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Statement of problem Limited information is available on the differences between tissue-level implants with an ultrathin threaded microsurface conical transmucosal portion and bone-level implants rehabilitated with conical custom abutments. Purpose The purpose of this retrospective study was to assess the outcomes of crowns designed as per the biologically oriented preparation technique (BOPT) cemented on conical titanium abutments on tissue-level and bone-level implants. Material and methods Patients consecutively rehabilitated with a delayed loading protocol with anterior implant-supported single crowns with a feather-edge margin, in function for at least 4 years, were recruited and divided into 2 groups based on the implant type they had received: tissue-level implants with a conical transmucosal portion or bone-level implants rehabilitated with a conical abutment by following the platform switching concept. Bone resorption, pink esthetic score (PES), and white esthetic score (WES) were collected and analyzed. The nonparametric Mann-Whitney test was performed to analyze all parameters (α=.05 for all tests). Results A total of 43 participants (48 implants) were included in the present study. The mean follow-up period was 4.5 years (range 52-64 months). A statistically significant difference (P=.004) was found in the mean ±standard deviation bone resorption between tissue-level implants (0.38 ±0.46 mm) and bone-level implants (0.83 ±0.58 mm). Higher values for both PES and WES were obtained in the tissue-level implant group. Conclusions Within the limitations of the present retrospective study, tissue-level implants with a conical transmucosal portion seem to provide a suitable alternative to bone-level implants in the anterior area.

Various kinds of implants of different diameters and connection types are used for patients with a range of bone densities and tooth sizes. However, comprehensive studies simultaneously analyzing the biomechanical effects of different diameters, connection types, and bone densities are scarce.The purpose of this 3-dimensional finite element analysis study was to evaluate the stress and strain distribution on implants, abutments, and surrounding bones depending on different diameters, connection types, and bone densities.Twelve 3-dimensional models of the implant, restoration, and surrounding bone were simulated in the mandibular first molar region, including 2 bone densities (low, high), 2 implant-abutment connection types (internal tissue level, internal bone level), and 3 implant diameters (3.5 mm, 4.0 mm, and 4.5 mm). The occlusal force was 200 N axially and 100 N obliquely. Statistical analysis was performed using the general linear model univariate procedure with partial eta squared (ηFor bone tissue, low-density bone induced a larger maximum and minimum principal strain (in magnitude) than high-density bone (P.001). As the implant diameter increased, the volume of the cancellous bone in low-density bone at the atrophy region (strain200 με) increased (P.001). For implant and abutment, the internal bone-level connection type was associated with increased peak stress as compared with the tissue-level connection type (P.001). For all models, the stress distribution on the implant complex was influenced by implant diameter (P.001): a decrease in implant diameter increased the stress concentration.The implant connection type had a greater impact on the stress of the implant and abutment than the diameter. A tissue-level connection was more advantageous than a bone-level connection in terms of stress distribution of the implant and abutment. Bone density was the most influential factor on bone strain. The selection of dental implants should be made considering these factors and other important factors including tooth size.

Statement of problem Computer-aided design and computer-aided manufacturing (CAD-CAM) methodologies allow the fabrication of custom dental implant abutments with a variety of materials and techniques. Studies on the mechanical strength of such components and the wear induced at their coupling interface during mechanical cycling are sparse. Purpose The purpose of this in vitro study was to measure the wear patterns at the hexagonal platform of dental implants induced by the installation and mechanical cycling of custom abutments fabricated by using 4 different CAD-CAM methods and to determine the compressive static resistance of the implant-abutment combinations. Material and methods A CAD software program was used to design a custom abutment for a single-unit screw-retained external hexagon dental implant crown. The same design file was used to manufacture with 4 CAM methods (N=40): milling and sintering of zirconium dioxide (ZO), cobalt-chromium (Co-Cr) sintered by selective laser melting (SLM), fully sintered machined Co-Cr alloy (MM), and machined and sintered agglutinated Co-Cr alloy powder (AM). Prefabricated titanium abutments were used as a control (TI). Each abutment was installed onto a dental implant (4.1×11 mm), and the specimens were mechanically aged (1 million cycles, 2 Hz, 100N, 37 °C). After mechanical cycling, the hexagonal connection of the dental implants was examined with a scanning electron microscope (SEM), and unused dental implants (NI) were examined as a control (n=10). The images were analyzed with a software program to quantify the areas that showed wear. The implant-abutment combinations were reassembled and submitted to a compression test (1mm/min) with a universal testing machine. The data obtained were submitted to 1-way ANOVA (α=.05). Results The mean ±standard deviation fracture load (N) of the specimens of each group were 1005 ±187 (ZO), 1074 ±123 (SLM), 1033 ±109 (MM), 1019 ±149 (AM), and 923 ±129 (TI). These values were statistically similar (P=.213). The mean ±standard deviation wear of the implants in squared-pixels were 1.1 ±0.38×105 (ZO), 2.0 ±0.29×105 (SLM), 1.0 ±0.38×105 (MM), 1.1 ±0.27×105 (AM), 1.1 ±0.33×105 (TI), and 0.51 ±0.29×105 (NI). The results indicated that, although significantly higher than those in in the control group (NI), the wear values found in the groups TI, ZO, MM, and AM were significantly lower than in the SLM group (P Conclusions The CAD-CAM abutments presented the same mechanical fracture load and wear measurements as the TI group, except for the SLM material, which showed increased wear. The failure mode from the load bearing test was the fracture of the abutments for the ZO group. The implants permanently deformed or fractured for the metal abutment groups.

Evidence to validate the routine use of angled screw-channel abutments in the anterior maxilla is sparse. If properly planned, they might provide surgical and prosthetic benefits.The purpose of this observational study was to determine the prevalence of digitally placed implants in the anterior maxilla that would allow screw-retained implant-supported restorations with either a straight or an angled screw-channel abutment.Two hundred cone beam computed tomography (CBCT) scans met the inclusion criteria for retrospective analysis and digital implant planning. Virtual implants were planned for randomly selected anterior maxillary teeth by using the anatomic crown and root position. Virtual abutments of varying angulation were attached to the implants to determine the ability to screw retain a restoration with either a straight or an angled screw-channel abutment.One hundred fifty-two (76%) sites required an angled screw-channel abutment to enable screw retention. Forty-eight (24%) sites allowed screw retention with a straight abutment. The percentage of implants requiring angled or straight abutments varied significantly among anterior teeth (P.005). One hundred nine (71.7%) angled screw-channel abutment sites required a 5-degree abutment, 41 (26.9%) required a 10-degree abutment, and 2 (1.3%) required a 15-degree abutment. Among the anterior teeth, lateral incisors presented a greater need for angled screw-channel abutments. None of the implants in the present study needed cement-retained restorations.Angled abutments allowed for screw-retained restorations on digitally planned implants in the anterior maxilla. The required angular correction to a screw-retained restoration was ≤15 degrees. Screw-retained restorations were frequently achievable (76%) with the use of angled screw-channel abutments or with straight abutments (24%), and lateral incisors presented a greater need for angled screw-channel abutments.

Statement of problem The use of reduced platform sets (implants and abutments) can help to control crestal bone loss around implants, which is essential for optimizing esthetics and biomechanical behavior. However, the information available on the fracture resistance of implants with a reduced platform is sparse. Purpose The purpose of this in vitro study was to analyze the maximum fracture strength value of implants with different platform designs during quasistatic fatigue, followed by a simulation of different bone levels of cervical insertion. Material and methods One hundred and twenty sets of dental implants and abutments with different diameters and platform designs were tested. All implants had an internal hexagon connection and conical macrogeometry. Four groups (n=30) were studied: O4.0-mm implants with a regular matched platform (rMatch group), O4.0-mm implants with a regular switched platform (PSwitch group), O5.0-mm implants with a wide matched platform (wMatch group), and O5.0-mm implants with a wide switched platform (wSwitch group). Three conditions simulating different levels of bone position around the cervical portion of the implants were proposed: insertion at the implant shoulder level=0 mm (L0), level=3 mm of insertion loss (L3), and level=5 mm of insertion loss (L5). All sets of all groups and proposed insertion level were subjected to a fracture strength test at 30 degrees in relation to the axis of the sets in a universal testing machine. Results Regardless of the insertion levels tested, the switched platform implants (rSwitch and wSwitch groups) showed similar mean fracture strength values (P>.05), while the implants of matched platforms (rMatch and wMatch groups) showed different fracture strength values for all insertion levels tested (P Conclusions The fracture strength values of the switched platform implants were lower at all insertion levels tested. However, for all insertion levels tested, the implants with a switched platform presented less deformation, whereas, in the matched platform implants, there was significant deformation of the implant structure.

Statement of problem The mechanical behavior of the conical connection implant with different torque levels requires evaluation. Purpose The purpose of the finite element analysis study was to investigate the impact of abutment screw torque on the formation of microgaps at the implant-to-abutment interface of a conical connection under oblique loading. This is important because it is thought that bacteria can invade the internal implant space through the abutment-implant microgaps, causing peri-implantitis. Material and methods Three-dimensional finite element analyses of the conical implant-abutment connection were performed by using screw torques of 20 Ncm and 30 Ncm. Oblique loads from 10 N to 280 N were applied to the prosthesis placed on the implant. The maximum von Mises stress in the abutment screw, the microgap formation process, and the critical load for bridging the internal implant space were evaluated. Results The stresses in the abutment screw under oblique loading had limited sensitivity to the screw torque. However, the residual stress in the screw with a 30-Ncm torque was 35% higher than that with a 20-Ncm torque in the absence of an external load. The area in contact at the implant-to-abutment interface decreased with increasing load for both torque values. The critical load for bridging the internal implant space was 160 N for a screw torque of 20 Ncm and 220 N for a screw torque of 30 Ncm. The maximum gap size was approximately 470 μm with all the loads. Conclusions Increasing the screw torque can reduce the formation of microgaps at the implant-to-abutment interface. However, this will result in higher mean stress in the abutment screw, which may reduce its fatigue life and consequently that of the prosthesis. Further research is needed to evaluate the relationship between the abutment screw torque and microleakage in implant-supported restorations.

This article describes a dental implant impression technique using custom impression copings. The implant impression coping was designed by using a dental computer-aided design software program and manufactured by using additive methods. The impression copings were cemented to stock abutments, and the assemblies were used to make the definitive pick-up impression.

Statement of problem. Polyetheretherketone (PEEK) has been advocated to replace metal components in dentistry. Although PEEK is a high-performance polymer with a white color, adequate biological response, and resistance to fracture, data to support PEEK as an alternative material for implant abutments are lacking. Purpose. The purpose of this in vitro study was to assess the mechanical and functional properties of PEEK implant abutments as a nonmetallic alternative to titanium abutments, which presents esthetic limitations and greater difficulty to customize clinically. Material and methods. Implant abutments manufactured by using PEEK (n=24) or titanium grade 5 (n=24) were attached to MIS Implants type M4 3.75×16 mm with an internal screw tightened to 25 Ncm. Screw loosening and microleakage was assessed by submersion in a 2% methylene blue solution for 48 hours at 37 C. Both groups were compared with and without applying dynamic loading; fatigue testing was performed following the International Organization for Standardization (ISO) 14801:2016 standard. All specimens were observed under a stereomicroscope at ×8 magnification. Statistically significant differences among the PEEK and titanium implant abutments were tested with 2-factor ANOVA and the chi-square analysis for nonpaired and paired data, respectively (a=.05). Results. The implant abutments made of titanium were better in all mechanical tests. The torque loss of titanium abutments was approximately 10%, while PEEK showed a significantly higher (P

Statement of problem How axial displacement may be affected by the mechanical properties and internal discrepancy of a cement-retained implant-supported prosthesis is unclear. Purpose The purpose of this in vitro study was to assess the difference in internal discrepancy and axial displacement according to the prosthesis material in cement-retained prostheses splinting nonparallel implants. Material and methods Computer-aided design and computer-aided manufacture (CAD-CAM) titanium abutments were fabricated for a vertically placed implant and a 15-degree tilted implant. Three types of prostheses, in zirconia, cobalt-chromium (Co-Cr) alloy, and polymethylmethacrylate resin (PMMA), were fabricated (n=10). The internal discrepancy between the CAD-CAM titanium abutment and the prosthesis was measured by using the replica technique. After luting with an interim cement, they were mounted in Type IV gypsum. The specimens were cyclic loaded, and axial displacement of the prosthesis was measured after 3, 10, 100, and 106 cycles. The internal discrepancy and cumulative axial displacement were assessed by using a 3-way analysis of variance and repeated measures analysis of variance (α=.05). Results The internal discrepancy of the prosthesis did not differ based on the prosthesis material (P=.869); however, it was significantly different based on the measurement location, with the occlusal discrepancy (224 ±29 μm) being greater than the axial discrepancy (21 ±10 μm) (P Conclusions Prostheses made with high-elastic moduli materials exhibited less axial displacement than PMMA prostheses, even though the internal discrepancy was not different. Moreover, vertically placed implants presented a greater axial displacement of the prosthesis than implants with angled placement.

A complete digital workflow to remove a cement-retained implant-supported crown by using an additively manufactured implant abutment screw-access guide is described. The existing cone beam computed tomography (CBCT) scan was superimposed on the digital scans of the patient, which facilitated the visualization of the implant abutment screw access and guided the design of the device. Advantages of the technique described include the precise translation of the implant abutment screw access, safe removal of the implant crown, and conservative clinical intervention.

Statement of problem Clinical studies comparing compatible computer-aided design and computer-aided manufacturing (CAD-CAM) titanium abutments (CAs) and original prefabricated 1-piece titanium abutments (PAs) for posterior fixed dental prostheses (FDPs) on Straumann Tissue Level (STL) implants are sparse. Purpose The purpose of this retrospective clinical study was to compare the performance of posterior FDPs supported by CAs and PAs on STL implants after a mean observation period of 7.2 years. Material and methods Patients who received STL implants and posterior FDPs by using CAs or PAs between January 2002 and December 2012 and returned for follow-up between January 2017 and September 2018 were included in this study. Technical and biological complications of FDPs were examined and recorded. Radiographs were used for the measurement of marginal bone loss (MBL) of each implant. Variables, complication rates, and MBL of the 2 groups were analyzed by using a generalized estimating equation and multivariable linear mixed model. Results Ninety-nine patients with 195 implants in the CA group and 75 patients with 143 implants in the PA group were included. The mean functional time of FDPs was 6.5 ±1.1 years for the CA group and 8.1 ±2.6 years for the PA group. No implant failure was noted in either group. The technical complication rate was 20.8% in the CA group and 26.3% in the PA group. Abutment screw loosening (ASL) was noted in the CA group (8.5%). The decementation rate was significantly higher in the PA group (14.1%) than that in the CA group (3.1%) (adjusted odds ratio=4.40, confidence interval=1.41 to 13.69, P=.011). No significant differences were found between the 2 groups in terms of the rates of ceramic chipping, peri-implantitis, peri-implant mucositis, or mean MBL. Conclusions Using CAs or PAs to support posterior FDPs on STL implants has no significant effect on the incidence rate of biological complications. However, a higher ASL rate and a lower decementation rate were noted with CAs than with PAs.

Statement of problem Angle-correcting options allow the use of screw-retained implant prostheses in situations where an implant has been placed with a facial inclination. However, manufacturers have different recommended torque values, and it is unclear whether the performance of these designs is equivalent to that of the traditional screw-retained crowns (SRCs) when subjected to cyclic loading forces. Purpose The purpose of this in vitro study was to compare torque differences between conventional straight-line screw access and angulated access SRCs before and after simulated functional loading. Material and methods Five groups consisting of 10 SRCs and implants were formed: Nobel Biocare zirconia crowns with 20-degree access channels (NB-20); Dynamic Abutment Solution zirconia crowns (DA-20) with 20-degree access channels; Core3dcentre angle correction zirconia crowns with 20-degree access channels (C3D-20); Nobel Biocare zirconia crowns with 0-degree access channels (NB-0); and gold alloy crowns cast to Nobel Biocare Gold-Adapt abutments (GA-0). Each specimen underwent thermocycling before cyclic loading. A preload torque based on the manufacturer’s recommendation was applied to each crown placed on an implant. Reverse torque measurements were obtained for each specimen before cyclic loading. Each implant-abutment assembly was then cyclic loaded at 0 to 100 N at 10 Hz for 1 million cycles. Reverse torque measurements were obtained after cyclic loading and the percentage difference calculated. Results No significant percentage torque loss differences were observed between the 0-degree and 20-degree SRCs after cyclic loading. No significant differences were seen among the angulated access channel crowns. DA-20 and C3D-20 specimens had significantly higher torque loss compared with the NB-0 group. The C3D-20 group reported the largest percentage torque loss (34.5%) among the angulated access screw channel groups. The GA-0 group reported the largest percentage torque loss of all the groups (35.9%). No crown mobility or other complications were observed in any of the groups after cyclic loading. Conclusions Angulated access channel crowns performed comparably with conventional straight-line screw access SRCs with regard to percentage torque values after cyclic loading. Angulated access channel crowns with lower manufacturer recommended torque values had higher percentage torque differences.

This report describes the fabrication of a custom healing stent for second stage implant surgery in advanced jaw reconstruction. Postoperative computed tomography data and digital dental implant component libraries were used to create a custom healing stent to fit connected implant abutments without the need for a definitive abutment impression. After segmentation of the dental implants and importation into a computer-aided design software program, the appropriate digital implant componentry was aligned to the dental implants. The healing stent was then virtually designed, rapid prototyped, and then converted into a biocompatible and sterilizable material by using conventional laboratory methods. The methods presented offer clinicians the opportunity to insert a healing stent at second stage implant surgery with no need to create a stent or obtain an impression during the procedure.

Statement of problem The grayish appearance of a titanium abutment discolors the peri-implant soft tissue, especially if the gingiva is thin. Whether an anodized titanium abutment can prevent the discoloration is unclear. Purpose The purpose of this clinical study was to investigate the color change of peri-implant soft tissue surrounding a titanium abutment that had been colored by anodic oxidation. Material and methods Commercially available titanium abutments were anodized to form a gold and pink titanium abutment and formed the experimental groups. Unanodized titanium and zirconia abutment were used as the control groups. Four types of abutments were fabricated for each participant who received dental implants in the anterior maxilla. The abutments and corresponding definitive crowns were inserted, and the color of the peri-implant soft tissue and contralateral gingiva were measured with a spectrophotometer. The thickness of the peri-implant soft tissue was recorded after probing with an endodontic file. Results Eleven participants were included in this study. The color differences caused by all tested abutments were higher than the critical threshold of ΔE=3.7. The mean color difference (ΔE), from low to high, was the zirconia, pink-anodized titanium, gold-anodized titanium, and unanodized titanium abutment; their values of (ΔE) were 6.81, 7.63, 7.90, and 8.74, respectively. The mean thickness of the peri-implant soft tissue was 2.41 ±0.52 mm. Conclusions Within the limitation of the small sample size in this study, the gold-anodized and pink-anodized titanium abutment achieved better esthetics for peri-implant soft tissue than the unanodized titanium abutment. Zirconia was the optimal abutment material for the esthetic region.

Statement of problem Implant abutment selection is complex because of the numerous factors involved. Computer-aided design (CAD) technology allows for the virtual selection and placement of abutments after all parameters have been precisely measured. The outcome of this new protocol should be validated. Purpose The purpose of this in vitro study was to validate a new digital protocol in which abutment selection is made through a CAD software program, the abutments are virtually placed, and the restoration is then designed based on the virtual abutments to fit the actual abutments when delivered to the implants intraorally. Material and methods A cast with 2 parallel implants was scanned 10 times. Then, 2 abutments were placed and scanned 10 times. Twenty identical superstructures were designed and manufactured to simulate the clinical situation of a 3-unit fixed partial denture, screw-retained to 2 implants. These were divided into 2 groups—A, real abutment and B, virtual abutment—and then compared by means of digital and optical measurements. Results No significant differences were detected for the measurements between the control and test groups in either the x-axis or y-axis; significant differences were found for the median value of the measurements obtained from both groups regarding the z-axis (P=.046). The mean gap in the virtual abutment group was 50 μm and 35 μm in the real abutment group. Conclusions Superstructures produced after the virtual selection and placement of intermediate restorative abutments compared favorably with those produced after the digitalization of actual abutments and placement in the implant model, thus validating the proposed digital protocol for virtual abutment selection and placement.

Statement of problem The use of cement-retained implant-supported prostheses is a well-established treatment option. Techniques have been proposed to reduce the amount of residual excess cement (REC) around cement-retained single-implant restorations. However, studies evaluating the effectiveness of such techniques related to cement-retained implant-supported fixed partial dentures (CRISFPDs) are lacking. Purpose The purpose of this in vitro study was to evaluate the effectiveness of various cement application techniques for CRISFPDs. Material and methods Two implant analogs were placed in the lateral incisor sites in a maxillary, 3D printed cast with 4 missing incisors. Twenty standardized, removable, printed soft-tissue replicas, 40 milled titanium custom abutments, and 20 milled zirconia CRISFPDs were fabricated. Two cement application techniques, the brush on technique (BOT), and the polyvinyl siloxane index (PI) technique were compared. Two cementation techniques, without bib (control) (n=10) and with a polytetrafluoroethylene (PTFE) bib (test) (n=10), were used. A premeasured amount of interim cement was used to cement the CRISFPDs. The CRISFPDs were retrieved after cementation, and standardized photographs of 4 quadrants of each abutment-CRISFPD assembly were made by using a software program that is used to calculate the ratio between the area covered with REC and the total specimen area. The extension of the REC on both the abutment and soft-tissue replica was measured at sites before and after cleaning the REC. A generalized linear mixed-model procedure was used for statistical analysis (α=.05). Results For cement application, the polyvinyl siloxane (PVS) index technique had significantly less REC than the brush on technique (P Conclusions The use of the PVS index technique along with a PTFE bib was effective in reducing REC for CRISFPDs.

Statement of problem Screw loosening is still among the most important complications of dental implants. Identifying effective factors in screw loosening plays an important role in preventing this problem. Purpose The purpose of this in vitro study was to assess the effect of fluid contamination on the reverse torque values (RTVs) of abutment screws at implant-abutment connections. Material and methods Five groups (9 specimens in each group) of implants were mounted in acrylic resin. Four groups of fixture screw holes were contaminated with chlorhexidine (CG), saliva (SG), blood (BG), or fluoride (FG), and a fifth group served as a control with no contamination (NC). Abutment screws were tightened by using a digital torque meter. The RTVs were recorded after thermocycling. Data were analyzed by 1-way ANOVA and the Tukey honestly significant difference test (α=.05). Results RTVs were lower in SG (13.65 ±0.91 Ncm) than NC (16.55 ±1.82 Ncm), while the values were significantly higher in CG (19.74 ±1.79 Ncm) than NC. No statistically significant difference was reported in BG (16.30 ±1.66 Ncm) and FG (15.92 ±1.82 Ncm) compared with the control group. Conclusions RTVs were significantly reduced by saliva contamination in comparison with those of other groups. The highest RTVs were detected in CG.

A straightforward and time-efficient technique is presented for recording digital scans in single- and multiple-unit tooth abutments with feather-edge finish lines. The margins of the interim restoration should be precise and sufficiently deep in the sulcus so that the tissues can be properly displaced. Definitive intraoral scans should be made approximately 3 to 4 weeks after the tooth (or teeth) has been prepared to allow healing of the soft tissues. The interim restoration is first removed and then reseated after removing cement residue. First, a scan is made with the interim restoration in place. The abutment tooth or teeth are then erased from the original digital file, the interim restoration is removed again, and a new scan enclosing only the abutment tooth is made.

This report describes the restoration of the healed single implant in the posterior region by using a lithium disilicate crown supported by an Acuris abutment. The restored implants were placed in the premolar and molar region of both the mandible and the maxilla by using a 1-stage approach. The definitive Acuris abutment was placed after an implant healing period of at least 3 months. Definitive impressions were made at least 3 months after surgery. The precrystallized lithium disilicate crown was adapted to a laboratory abutment and evaluated. The crown was then crystallized, finished, colored, and cemented to the definitive abutment by using an adhesive resin cement. The definitive restoration engaged the abutment without the use of screws or cement. A single healed implant can be successfully restored by using a lithium disilicate restoration supported by an Acuris abutment.

When dental implant abutments are fabricated, the use of an implant indexing device (IID) is recommended to evaluate the accuracy of a definitive cast. An IID is also useful to position multiple implant abutments on implants. Several methods have been used to fabricate an IID. However, the existing methods are labor-intensive. This article presents a digital workflow for fabricating an IID using computer-aided design and computer-aided manufacturing (CAD-CAM) technology with minimal human error.

Abutment screw loosening is still the most common complication reported with implant-supported crowns. One factor that contributes to screw loosening is not achieving the proper torque during the tightening process. Torque application and measurement is usually achieved by using one of the available types of mechanical torque wrench. Of these, the toggle wrench has been shown to produce erroneous readings, and regular testing is recommended. If it is inaccurate, it must be recalibrated or replaced. Calibration typically requires specialized instruments unavailable to most clinicians, so the device must be sent away. This article describes a straightforward, in-office, and inexpensive alternative for testing and recalibrating a toggle torque wrench.

Removing cement-retained implant-supported prostheses may be challenging for clinicians. A method combining a cone beam computed tomography (CBCT) and a digital scan with a virtual surgical planning software program is described to identify the perforation site of a cement-retained implant-supported prosthesis to locate the abutment screw.

The strain developed around implants with angled abutments should be considered when selecting a superstructure material. Studies that evaluated the strain developed around implants with angled abutments when using fiber-reinforced polymer as the implant superstructure material are lacking.The purpose of this in vitro study was to assess the strain developed around implants with angled abutments (15 and 25 degrees) of biocompatible high-performance polymer (BioHPP) and reinforced nanohybrid polymer with a multilayered glass fiber (TRINIA) superstructure under axial and oblique loading. The strain developed around implants was evaluated by using strain gauges.Thirty-two polyurethane test blocks were divided into 2 main groups (n=16) according to the degrees of buccal tilting of the implant platform (15 and 25 degrees). Each group was divided into 2 subgroups (n=8), and each subgroup received different superstructure materials (BioHPP or TRINIA). Two buccal and palatal strain gauges were installed on their corresponding prepared sites to measure the microstrains in the medium surrounding the implant. A universal testing machine was used to apply the static load from 0 to 100 N in the axial and 45-degree oblique direction, with the loading tip of the device on the loading point at the central fossa of the crown. For each tested implant, loads were applied, microstrains were recorded with the strain gauges, and the strain developed around the implant was statistically evaluated with 1-way ANOVA, followed by multiple pairwise comparisons by using the Bonferroni adjusted significance level (α=.05).For superstructure materials, the microstrain values recorded around implants restored with TRINIA were significantly lower than those restored with BioHPP in all groups (P.001). The 25-degree implant angulation recorded significantly higher microstrain than 15 degrees buccally and palatally when axial and oblique loads were applied (P.05). The microstrain was significantly higher in the oblique load than in the axial load in both the BioHPP and TRINIA groups in 15- and 25-degree implant angulations on the buccal and palatal sides (P.001).The strain developed around dental implants was significantly affected by the superstructure material. The microstrain was considerably higher when the implant abutment angulation increased. When a 45-degree loading direction was used, this tendency became more pronounced.

Residual cement around implant crowns can cause peri-implant disease, which can be minimized by precementing on a copy abutment. This article describes the use of polytetrafluoroethylene (PTFE) tape to allow an intraorally delivered custom or stock abutment to act similar to a copy abutment. It requires minimal change to the restorative dentist's routine and helps minimize the risk of cement-induced peri-implant disease.

This article presents an impression technique involving transfer of the position of implants and the emergence profile of splinted interim prostheses fabricated on nonindexed interim abutments to definitive single crowns fabricated on indexed abutments.

Studies that evaluated the accuracy of different methods for making an impression of 2 implants in close proximity or with adverse axial convergence are lacking.The purpose of this in vitro study was to compare the accuracy of impressions made with metal and resin computer-aided design and computer-aided manufacturing (CAD-CAM) impression copings and an altered cast technique.Two implant analogs with an interimplant angulation of 50 degrees were placed in an acrylic resin master model. Thirty impressions were made with 3 techniques (n=10). Two angled abutments were scanned to print 40 impression copings from a castable resin, half of which were cast with nickel-chromium alloy (M-CAD) and half of these were used in the R-CAD group. Impressions were made and poured. For the altered cast technique (Alt-cast), casts with only the mesial analogs were made and hollowed at the site of the distal analogs. The position of the distal analogs was transferred by resin indices (n=10) fabricated with light-polymerized resin on the master model. The linear displacements of mesial (ΔR1) and distal (ΔR2) analogs and the interanalog distance (ΔRt) were measured with a coordinate measuring machine. The data were analyzed by using the Kruskal-Wallis and Dunn post hoc tests (α=.05).No significant difference was found between the M-CAD and R-CAD groups regarding ΔR1 (P=.722), ΔR2 (P=.576), or ΔRt (P=.939). However, the Alt-cast group differed from the M-CAD group in ΔR1 (P.001), ΔR2 (P.001), and ΔRt (P=.002) and also from the R-CAD group in ΔR1 (P=.001), ΔR2 (P=.002), and ΔRt (P=.003).The impressions made with metal and resin CAD-CAM impression copings were more accurate than those made with the Alt-cast technique although all techniques had acceptable accuracy.

[EN] STATEMENT OF PROBLEM: Dental implant geometry affects the mechanical performance and fatigue behavior of butt-joint implant-supported restorations. However, failure of the implant component has been generally studied by ignoring the prosthetic screw, which is frequently the critical restoration component. PURPOSE: The purpose of this invitro study was to evaluate the effect of 3 main implant geometric parameters: the implant body diameter, the platform diameter, and the implant-abutment connection type (external versus internal butt-joint) on the fatigue life of the prosthetic screw. The experimental values were further compared with the theoretical ones obtained by using a previously published methodology. MATERIAL AND METHODS: Four different designs of direct-to-implant dental restorations from the manufacturer BTI were tested. Forty-eight fatigue tests were performed in an axial fatigue testing machine according to the International Organization for Standardization (ISO) 14801. Linear regression models, 95% interval confidence bands for the linear regression, and 95% prediction intervals of the fatigue load-life (F-N) results were obtained and compared through an analysis of covariance (ANCOVA) to determine the influence of the 3 parameters under study on the fatigue behavior (alpha=.05). RESULTS: Linear regression models showed a statistical difference (P

A technique is described for detecting areas of interference for removable partial denture frameworks. An occlusal marking film is placed between the misfitted abutment teeth and framework region. Gentle pressure is applied to seat the framework, and the exact areas of interference are seen on removal. With this clean, rapid, cost-effective, and straightforward approach, areas of interference can be precisely adjusted for complete seating of the removable partial denture framework.

Statement of problem Clinical studies comparing the occurrence and quality of residual cement between custom zirconia and custom titanium abutments with subgingival margins are scarce. Purpose The purpose of this clinical study was to assess the difference in the amount of residual cement between custom zirconia and titanium abutments with a 1-mm subgingival margin. Material and methods Eighty participants were randomized to receive either a custom zirconia abutment with a bonded titanium insert or a custom titanium abutment with a 1-mm subgingival margin on a posterior bone-level implant. Monolithic lithium disilicate crowns with a screw-access hole were cemented to abutments randomly with either a resin-modified glass ionomer cement or a resin cement. After cementation, the crown-abutment assemblies were removed and photographed from the mesial, buccal, distal, and lingual of the specimen to record the residual cement. The length along the abutment margin of each aspect of the assembly was measured. The surface area of the residual cement (SA) and the surface area of the residual cement per unit length of margin (SA_P) were calculated. Results for the groups were compared with the Fisher exact test, the Friedman test, and the Mann-Whitney U test (α=.05). Results The median (lower quartile, upper quartile) of SA and SA_P for the custom zirconia abutment with a bonded titanium insert was 1.9 (0.5, 3.9) mm2 and 0.086 (0.032, 0.02) mm2, respectively, and for the custom titanium abutment, the values were 2.9 (1.3, 5.1) mm2 and 0.138 (0.062, 0.239) mm2, respectively. No significant difference was found between the custom zirconia abutments with bonded titanium inserts and titanium abutments for SA (P=.075) and SA_P (P=.083) with the Mann-Whitney U test. No significant difference was found in residual cement between the 4 aspects of the abutment (SA: P=.852; SA_P: P=.954) with the Friedman test and between the 2 types of cement (SA: P=.447; SA_P: P=.878) with the Mann-Whitney U test. Conclusions A similar amount of subgingival residual cement was recorded around the abutment-crown assembly, regardless of the abutment material or cement type used.

Statement of problem The press-fit (Morse taper) implant system is commonly used to restore edentulous areas. However, abutment screws in this system may be damaged because of the 2- or 3-piece design, consequently causing complications. How these damaging situations occur is unclear. Purpose The purpose of this in vitro and finite element analysis (FEA) study was to elucidate the mechanisms of the press-fit implant system underlying abutment screw damage. Material and methods The ANKYLOS implant system was used as a simulation model and for experimental test specimens. The experimental test was performed by using a material test system, and the obtained data were used to validate the FEA outcome. In the FEA simulation, the bilinear material property and nonlinear contact conditions were applied to simulate the process of tightening the abutment screw between the abutment and implant. A force of 300 N was then applied to the abutment to investigate the stress distribution and deformation of the implant system. Results In the experimental test, the fracture site of all specimens was observed at the abutment-screw thread. All implants and abutments exhibited permanent bending deformation. The results of the FEA simulation generally concurred with the experimental outcomes. Conclusions The abutment torque used to generate the press-fit contact interface between the abutment and implant induced stresses within the implant components, substantially increasing the failure probability of the conical implant system during function.

Statement of problem How adjacent dental implants with different sizes, designs, and abutment connection shapes affect stress on the prosthetic structure is unclear. Purpose The purpose of this finite element analysis (FEA) study was to analyze stress distribution around bone and around 2 implants with different sizes, diameters, shapes, and loading directions placed next to each other in splinted and unsplinted prostheses. Material and methods On 3D FEA models representing the posterior right lateral segment of the mandible, 1 implant (O3.5×12 mm) and 1 implant (O5.5×8 mm) were placed adjacent. Three different contemporary implant models were created with different teeth, pitch, spiral numbers, and self-taping features, and different abutments for them were modeled in 3D. The implant-abutment connection was internal hexagonal (MIH), stepped conical (MSC), and internal conical (MIC). Vertical and oblique loads of 365 N for molar teeth and of 200 N for premolar teeth were applied as boundary conditions to the cusp ridges and grooves in a nonlinear FEA. Results The MIH implants resulted in improved stress conditions. According to the von Mises stresses occurring on the screw, abutment, and implant, especially under oblique loads, MIH was exposed to less stress than MSC, and MSC was exposed to less stress than MIC. Conclusions When a standard implant and a short implant were placed adjacent and splinted by crowns, the implants, abutments, and screws had unfavorable stress levels; therefore, adjacent splinted implants should be of similar size. The form of the implant-abutment junction is also an important factor affecting stress.

Statement of problem Currently many options are available for restoring a dental implant, although the ideal implant abutment for withstanding the occlusal load and the restorative material for fulfilling the esthetic need remains unclear. Zirconia (Zir) abutments offer good esthetics, but concerns still remain regarding their fracture strength, complex fabrication, and higher cost as compared with those of titanium (Ti) base abutments offering lower cost, acceptable esthetics, and a straightforward procedure. Purpose The purpose of this in vitro study was to evaluate the fracture strength and failure mode of single-tooth Zir and Ti base implant abutments with fatigue loading. Material and methods Forty restorations were included using 4 different types of abutment-restorations. Zir abutments with lithium disilicate crowns (ZirLd); titanium base abutments with custom Zir abutments and lithium disilicate crowns (TiZirLd); titanium base abutments with monolithic lithium disilicate abutment-crowns (TiLd); titanium base abutments with monolithic polymer-infiltrated ceramic abutment-crowns (TiEn). Specimens were subjected to a progressive cyclic loading by using a custom-made mastication simulator at a frequency of 1.4 Hz starting with a load of 88 N followed by stages of 170, 210, 250, and 290 N for a maximum of 20 000 cycles each or until fracture occurred. The number of cycles, maximum load, and failure modes were recorded. Statistical analysis was done by using the Mann-Whitney U test (α=.05). Results Group TiEn showed a lower resistance to fatigue, with a mean ±standard deviation of 5054 ±123.3 cycles subjected to a mean force of 170 N. Groups ZirLd and TiLd resisted higher forces without fracture 13452.6 ±7094.3 cycles, and load of 178 ±16.9 N, followed by the TiLd group with a mean ±standard deviation of 25798.6 ±5498.7 cycles, and load of 202 ±16.9 N, while the TiZirLd group showed a mean of 48235.4 cycles subjected to a mean force of 258 N. The failure mode observed in the TiEn occurred only in the ceramic, whereas in the ZirLd and TiLd group, it was above the shoulder level of the Ti base abutment. Even though the TiZirLd group was able to withstand higher loads and a higher number of cycles, the failures were catastrophic and presented fractures of the titanium-base abutment and prosthetic screw. Conclusions The TiZirLd, ZirLd, and TiLd abutment-restorations have the potential to withstand the average physiological occlusal forces that occur in the anterior region. The group with the higher fatigue resistance was TiZirLd, although care should be taken with patients presenting parafunctional habits since the failure mode can be catastrophic. Also, polymer-infiltrated ceramic is not suitable for a Ti base abutment when subjected to oblique loading.

This article describes a technique for fabricating a custom anatomic healing abutment for delayed loaded implants by using the computer-aided design and computer-aided manufacturing (CAD-CAM) technology from a polymethyl methacrylate (PMMA) blank. The dimensions of the custom healing abutment are measured from a conventional dental radiograph and diagnostic casts. The healing abutment is used in the second surgical stage to guide soft tissue healing. The resulting soft tissue contour guides the design of the mucosal part of the custom implant abutment.

Internal conical connections provide mechanical stability for the prosthetic abutment and implant connection. However, some clinical situations require the use of angled prosthetic abutments that may increase stress on supportive implants by difference force vectors under cyclic loading.The purpose of this in vitro study was to measure the screw loosening values of prosthetic abutments with internal conical connections (indexed and nonindexed) having different angles under mechanical cycling.Thirty-six implants (4.0×13 mm, Titamax) with internal conical connections and their respective universal prosthetic abutments (n=36, 3.5×3.3 mm) were divided into indexed and nonindexed groups (n=18) with abutment inclinations of 0 (straight), 17, and 30 degrees. An insertion torque of 15 Ncm was applied according to the manufacturer's specifications. The specimens underwent fatigue testing of 500 000 cycles at a frequency of 2 Hz with a dynamic compressive load of 120 N at an angle of 30 degrees. The detorque values were measured by using a digital torque meter and tabulated for statistical analyses.The specimens with indexed abutments had mean ±standard deviation detorque values of 6.72 ±2.29 Ncm under mechanical cycling, whereas those with nonindexed abutments had values of 8.98 ±1.84 Ncm. In the indexed group, the lowest detorque value was observed for abutments at 30 degrees compared with the straight group (P.05). As for nonindexed abutments, similar detorque values were observed after increasing the abutment inclination (P.05).A decrease in detorque values in the indexed abutments related to their inclination was found under mechanical cycling, whereas the prosthetic abutments with 30 degrees of angulation had the lowest values. No decrease was found in the nonindexed abutments.

Statement of problem The accuracy of a full digital workflow using an Atlantis abutment and a milled zirconia crown; a full digital workflow with a 3Shape split-file workflow using a zirconia abutment and crown; and an interrupted digital workflow using an Atlantis abutment and a milled zirconia crown is unclear. Purpose The purpose of this in vitro study was to compare 2 full digital workflows relative to an interrupted workflow for restoring an implant with a custom abutment and crown. The secondary purpose of this study was to validate a digital means of measuring internal fit and marginal discrepancy using engineering software programs. Material and methods Three workflows were evaluated. The first group, interrupted digital Atlantis (IDA) workflow, included a customized Atlantis abutment that was designed, received, and then rescanned for the definitive crown design. The second group, full digital Atlantis (FDA) workflow, included a customized Atlantis abutment and its corresponding standard tessellation language (STL) file, the Atlantis Core File, which was immediately imported into design software and used for crown design and milling. The third group, full digital split-file (FDSF) workflow, used 3Shape's full digital workflow for abutment and crown design called the split-file workflow, in which the crown and abutment were designed and milled simultaneously. All restorations were evaluated with standardized measurements using a scanning electron microscope (SEM) for 2D measurements, followed by standardized measurements using Geomagic Control, an engineering software program, which facilitated 3D evaluations of the specimens. Results The 2 Atlantis workflows, IDA and FDA, had statistically smaller marginal openings (P=.002) than the FDSF when measured using 2D SEM. The FDA had a statistically smaller 2D SEM marginal gap than the other 2 groups, IDA (P=.002) and FDSF (P=.002). The FDA had a statistically smaller 3D Geomagic marginal gap than the other 2 groups, IDA (P=.004) and FDSF (P=.006). The FDSF had a statistically smaller 3D Geomagic internal fit than the other 2 groups, FDA and IDA (both P=.006). Conclusions All 3 workflows evaluated in this study showed clinically acceptable results in terms of mean marginal gap below 120 μm. The SEM evaluation of mean marginal opening revealed that IDA and FDA mean marginal openings were statistically smaller than the FDSF mean marginal opening. SEM and Geomagic measurements revealed that the FDA mean marginal gap was significantly smaller than IDA and FDSF mean marginal gaps. Geomagic evaluation of mean internal fit revealed that the FDSF was significantly smaller than IDA and FDA. The use of Geomagic to measure and evaluate mean marginal gap and mean internal fit as defined in this study proved to be an acceptable form of measurement with statistical validation.

STATEMENT OF PROBLEM: Implant-based prosthetic solutions can be time consuming. If implants can be loaded immediately, treatment time can be reduced. PURPOSE: The purpose of this prospective randomized controlled trial was to monitor the survival rate of Ankylos implants, comparing conventional with immediate loading by using abutments with the SynCone concept for screw-retained removable prostheses in the edentulous maxilla. MATERIAL AND METHODS: A total of 90 implants were placed in 15 study participants. The participants were randomly assigned to the immediate or conventional loading treatment group. Radiographic and clinical parameters were recorded at the time of permanent prosthesis installment and at 1- and 2-year follow-up examinations, and participants' satisfaction was measured by using questionnaires before and after prosthesis installation. A linear mixed model was used to measure differences. RESULTS: One implant in the conventional group was lost during abutment placement; hence, 89 implants could be followed for 2 years. Approximately 90% of these implants showed no bone loss or even bone gain at 1 and 2 years follow-up. Mean values for the immediate group were, respectively, 0.09 ±0.35 mm and 0.13 ±0.38 mm and 0.01 ±0.41 mm and -0.06 ±0.32 mm for the conventional method. No significant differences (P=.053) were found in bone level alterations between the groups. For all participants, the mean number of surfaces (4 per implant) with bleeding on probing (BoP) and plaque were 0.76 ±0.81 and 0.16 ±0.42 at 1 year follow-up and 0.44 ±0.66 and 0.02 ±0.15, respectively, at the second-year follow-up. The mean pocket probing depths were 2.05 ±0.54 mm at 1 year and 2.18 ±0.64 mm at 2 years. For both groups, a significant rise in satisfaction and quality of life was observed (P≤.001) at 1 and 2 years compared with pretreatment. CONCLUSIONS: Ankylos implants placed in the edentulous maxilla, immediately or conventionally loaded by a detachable prosthesis, showed favorable bone-level preservation after 2 years of follow-up. No significant differences could be found between the immediate and conventional groups. A significant increase in quality of life was observed for both loading modes. ispartof: JOURNAL OF PROSTHETIC DENTISTRY vol:121 issue:2 pages:258-264 ispartof: location:United States status: published

Statement of problem Displacement of abutments into conical connection implants during screw tightening may also occur during functional loading, creating unsettling forces that may cause loss of preload. A recent conical-hexagon connection with double friction fit (conical-hexagon connection) could prevent this axial displacement. Purpose The purpose of this in vitro study was to measure the 3D axial displacement of abutments with a conical-hexagon connection or conical connection in narrow-diameter implants. Removal torque values (RTVs), preload efficiency, and survival after cyclic loading were also compared. Material and methods Narrow-diameter implants with a conical connection (Osseospeed EV, 3.0×13 mm-AST) and narrow-diameter implants with a conical-hexagon connection (Eztetic, 3.1×13 mm) were embedded in resin rods (G10) (n=6). Six titanium abutments per system were used, and their spatial relationship to the implant platforms after hand tightening was determined by using 3D digital image correlation. The abutments were tightened to the manufacturers’ specified values, and the abutments’ relative position was recorded again. The displacement of the abutment after tightening was calculated. The implants were subjected to cyclic loading (5×106 cycles at 2 Hz) under 200-N loads at a 30-degree angle. After cyclic loading, the RTVs of screws were measured and compared with those specified by the manufacturers to calculate preload efficiency. ANOVA was used to compare the differences in displacements after tightening and to compare differences in RTVs after cyclic loading across the groups (α=.05). Results The mean displacement in the U direction (X-axis) for the AST was −0.7 μm and −4.7 μm for ZIM, with no statistical difference (P=.73). The mean displacement in the V direction (Y-axis) for AST was −37.0 μm, and −150.0 μm for ZIM, with significant statistical difference (P Conclusions Greater abutment displacements were observed with the conical-hexagon connection, which required a higher torque, as specified by its manufacturer. The abutments displaced more in the V-axis in both implants. Only the conical connection implant (Ti Grade 4, commercially pure) had failures during cyclic loading, but the survival of the implants was similar. After cyclic loading, the abutment screws in both systems lost some of their torque value. The abutment screws of the conical-hexagon connection implant maintained preload more efficiently during cyclic loading than those of the conical connection implant.

Implant-supported fixed dental prostheses have been classified into screw-retained and cement-retained types, and each retaining type has complications. A novel retentive cementless double crown (CLD) type of the implant-supported fixed prosthesis has been developed. CLD has air pockets in the intaglio surface of the crown and does not require cement or a screw hole. However, studies on the retention force and stress distribution of the system are lacking.The purpose of this in vitro study was to evaluate the retention force and stress distribution in the CLD system.The specimen comprised an implant, a titanium abutment, and a zirconia crown. Retention forces of 10 specimens of the CLD type were measured at no loading and after cyclic loading for 50, 100, 200, 600, 10 000, and 1 000 000 cycles by using a universal testing machine with a custom attachment device. Forty specimens of the stress distribution test were divided into 4 groups based on the retention type (cement-retained or CLD type) and load direction (vertical or oblique). Strain gauges were attached onto the buccal and lingual sides of the implant, and microstrain values were measured. One-way analysis of variance with the post hoc Tukey honestly significant difference test was performed on the retention force data, and the t test was performed to analyze the microstrain value data (α=.05).Retention forces after 0, 50, 100, 200, 600, 10 000, and 1 000 000 load cycles were 18.12 ±6.16 N, 20.47 ±5.78 N, 19.79 ±6.61 N, 18.46 ±5.23 N, 19.60 ±6.93 N, 21.75 ±5.03 N, and 40.91 ±9.32 N, respectively, and after 1 000 000 cycles, the retention force was significantly higher than that of other load cycles (P.05). The mean of maximum microstrain values under the vertical load were similar in the cement-retained type (buccal side, 834.96 ±53.69 μm/m; lingual side, 490.76 ±34.12 μm/m) and the CLD type (buccal side, 814.28 ±71.20 μm/m; lingual side, 479.10 ±30.74) (P.05), and the mean of maximum microstrain values under the oblique load was also similar in the cement-retained type (buccal side, 1991.04 ±109.89 μm/m; lingual side, -2232.41 ±189.88) and the CLD type (buccal side, 1932.47 ±152.51 μm/m; lingual side, -2097.47 ±130.69 μm/m) (P.05).The CLD type had clinically acceptable retention during 1 000 000 load cycles and had a similar or better stress distribution capability than the cement-retained type.

The gradual loss of retention and the need for periodic replacement of attachment-system components are the most frequent complications in implant-supported overdentures.The purpose of this in vitro study was to develop a new attachment system for overdentures with polymeric materials and compare its retention and deformation with a conventional O-ring attachment system.A matrix with 2 mini-implants with ball abutments was used to simulate the mandibular border during a fatigue resistance test. A total of 60 polyacetal (n=20), polytetrafluoroethylene (n=20), and conventional O-ring (n=20) attachments were captured in pairs with acrylic resin and subjected to 3625 insertion and removal cycles, simulating 30 months of overdenture use. The internal and external deformations of the attachments were assessed using an optical stereomicroscope. One-way ANOVA and the Tukey honestly significant difference tests were used for statistical evaluation (α=.05).The polyacetal attachment system showed the highest retention (P.001), followed by the O-ring and polytetrafluoroethylene attachments. The O-ring attachments exhibited the lowest deformation (P.001), and the polyacetal attachments had the highest internal deformation (P.001).The newly developed polyacetal attachment model increased the retention of mini-implant-retained overdentures, and despite the deformation experienced, the retention period appears to be better than that of conventional systems.

Discolored substrates constitute a challenge to the esthetics of the definitive restoration. Because of technique sensitivity, the generally prolonged treatment time is a drawback to both the patient and the dentist. The technique described presents the replacement of ceramic maxillary incisors crowns over discolored substrates in a single visit by using a milling machine. Translucent blocks of a lithium silicate ceramic reinforced with zirconium dioxide particles were used. Intraoral scans of the trial restorations and of the tooth preparations were performed. The crown parameters were defined in the software. Ceramic blocks were milled in the presintered phase and characterized. The crowns were cemented at the end of the appointment with excellent esthetics.

This clinical report describes a ceramic complete-mouth rehabilitation with screw-retained implant abutment crowns, optimizing esthetics by combining the properties of ceramic materials. The abutments connected a titanium insert to a computer-aided design and computer-aided manufacturing (CAD-CAM) monolithic zirconia framework, offering improved esthetics and biologic response without negatively affecting the implant abutment interface. Lithium disilicate crowns were cemented extraorally on the abutments, resulting in a screw-retained restoration.

Statement of problem The effect of a recently introduced metal opaquer when used to mask the color of a titanium abutment under ceramic crown systems is unknown. Purpose The purpose of this study was to compare the color coordinates of 3 ceramic crown types—characterized monolithic lithium disilicate (LDC) (IPS e.max; Ivoclar Vivadent AG), layered lithium disilicate (LDL) (IPS e.max; Ivoclar Vivadent AG), and layered zirconia (ZL) (H.C. Starck)—on 3 abutment configurations, nonopaqued titanium (Ti), resin opaqued titanium (Op), and zirconia (Zir). In addition, the color differences (CIEDE2000) were evaluated among the 3 crown types on 3 different abutment substrates. Material and methods Ten Ti disks (10×1 mm) were fabricated with computer-aided design and computer-aided manufacturing (CAD-CAM) to represent the Ti abutments. Five Ti specimens were opaqued (Op) (whiteMetal Opaquer wMO; Blue Sky Bio), and 5 were not opaqued (Ti). Ten zirconia disks were fabricated with CAD-CAM and sintered (10×1.2 mm). Five disks were used as backings to represent Zir abutments, and 5 disks were layered with 1 mm of porcelain (B1, IPS e.Max Ceram; Ivoclar Vivadent AG) to represent layered zirconia crowns (ZL). Ten lithium disilicate plates (14×14×1.2 mm) were sectioned from CAD blocks (B1 IPS e.Max CAD; Ivoclar Vivadent AG). Five plates were layered with the same porcelain (B1, 1 mm), and 5 plates were surface characterized and glazed. An LDL crown on a Zir abutment configuration was used as the control. The 3 simulated crown types (n=5) were optically connected to each of the 3 abutment types, and the color of the 9 groups was measured using a spectroradiometer. Measured data were reported in CIELab coordinates. CIELab data were used to calculate color differences between the control and the 8 experimental groups. Color data were summarized for each group, and analyzed by repeated-measures ANOVA. For pairwise comparisons, a Bonferroni correction of t tests was used, and for interpretive analysis of resulting color difference data, a 1-way ANOVA and subsequent Tukey testing for pairwise comparisons were used. Results The statistical significance of the analysis of color coordinates was found to be P ≤.002. Although 3-way interaction was not found to be significant ( P =.335), all three 2-way interactions of the main effects were found to be significant ( P ≤.002). All crown types on the Zir abutment revealed color differences from the control group. The color differences of the crown types on the Op and Zir abutment configurations compared with the control (LDL/Zir) were not ( P >.05) statistically different. Conclusions Colors of tested crown systems on Ti backing were each unacceptably different from the control group. Colors of these systems on zirconia backing were not perceivably different. Use of opaquer on titanium backing resulted in a small color difference from the control group ( P >.05) for each crown system, demonstrating that it may be used to prevent the unfavorable metal show-through that can influence the final color of all ceramic crown systems tested.

Insufficient crown height space, particularly in the interforaminal region of edentulous ridges with knife-edge morphology, may prevent successful prosthetic rehabilitation. Such conditions require osteoplasty, which might complicate computer-guided implant placement. This clinical report illustrates the treatment of a patient with complete edentulism rehabilitated with a mandibular implant-supported fixed dental prosthesis by using a virtually guided approach. Both alveolar ridge reduction and prosthetically driven implant insertions were computer-guided by surgical stents to increase accuracy and predictability. This approach enabled the immediate loading of the implants with an interim prosthesis before the delivery of a definitive screw-retained fixed prosthesis. At the 1-year follow-up visit, clinical and radiographic examination revealed a stable outcome.

Statement of problem Intraoral scanners are effective for direct digital impression when dental restorations are fabricated using computer-aided design and computer-aided manufacturing (CAD-CAM); however, if the abutment tooth cannot be dried completely or the prepared margin is placed subgingivally, accurate digital images cannot always be guaranteed. Purpose The purpose of this in vitro study was to compare the internal and marginal discrepancies of zirconia copings fabricated directly using an intraoral scanner with those fabricated indirectly with impression scanning. Material and methods Forty-five resin dies fabricated with a 3-dimensional (3D) printer were divided into 3 groups: direct scanning (DS), impression scanning (IMP), and lost-wax casting (LW). For the DS group, a resin die was scanned with an intraoral scanner (Trios; 3Shape), whereas for the IMP group, impressions made with polyether were scanned with a cast scanner (D700; 3Shape). The zirconia copings were fabricated in the same way in the DS and IMP groups. For the LW group, impressions were made in the same way as in the IMP group, and Ni-Cr alloy copings were fabricated using LW. The marginal and internal discrepancies of the copings were measured by cementing them onto resin dies, embedding them in acrylic resin, and sectioning them in a buccolingual direction. The cement layer was measured, and the Kruskal-Wallis test was used to detect significant differences (α=.05). A nonparametric Friedman test was also performed to compare the measurements of each group by location (α=.05). Results The mean marginal discrepancies in the DS, IMP, and LW groups were 18.1 ±9.8, 23.2 ±17.2, and 32.3 ±18.6 μm (mean ±standard deviation), respectively. The mean internal discrepancies of the DS, IMP, and LW groups in the axial area were 38.0 ±9.1, 47.0 ±16.3, and 36.5 ±15.8 μm, and those in the occlusal area were 36.7 ±16.9, 33.4 ±21.6, and 44.5 ±31.9 μm, respectively. No statistically significant differences were found in marginal or internal discrepancies among groups ( P >.05). Conclusions Within the limitations of this study, the zirconia copings fabricated with CAD-CAM using different digitization methods and Ni-Cr copings fabricated using the lost-wax technique and casting produced clinically acceptable marginal and internal discrepancies. No significant differences were found among the DS, IMP, and LW groups.

Due to the increased esthetic demands, custom zirconia post-and-cores have recently become popular. A post-and-core pattern with acrylic resin or wax is scanned using a laboratory scanner for the design of a definitive post-and-core restoration. This procedure requires additional time and material handling experience. If a scan post is used for an intracanal digital scan, substantial initial investments for hardware and software are required. This article introduces an alternative technique for fabricating a custom zirconia post-and-core with a conventional impression. By using this technique, a properly fitted zirconia post-and-core is quickly and easily fabricated with less human error.

Statement of problem Anterior shade matching is an essential factor influencing the esthetics of a ceramic restoration. Dentists face a challenge when the color of an implant abutment creates an unsatisfactory match with the ceramic restoration or neighboring teeth. Purpose The purpose of this in vitro study was to evaluate the influence of abutment material and ceramic thickness on the final color of different ceramic systems. Material and methods Four experimental and control ceramic specimens in shade A3 were cut from IPS e.max CAD, IPS Empress CAD, and VITA Suprinity PC blocks. These specimens had thicknesses of 1.0 mm, 1.5 mm, 2.0 mm, and 2.5 mm, respectively, for the experimental groups, and 4 mm for the controls. Background abutment specimens were fabricated to yield 3 different shades: white zirconia, yellow zirconia, and titanium at a 3-mm thickness. All 3 ceramic specimens in each thickness were placed in succession on different abutment backgrounds with glycerin optical fluid in between, and the color was measured. A digital spectrophotometer was used to record the specimen color value in the Commission Internationale De L'eclairage (CIELab) color coordinates system and to calculate the color difference (ΔE) between the control and experimental groups. The Kruskal-Wallis test was used to analyze the effect of ceramic thickness on different abutments, and the pair-wise test was used to evaluate within the group (α=.05). Results The color differences between the test groups and the control decreased with increasing ceramic thickness for every background material. In every case, significant differences were found between 1.0- and 2.5-mm ceramic thicknesses. Only certain 2.5-mm e.max CAD, VITA Suprinity PC, and Empress CAD specimens on yellow-shade zirconia or VITA Suprinity PC on titanium were identified as clinically acceptable (ΔE Conclusions Increasing ceramic restoration thickness over the abutment background decreased the color mismatch. Increasing the thickness of ceramic on a yellow-shaded zirconia abutment rather than on titanium or white zirconia yielded a more esthetic color for the whole restoration.