Faculty Bibliography

Purpose: To investigate the reliability and failure modes of indirect composites as single-unit implant crowns. Materials and Methods: Thirty-eight custom-milled titanium alloy locking-taper abutments were divided into two groups (n = 19 each), and crown build-up of a mandibular molar was accomplished using two indirect composite systems (Ceramage, Shofu, Kyoto, Japan; Diamond Crown, DRM, Branford, CT). Three crowns of each material were loaded until failure for determination of the step-stress profiles. Reliability testing started at a load 30% of the mean load to failure and used three profiles with increasing fatigue loading (step stress). Weibull curves with 300 N stress and 90% confidence intervals were calculated and plotted using a power-law relationship. Weibull modulus 'Beta' and characteristic strength 'Eta' were identified, and a contour plot was used (Beta vs. Eta) for examining differences between groups. Specimens were inspected in polarized light and scanning electron microscope for fracture analysis. Results: Use level Weibull probability showed fatigue being a damage factor only for the Ceramage group (beta= 3.39) but not for the Diamond Crown group (beta= 0.40). Overlap in the confidence bounds resulted in no statistical difference. Irrespective of composite system, fracture initiated in the region immediately below the contact between the indenter and the cusp, with the crack propagating toward the margins of cohesive failure. Conclusions: No significant differences were observed in life and Weibull probability calculations for Ceramage and Diamond Crown veneered onto Ti alloy abutments. Failure modes comprised composite veneer chippings

OBJECTIVE: To evaluate the biomechanical scenario of platform switching geometric implant-abutment configuration relative to standard configurations by means of finite element analysis. STUDY DESIGN: A 3D Finite Element Analysis (FEA) was performed on 3 different implant-abutment configurations: a 3.8 mm implant with a matching diameter abutment (Standard Control Design, SCD), a 5.5 mm implant with matching diameter abutment (Wider Control Design, WCD), and a 5.5mm implant with a 3.8 mm abutment (Experimental Design, ED). All the different experimental groups were discretized to over 60000 elements and 100000 nodes, and 130N vertical (axial) and 90N horizontal loads were applied on the coronal portion of the abutment. Von Mises stresses were evaluated and maximum and minimum values were acquired for each implant-abutment configuration. RESULTS: The load-induced Von Mises stress (maximum to minumum ranges) on the implant ranged from 150 MPa to 58 Pa (SCD); 45 MPa to 55 Pa (WCD); 190 MPa to 64 Pa (ED). The Von Mises stress on the abutment ranged from 150 MPa to 52 MPa (SCD); 70 MPa to 55 MPa (WCD), and 85 MPa to 42 MPa respectively (ED). The maximum stresses transmitted from the implant-abutment system to the cortical and trabecular bone were 67 Pa and 52 MPa (SCD); 54 Pa and 27 MPa (WCD); 64 Pa and 42 MPa (ED), respectively. When the implant body was evaluated for stresses, a substantial decrease in their levels were observed at the threaded implant region due to the diametral mismatch between implant and abutment for the ED configuration. CONCLUSION: The platform switching configuration led to not only to a relative decrease in stress levels compared to narrow and wide standard configurations, but also to a notable stress field shift from bone towards the implant system, potentially resulting in lower crestal bone overloading.

The clinical success of modern dental ceramics depends on an array of factors, ranging from initial physical properties of the material itself, to the fabrication and clinical procedures that inevitably damage these brittle materials, and the oral environment. Understanding the influence of these factors on clinical performance has engaged the dental, ceramics, and engineering communities alike. The objective of this review is to first summarize clinical, experimental, and analytic results reported in the recent literature. Additionally, it seeks to address how this new information adds insight into predictive test procedures and reveals challenges for future improvements

Freitas AC Jr, Bonfante EA, Rocha EP, Silva NRFA, Marotta L, Coelho PG. Effect of implant connection and restoration design (screwed vs. cemented) in reliability and failure modes of anterior crowns. Eur J Oral Sci 2011; 119: 323-330. (c) 2011 Eur J Oral Sci The mechanical performance of cemented or screw-retained implant-supported crowns with an internal or external configuration is yet to be understood. This in vitro study evaluated the effect of screw-retained and cement-retained prostheses on internal and external implant-abutment connections. Thereby, the reliability and failure modes of crowns were investigated. Eighty-four implants (Emfils; Colosso Evolution system) were divided into four groups (n=21 each): screw-retained and internal connection (Si), screw-retained and external connection (Se), cement-retained and internal connection (Ci), and cement-retained and external connection (Ce). Ti-6Al-4V abutments were torqued (30 Ncm) to the implants, and maxillary central incisor metal crowns were torqued (30 Ncm) or cemented (Rely X Unicem; 3M-ESPE) and subjected to accelerated life-testing in water. Use-level probability Weibull curves and reliability for 50,000 cycles at 150 N were calculated. The beta values for Si (1.72), Se (1.50), Ci (1.34), and Ce (1.77) groups indicated that fatigue/damage accumulation accelerated their failure. The Ci group presented the highest reliability, the Se group presented the lowest reliability, and Si and Ce groups presented intermediate reliability. Screw-retained restorations presented mainly abutment fracture. Cement-retained restorations resulted in failures of the screw in the Ce group, but implant/screw fracture in the Ci group

PURPOSE: This study tested the hypothesis that early integration of plateau root form endosseous implants is significantly affected by surgical drilling technique. MATERIALS AND METHODS: Sixty-four implants were bilaterally placed in the diaphysial radius of 8 beagles and remained 2 and 4 weeks in vivo. Half the implants had an alumina-blasted/acid-etched surface and the other half a surface coated with calcium phosphate. Half the implants with the 2 surface types were drilled at 50 rpm without saline irrigation and the other half were drilled at 900 rpm under abundant irrigation. After euthanasia, the implants in bone were nondecalcified and referred for histologic analysis. Bone-to-implant contact, bone area fraction occupancy, and the distance from the tip of the plateau to pristine cortical bone were measured. Statistical analyses were performed by analysis of variance at a 95% level of significance considering implant surface, time in vivo, and drilling speed as independent variables and bone-to-implant contact, bone area fraction occupancy, and distance from the tip of the plateau to pristine cortical bone as dependent variables. RESULTS: The results showed that both techniques led to implant integration and intimate contact between bone and the 2 implant surfaces. A significant increase in bone-to-implant contact and bone area fraction occupancy was observed as time elapsed at 2 and 4 weeks and for the calcium phosphate-coated implant surface compared with the alumina-blasted/acid-etched surface. CONCLUSIONS: Because the surgical drilling technique did not affect the early integration of plateau root form implants, the hypothesis was refuted.

PURPOSE: The aim of this study was to evaluate the influence of estrogen deficiency on bone around osseointegrated dental implants in a rat jaw model. MATERIALS AND METHODS: This study used 16 female rats that had the first molars bilaterally extracted and were allowed to heal for 30 days before implant placement. Sixty days after implant placement, the animals were randomly subjected to sham surgery or ovariectomy (OVX). The animals were euthanized 90 days after OVX. Bone-to-implant contact, bone area fraction occupancy between implant threads, mineral density, turnover markers, and cells positive for tartrate-resistant acid phosphatase were assessed for the 2 groups. RESULTS: The results showed that OVX group presented a decrease of systemic bone density, alterations in bone turnover markers, and an increase of cells positive for tartrate-resistant acid phosphatase compared with the sham-surgery group. However, no difference relative to bone-to-implant contact and bone area fraction occupancy was observed between groups. CONCLUSIONS: The findings of this study demonstrate that estrogen deficiency may not be considered a risk factor for osseointegrated implant failure in jaw bone.

Presently, several different graft materials are employed in regenerative or corrective bone surgery. However current misconceptions about these biomaterials, their use and risks may compromise their correct application and develop- ment. To unveil these misconceptions, this work briefly reviewed concepts about bone remodeling, grafts classifica tion and manufacturing processes, with a special focus on calcium phosphate materials as an example of a current em- ployed biomaterial. Thus a search on the last decade was performed in Medline, LILACS, Scielo and other scientific electronic libraries using as keywords biomaterials, bone remodeling, regeneration, biocompatible materials, hy- droxyapatite and therapeutic risks. Our search showed not only an accelerated biotechnological development that brought significant advances to biomaterials use on bone remodeling treatments but also several therapeutic risks that should not be ignored. The biomaterials specificity and limitations to clinical application point to the current need for developing safer products with better interactions with the biological microenvironments

BACKGROUND: Thin bioceramic coatings have been regarded as potential substitutes for plasma-sprayed hydroxyapatite coatings. PURPOSE: This study tested the hypothesis that a thin bioactive ceramic coating deposition on an alumina-blasted/acid-etched (AB/AE) surface would positively affect the biomechanical fixation and bone-to-implant contact (BIC) of plateau root form implants. MATERIALS AND METHODS: Implants of two different lengths (i.e., 4.5 x 11 mm long, n = 36) and 4.5 x 6 mm (short, n = 36) and two different surfaces, that is, control (AB/AE) and test (AB/AE + 300 - 500 nm bioactive ceramic coating), were placed in the proximal tibiae of six beagle dogs. The implants were retrieved for analyses 2 and 4 weeks after placement. The implants in bone specimens were subjected to torque loads until a 10% drop of the maximum torque was recorded. The specimens were evaluated under optical microscopy for bone morphology and percent BIC. Statistical analysis was performed by a generalized linear mixed effects analysis of variance model and statistical significance set at p < 0.05. RESULTS: Significantly higher torque-to-interface fracture levels for test surface groups of both lengths when compared to control surfaces were observed. No significant difference in BIC was observed between test and control implants of equal length. Histomorphological analysis showed higher degrees of bone organization between the plateaus of test implant surfaces at both implantation times. CONCLUSION: Because the presence of a thin bioactive ceramic coating on the surface did not affect BIC, but positively affected implant biomechanical fixation, the hypothesis was partially validated.

ABSTRACT Background: The number of patients with oral implants has increased significantly. However, the literature addressing the effect of impact force on titanium and/or ceramic implants is inconclusive. This study sought to determine the fracture resistance to impact load of titanium and ceramic endosseous oral implants. Materials and Methods: Endosseous oral implants were vertically positioned in two different mounting media: brass and a bone-simulation material. The implant configurations tested included an experimental one-piece Y-TZP implant and a commercially available titanium implant (external hex) with both titanium and zirconia abutments. The specimens were subjected to an impact load using a pendulum impact tester with tup weights varying from 0.9 to 4.5 kg delivered at a radius of 40.64 mm. Loads were delivered to the abutment at a point 4.27 mm above the implant fixture and block junction. Statistical differences (p < .05) were established using the F-test for variances and, when different, t-test assuming unequal variances. Results: For implants clamped in brass, the titanium implant with titanium abutment required the greatest energy to fracture the implant-abutment system (only the abutment screw failed). The ceramic implant and ceramic abutment on titanium implant presented the lowest fracture energy (p < .01). No significant differences were observed when different systems were inserted into the foam blocks of the bone substitute (p > .25). Conclusion: This investigation showed that the fracture energy of two titanium-abutment systems versus a single-piece Y-TZP implant in foam blocks simulating bone elastic modulus was not different, and that differences occurred when the embedding material elastic modulus was increased an order of magnitude

Signal transduction involves studying the intracellular mechanisms that govern cellular responses to external stimuli such as hormones, cytokines, and also cell adhesion to biomaterials surfaces. Several events have been shown to be responsible for cellular adhesion and adaptation onto different surfaces. For instance, cytoskeletal rearrangements during cell adhesion require the recruitment of specific protein tyrosine kinases into focal adhesion structures that promote transient focal adhesion kinase and Src phosphorylations, initially modulating cell behavior. In addition, the phosphorylation of tyrosine (Y) residues have been generally accepted as a critical regulator of a wide range of cell-related processes, including cell proliferation, migration, differentiation, survival signalling, and energy metabolism. The understanding of the signaling involved on the mechanisms of osteoblast adhesion, proliferation, and differentiation on implant surfaces is fundamental for the successful design of novel "smart" materials, potentially decreasing the repair time, thereby allowing for faster patient rehabilitation.