This article describes the protocol for determining the cause of failure for retrieved failed implant supported fixed dental prostheses (FDPs) in a clinical study of three-unit bridges. The results of loading of flexure bars of different veneer compositions at different stress rates were presented for two veneer materials (leucite reinforced and fluorapatite glass-ceramic veneers) and a Y-TZP core zirconia ceramic used in the clinical study. From these results, the strengths of the fast loading conditions were used to determine the fracture toughness of these materials. Fractal dimension measurements of the flexure bars and selected FDPs of the same materials demonstrated that the values were the same for both the bars and the FDPs. This allowed the use of fracture toughness values from the flexure bars to determine the strengths of the FDPs. The failure analysis of clinically obtained FDP replicates to determine the size of the fracture initiating cracks was then performed. Using the information from the flexure bars and the size of the fracture initiating cracks for the failed FDPs, the strengths of the FDPs were determined. The clinical failures were determined to be most likely the result of repeated crack growth due to initial overload and continuous use after initial cracking.

The aim of this work is to investigate the effects produced by polymicrobial biofilm (Porphyromonas gingivalis, Streptococcus mutans, Streptococcus sanguinis, and Streptococcus salivarius) on the corrosion behavior of titanium dental implants. Pure titanium disks were polished and coated with titanium nitride (TiN) and silicon carbide (SiC) along with their quarternized versions. Next, the disks were cultivated in culture medium (BHI) with P. gingivalis, S. mutans, S. sanguinis, and S. salivarius and incubated anaerobically at 37 °C for 30 days. Titanium corrosion was evaluated through surface observation using Scanning Electron Microscope (SEM) and Atomic Force Microscopy (AFM). Furthermore, the Ti release in the medium was evaluated by Inductively Coupled Plasma Mass Spectrometry (ICP-MS). SEM images showed that coated Ti disks exhibited lower corrosion compared to non-coated disks, except for the quartenized TiN. This was confirmed by AFM, where the roughness was higher in non-coated Ti disks. ICP showed that Ti levels were low in all coating disks. These results indicate that these SiC and TiN-based coatings could be a useful tool to reduce surface corrosion on titanium implant surfaces.

Tooth decay is a prevalent disease that initiates when the oral pH becomes acidic. Fluoride and/or bioactive glass (NovaMin) were used to regenerate/repair teeth that had been decalcified. In this present study, we investigated the effect of fluoride and/or bioactive glass (NovaMin) on remineralization of hydroxyapatite (HA) discs, which mimic the enamel surface of natural teeth. HA discs were etched with phosphoric acid and treated with one of the following toothpastes: (1) Sensodyne toothpaste with fluoride; (2) Sensodyne toothpaste with fluoride and bioactive glass (NovaMin); (3) Tom's toothpaste without fluoride or bioactive glass (NovaMin); and (4) Tom's toothpaste with bioactive glass (NovaMin). The toothpastes were applied on the etched discs for two minutes, once a day for 15 days. Scanning electron microscopy (SEM) was used to analyze surface morphologies and X-ray photoelectron spectroscopy (XPS) was used to analyze surface compositions. Tom's toothpaste with only NovaMin demonstrated the most remineralization potential compared with the other groups. In conclusion, incorporating bioactive glass (NovaMin) into toothpastes could benefit the repair and remineralization of teeth.

Titanium implants are commonly used in the field of dentistry for prosthetics such as crowns, bridges, and dentures. For successful therapy, an implant must bind to the surrounding bone in a process known as osseointegration. The objective for this ongoing study is to determine the potential of different implant surface coatings in providing the formation of hydroxyapatite (HA). The coatings include titanium nitride (TiN), silicon dioxide (SiO2), and quaternized titanium nitride (QTiN). The controls were a sodium hydroxide treated group, which functioned as a positive control, and an uncoated titanium group. Each coated disc was submerged in simulated body fluid (SBF), replenished every 48 h, over a period of 28 days. Each coating successfully developed a layer of HA, which was calculated through mass comparisons and observed using scanning electron microscopy (SEM) and energy dispersive analysis x-rays (EDX). Among these coatings, the quaternized titanium nitride coating seemed to have a better yield of HA. Further studies to expand the data concerning this experiment are underway.

Titanium (Ti) corrodes clinically in the presence of bacteria. We investigated this phenomenon as a function of Ti particles found in biopsied tissues around peri-implantitis sites and surface roughness of failed Ti implants. Tissue biopsies were surgically collected from peri-implantitis sites, processed, and embedded in resin. The resin-embedded samples were hand trimmed to the region of interest and semi-thick (500 nm) sections were collected onto coverslips. One section was toluidine blue post-stained as a reference. The remainder sections were left unstained for energy-dispersive X-ray spectroscopy (EDX) analysis. Processed samples were examined under scanning electron microscopy (SEM) and EDX. Corresponding failed implants were also removed and examined under SEM and EDX. Five out of eight biopsied samples demonstrated the presence of Ti particles in the soft tissue, suggesting the true rate among all failures was between 24.5% and 91.5% (the lower bound of a 95% confidence interval for the true rate of Ti presence). SEM analysis of failed implant bodies also indicated changes in surface morphology and appeared less detailed with decreased weight percent of Ti on the surface of the failed implants. In conclusion, Ti particles were noted in 5/8 biopsied samples. Surface morphologies were smoother in failed implants compared with the reference implant.

ObjectiveThe goals of this research are: (1) to determine the clinical survival of ceramic-ceramic 3-unit implant supported fixed dental prostheses (FDPs) compared with control metal-ceramic and; (2) to analyze the effects of design parameters such as connector height, radius of curvature of gingival embrasure, and occlusal veneer thickness.Materials and MethodsThis randomized, controlled clinical trial enrolled 96 participants with 129 3-unit implant-supported FDPs. Participants were randomized to receive different design combinations to include FDP material, thickness of occlusal veneer ceramic, radius of curvature of gingival embrasure and connector height. Participants were recalled for 6 months, 1year and yearly thereafter for the next 5 years. FDPs were examined for evidence of fracture and radiographs were made to assess viability of implants. Fractographic analyses and Kaplan Meier survival analysis was used to analyze the data.Results27 FDPs, representing 21%, exhibited chipping fractures of the veneer during the 5-year observation period. There was no statistically significant effect of type of material, veneer thickness, radius of curvature of gingival embrasure and connector height on occurrence of fracture. Fractographic and occlusal analyses reveal that fractures originated from the occlusal surface and that occlusion was the most important factor in determining survival. Stresses calculated at failure demonstrated lower values compared with in vitro data.ConclusionImplant-supported ceramic-ceramic prosthesis is a viable alternative to metal-ceramic. Survival analysis for both materials were comparable and design parameters employed in this study did not affect survival as long as zirconia was used as the core material.

The effect of a novel silicon carbide (SiC) coating on the chemical durability of a fluorapatite glass-ceramic veneer was investigated by examining weight loss and ion release levels. The hypothesis that this novel coating will exhibit significant corrosion resistance was tested. Inductively coupled plasma atomic emission spectrometer (ICP) was used for ion concentration determination and scanning electron microscopy (SEM) for surface morphology analyses. Samples were immersed in pH 10 and pH 2 buffer solutions to represent extreme conditions in the oral cavity. Analyses were done at 15 and 30 days. The SiC coated group demonstrated significant reduction in weight loss across all solutions and time points (p < 0.0001). Ion release analyses demonstrated either a marginally lower or a significantly lower release of ions for the SiC-coated disks. SEM analysis reveals planarization of surfaces by the SiC-coated group. The surfaces of coated samples were not as corroded as the non-coated samples, which is indicative of the protective nature of these coatings. In conclusion, SiC is a novel coating that holds promise for improving the performance of ceramic materials used for dental applications.

A 200 nm plasma-enhanced chemical vapor-deposited SiC was used as a coating on dental ceramics to improve anti-bacterial properties for the applications of dental prosthesis. A thin SiO2 (20 nm) in the same system was deposited first, prior to SiC deposition, to improve the adhesion between SiC to dental ceramic. Silane and methane were the precursors for SiC deposition, and the SiO2 deposition employed silane and nitrous oxide as the precursors. SiC antimicrobial activity was evaluated on the proliferation of biofilm, Streptococcus sanguinis, and Streptococcus mutans on SiC-coated and uncoated dental ceramics for 24 h. The ceramic coating with SiC exhibited a biofilm coverage of 16.9%, whereas uncoated samples demonstrated a significantly higher biofilm coverage of 91.8%, measured with fluorescence and scanning electron microscopic images. The cytotoxicity of the SiC coating was evaluated using human periodontal ligament fibroblasts (HPdLF) by CellTiter-BlueCell viability assay. After 24 h of HPdLF cultivation, no obvious cytotoxicity was observed on the SiC coating and control group; both sets of samples exhibited similar cell adhesion and proliferation. SiC coating on a ceramic demonstrated antimicrobial activity without inducing cytotoxic effects.

The effect of pH changes on the chemical durability of dental glass–ceramic materials was evaluated using weight loss and ion release levels. The hypothesis that increased pH changes will exhibit greater corrosion was investigated. The ion concentration was analyzed using inductively coupled plasma atomic emission spectrometer (ICP). The surface compositions were investigated using X-ray photoelectron spectroscopy (XPS). The surface morphologies were examined using scanning electron microscopy (SEM). Dental glass–ceramics were tested in constant immersion, 3-day cycling, and 1-day cycling with pH 10, pH 2, and pH 7 for 3, 15, and 30 days. The 1-d cycling group demonstrated the highest levels of weight loss compared with 3-d cycling and constant immersion. For the ion release, Si4+ and Ca2+ had the highest rates of release in 1-d cycling, whereas the Al3+ release rate with constant pH 2 was highest. The alteration/passivation layer that was formed on the surface of disks possibly prevented further dissolution of pH 10 corroded disks. XPS analysis demonstrated different surface compositions of corroded disks in pH 10 and pH 2. Si4+, K+, Na+, Al3+, and Ca2+ were detected on the surface of corroded pH 10 disks, whereas a Si4+ and P5+-rich surface formed on corroded pH 2 disks. SEM results demonstrated rougher surfaces for corroded disks in cycling conditions and pH 2 constant immersion. In conclusion, increased pH changes significantly promote the corrosion of dental glass–ceramic materials.

• First complete research on dissolution activation of fluoroapatite glass-ceramic dental veneer. • Discussion of acid and alkaline corrosion behavior of fluoroapatite glass-ceramic dental veneer. • Characterization of crystalline phase and surface compositions in fluoroapatite glass-ceramic dental veneer.

Purpose: The aim of this study was to determine stress levels on supporting structures of implant-retained overdentures as a function of varying degrees of palatal coverage using finite element analysis modeling at different loading angles. Materials and Methods: ABAQUS®-software was used to perform finite element analysis on eight overdenture models with three and four implants and with and without palatal coverage designs. Loads were applied perpendicular and 45º to the implants. Von Mises stress was measured to determine bone stress. A one-way ANOVA determined which model caused the most stress to the maxillary bone. Results: Palatal coverage increased stress to anterior implant in three implant (p = 0.08) models but decreased stress to all implants in four implant models (p = 0.43). Distal implants received more stress than anterior implants for all models. There was no significant difference between a full palate and no palate coverage overdenture prosthesis when a bar was added under axial loading (p = 0.954). Under non-axial loading, a decrease in stress was noted with the bar in all areas except the anterior implant site. Conclusions: Palatal coverage may not be necessary when applying a pure axial load. The addition of a bar decreased stress at loading.

Titanium nitride (TiN) and silicon carbide (SiC) adhesion properties to biofilm and the proliferation of human osteoblasts were studied. Quaternized titanium nitride (QTiN) was produced by converting the surface nitrogen on TiN to a positive charge through a quaternization process to further improve the antibacterial efficiency. The SiC required a nitridation within the plasma chamber of the surface layer before quaternization could be carried out to produce quaternized SiC (QSiC). The antimicrobial activity was evaluated on the reference strains of Porphyromonas gingivalis for 4 h by fluorescence microscopy using a live/dead viability kit. All the coatings exhibited a lower biofilm coverage compared to the uncoated samples (Ti-85.2%; TiN-24.22%; QTiN-11.4%; SiC-9.1%; QSiC-9.74%). Scanning Electron Microscope (SEM) images confirmed the reduction in P. gingivalis bacteria on the SiC and TiN-coated groups. After 24 h of osteoblast cultivation on the samples, the cell adhesion was observed on all the coated and uncoated groups. Fluorescence images demonstrated that the osteoblast cells adhered and proliferated on the surfaces. TiN and SiC coatings can inhibit the attachment of Porphyromonas gingivalis and promote osteoblast adhesion on the titanium used for implants. These coatings may possess the ability to prevent the development of peri-implantitis and stimulate osteointegration.

The formation and characterization of positively surface charged TiN surfaces were investigated for improving dental implant survival. Surface nitrogen atoms of a traditional TiN implant were converted to a positive charge by a quaternization reaction which greatly increased the antibacterial efficiency. Ti, TiN, and quaternized TiN samples were incubated with human patient subgingival bacteria for 4 hours at 37°C in an anaerobic environment with an approximate 40% reduction in counts on the quaternized surface over traditional Ti and TiN. The samples were challenged with Streptococcus Mutans and fluorescent imaging confirmed significant reduction in the quaternized TiN over the traditional Ti and TiN. Contact angle measurement and X-Ray Photoelectron Spectroscopy (XPS) were utilized to confirm the surface chemistry changes. The XPS results found the charged quaternized nitrogen peak at 399.75 eV that is unique to the quaternized sample.

Statement of problem. The clinical survival of different types of post-and-core systems requires assessment. Purpose. The purpose of this retrospective clinical study was to evaluate the clinical survival rate (CSR) of custom-fabricated cast metal and prefabricated (both metal- and fiber-reinforced composite resin post) post-and-cores as a function of patient- and restoration-related variables. Material and methods. A retrospective analysis was conducted on electronic charts indicating that these patients had received some type of post-and-core between January 2003 and January 2018. A total of 754 records were included in the analysis based on the inclusion criteria. Data were analyzed by using the Kaplan-Meier and Cox proportional hazards analysis. Results. Kaplan-Meier analysis demonstrated the mean survival time for each group to be 12.0 years for fiber-reinforced composite resin posts, 11.8 years for cast metal post-and-cores, and 10.2 years for prefabricated metal posts. Although the mean survival time differed by 1.8 years among groups, with prefabricated metal posts having a slightly higher risk of failure, this effect was not statistically significant (P=.067). The effect of post type also failed to reach significance when controlling for patient demographics and post position in a Cox proportional hazards analysis (P=.106). However, the Cox model did show that survival was associated with tooth position (P=.003), cement (P=.021), and type of restoration (P<.001). Conclusions. Analysis showed no evidence that post-and-core survival was significantly associated with 3 types of post-and-cores (custom-fabricated metal, prefabricated metal, and prefabricated fiber-reinforced composite resin). The percentage of root in the bone, tooth position, cement, and type of restoration, however, were significantly associated with survival.

SiO2/SiC coatings were deposited onto ceramics disks using plasma-enhanced chemical vapor deposition. The effects of deposition pressure and gas-flow ratio on the refractive index, extinction coefficient, and SiC composition were studied. For the highest studied SiH4 to CH(4 )gas-flow ratio of 1.5, the refractive index increased by 17% from 2.53 (at the wavelength of 845 nm) to 2.96 (at the wavelength of 400 nm). For the lowest studied SiH4 to CH(4 )gas-flow ratio of 0.5, the refractive index only increased by 4% from 2.11 (at the wavelength of 845 nm) to 2.20 (at the wavelength of 400 nm). At higher deposition pressures, the variation in refractive index of the SiC coatings was significantly lower showing a slight increase from 1.93 (at a wavelength of 845 nm) to 1.96 at a wavelength of 400 nm. Except for the case of a low SiH4 to CH4 gas-flow ratio of 0.5, for light with wavelengths <= 650 nm, the extinction coefficient of the SiC coatings increased significantly. Light with a wavelength >650 nm had an extinction coefficient near 0 in all cases. After annealing the sample at 400 degrees C for 4 hours, hydrogen-related bonds broke and the stress of the film was reduced from -245 to -71 MPa. By utilizing different thicknesses of SiC, the full standard dental shade guide was matched with the Delta E of each coated disk being less than 3.3 compared to the shade guide.

STATEMENT OF PROBLEM:Whether tooth whitening alters the surface topography of enamel causing an increase in surface roughness that could increase susceptibility to restaining is unclear. PURPOSE:The purpose of this in vitro study was to evaluate whether immersing enamel in common solutions produces a color change of ΔE greater than 2; whether the highest concentration carbamide peroxide bleaching agent produces the greatest ΔE; whether bleaching increases the susceptibility to further staining by common solutions; and whether morphologic changes to the enamel surface are observed after staining and bleaching as evidenced by scanning electron microscopy (SEM) analysis and energy-dispersive X-ray spectroscopy (EDS). MATERIAL AND METHODS:Forty-five extracted human teeth were immersed in 5 solutions (wine, coffee, tea, soda, and water) for 15 days at 80°C, and the change in ΔE was assessed with a colorimeter. The teeth were bleached using different concentrations of carbamide peroxide (20%, 35%, and 44%) and ΔE was measured at different time intervals. The teeth were then restained with the same solutions. The ΔE after initial staining was compared with the ΔE after bleaching and restaining of the same teeth. SEM was performed at baseline, after staining, bleaching, and restaining to evaluate the changes in the enamel surface topography. EDS was used to determine the elemental composition of tooth surfaces after restaining. RESULTS:All liquids caused a ΔE greater than 2 after 15 days. The concentration of bleaching agent was not significantly associated with ΔE for any stain types. No significant difference was found in the rate of staining between initial staining and restaining after bleaching. However, a significant effect of time was found for the staining, where the overall ΔE increased by 0.34 for each day in the solution (P<.001). SEM images showed no major changes to enamel topography after bleaching. However, a coating was noted on teeth stained with wine and tea, which had different elemental compositions when compared with the tooth surface. CONCLUSIONS:Based on SEM observation, bleaching teeth with carbamide peroxide does not increase the susceptibility of enamel to staining and does not alter the topography of the enamel. Using higher bleaching concentrations did not increase tooth whitening as a function of time.

OBJECTIVES:To test the hypothesis that there is no difference in the in vivo maximum wear of enamel opposing monolithic zirconia crowns, enamel opposing porcelain fused to metal crowns and enamel opposing enamel.METHODS:Thirty patients needing single crowns were randomized to receive either a monolithic zirconia or metal-ceramic crown. Two non-restored opposing teeth in the same quadrants were identified to serve as enamel controls. After cementation, quadrants were scanned for baseline data. Polyvinylsiloxane impressions were obtained and poured in white stone. Patients were recalled at six-months and one-year for re-impression. Stone models were scanned using a tabletop laserscanner to determine maximum wear. Statistical analysis was performed using Mann-Whitney U to determine any significant differences between the wear of enamel against zirconia and metal-ceramic crowns.RESULTS:Sixteen zirconia and 14 metal-ceramic crowns were delivered. There were no statistical differences in mean wear of crown types (p=0.165); enamel antagonists (p=0.235) and enamel controls (p=0.843) after one year.CONCLUSION:Monolithic zirconia exhibited comparable wear of enamel compared with metal-ceramic crowns and control enamel after one year.SIGNIFICANCE:This study is clinically significant because the use of polished monolithic zirconia demonstrated comparable wear of opposing enamel to metal-ceramic and enamel antagonists.

Tetragonal magnetostriction (λγ,2) and elastic constants (c′, c44, and c11) for Fe100−xSixwere measured as a function of temperature (T). Compositions corresponding to the disordered A2 (x = 5), ordered D03 (x = 19.8), and mixed (x = 11.6) phases, were investigated. The magnetoelastic coupling (−b1) was determined for 77 < T < 300 K and compared with those of Fe-Ga, Fe-Ge, and Fe-Al. Both λγ,2(T) and −b1(T) of Fe-Si behave similarly to those of Fe-Ge, while other notable differences exist between the measured properties of Fe-Si and those of the other three alloys. Due to the early establishment of short range order, Fe-Si exhibits a positive, although small, slope in λγ,2(T) at 5 at. % Si, and a remarkable drop in −b1 before the solubility limit. The weaker softening of the tetragonal shear modulus with the addition of Si and the lack of strong anharmonic effects in the Fe-Si lattice inferred from the weak T-dependence of all the moduli suggest that FeSi exhibits more structural stability than the other three alloys. The distinctive behavior is likely due to the smaller size of Si compared to the sizes of Ga, Ge and Al, and therefore to the effect of the larger size difference between Fe and Si in the Fe-Si lattice.

OBJECTIVES:(1) To assess whether there is evidence of an association between the number of peri-implant tissue complications and patient characteristics such as gender, diabetes status, smoking status, and bite force; (2) To assess whether there is evidence of an association between the number of peri-implant tissue complications and location of the implant, surgical technique used, bone graft status and sinus lift status.MATERIALS AND METHODS:This randomized, controlled clinical trial included a total of 176 implants (OsseoSpeed, DENTSPLY) in 67 participants with 88 fixed dental prostheses. Information was obtained from health histories, a baseline exam, surgical notes, and post-operative exams. The data were analyzed using Fisher's exact and Mann-Whitney tests and generalized estimating equations using logistic regression with a significance level set at 0.05.RESULTS:All 176 implants survived within a recall period of 3 years, but 11 implants demonstrated peri-implant tissue complications. Ten sites showed dehiscence and one case exhibited vertical bone loss. There was a statistically significant association between surgical technique used (1-stage or 2-stage) and the presence of soft tissue complications (P = 0.005), where 2-stage surgery was associated with a higher frequency of peri-implant soft tissue complications. A correlation, although not statistically significant (P = 0.077), was noted, between peri-implant tissue complications and bone grafting, suggesting a possible role for this factor as well.CONCLUSIONS:Participants who did not require any second-stage surgery at the implant sites experienced fewer complications. Therefore, additional surgical procedures should be performed judiciously considering their possible effects on peri-implant tissue health.CLINICAL SIGNIFICANCE:The clinical implication of this research study is that secondary surgery should be considered with caution during implant placement and it should be performed only when other options have been exhausted, as it has been shown to have a direct adverse effect on the long-term peri-implant tissue health.

Objective: Fractures of posterior fixed dental all-ceramic prostheses can be caused by one or more factors including prosthesis design, flaw distribution, direction and magnitude of occlusal loading, nature of supporting infrastructure (tooth root/implant), and presence of adjacent teeth. This clinical study of implant-supported, all-ceramic fixed dental prostheses, determined the effects of (1) presence of a tooth distal to the most distal retainer; (2) prosthesis loading either along the non-load bearing or load bearing areas; (3) presence of excursive contacts or maximum intercuspation contacts in the prosthesis; and (4) magnitude of bite force on the occurrence of veneer ceramic fracture.Methods: 89 implant-supported FDPs were randomized as either a three-unit posterior metal-ceramic (Au-Pd-Ag alloy and InLine POM, Ivoclar, Vivadent) FDP or a ceramicceramic (ZirCAD and ZirPress, Ivoclar, Vivadent) FDP. Two implants (Osseospeed, Dentsply) and custom abutments (Atlantis, Dentsply) supported these FDPs, which were cemented with resin cement (RelyX Universal Cement). Baseline photographs were made with markings of teeth from maximum intercuspation (MI) and excursive function. Patients were recalled at 6 months and 1-3 years. Fractures were observed, their locations recorded, and images compared with baseline photographs of occlusal contacts.Conclusion: No significant relationship existed between the occurrence of fracture and: (1) the magnitude of bite force; (2) a tooth distal to the most distal retainer; and (3) contacts in load-bearing or non-load-bearing areas. However, there was a significantly higher likelihood of fracture in areas with MI contacts only.Clinical significance: Because of the absence of a periodontal ligament, this clinical study demonstrates that there is a need to evaluate occlusion differently with implant-supported prostheses than with natural tooth supported prostheses. Implant supported prostheses should have minimal occlusion and lighter contacts than those supported by natural dentition. (C)2014 Elsevier Ltd. All rights reserved.