjected to load. Conclusions: Undersized preparation of cortical bone ensured a greater BIC compared to a nonundersized preparation. Moreover, this study demonstrated that immediate loading did not interfere with the osseointegration process, but loading induced intense new bone formation in the NUS group. It is not recommended to immediately load the implants when the clinically perceived primary stability is lower than an ITV of 10 Ncm and an RFA value of 60.

Several viewpoints have been reported regarding the effect of temporary cements, different surface pretreatment protocols before adhesive cementation, and predictive factors. This in vitro study tested if temporary cement, pretreatment of the tooth surface, the size of enamel or dentine influence adhesive cementation to zirconia ceramics. Twenty premolars were prepared for determination of enamel and dentin area, bond strength test and failure analysis. The samples were divided into two groups: untreated prior adhesive cementation (n = 10) and with temporary cementation done, pretreated prior adhesive cementation (n = 10). Zirconia overlays (Katana Zirconia STML) were cemented on the grounded flat teeth surfaces using Panavia V5. An additional six premolars underwent dentine tubule analysis with SEM to detect temporary cement residues after temporary cementation on an untreated tooth surface (n = 3) and on a pretreated surface (n = 3). The independent sample t-test was used to compare the two groups and the means of the total tooth, dentin or enamel areas did not differ significantly between the untreated and pretreated specimens. The mean tensile bond strength was significantly (p = 0.005) higher in the pretreated specimens (337N) than in the untreated ones (204N). The overall multivariable linear regression model with three predictors (surface pre-treatment, enamel area and dentine area) was significant (p = 0.003), among which the size of enamel was the strongest predictor (beta = 0.506; p = 0.049), followed by the pretreatment effect (beta = 0.478; p = 0.001) and the size of dentin area (beta = -0.105; p = 0.022).

OBJECTIVES: The aim of this study was to evaluate whether salivary contamination during placement of implants with different surface characteristics affects osseointegration in native and in augmented bone areas.

MATERIALS AND METHODS: Forty eight implants with machined surface (MS) and 48 implants with moderately rough surface (RS) were tested in the calvaria of 12 sheep. At the first surgery, 64 bony critical defects were randomly created and were subsequently augmented with two materials (autogenous or bovine bone). After 5 weeks of graft healing, 8 implants were placed per sheep, in native bone and in the centre of the augmented defects. Forty eight implants were soaked with saliva before placement (contaminated group [CG]), while 48 implants were not (non-contaminated group [NCG]). Five weeks after implant placement, bone-to-implant contact (BIC) and bone material area fraction occupancy (BMAFO) were calculated histomorphometrically.

RESULTS: Saliva contamination showed a significant negative effect (p = .000) on BIC, especially in augmented areas. RS showed significant positive effect on BIC, compared to MS (p = .000), while there were no significant differences for different bone conditions (p = .103). For BMAFO, the contamination showed a significantly negative affect (p = .000), while there were no significant differences for surface characteristics (p = .322) and for bone condition (p = .538).

CONCLUSION: Saliva contamination during dental implant placement has a negative effect on osseointegration in augmented areas. Moderately rough surface has a possible advantage in the aspect of initial bone to implant contact. However, it seems to be advisable to avoid saliva contamination especially for implants placed in augmented bone areas.

Because new zirconia materials are constantly being developed, the aim was to identify and qualitatively synthesize research on how processing and time-related factors affect the properties of high translucent (HT) zirconia intended for monolithic restorations. Cochrane Library, PubMed, Scopus, Web of Science, and reference lists were searched for in vitro and clinical studies. Eligibility and risk of bias were assessed. A synthesis of 142 publications was performed. HT 3Y-TZP was the most common, followed by 5YSZ, 4YSZ, and multilayer. In the laboratory, HT 3Y-TZP should be sintered according to the manufacturer’s recommendation and polished before glazing to favour strength, roughness, and wear behaviour. In the clinic, polishing is necessary after grinding to favour roughness and aging resistance. Over time, when using hydrothermal aging, t–m phase transformation and reduced translucency are expected, without affecting the strength and roughness. The strength of 4YSZ and 5YSZ is unaffected. However, the time-related methods are of questionable clinical significance. The evidence of all other factors’ effects on the properties of HT zirconia is lacking or limited; thus, these factors are of relevance for future research. There is a high heterogeneity of study designs and methods, and the results are brand-dependent.