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Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies

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A special issue of Materials (ISSN 1996-1944). This special issue belongs to the section "Biomaterials".

Deadline for manuscript submissions: closed (31 May 2021) | Viewed by 40053

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Prof. Sergio Caputi

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Department of Medical, Oral, and Biotechnological Sciences, “G.d’Annunzio” University of Chieti-Pescara, Chieti, Italy
Interests: new materials in prosthodontics and implantology; stem cell and tissue engineering; electron microscopy (SEM, TEM, and AFM) new implant surfaces and biomaterials

Dr. Bruna Sinjari

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Guest Editor

Department of Innovative Technologies in Medicine and Dentistry, University “G.d’Annunzio” of Chieti-Pescara, Chieti, Italy
Interests: dental materials; biomaterials; prosthodontics; implantology; regenerative dentistry
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Today, the success of oral implantology has increased the need for long-term prosthetic implant rehabilitation. However, despite the enormous results achieved in the field of implant–prosthetic dentistry, there are still gaps in the literature in this field.

At a moment like this, in which new materials and new techniques are progressing more and more, and the demands are high, both from the clinical and patient point of view, we cannot fail to concentrate our research in the field of implantology and prostheses. These two fields, which are so related, and that have implications between them are now undergoing a revolution. Hence, the need for a new Special Issue, to raise awareness of the most advanced techniques, protocols, and materials used today in the field of implantology and prostheses worldwide.

The aim of this Special Issue is to provide an update of the current knowledge in the field of implantology and prosthesis. It is also intended to focus on the advantages and disadvantages of the new materials and new protocols used for the management and rehabilitation of these patients also through CAD/CAM technologies.

The research published in this Special Issue may help to increase the knowledge on these two fields, thus to better perform the clinical practice.

Prof. Sergio Caputi
Prof. Bruna Sinjari
Guest Editors

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Keywords

Prosthodontics
Dental implants
Dental materials
New technology
Digital dentistry
CAD/CAM dentistry

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Published Papers (12 papers)

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10 pages, 15842 KiB

Open AccessArticle

Comparison of the Fracture Resistance and Fracture Mode of Contemporary Restorative Materials to Overcome the Offset of Mandibular Implant-Supported, Cement-Retained Crowns

by Salwa Omar Bajunaid, Ibraheem Alshiddi, Lamya Alhomaidhi, Rania Almutairi, Shoq Alolayan and Syed Rashid Habib

Materials 2021, 14(17), 4838; https://doi.org/10.3390/ma14174838 - 26 Aug 2021

Cited by 3 | Viewed by 1844

Abstract

Background: The purpose was to compare the fracture resistance and the mode of failure of different contemporary restorative materials to restore implant supported, cement-retained mandibular molars. Methods: Two 5 × 10 mm titanium dental implants were mounted in resin blocks and prefabricated titanium and zirconia abutments were connected to each implant. Each implant received forty crowns resembling mandibular first molars. The specimens were divided into four groups (n = 10/group) for each abutment according to the type of material; Group A: porcelain fused to metal crowns; Group B: monolithic zirconia crowns; Group C: zirconia coping with ceramic veneer; Group D: all ceramic lithium disilicate crowns. Specimens were cemented to the abutments, mounted into a universal testing machine, and vertical static load was applied at a speed of 1 mm/min. The test stopped at signs of visual/audible fracture/chipping. Fracture resistance values were analyzed using ANOVA and Tukey’s tests (α ≤ 0.05). The modes of failure were visually observed. Results: A statistically significant difference (p < 0.001) of the fracture resistance values among tested groups was found. The group that showed the highest fracture resistance was Group A for both the titanium and the zirconia abutments (3.029 + 0.248 and 2.59 ± 0.39, respectively) while Group D for both abutments (1.134 + 0.289 and 1.68 ± 0.13) exhibited the least resistance. Conclusions: Fracture resistance and fracture mode varied depending on type of restorative material. For both titanium and zirconia abutments, porcelain fused to metal showed the highest fracture resistance values followed by monolithic zirconia. Full article

(This article belongs to the Special Issue Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies)

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15 pages, 1345 KiB

Open AccessArticle

Clinical Outcome of Dental Implants after Maxillary Sinus Augmentation with and without Bone Grafting: A Retrospective Evaluation

by Gianluca Martino Tartaglia, Pier Paolo Poli, Stephen Thaddeus Connelly, Carlo Maiorana, Davide Farronato and Silvio Taschieri

Materials 2021, 14(10), 2479; https://doi.org/10.3390/ma14102479 - 11 May 2021

Cited by 4 | Viewed by 2473

Abstract

(1) Background: The purpose of the present study was to retrospectively evaluate and compare the outcome of two sinus augmentation grafting protocols using a xenograft or blood clot alone over a 72-month follow-up. (2) Methods: Patients who received simultaneous lateral sinus floor augmentation and implant placement were included. Subjects were divided into two groups according to the grafting material, namely xenograft or blood clot, and into sub-groups based on the residual alveolar bone height (RABH) below the maxillary sinus, namely 4 to 6 mm or >6 mm. Kaplan–Meier survival estimates were calculated for each material group and for each sub-group at 1, 3, and 6 years. (3) Results: In total, 289 implants inserted in 136 patients with a one-stage procedure were considered. A total of 35 failures were registered. Overall survival rates were 94.2% for xenograft and 85.9% for blood clot alone at 1 year, 91.1% and 81.6% at 3 years, and 91.1% and 78.7% at 6 years. (4) Conclusions: In patients with 4–6 mm RABH, graftless interventions exploiting blood clot alone were not as successful as those using xenograft. When the RABH is low, sinus floor augmentation associated with grafting materials should be preferred whenever possible. Full article

(This article belongs to the Special Issue Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies)

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10 pages, 2554 KiB

Open AccessArticle

In Vitro Assessment of the Effect of Implant Position on Biomechanical Behaviors of Implant-Supported Removable Partial Dentures in Kennedy Class II Condition

by Masafumi Kihara, Yoichiro Ogino, Yasuyuki Matsushita, Takehiro Morita, Yoshinori Sawae, Yasunori Ayukawa and Kiyoshi Koyano

Materials 2021, 14(9), 2145; https://doi.org/10.3390/ma14092145 - 23 Apr 2021

Cited by 7 | Viewed by 3727

Abstract

The purpose of this study was to investigate the effects of implant position and loading position on biomechanical behaviors using implant-supported removable partial denture (ISRPD) models in a simulated Kennedy class Ⅱ partially edentulous mandible. Three types of Kennedy class Ⅱ mandibular acrylic resin models (a conventional RPD without support by an implant—CRPD; models with an implant placed at first molar (#46)—MP-ISRPD— and second molar (#47)—DP-ISRPD) were used to measure vertical displacement of the RPD, mesio-distal displacement of the abutment tooth, and bending moment of the abutment tooth and implant under one-point loading. The variables at three respective loading points (#45, #46 and #47) were compared statistically. Vertical displacement was suppressed in ISRPDs compared to the CRPD, and significant effects were identified under loading at the implant position. The largest meiso-distal displacement was observed in MP-ISRPD under #47 loading. Bending moments of the abutment tooth and implant were significantly higher in MP-ISRPD than in DP-ISPRD. In MP-ISRPD, a higher bending moment of the abutment tooth under #45 and #47 loading was detected, although the bending moment in DP-ISRPD was almost zero. The results of this study suggested that MP-ISRPD shows the specific biomechanical behaviors, although DP-ISRPD might provide biomechanical benefits under all one-point loading conditions. Full article

(This article belongs to the Special Issue Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies)

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11 pages, 2546 KiB

Open AccessArticle

Mechanical Pull-Out Test of a New Hybrid Fixture-Abutment Connection: An In Vitro Study

by Gianmaria D’Addazio, Bruna Sinjari, Lorenzo Arcuri, Beatrice Femminella, Giovanna Murmura, Manlio Santilli and Sergio Caputi

Materials 2021, 14(6), 1555; https://doi.org/10.3390/ma14061555 - 22 Mar 2021

Cited by 3 | Viewed by 2392

Abstract

Implant abutment connection was described among the main causes of peri-implant bone resorption. The aim of this in vitro study was to test the coupling capacity, the surface modification of a new hybrid connection and the influence of repeated connection activations caused during the main clinical and laboratory phases. A total of 40 implant-abutment screw retained systems with 10°-conical and internal hexagon connection were tested. The connection was screwed, fixed to the universal test machine, removed the screw and a pull-out test was performed. Test was repeated five times in succession. Also Scanning Electron Microscopy (SEM) was used to detect microscopically surface modification. Analysis of variance and Tukey tests were used for the statistical analysis. Pull-out test reveals a mean value of 131.35 ± 16.52 Newton Centimeter (N·cm). For each single activation, results from first to fifth were: 113.9 ± 13.02, 126.1 ± 12.81, 138.11 ± 15.15, 138.8 ± 11.90 and 140 ± 12.99 N·cm. A statistically significant difference between the measurements and an increase in the removal force was shown. The collected data supports the use of this new type of connection, resulting in a very strong interface between implant and abutment. Also, repeated activation of connection can promote a better coupling of the implant-abutment interface. Full article

(This article belongs to the Special Issue Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies)

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11 pages, 1903 KiB

Open AccessArticle

The Influence of Cement Layer Thickness on the Stress State of Metal Inlay Restorations—Photoelastic Analysis

by Grzegorz Sokolowski, Michal Krasowski, Agata Szczesio-Wlodarczyk, Bartlomiej Konieczny, Jerzy Sokolowski and Kinga Bociong

Materials 2021, 14(3), 599; https://doi.org/10.3390/ma14030599 - 28 Jan 2021

Cited by 9 | Viewed by 2233

Abstract

The successful restoration of teeth requires a good connection between the inlay and natural tissue. A strong bond may improve retention and reinforce tooth structure. The purpose of this study was to evaluate the influence of cement layer thickness on contraction stress generated during photopolymerization, and to determine the changes in stress state of the cement occurring during aging in water (over 84 days). Two cements were used: resin composite cement (NX3) and self-adhesive resin cement (Maxcem Elite Chroma). A cylindrical sample made of CuZn alloy was used to imitate the inlay. The stress state was measured by photoelastic analysis. The contraction stress of the inlay restoration was calculated for cement layer thicknesses of 25 µm, 100 µm, 200 µm, and 400 µm. For both tested materials, the lowest contraction stress was observed for the thinnest layer (25 µm), and this increased with thickness. Following water immersion, a significant reduction in contraction stress was observed due to hygroscopic expansion. Applying a thin layer (approximately 25 µm) of composite and self-adhesive resin cements resulted in high levels of expansion stresses (over −6 MPa) after water aging. Full article

(This article belongs to the Special Issue Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies)

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12 pages, 1265 KiB

Open AccessArticle

The Influence of Surgical Experience and Bone Density on the Accuracy of Static Computer-Assisted Implant Surgery in Edentulous Jaws Using a Mucosa-Supported Surgical Template with a Half-Guided Implant Placement Protocol—A Randomized Clinical Study

by Márton Kivovics, Dorottya Pénzes, Orsolya Németh and Eitan Mijiritsky

Materials 2020, 13(24), 5759; https://doi.org/10.3390/ma13245759 - 17 Dec 2020

Cited by 15 | Viewed by 3543

Abstract

The aim of our randomized clinical study was to analyze the influence of surgical experience and bone density on the accuracy of static computer-assisted implant surgery (CAIS) in edentulous jaws using a mucosa-supported surgical template with a half-guided implant placement protocol. Altogether, 40 dental implants were placed in the edentulous jaws of 13 patients (novice surgeons: 18 implants, 6 patients (4 male), age 71 ± 10.1 years; experienced surgeons: 22 implants, 7 patients (4 male), age 69.2 ± 4.55 years). Angular deviation, coronal and apical global deviation and grey level measurements were calculated for all implants by a blinded investigator using coDiagnostiX software. 3DSlicer software was applied to calculate the bone volume fraction (BV/TV) for each site of implant placement. There were no statistically significant differences between the two study groups in either of the primary outcome variables. There was a statistically significant negative correlation between angular deviation and both grey level measurements (R-value: −0.331, p < 0.05) and BV/TV (R-value: −0.377, p < 0.05). The results of the study suggest that surgical experience did not influence the accuracy of implant placement. The higher the bone density at the sites of implant placement, the higher the accuracy of static CAIS. Full article

(This article belongs to the Special Issue Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies)

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12 pages, 1775 KiB

Open AccessArticle

Long-Term Sorption and Solubility of Zirconia-Impregnated PMMA Nanocomposite in Water and Artificial Saliva

by Saleh Zidan, Nikolaos Silikas, Julfikar Haider and Julian Yates

Materials 2020, 13(17), 3732; https://doi.org/10.3390/ma13173732 - 24 Aug 2020

Cited by 15 | Viewed by 2510

Abstract

Exposure of denture base acrylic resins to the oral environment and storage media for extended periods of time results in sorption of saliva or water, leading to a reduction in physical properties and thus clinical service life. The purpose of this in vitro study was to assess the sorption and solubility of high-impact heat-polymerised denture base acrylic resin (HI PMMA) impregnated with zirconia nanoparticles after being stored for 180 days in distilled water (DW) and artificial saliva (AS). The specimens were divided into six groups for each storage medium, according to the concentration of zirconia nanoparticles (0, 1.5, 3.0, 5.0, 7.0, and 10.0 wt.%). Data were statistically analysed for sorption and solubility using one-way and two-way ANOVA statistical tests. Sorption in DW and AS for all groups containing zirconia showed sorption values lower than the control group at 90 days, though not significantly different (p > 0.05) compared to the control group. For both the DW and AS groups, the lowest solubility value was measured in the group containing 3 wt.% zirconia, however, there was no significant difference compared to the control group except when observing 10 wt.% zirconia in AS, which showed a significantly higher solubility (p < 0.05). High-impact PMMA, impregnated with low concentrations of ZrO₂, showed the lowest sorption and solubility in both media, but was not significantly different compared to pure HI PMMA. Full article

(This article belongs to the Special Issue Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies)

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11 pages, 3047 KiB

Open AccessArticle

Influence of Dentine Pre-Treatment by Sandblasting with Aluminum Oxide in Adhesive Restorations. An In Vitro Study

by Bruna Sinjari, Manlio Santilli, Gianmaria D’Addazio, Imena Rexhepi, Alessia Gigante, Sergio Caputi and Tonino Traini

Materials 2020, 13(13), 3026; https://doi.org/10.3390/ma13133026 - 7 Jul 2020

Cited by 15 | Viewed by 4049

Abstract

Dentine pretreatment through sandblasting procedures has been widely studied but no curve test results are currently available. Thus, the aim herein was to in vitro compare the adhesive strength in sandblasted or not samples using a universal testing machine. Thirty -two bovine teeth were divided into two groups, namely test (n = 16 bars), sandblasting with aluminum oxide particles (50 µm) was performed before the adhesion procedures), and control (n = 16 bars), where no sandblasting procedure was performed. A bi-material curve test was used to evaluate the characteristics of the dentine pretreatment in terms of tensile stress and fracture strength. A scanning electron microscope (SEM) was used to analyze the fracture topography in the composite, bonding, dentin, and at the relative interfaces. The results demonstrated a statistically significant difference between the two groups in terms of tensile stress at maximum load showing values of 84.300 ± 51.342 MPa and 35.071 ± 16.609 MPa, respectively for test and control groups (p = 0.033). Moreover, a fracture strength test showed values of 18.543 ± 8.145 MPa for test and 8.186 ± 2.833 MPa for control group (p = 0.008). In conclusion, the sandblasting treatment of the dentine significantly influenced the mechanical resistance of the adhesion in this in vitro study. Full article

(This article belongs to the Special Issue Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies)

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14 pages, 4109 KiB

Open AccessArticle

Evaluation of Equivalent Flexural Strength for Complete Removable Dentures Made of Zirconia-Impregnated PMMA Nanocomposites

by Saleh Zidan, Nikolaos Silikas, Julfikar Haider, Abdulaziz Alhotan, Javad Jahantigh and Julian Yates

Materials 2020, 13(11), 2580; https://doi.org/10.3390/ma13112580 - 5 Jun 2020

Cited by 24 | Viewed by 4561

Abstract

High-impact (HI) polymethyl methacrylate (PMMA), obtained from modification of conventional PMMA, is commonly used in prosthodontics as a denture base material for improved impact resistance. However, it suffers from poor flexural strength properties. The aim of this study was to investigate the flexural strength of complete removable dentures made of HI heat-polymerised PMMA resin reinforced with zirconia nanoparticles at two different concentrations. The effect of fatigue loading on the flexural strength behaviour of the dentures was also investigated. A total of 30 denture specimens were fabricated from PMMA with different concentrations of zirconia nanoparticles: 0 (control), 3, and 5 wt.%. Ten specimens in each group were divided into two subgroups, with five specimens in each, to conduct both flexural strength and fatigue loading test of each of the subgroups. Fatigue loading was applied on the dentures using a mastication simulator and equivalent flexural strength was calculated with data from bending tests with and without fatigue cyclic loading. One-way analysis of variance (ANOVA) of the test data was conducted with the Bonferroni significant difference post-hoc test at a preset alpha value of 0.05. Paired t-test was employed to identify any difference between the specimens with and without the application of fatigue loading. The fractured surface of the denture specimens was examined with a scanning electron microscope (SEM). The bending tests demonstrated that the mean equivalent flexural strength of reinforced HI PMMA denture specimens with 5 wt.% zirconia nanoparticles increased significantly (134.9 ± 13.9 MPa) compared to the control group (0 wt.%) (106.3 ± 21.3 MPa) without any fatigue loading. The mean strength of the dentures with PMMA +3 wt.% zirconia also increased, but not significantly. Although the mean strength of all specimen groups subjected to fatigue loading slightly decreased compared to that of the specimen groups without any fatigue cyclic loading, this was not statistically significant. Denture specimens made of HI heat-polymerised PMMA reinforced with 5 wt.% zirconia nanoparticles had significantly improved equivalent flexural strength compared to that made of pure PMMA when the specimens were not subjected to any prior fatigue cyclic loading. In addition, the application of fatigue cyclic loading did not significantly improve the equivalent flexural strengths of all denture specimen groups. Within the limitations of this study, it can be concluded that the use of zirconia-impregnated PMMA in the manufacture of dentures does not result in any significant improvement for clinical application. Full article

(This article belongs to the Special Issue Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies)

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15 pages, 2649 KiB

Open AccessArticle

A 4 Year Human, Randomized, Radiographic Study of Scalloped versus Non-Scalloped Cemented Implants

by Bruna Sinjari, Gianmaria D’Addazio, Manlio Santilli, Barbara D’Avanzo, Imena Rexhepi, Antonio Scarano, Tonino Traini, Maurizio Piattelli and Sergio Caputi

Materials 2020, 13(9), 2190; https://doi.org/10.3390/ma13092190 - 10 May 2020

Cited by 8 | Viewed by 3053

Abstract

Marginal bone loss (MBL) is a key factor in long-term implant success rate. Among the different factors that influence MBL, it is the different implant shoulder designs, such as scalloped or non-scalloped, which have been widely studied on screw retained but not on cemented retained implants. Thus, the aim of the present study was to evaluate the MBL around scalloped and non-scalloped cemented retained dental implants after 4 years of loading, in humans. A total of 15 patients were enrolled in the present study. A radiographic and clinical examination was performed after implant placement (T0) and after 4 years from it (T1). The results demonstrated a differential MBL (T1-T0) of 2.436 ± 1.103 mm and 1.923 ± 1.021 mm, respectively for test (scalloped) and control (non-scalloped) groups with a statistically significant difference between them. On the other hand, no statistically significant differences were found between the groups in terms of prosthetic complication and abutment decementation, whilst ceramic crowns chipping was shown in both groups. In conclusion, the use of a scalloped platform did not provide better results on the maintenance of MBL after 4 years follow-up. In this study, this probably was determined by multiple factors, among which was the subcrestal insertion of scalloped implants. Full article

(This article belongs to the Special Issue Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies)

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11 pages, 2727 KiB

Open AccessArticle

Fracture Resistance of Zirconia-Reinforced Lithium Silicate Ceramic Crowns Cemented with Conventional or Adhesive Systems: An In Vitro Study

by Gianmaria D’Addazio, Manlio Santilli, Marco Lorenzo Rollo, Paolo Cardelli, Imena Rexhepi, Giovanna Murmura, Nadin Al-Haj Husain, Bruna Sinjari, Tonino Traini, Mutlu Özcan and Sergio Caputi

Materials 2020, 13(9), 2012; https://doi.org/10.3390/ma13092012 - 25 Apr 2020

Cited by 22 | Viewed by 4885

Abstract

In recent years, Zirconia-reinforced Lithium Silicate ceramic (ZLS), combining lithium-silicate and zirconia features, has shown to have excellent mechanical and aesthetic characteristics. Thus, the aim of this study was to compare the fracture strength of ZLS single crowns cemented with two different cementation techniques. Twenty crowns were realised and cemented on teeth replicas achieved from an extracted premolar human tooth. The samples were divided into two groups of 10 specimens each, Glass-ionomeric cement (GIC) group and Self-Adhesive Resin Cement (ARC) group. The mechanical test was performed using a universal testing machine. The specimens were then evaluated with a scanning electron microscope (SEM) to identify for all crowns and related abutments the pattern of fracture after the breaking point. The data obtained were statistically analysed. The mean fracture toughness values and standard deviations (±SD) were 2227 ± 382 N and 3712 ± 319 N respectively for GIC and ARC groups. In fact, t-test showed a statistically significant difference between the two groups (p < 0.001). Moreover, the SEM results demonstrated portions of abutments still attached to the crown fragments in the ARC group, whilst these were not present in the GIC group. Within the limitations of this study, these results suggest the use of adhesive cementation for ZLS crowns, which significantly increase the compressive strength of ZLS restorations compared to GIC. Full article

(This article belongs to the Special Issue Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies)

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13 pages, 2829 KiB

Open AccessSystematic Review

Narrow Diameter Dental Implants as an Alternative Treatment for Atrophic Alveolar Ridges. Systematic Review and Meta-Analysis

by Georgina González-Valls, Elisabet Roca-Millan, Juan Manuel Céspedes-Sánchez, Beatriz González-Navarro, Aina Torrejon-Moya and José López-López

Materials 2021, 14(12), 3234; https://doi.org/10.3390/ma14123234 - 11 Jun 2021

Cited by 19 | Viewed by 3462

Abstract

To determine the marginal bone loss and the survival, success and failure rates of narrow dental implants, a systematic literature search was carried out in the MEDLINE (Pubmed), Cochrane, Scopus, and Scielo databases for articles published between 2010 and 2021. The exclusion criteria were: systematic reviews, case reports, expert opinions; animal studies; samples of less than 10 subjects; follow-up periods of less than 36 months; smokers of minimum 10 cigarettes/day; and articles about mini-implants for orthodontic anchorage. Meta-analyses were performed to assess marginal bone loss and implant survival, success, and failure rates. Fifteen studies were included: 7 clinical trials, 3 randomized clinical trials, 3 cohort studies, and 2 case series. The total number of subjects was 773, in whom 1245 implants were placed. The survival rate for the narrow diameter implants was 97%, the success rate 96.8%, and the failure rate 3%. Marginal bone loss was 0.821 mm. All these data were evaluated at 36 months. Based on the literature, it can be considered that there is sufficient evidence to consider small diameter implants a predictable treatment option. These show favorable survival and success rates and marginal bone loss. All of them are comparable to those of standard diameter dental implants. Full article

(This article belongs to the Special Issue Advanced Dental Implants and Prosthodontics Protocols and Materials: Simulation, Modeling, and Experimental Studies)

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