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PubMedDate not supplied

Ion release from copper phosphate cement and influence on Streptococcus mutans growth in vitro: a comparative study.

The aim of this study was to compare the effects of a black copper cement (BCC), an established restorative material (a conventional glass ionomer cement) and two temporary restorative materials (a zinc phosphate and a zinc polycarboxylate cement) on the growth of Streptococcus mutans in vitro, and to correlate bacterial growth with ion release from each material. Test specimens were eluted in either 0.1 M lactic acid, pH 4, or 0.1 M sodium chloride, pH 7. At 2 days, 7 days, 28 days and 6 months, eluates were inoculated with S. mutans and bacterial growth was recorded. Metal ion (Cu(2+), Zn(2+ )and Mg(2+)) and fluoride release were measured. At most immersion times, the different materials had a statistically significant inhibitory effect on bacterial growth compared to the respective control, at both pH levels. The inhibitory effect decreased with time and in most cases was associated with high levels of ion release at the beginning of the experimental period, followed by significantly lower levels. For BCC, there were statistically significant relationships between the median rates of growth of S. mutans in the presence of BCC eluates and the median values for release of copper and zinc, although not magnesium. Of the different materials, BCC demonstrated greatest antibacterial activity.

Anti-Bacterial Agents↗
PubMed1997

The role of implants in restorative dentistry: prosthesis design and aesthetic considerations.

When implants are used to anchor an intra-oral prosthesis, the resulting dentition should not only function well but also be aesthetically pleasing. Both aspects must therefore be carefully considered in the assessment of each case. Optimal aesthetics can be achieved only if a number of criteria, of which the amount and quality of bone present in a potential implant site are most important, are fulfilled. Collapse of the labial cortical plate is common, occurring two to three years after extraction. It can result in palatal placement of implant fixtures, leading to a poor crown emergence profile. Insertion of an implant fixture after initial socket healing but before resorption has occurred will maintain the labial contour. This technique is being used with increasing success.

Dental Abutments↗
PubMed2004

Immediate occlusal loading of Osseotite implants in the lower edentulous jaw. A multicenter prospective study.

OBJECTIVE: This paper reports the results of a prospective multicenter clinical study on immediately fully occlusally loaded full-arch screw-retained prostheses with distal extensions (hybrid prostheses) supported by Osseotite implants inserted in edentulous lower jaws. METHOD AND MATERIAL: Sixty-two patients were enrolled in four clinical centers. Three hundred and twenty-five Osseotite implants were inserted and occlusally loaded according to an immediate loading protocol. The temporary prosthesis was delivered 4 h from surgery. The final prosthesis was delivered after 6 months. Marginal bone loss was monitored from periapical radiographs using a computerized technique. RESULTS: Two implants failed to integrate within 2 months of occlusal loading. A cumulative implant success rate of 99.4% was achieved for a period of 12-60 months postplacement (mean 28.6+/-14.1 (SD) months). Crestal bone loss around the immediately loaded implants was similar to that reported for standard delayed loading protocols. CONCLUSION: The results of this study suggest that the rehabilitation of the edentulous mandible by an immediate occlusally loaded hybrid prosthesis supported by five to six Osseotite implants represents a viable alternative treatment to classic delayed loading protocols.

Alveolar Bone Loss↗
PubMedDate not supplied

The periodontal-restorative interface in fixed prosthodontics: tooth preparation, provisionalization, and biologic final impressions. Part I.

The delicate dento-gingival attachment apparatus must be treated with utmost respect during all preparational maneuvers in the crevicular region. There is little room for error within these minute dimensions. To avoid irreparable harm during chemo-mechanical manipulation of the attachment apparatus, the dentist must always think on a histologic level in order to respect the cellular integrity of the periodontium. The learning objective of this article is to encourage the dentist to be ever vigilant when approaching the subcrevicular tissues during biomechanical tooth preparation, provisionalization, biologic final impressions, and final cementation. Part I discusses the emergence profile, retraction, preparation modalities, and provisionalization; it is presented in this issue. Part II will cover final impressions and casts, derived from information provided by morphologically correct provisionals, surgical provisionalization, and final rehabilitative results; it will appear in the April, 1994, issue of PP&A.

Crowns↗
PubMed1989

Psychological implications of provisional prostheses.

The use of provisional restorations in the practice of partial and complete prosthodontics affords the dentist a productive method of arriving at an effective and pleasing prosthesis for the patient. Similarly, it serves the patient as a means of maintenance during multidisciplinary care. It can provide immediate replacement of extracted teeth and serve as a guide for correcting pre-existing conditions such as collapsed vertical dimension, related esthetic or facial collapse, centric occlusion, and changes caused by deterioration. After one or more visits, preliminary to the dental treatment plan, in which there has been an evaluation of the patient's physical, oral, and emotional condition, the dentist can arrive at a plan in which all factors may be considered and treatment directed appropriately. This article, in its limited approach, has attempted to emphasize the importance of knowing and understanding the patient's needs, which are not often clearly expressed by the patient. There must be adequate preparation of the patient to reduce or eliminate anxieties. Patient-practitioner discussions regarding procedures and realistic expectations are most helpful. A broad span of multidisciplinary dental treatment may well be served by the use of the transitional prosthesis, affording the dentist and patient adequate time for treatment, corrections, and optimal esthetics.

Dentist-Patient Relations↗
PubMed1998

Aesthetics in implantology.

A young man presented himself with a missing maxillary central incisor and a depressed defect due to a trauma. The trauma caused the loss of No. 8 and its surrounding supportive structure. The defective results were seen by the labial bone loss in the area and a depression. The depression became a food-and-plaque trap and an unaesthetic eyesore. Before the tooth loss, iatrogenic factors from a root canal or retrograde amalgam caused a permanent gingival tattoo. The bonded temporary pontic was larger mesio-distally than the adjacent teeth, and this was very noticeable. It was dull in its finish and poor aesthetically. The patient requested an implant to avoid excess drilling of natural teeth. A combined effort was used to achieve the pleasing final result. To correct the area and improve the physiology and aesthetics, several techniques had to be understood. These techniques also need to be mastered, recalled, and used almost instinctively, and done in a proper team-like sequence. In this case we performed an aesthetic ridge augmentation and tissue surgical manipulation to acquire the form, shape, and correct color background. Deciding upon which implant and material involved choosing the size, type, and shape for the area involved. The techniques used included implant insertion, surgical second stage abutment, mucosal periosteal flap design, various suturing and gingival grafting techniques, ridge buildup augmentation, and GTR. Other choices included which resorbable membrane to use, what bone graft materials, and what oral hygiene to recommend to maintain final health. The restorative technique included full crown coverage, laminate veneers, provisional pontic design and bonding, control of porcelain materials, computer imaging, occlusion, cementing, smile designs, and implant prosthodontics.

Adult↗
PubMed1990

Evaluation of fracture resistance of resins used for provisional restorations.

Fracture resistance of provisional restorations is an important concern for the restorative dentist. Fracture resistance of a material is directly related to the transverse strength. This study evaluated the transverse strengths of provisional resins under varied conditions. Uniform samples were made from seven resins and tested immediately after the set of the material, after 7 days of dry storage, and after 7 days of wet storage. The fractured samples from the 7-day wet storage group were repaired with the same provisional material the sample was made from and fractured again to determine transverse strength for repaired samples. Five of the resins tested demonstrated statistically similar strength in the 7-day wet group. Two were found to be significantly weaker. Absorption of water resulted in a slight, but insignificant decrease in strength. Transverse strengths varied widely in the repaired group, and all materials showed a statistically significant reduction compared with the 7-day wet storage group.

Absorption↗
PubMed1998

In vitro mechanical property comparison of four resins used for fabrication of provisional fixed restorations.

PURPOSE: This study recorded and compared the flexural elastic moduli and moduli of rupture of four materials (Provipont DC resin, Triad provisional restorative material, Jet acrylic resin, and a 50:50 mixture of Jet acrylic resin and orthodontic resin) used to make provisional restorations. MATERIAL AND METHODS: Thirty-nine identical 63 x 10 x 3 mm specimens were made from each of the four materials. After 24 hours, 30 days, and 60 days of water storage at 37 degrees C (13 specimens each), standard three-point bend tests were conducted on an Instron universal testing machine at a crosshead speed of 0.5 cm/minute. Stress strain curves were generated, and values for the flexural elastic moduli and moduli of rupture were calculated. Data were subjected to two-way and one-way analyses of variance (alpha = 0.05). RESULTS: Provipont DC resin exhibited significantly higher flexural elastic moduli and moduli of rupture values at the 24-hour test time. However, Provipont DC resin exhibited the greatest decrease in these values over time.

Acrylic Resins↗
PubMed2006

On the causes of persistent apical periodontitis: a review.

Apical periodontitis is a chronic inflammatory disorder of periradicular tissues caused by aetiological agents of endodontic origin. Persistent apical periodontitis occurs when root canal treatment of apical periodontitis has not adequately eliminated intraradicular infection. Problems that lead to persistent apical periodontitis include: inadequate aseptic control, poor access cavity design, missed canals, inadequate instrumentation, debridement and leaking temporary or permanent restorations. Even when the most stringent procedures are followed, apical periodontitis may still persist as asymptomatic radiolucencies, because of the complexity of the root canal system formed by the main and accessory canals, their ramifications and anastomoses where residual infection can persist. Further, there are extraradicular factors -- located within the inflamed periapical tissue -- that can interfere with post-treatment healing of apical periodontitis. The causes of apical periodontitis persisting after root canal treatment have not been well characterized. During the 1990s, a series of investigations have shown that there are six biological factors that lead to asymptomatic radiolucencies persisting after root canal treatment. These are: (i) intraradicular infection persisting in the complex apical root canal system; (ii) extraradicular infection, generally in the form of periapical actinomycosis; (iii) extruded root canal filling or other exogenous materials that cause a foreign body reaction; (iv) accumulation of endogenous cholesterol crystals that irritate periapical tissues; (v) true cystic lesions, and (vi) scar tissue healing of the lesion. This article provides a comprehensive overview of the causative factors of non-resolving periapical lesions that are seen as asymptomatic radiolucencies post-treatment.

Actinomycosis↗
PubMedDate not supplied

Fixed temporization and bone-augmented ridge stabilization with transitional implants.

Utilization of dental implants in full-mouth restorations is now a well-accepted treatment modality, with numerous modifications and implant systems documented in the literature. The efficacy of the treatment procedure generally requires an extended postplacement healing period prior to loading the implant fixture with the stress of mastication. Until recently, clinicians have not been able to address patient comfort requirements during the healing period. The teaching objective of this article is to present and evaluate a transitional implant system used to provide function during the healing phase. The system consists of thin titanium transitional implants and a three-component overdenture that is intended to absorb the pressure during function and protect the augmented implant site and the definitive implant fixtures from the stress of immediate loading. Treatment objectives for the transitional and definitive implants are made during the initial treatment planning. Three cases are presented to document and illustrate the clinical procedure.

Aged↗
PubMed2005

Immediate restoration of implants placed into fresh extraction sockets for single-tooth replacement: a prospective clinical study.

The aim of the present clinical study was to evaluate the placement of transmucosal implants into fresh extraction sockets and their immediate restoration with temporary crowns. A series of 22 cases with a 12-month follow-up is presented. Twenty-two patients (15 women and 7 men; mean age 39 years) who needed a single tooth replaced because of vertical or horizontal root fracture, caries, endodontic lesions, or periodontal disease were treated with immediate postextraction implant placement. The implant was then restored with a screw-retained prosthetic restoration within 24 hours. Radiographic assessments were made at baseline and 12 months after implant placement. Clinical parameters, such as plaque score, mucositis score, probing attachment level, mucosal margin position, variation of gingival level, and variation of papilla position, were also measured at baseline and after 12 months of follow-up. At 12 months, no implants had failed. Radiographic examination revealed mean bone resorption of 0.5 mm at 12 months compared to baseline. The mean variation of gingival level, compared to the neighboring teeth, was -0.75 mm. Probing attachment levels were 0.79, 0.45, and 0.54 mm at proximal, buccal, and lingual sites, respectively. The values for the mucosal margin position were 2.9, 2.2, and 2.4 mm at proximal, buccal, and lingual sites, respectively. Regarding variation of papilla position, according to Jemt's index, 27 papillae presented with a score of 2 (61%) and 17 with a score of 3 (39%). An examination of oral hygiene and peri-implant soft tissue conditions at the 12-month follow-up visit revealed an overall frequency of plaque-carrying implant surfaces of 13%. Furthermore, mucositis (score 2) was not observed at any of the peri-implant units. Primary implant stability did not significantly increase over time. The immediate restoration of dental implants placed into fresh extraction sockets was shown to be a safe and predictable procedure. The success rate and radiographic and clinical results were comparable to those obtained following the standard protocol. Within the limits of the present investigation, immediate restoration of single-tooth implants placed in fresh extraction sockets can be considered a valuable option to replace a missing tooth. However, long-term clinical trials are needed to confirm the present results.

Adult↗
PubMed1997

Reinforcement of acrylic resins for provisional fixed restorations. Part I: Mechanical properties.

Acrylic resins are commonly used in many dental applications; especially in the fabrication of provisional fixed partial dentures. Among noticed technical drawbacks associated with this material are unsatisfactory mechanical properties. Moreover, if acrylic resins are exposed to moist environment, water sorption results in further mechanical deterioration. In order to improve the mechanical properties, aluminum, magnesium, and zirconium oxide powders and pulverized E-glass particles were separately admixed with pre-polymerized acrylic resin beads prior to mixing with monomer liquid. Particle loading ratios were 1, 2 and 3 vol.% with respect to pre-polymerized beads. Poly(methyl methacrylate), poly(ethyl methacrylate) and poly(isobutyl methacrylate) were used as resin matrices. Furthermore, a metal primer agent was employed in order to form a strong interphase between admixed particles and polymer matrix phase. Samples were subjected to three-point transverse bending tests at a crosshead speed of 10 mm/min. It was concluded that (1) addition of particles generally increases the water sorbed by the composite resins systems, (2) however, two vol.% admixtures in a PMMA resin matrix showed significant improvements in the mechanical properties (p < 0.05), (3) among the oxide particles, zirconia exhibited the greatest improvements in modulus of elasticity, transverse strength, toughness and hardness, and (4) mechanical properties (transverse strength, 0.2% offset yield strength and modulus of elasticity) were linearly correlated to hardness numbers.

Acrylic Resins↗
PubMedDate not supplied

Influence of interimplant distance on gingival papilla formation and bone resorption: clinical-radiographic study in dogs.

PURPOSE: The purpose of this study was to evaluate in dogs the area between implants after prosthetic restoration within 5 mm distance between the contact point (CP) between crowns and the bone crest (BC). MATERIALS AND METHODS: The mandibular premolars of 6 dogs were extracted bilaterally. After 12 weeks of healing, each dog received 8 implants. On each side, 2 implants were separated by 2 mm (group 1) and 2 by 3 mm (group 2). After a healing period (3 months), the implants were restored with temporary acrylic resin prostheses and after 4 more weeks, with definitive metallic prostheses. After 8 weeks, the distance between the CP and the papilla (P) was measured. The distance between a line extending from the CP and the gingival height at the distal extension of the prosthesis (DE) was also measured. Digital radiographic images were obtained for evaluation of the CP-BC and BC-P distances and the analysis of bone resorption adjacent to the implant surfaces. RESULTS: The median CP-P distances were 1.75 mm and 1.98 mm for groups 1 and 2, respectively; the median CP-DE distances were 2.60 and 2.69, respectively. The mean CP-BC distances were 5.64 mm and 6.45 mm, for groups 1 and 2, respectively; mean BC-P distances were 3.07 mm and 3.55 mm, respectively. DISCUSSION AND CONCLUSIONS: The differences in distances of 2 and 3 mm between implants did not present significant differences in the formation of papillae or in crestal resorption. The CP-BC distances for prostheses should be different from those of natural teeth because in natural teeth, the biologic width is already present, and in the case of implant-supported prostheses, it will develop following second-stage surgery.

Animals↗
PubMed1997

Factors influencing the retention of cemented implant-supported crowns.

This study is a retrospective analysis of the influence of cement, coping type, and fixture site on the cementation failure of 36 selected implant-supported single crowns placed between 1991 and 1995. Fisher's exact test and a log linear analysis were performed on the data. Crowns constructed with a milled-metal coping, cemented with a temporary cement, or placed in the maxillary premolar site were more likely to be associated with cement failure than those cemented with zinc phosphate, constructed with cast metal or ceramic copings, or placed in the anterior maxilla. We were unable to account for some variables-for example, bite force or oral habits. For this reason we consider that we would overstate the strength of this case analysis if we drew general conclusions from our results. However, we have altered our treatment protocol to reduce the initial cost and the maintenance associated with recementing implant-supported crowns, discontinuing the use of the milled-gold cylinder in view of the lack of any clear clinical advantage and the results of this study. In addition, and because only one internal gold screw in our series of patients has loosened, we now use a permanent cement.

Confidence Intervals↗
PubMedDate not supplied

Immediate loading with complete implant-supported restorations in an edentulous heavy smoker: histologic and histomorphometric analyses.

The clinical case presented is that of an edentulous female patient, a heavy smoker, who received implant-supported complete restorations in the maxilla and mandible using the immediate loading concept according to the Ankylos implant system. The patient received 12 commercially pure titanium (grade 2) Ankylos implants, 6 in the maxilla and 6 in the mandible. The implants were loaded immediately after surgery with temporary acrylic resin prostheses fabricated chairside using a prefabricated customized splint. The definitive ceramometal restorations were seated 4 months after surgery. Clinical and radiologic evaluation at 7 months after implant placement indicated functional bone anchorage of all implants, despite the patient being a smoker and having poor bone quality. The patient died 7 months after implant placement because of lung cancer; however, there was no known disease at the time of implant placement. After her death, the implants with the surrounding tissues were removed en bloc and examined histologically and histomorphometrically using undecalcified cut and ground sections. All implants were osseointegrated to some extent and surrounded by lamellar bone. However, around the upper, nonthreaded parts of the implants, much of the bone had been resorbed. In this region, fibrous connective tissue was in close contact with the titanium surface. Epithelial proliferation with pocket formation could not be observed in any of the implants. The histomorphometric evaluation of bone-implant contact in threads demonstrated a mean of approximately 51% of the available surface and a mean bone volume of approximately 52%, with a tendency toward greater contact and volume around the implants in the maxilla. If the nonthreaded cylindric portions of the implants were included, mean bone-implant contact was 46% and mean bone volume was 47%.

Acrylic Resins↗
PubMedDate not supplied

Influence of reinforcement design on the loss of marginal seal of provisional fixed partial dentures.

Loss of marginal cement seal, initial fracture, and stiffness of three four-unit provisional restorations were tested. Loss of marginal cement seal was monitored using strain gauges located occlusogingivally at the distal of the second molar abutment and the mesial of the first premolar abutment of a four-unit posterior fixed provisional restoration with two pontics. The provisional restorations were then placed in an Instron testing machine and loaded to initial fracture. Stiffness was calculated from the Instron recordings. The provisional designs were permachrome band-reinforced, wire-reinforced, and a nonreinforced control. Analysis showed: (1) the band-reinforced design withstood a significantly greater load before loss of cement seal (P< or =.05); (2) the band-reinforced design had a significantly higher stiffness (P< or =.05); and (3) there was no difference between the three designs for load at initial fracture. Within the same sample it was found that for both band- and wire-reinforced designs the premolar abutment lost the marginal cement seal at a significantly lower load than the molar (P< or =.05). For the control there was no significant difference for load at marginal cement seal loss between abutments.

Acrylic Resins↗
PubMed1996

A comparison of two methods of adhering composite to metal.

Composites are used as an esthetic restorative material in prosthetic dentistry, often with a metallic substructure that provides support when large restorations are required. Different bonding systems have been proposed to occupy the gap between the composite and metal and to reduce marginal leakage at this interface, which with time results in a degradation of the metal-composite junction with dissociation of these two materials. This study compared two methods of adhesion of composite to metal: (1) the Silicoater, based on a silanization of metal and (2) the Spectralink, based on an ionization of metal. A total of 108 metal pellets were covered with composite; 36 pellets formed the baseline or control group and 72 pellets were placed on temporary fixed partial dentures for the 12 patients in the study. The two bonding methods were compared at 0, 30, and 90 days. Marginal leakage (< 0.7 microns) and marginal gap (< 0.6 microns) for the baseline groups were minimal and demonstrated no significant difference between the two samples. The degradation of marginal adaptation and hermeticity was faster and more severe with the pellets of the ionization sample. The Silicoater samples exhibited a better hydrolytic resistance with the formation of a hydrophobic polymer. The degradation of the composite-metal interface with the Spectralink method appeared to be the result of the hydrophilic character of polyfluoromethacrylate. Nevertheless, the values of the marginal gap (< 6.0 microns) and the microleakage (< 30.0 microns) remained low for the metal treatments.

Acrylic Resins↗
PubMed2000

Effects of the Nd:YAP laser on coronal restorative materials: implications for endodontic retreatment.

With new wavelengths that allow light transmission by optical fibers, the laser is now often used in endodontics either during treatment or retreatment. The aims of this study were to (i) specify the effects of laser irradiation on restorative materials in terms of topographic effects and (ii) describe different protocols for the first steps of retreatment. The laser used in this study was an optical fiber Nd:YAP (Lokki dt, Vienne, France) with a wavelength of 1.34 microns. Samples of the following restorative materials were prepared: amalgam, composite, permanent and temporary cements, and prosthodontic alloy. The handpiece of the Nd:YAP laser was fixed perpendicular to the surface of the different preparations. All trials were performed with the fiber tip either in contact with or at a distance of 2 mm from the material. The surface effects in all cases were (i) the creation of craters in the center of the lased areas, (ii) a border of fusion material at the edge of the craters, and (iii) cracks or fractures at a distance from the target areas. For the cements, amalgam and composite, the effects included a projection of material from the center to the edge of the lased area and/or the apparent photovolatization of light particles. For all materials the laser induced deeper absorption in the areas of direct contact than when it was held at a distance. This suggests that the fiber should be in contact with the restorative material for lasing in the straight part of the canal when the objective is either to pass through the material or alongside it between material and tooth. If the practitioner cannot determine the direction of the curve of the canal, lasing should be performed at a distance to weaken the material and thus permit more efficient use of an ultrasonic device. Lasing should in all cases be performed under close X-ray monitoring. Provided that sufficient caution is used, the laser may be helpful in removing restorative materials during retreatment.

Absorption↗