Journal of Prosthetic Dentistry

Long term success of 6 implants supporting a mandibular screw-retained fixed dental prosthesis: A clinical report

Ilser Turkyilmaz, John D. Jones — 2012-05-01

Dental implant therapy has become successful with improved surgical and prosthodontic techniques. However, most clinical trials, even though well controlled, are limited in longevity. There are few clinical reports that show long-term results with dental implants. Although there are many similarities among criteria for success in these studies, these criteria may vary from what the individual patient reports as a success. This clinical report describes the 28-year successful clinical outcome of a 62-year-old woman with dental implants supporting a mandibular screw-retained fixed dental prosthesis.

Marginal gap, internal fit, and fracture load of leucite-reinforced ceramic inlays fabricated by CEREC inLab and hot-pressed techniques

2012-05-01

Keshvad, A, Hooshmand, T, Asefzadeh, F, Khalilinejad, F, Alihemmati, M, Van Noort, R. J Prosthodont 2011;20:535-40

Myofunctional therapy as an aid to prosthodontic treatment after hemiglossectomy: A clinical report

Fabiana M. Varjão — 2012-05-01

Although several reports describe the prosthetic management of patients after hemiglossectomy, the techniques are related to the fabrication of the prostheses, no reports on maximizing the functional potential of the remaining tongue musculature and surrounding tissues were identified by the authors. This clinical report describes the use of myofunctional therapy as an aid to the maxillofacial prosthodontic rehabilitation of an edentulous patient who was diagnosed with invasive squamous cell carcinoma of the tongue and underwent hemiglossectomy. Myofunctional therapy was introduced before, during, and after the fabrication of conventional maxillary and mandibular complete dentures. Muscle exercises were devised to improve the posture and muscular tonus of the remaining tongue, and thus help with mastication and adaptation to the mandibular denture. Myofunctional therapy improved the posture and function of the remaining tongue, providing acceptable mastication and increased stability of the mandibular denture.

Techniques for incorporation of attachments in implant-retained overdentures with unsplinted abutments

Avinash S. Bidra, John R. Agar, Thomas D. Taylor, Cornell Lee, Sergio Ortegon — 2012-05-01

A variety of techniques have been reported in the literature for the incorporation of attachments in implant-retained partial and complete overdentures with unsplinted or individual abutments. Three important elements that are necessary in describing any technique for incorporation of attachments are the type of final impression method (tissue-level impression, abutment-level impression, or implant-level impression), stage of overdenture fabrication (record base stage, denture-processing stage, or denture insertion stage) and nature of technique (direct or indirect). This article reviews 7 different techniques for the incorporation of attachments in implant-retained complete and partial overdentures. Discussion of indications, contraindications, advantages, and disadvantages of each technique is provided to aid the clinician in making an appropriate choice.

Longitudinal clinical evaluation of undercut areas and rest seats of abutment teeth in removable partial denture treatment

2012-05-01

de Aquino, AR, Oliveira Barreto, A, de Aquino, LM, Ferreira, AM, da Fonte Porto Carreiro, A. J Prosthondont 2011;20:639-42. Adequate preparation of abutment fir removable partial denture (RPD) rest seats appropriate masticatory force transmission, retention, and stability of supporting structures. It follows that careful preparation will be important for the longevity of the rehabilitation. The present study aimed to clinically evaluate rest seats and undercut areas of abutment teeth in RPD wearers after 2 years of use.

Evaluation of the optical properties of CAD-CAM generated yttria-stabilized zirconia and glass-ceramic laminate veneers

2012-05-01

Statement of problem: When feldspathic porcelain (FP) laminate veneers are used to mask tooth discoloration that extends into the dentin, significant tooth reduction is needed to provide space for the opaque layer and optimize the bonding of the restoration. Purpose: The purpose of this study was to investigate the color effect of trial insertion paste (TP), composite resin abutment (CRA), and veneer regions on the optical properties of feldspathic porcelain (FP), yttria-stabilized zirconia (Y-TZP), and IPS e.max CAD HT (IEC) veneers. Material and methods: A melamine tooth was prepared for a laminate veneer on a model, and a definitive cast was made. The definitive die was scanned by using the TurboDent System (TDS), then 30 CRA were machined and 10 veneers were fabricated for each ceramic material (FP, Y-TZP, IEC). The optical properties of different veneer materials, CRA (A1, A2, A3) and TP (bleach XL, opaque white, transparent, and yellow) were evaluated in the cervical, body, and incisal regions with a spectrophotometer. Results were analyzed by using 1-way ANOVA (.05). Results: The color difference for all the veneers was affected by TP and CRA colors in different regions. The mean values for the Y-TZP veneer color coordinates (L*: 74 ±0.34, a*: 0.09 ±0.20, and b*: 17.43 ±0.44) were significantly different (P<.001) from those of IEC veneers (L*: 70.15 ±0.23, a*: −0.69 ±0.073, and b*:11.48 ±0.30) and FP veneers (L*: 70.00 ±0.86, a*: – 0.28 ±0.203, and b*: 13.86 ±1.08). There was no difference between IEC for L* and FP. Significant difference was detected (P<.001) in color coordinates among the 3 veneer materials for a* and b*. Conclusions: The TP color affected the color difference for all veneer materials except the Y-TZP, while there was no effect on the CRA color. The magnitude of color coordinates changed as a function of TP color and veneer material.

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2012-05-01

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Comparison of different grinding procedures on the flexural strength of zirconia

Ufuk İşeri, Zeynep Özkurt, Ayşe Yalnız, Ender Kazazoğlu — 2012-05-01

Statement of problem: The surface of zirconia ceramic is damaged during grinding, which may affect the mechanical properties of the material. Purpose: The purpose of this study was to compare the biaxial flexural strength of zirconia after different grinding procedures and to measure the temperature rise from grinding. Material and methods: Forty disk-shaped zirconia specimens (15 × 1.2 mm) with a smaller disk in the center of each disk (1 × 3 mm) were divided into 4 groups (n=10). The specimens were ground with a high-speed handpiece and micromotor with 2 different grinding protocols, continual grinding and periodic grinding (10 seconds grinding with 10 seconds duration), until the smaller disk was removed. Control specimens without the center disk (n=10) were analyzed without grinding. The biaxial flexural strengths of the disks were determined in a universal testing machine at a crosshead speed of 0.5 mm/min. The fracture strength (MPa) was recorded, and the results were analyzed using a 1-way ANOVA, Tukey HSD test, Student's t test, and Pearson correlation test (α=05). Results: All grinding procedures significantly decreased flexural strength (P<.01). The mean flexural strength of the high-speed handpiece groups was higher (815 MPa) than that of the micromotor groups (718 MPa). The temperature values obtained from micromotor grinding (127°C) were significantly higher than those from high-speed handpiece grinding (63°C) (P<.01). Conclusions: Grinding zirconia decreased flexural strength. Zirconia material ground with a high-speed handpiece run continually caused the least reduction in flexural strength.

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2012-05-01

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A retrospective analysis of 102 zirconia single crowns with knife-edge margins

Carlo E. Poggio, Riccardo Dosoli, Carlo Ercoli — 2012-05-01

Statement of problem: Clinical reports of feldspathic porcelain veneered-zirconia crowns placed on teeth with knife-edge marginal finish lines have recently been presented but with data available for only a limited number of crowns in the anterior maxilla. Purpose: This retrospective study evaluated the clinical success and survival of feldspathic porcelain veneered-zirconia crowns fabricated with knife-edge margins in a private practice. Material and methods: One hundred and two teeth (51 anterior, 51 posterior) were prepared with knife-edge margins and restored with feldspathic porcelain veneered-zirconia crowns. The modified California Dental Association (CDA) criteria were used to clinically evaluate subjects recalled between May and December 2010. Data were analyzed with descriptive statistics. Results: The mean follow-up time was 20.9 months (SD, 13.6; range, 10-72). One tooth had to be extracted because of an endodontic problem not related with the restoration, 2 crowns had minor chipping of the veneering porcelain, while no crowns exhibited fracture of the zirconia core. Conclusions: In this retrospective evaluation, feldspathic porcelain veneered-zirconia crowns with knife-edge margins provided clinical performance similar to that reported with other margin designs.

Effect of three endodontic sealers on the bond strength of prefabricated fiber posts luted with three resin cements

Khalil Aleisa, Rawda Alghabban, Khalid Alwazzan, Steven M. Morgano — 2012-05-01

Statement of problem: There is limited information in the literature regarding the effect of eugenol-based sealers on the bond strength of resin-bonded endodontic posts. Purpose: The purpose of this study was to evaluate the effect of 1 resin-based and 2 different eugenol-based endodontic sealers on the bond strength of prefabricated fiber posts luted with 3 different resin cements. Material and methods: One hundred thirty-five prefabricated fiber posts were luted into extracted single-rooted teeth with 1 of 3 composite resin cements (Rely X Unicem, Paracore, and Variolink II). Specimens were divided into 3 groups with 45 teeth each. The first 2 groups were obturated with gutta percha and 1 of 2 eugenol-based endodontic sealers (Endofil, Tubli-Seal). The third group was obturated with a resin-based root canal sealer (AH26). The forces required for dislodgment of posts from their prepared post spaces were recorded by using a universal testing machine. Data were collected and a 2-way ANOVA was applied to the mean retentive strengths of various combinations of sealer and cement. A Tukey multiple comparison test was performed to determine which groups were significantly different (α=.05). Results: Endofil and Tubli-Seal (eugenol-based sealers) groups had significantly lower bond strengths for the posts than the AH26 group (P<.001). There was no significant difference between the means of post bond strength for the Endofil and Tubli-Seal groups. There was significant difference among the means of post bond strength for all 3 cement groups (P<.05). Conclusions: Endofil and Tubli-Seal (eugenol-based) sealers demonstrated significantly reduced mean bond strength for prefabricated fiber posts luted with resin cement. Rely X Unicem resin cement exhibited higher mean bond strength than with Paracore and Variolink II resin cements when a eugenol sealer was used.

Smile characterization by U.S. white, U.S. Asian Indian, and Indian populations

Neeru Sharma, Stephen F. Rosenstiel, Henry W. Fields, F. Mike Beck — 2012-05-01

Statement of problem: With growing demand for high esthetic standards, dentists must understand patient perception and incorporate their preferences into treatment. However, little is known about how cultural and ethnic differences influence esthetic perception. Purpose: The purpose of this study was to determine whether differences in ethnic background, including the possibility of assimilation, affected a layperson's perception of esthetic and smile characteristics. Material and methods: A survey was developed containing images that were digitally manipulated into a series of barely perceptible steps, changing 1 smile parameter to form a strip of images that displayed that parameter over a wide range. Data were collected with a customized program which randomly displayed a single image and allowed the subject to use the mouse to adjust an on-screen slider according to displayed instructions, that is, “Please move the slider to select the image you find to be most ideal”; or “Please move the slider to select the first image that you find unattractive.” A convenience sample (n=288) comprised of U.S. whites, U.S. Asian Indians, and Indians living in India was surveyed. This sample provided a power of .86 to detect a difference of ±1.5 mm. Subjects evaluated images showing the smile arc, buccal corridor, gingival display, vertical overlap, lateral incisal step, maxillary midline to midface, and maxillary to mandibular midline. Rater reliability was assessed with the Fleiss-Cohen weighted Kappa (Kw) statistic and corresponding 95% confidence interval after each question was repeated in a random sequence. Choice differences due to ethnicity were assessed with a multiple randomization test and the adjusted P value with the step-down Bonferrroni method of Holm (α=.05). Results: The Kw for the 17 variables in all 3 groups ranged from 0.11 for ideal vertical overlap to 0.64 for ideal buccal corridor space. Overall reliability was fair to moderate. Differences attributed to ethnicity were demonstrated between the Asian Indians and U.S. whites. Differences attributed to assimilation were demonstrated between U.S. Asian Indians and Asian Indians. Differences between U.S. Asian Indians and U.S. whites can be instructive and demonstrate the relative power of ethnicity and assimilation. A difference between these groups shows the power of ethnicity and no difference between these groups shows the power of assimilation. The ratings of the Asian Indians and the U.S. whites showed a clinically significant difference for Ideal Buccal Corridor and Maximum Smile Arc. There were no significant differences between the U.S. Asian Indians and Asian Indians. There were clinically significant differences between the U.S. Asian Indians and U.S. whites only for Ideal Buccal Corridor. Conclusions: Ethnicity had a significant effect on the esthetic choices for Buccal Corridor and Smile Arc. There is no conclusive evidence for assimilation.

Finite element analysis of maxillary bone stress caused by Aramany Class IV obturator prostheses

2012-05-01

Statement of problem: The retention of an Aramany Class IV removable partial dental prosthesis can be compromised by a lack of support. The biomechanics of this obturator prosthesis result in an unusual stress distribution on the residual maxillary bone. Purpose: This study evaluated the biomechanics of an Aramany Class IV obturator prosthesis with finite element analysis and a digital 3-dimensional (3-D) model developed from a computed tomography scan; bone stress was evaluated according to the load placed on the prosthesis. Material and methods: A 3-D model of an Aramany Class IV maxillary resection and prosthesis was constructed. This model was used to develop a finite element mesh. A 120 N load was applied to the occlusal and incisal platforms corresponding to the prosthetic teeth. Qualitative analysis was based on the scale of maximum principal stress; values obtained through quantitative analysis were expressed in MPa. Results: Under posterior load, tensile and compressive stresses were observed; the tensile stress was greater than the compressive stress, regardless of the bone region, and the greatest compressive stress was observed on the anterior palate near the midline. Under an anterior load, tensile stress was observed in all of the evaluated bone regions; the tensile stress was greater than the compressive stress, regardless of the bone region. Conclusions: The Aramany Class IV obturator prosthesis tended to rotate toward the surgical resection when subjected to posterior or anterior loads. The amount of tensile and compressive stress caused by the Aramany Class IV obturator prosthesis did not exceed the physiological limits of the maxillary bone tissue. (J Prosthet Dent 2012;107:336-342)

Reinforcement of an existing implant-retained complete dental prosthesis for use in compensatory techniques by a patient missing an upper limb

Philip S. Baker, Esam Abou Nahlah — 2012-05-01

The purpose of this article is to describe the adaptation of a method suggested for prevention of fractures of partial removable dental prostheses to the reinforcement of an existing implant-retained fixed complete dental prosthesis (IRFCDP). The patient, an upper limb amputee, had subjected the original IRFCDP to parafunctional forces generated from use as a replacement hand in a compensatory technique commonly taught in rehabilitation. Advantages of the technique are that it provides an alternative to remaking the entire prosthesis, which was otherwise satisfactory; it adapts to a variety of situations involving anterior tooth reinforcement; and it offers a potential solution to anterior prosthetic tooth damage caused by other types of parafunction. It may also be adaptable to the reinforcement of other types of prostheses. A disadvantage is the possible need to provide a new interim prosthesis or modify an existing one while laboratory repair procedures are completed. Following reinforcement of the IRFCDP, no tooth damage was evident after one year of use. (J Prosthet Dent 2012;107:343-345)

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2012-05-01

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2012-05-01

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Carol A. Lefebvre — 2012-05-01

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2012-05-01

If you have questions or comments regarding original articles and editorial management, please contact: Dr Carol A. Lefebvre, Georgia Health Sciences University College of Dental Medicine 1120 15th St, GC-3094 Augusta, GA 30912-1255 Telephone: (706) 721-4558 Fax: (706) 721-4571.