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Clinical Oral Implants Research Sep 2023The aim of Working Group 3 was to address the influence of both material- and anti-resorptive drug- related factors on clinical and biological outcomes and complications... (Review)
Review
OBJECTIVES
The aim of Working Group 3 was to address the influence of both material- and anti-resorptive drug- related factors on clinical and biological outcomes and complications in implant dentistry. Focused questions were addressed on (a) implant materials other than titanium (alloy)s, (b) transmucosal abutment materials and (c) medications affecting bone metabolism were addressed.
MATERIALS AND METHODS
Three systematic reviews formed the basis for discussion in Group 3. Consensus statements and clinical recommendations were formulated by group consensus based on the findings of the systematic reviews. Patient perspectives and recommendations for future research were also conveyed. These were then presented and accepted following further discussion and modifications as required by the plenary.
RESULTS
Zirconia is a valid alternative to titanium as material for implant and transmucosal components, allowing soft and hard tissue integration with clinical outcomes-identified by implant survival, marginal bone loss and peri-implant probing depths-up to 5-years comparable to titatnium. However, most of the evidence for zirconia implants is based on 1-piece implants limiting the indication range. Furthermore, based on expert opinion, zirconia transmucosal components might be preferred in the esthetic zone. In patients receiving low-dose bisphosphonate therapy, the rate of early implant failure is not increased, while the long-term effects remain poorly studied. Although it has not been sufficiently addressed, similar outcomes can be expected with low-dose denosumab. A drug holiday is not recommended when considering implant placement in patients treated with low-dose ARD. However, the specific therapeutic window, the cumulative dose and the administration time should be considered. Access to peri-implant supportive care is mandatory to prevent peri-implantitis-related medication-related osteonecrosis of the jaw (MRONJ) or implant-related sequestra (IRS). In patients receiving low-dose anti-resorptive drugs (ARD) therapy, the risk of complications related to implant placement is high, and implant procedures in this specific population should be strictly treated in a comprehensive multidisciplinary center. Finally, healthy dental implants should not be removed before low or high-dose ARD.
CONCLUSIONS
Zirconia implants can be an alternative to titanium implants in selected indications. However, the current state of evidence remains limited, especially for 2-piece implant designs. Administration of low-dose ARD did not show any negative impact on early implant outcomes, but careful follow-up and supportive care is recommended in order to prevent peri-implant MRONJ and IRS. Implant placement in high-dose patients must be strictly considered in a comprehensive multidisciplinary center.
Topics: Humans; Bone Density Conservation Agents; Titanium; Dental Implants; Alloys
PubMed: 37750518
DOI: 10.1111/clr.14135 -
Clinical Oral Implants Research Sep 2023For the present review, the following focused question was addressed: In patients with root-analog dental implants, what is the effect of implants made of other... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
For the present review, the following focused question was addressed: In patients with root-analog dental implants, what is the effect of implants made of other materials than titanium (alloy) on implant survival, marginal bone loss (MBL), and technical and biological complications after at least 5 years.
MATERIALS AND METHODS
An electronic (Medline, Embase, Web of Science) search was performed to identify observational clinical studies published from January 2000 investigating a minimum of 20 commercially available zirconia implants with a mean follow-up of at least 60 months. Primary outcome was implant survival, secondary outcomes included peri-implant MBL, probing depths (PDs), and technical and biological complications. Meta-analyses were performed to evaluate implant survival, MBL, and PD.
RESULTS
From 5129 titles, 580 abstracts were selected, and 111 full-text articles were screened. Finally, 4 prospective and 2 retrospective observational clinical cohort studies were included for data extraction. Meta-analyses estimated after 5 years of loading mean values of 97.2% (95% CI 94.7-99.1) for survival (277 implants, 221 patients), 1.1 mm (95% CI: 0.9-1.3) for MBL (229 implants, 173 patients), and 3.0 mm (95% CI 2.5-3.4) for PDs (231 implants, 175 patients).
CONCLUSIONS
After 5 years, commercially available zirconia implants showed reliable clinical performance based on survival rates, MBL, and PD values. However, more well-designed prospective clinical studies and randomized clinical trials investigating titanium and zirconia implants are needed to confirm the presently evaluated promising outcomes.
Topics: Humans; Dental Implants; Prospective Studies; Retrospective Studies; Titanium; Bone Diseases, Metabolic
PubMed: 37750521
DOI: 10.1111/clr.14133 -
Materials (Basel, Switzerland) Oct 2023Dental implants have revolutionised restorative dentistry, offering patients a natural-looking and durable solution to replace missing or severely damaged teeth.... (Review)
Review
Dental implants have revolutionised restorative dentistry, offering patients a natural-looking and durable solution to replace missing or severely damaged teeth. Titanium and its alloys have emerged as the gold standard among the various materials available due to their exceptional properties. One of the critical advantages of titanium and its alloys is their remarkable biocompatibility which ensures minimal adverse reactions within the human body. Furthermore, they exhibit outstanding corrosion resistance ensuring the longevity of the implant. Their mechanical properties, including hardness, tensile strength, yield strength, and fatigue strength, align perfectly with the demanding requirements of dental implants, guaranteeing the restoration's functionality and durability. This narrative review aims to provide a comprehensive understanding of the manufacturing techniques employed for titanium and its alloy dental implants while shedding light on their intrinsic properties. It also presents crucial proof-of-concept examples, offering tangible evidence of these materials' effectiveness in clinical applications. However, despite their numerous advantages, certain limitations still exist necessitating ongoing research and development efforts. This review will briefly touch upon these restrictions and explore the evolving trends likely to shape the future of titanium and its alloy dental implants.
PubMed: 37959457
DOI: 10.3390/ma16216860 -
Materials (Basel, Switzerland) Dec 2023Titanium alloys have emerged as the most successful metallic material to ever be applied in the field of biomedical engineering. This comprehensive review covers the... (Review)
Review
Titanium alloys have emerged as the most successful metallic material to ever be applied in the field of biomedical engineering. This comprehensive review covers the history of titanium in medicine, the properties of titanium and its alloys, the production technologies used to produce biomedical implants, and the most common uses for titanium and its alloys, ranging from orthopedic implants to dental prosthetics and cardiovascular devices. At the core of this success lies the combination of machinability, mechanical strength, biocompatibility, and corrosion resistance. This unique combination of useful traits has positioned titanium alloys as an indispensable material for biomedical engineering applications, enabling safer, more durable, and more efficient treatments for patients affected by various kinds of pathologies. This review takes an in-depth journey into the inherent properties that define titanium alloys and which of them are advantageous for biomedical use. It explores their production techniques and the fabrication methodologies that are utilized to machine them into their final shape. The biomedical applications of titanium alloys are then categorized and described in detail, focusing on which specific advantages titanium alloys are present when compared to other materials. This review not only captures the current state of the art, but also explores the future possibilities and limitations of titanium alloys applied in the biomedical field.
PubMed: 38203968
DOI: 10.3390/ma17010114 -
Cureus Oct 2023Orthodontic archwires are the primary aid to achieve desirable tooth movement. These wires are also considered to be the backbone of orthodontic treatment. Orthodontic... (Review)
Review
Orthodontic archwires are the primary aid to achieve desirable tooth movement. These wires are also considered to be the backbone of orthodontic treatment. Orthodontic archwires are available in various materials. The journey of advancement of these wires has shown immense growth in aesthetics as well as the mechanical properties of the materials used to ultimately provide patient satisfaction. This review highlights the properties of orthodontic archwires and the disadvantages associated with these wires which limit their use in today's era. The major role of the clinician is to choose the most appropriate alloy as per the needs of the patient. This can be done by accurately analyzing the properties of every material. The introduction of robotic systems in bending archwires and the properties of newer materials like organic polymer wires and bactericide archwires have also been described in this review. Thus, this review article focuses on the recent advances in orthodontic archwires and their properties for selection as per need.
PubMed: 38022289
DOI: 10.7759/cureus.47633 -
Journal of Biological Engineering Aug 2023The use of biodegradable polymers for treating bone-related diseases has become a focal point in the field of biomedicine. Recent advancements in material technology... (Review)
Review
The use of biodegradable polymers for treating bone-related diseases has become a focal point in the field of biomedicine. Recent advancements in material technology have expanded the range of materials suitable for orthopaedic implants. Three-dimensional (3D) printing technology has become prevalent in healthcare, and while organ printing is still in its early stages and faces ethical and technical hurdles, 3D printing is capable of creating 3D structures that are supportive and controllable. The technique has shown promise in fields such as tissue engineering and regenerative medicine, and new innovations in cell and bio-printing and printing materials have expanded its possibilities. In clinical settings, 3D printing of biodegradable metals is mainly used in orthopedics and stomatology. 3D-printed patient-specific osteotomy instruments, orthopedic implants, and dental implants have been approved by the US FDA for clinical use. Metals are often used to provide support for hard tissue and prevent complications. Currently, 70-80% of clinically used implants are made from niobium, tantalum, nitinol, titanium alloys, cobalt-chromium alloys, and stainless steels. However, there has been increasing interest in biodegradable metals such as magnesium, calcium, zinc, and iron, with numerous recent findings. The advantages of 3D printing, such as low manufacturing costs, complex geometry capabilities, and short fabrication periods, have led to widespread adoption in academia and industry. 3D printing of metals with controllable structures represents a cutting-edge technology for developing metallic implants for biomedical applications. This review explores existing biomaterials used in 3D printing-based orthopedics as well as biodegradable metals and their applications in developing metallic medical implants and devices. The challenges and future directions of this technology are also discussed.
PubMed: 37644461
DOI: 10.1186/s13036-023-00371-7 -
Materials (Basel, Switzerland) Sep 2023(1) Background: In dentistry, a reduction in surface roughness is established mostly by conventional mechanical polishing to hinder biofilm adhesion. This is time- and...
(1) Background: In dentistry, a reduction in surface roughness is established mostly by conventional mechanical polishing to hinder biofilm adhesion. This is time- and labor-intensive. Plasma electrolytic polishing is believed to be an effective finishing method due to the reduced treatment time and materials used for applications in dentistry. (2) Methods: Co-Cr-Mo dental alloy samples were sandblasted and prepared with either plasma electrolytic or conventional mechanical polishing. Evaluation of the polishing methods was obtained by atomic force microscopy, scanning electron microscopy and energy-dispersive X-ray spectroscopy. (3) Results: The sandblasted samples showed the highest surface roughness (Heraenium Sun 991 ± 288 nm; Wironit 1187 ± 331 nm). Our results show that with plasma electrolytic polishing, Co-Cr-Mo surfaces can be polished with a surface roughness in the nanometer range, comparable to those achieved by conventional mechanical polishing. Conventional mechanical polishing (Heraenium Sun 134 ± 23 nm; Wironit 114 ± 11 nm) provided lower surface roughness values compared to plasma electrolytic polishing (Heraenium Sun 288 ± 94 nm; Wironit 261 ± 49 nm). We anticipate our pilot study as a starting point for future studies to refine process parameters and quantitative microbiological assays. (4) Conclusions: Plasma electrolytic polishing might have a promising future for polishing dental alloys.
PubMed: 37763500
DOI: 10.3390/ma16186222 -
International Dental Journal Oct 2023The aim of this study was to assess the dynamic cyclic fatigue resistance of an R-Motion file at simulated body temperature and document corresponding phase...
INTRODUCTION
The aim of this study was to assess the dynamic cyclic fatigue resistance of an R-Motion file at simulated body temperature and document corresponding phase transformations compared to OneCurve and HyFlex EDM (HFEDM).
METHODS
R-Motion (25/.06), OneCurve (25/.06), and HFEDM (25/.06) files were selected and divided into 3 groups (n = 9) according to the file type. Dynamic cyclic fatigue testing was done with a custom-made artificial stainless-steel canal that had a 90° angle of curvature and a 5-mm radius of curvature. Files were operated continuously at body temperature until fracture in the artificial canal. The time to fracture was calculated. Statistical analysis was performed, and significance was set at 5%. Phase transformation temperatures for 2 instruments of each group were analysed by differential scanning calorimetry (DSC) analysis.
RESULTS
The highest mean time to fracture value was measured in the HFEDM group (277.84 ± 2.51), followed by the R-Motion group (115.09 ± 0.01), whilst the lowest value was found in the OneCurve group (44.28 ± 3.63). Post hoc pairwise comparisons were all statistically significant (P < .001). DSC heating curves show austinite start temperatures to be 33.94 °C and 43.32 °C and austinite finish temperatures to be 35.09 °C and 50 °C for R-Motion and HFEDM, respectively. DSC cooling curves show martensite start temperatures to be 27.54 °C and 44.52 °C and martensite finish temperatures to be 29.13 °C and 37.68 °C for R-Motion and HFEDM, respectively. DSC curves of OneCurve failed to demonstrate transformation temperatures within the tested heat range.
CONCLUSIONS
Crystalline arrangement of Ni and Ti atoms within the NiTi alloys greatly affects the dynamic cyclic fatigue resistance of the file.
Topics: Humans; Equipment Failure; Calorimetry, Differential Scanning; Alloys; Materials Testing; Equipment Design
PubMed: 36631389
DOI: 10.1016/j.identj.2022.12.007 -
International Journal of Implant... Jul 2023The purpose of this study was to perform a systematic review with meta-analysis on the long-term survival rates of zygomatic implants (ZI). ZI success, prostheses... (Meta-Analysis)
Meta-Analysis Review
PURPOSE
The purpose of this study was to perform a systematic review with meta-analysis on the long-term survival rates of zygomatic implants (ZI). ZI success, prostheses survival and success, sinus pathology and patient reported outcomes were also investigated.
METHODS
Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines were followed. Embase and OvidMedline databases were searched alongside the grey literature. The systematic review was recorded in PROSPERO (CRD42022358024). Studies reporting titanium/titanium alloy ZI survival data, ZI-supported prosthesis data, ZIs directly compared to any other implant therapy including grafted sites, a minimum follow-up time of 3 years and a minimum number of 10 patients were included. All study designs were considered if they met the inclusion criteria. Studies not involving ZIs, ZIs not made from titanium/titanium alloy, a follow-up time of < 3 years or < 10 patients, animal studies and in vitro studies were excluded. Long-term follow-up has not been defined in the literature. A minimum of 3 years follow-up was considered acceptable to capture survival after initial healing, alongside in-function prosthesis data via delayed or immediate load protocols. ZI success, was predominantly defined as ZI survival without biological or neurological complications. Meta-analyses were performed for ZI survival, ZI failure incidence, ZI success, loading protocol, prosthesis survival, and prevalence of sinusitis using random effects models. Descriptive analysis was used for ZI success, prosthesis success and patient reported outcome measures.
RESULTS
Five hundred and seventy-four titles were identified, of which 18 met the inclusion criteria. Eligible studies included 1349 ZIs in 623 patients. Mean follow-up period was 75.4 months (range 36-141.6). The mean survival of ZIs was 96.2% [95% CI: 93.8; 97.7] at 6 years. Mean survival for delayed loading was 95% [95% CI: 91.7; 97.1] and 98.1% [95% CI: 96.2; 99.0] for immediate loading (p = 0.03). Annual incidence rate of ZI failure was 0.7% [95% CI 0.4; 1.0]. Mean ZI success was 95.7% [95% CI 87.8; 98.6]. Mean prosthesis survival was 94% [95% CI 88.6; 96.9]. Sinusitis prevalence was 14.2% [95% CI 8.8; 22.0] at 5 years. Patients' reported increased satisfaction with ZIs.
CONCLUSIONS
ZIs have long-term survival comparable to conventional implants. Immediate loading showed a statistically significant increase in survival over delayed loading. Prosthesis survival was similar to that of prostheses supported by conventional implants, with similar complications. Sinusitis was the most frequently encountered biological complication. Patients reported improved outcome measures with ZI use.
Topics: Humans; Dental Implantation, Endosseous; Dental Implants; Prosthesis Failure; Titanium; Treatment Outcome; Alloys
PubMed: 37405545
DOI: 10.1186/s40729-023-00479-x -
Clinical Oral Implants Research Nov 2023This scoping review aimed to identify the available evidence in the use of 3D printing technology in dental implantology. Due to the broad scope of the subject and its... (Review)
Review
OBJECTIVES
This scoping review aimed to identify the available evidence in the use of 3D printing technology in dental implantology. Due to the broad scope of the subject and its application in implantology, three main areas of focus were identified: (1) customized dental implants, (2) manufacturing workflow for surgical implant guides, and (3) related implant-supported prostheses factors, which include the metallic primary frameworks, secondary ceramic or polymer superstructures, and 3D implant analog models.
MATERIALS AND METHODS
Online databases (Medline, Cochrane, Embase, and CINAHL) were used to identify the studies published up to February 2023 in English. Two experienced reviewers performed independently the screening and selection among the 1737 studies identified. The articles evaluated the additive manufacturing (AM) technology, materials, printing, and post-processing parameters regarding dental implantology.
RESULTS
The 132 full-text studies that met the inclusion criteria were examined. Thirteen studies of customized dental implants, 22 studies about the workflow for surgical implant guides, and 30 studies of related implant-supported prostheses factors were included.
CONCLUSIONS
(1) The clinical evidence about AM titanium and zirconia implants is scarce. Early data on survival rates, osseointegration, and mechanical properties are being reported. (2) 3D printing is a proven manufacturing technology to produce surgical implant guides. Adherence to the manufacturer's instructions is crucial and the best accuracy was achieved using MultiJet printer. (3) The quality of 3D printed prosthetic structures and superstructures is improving remarkably, especially on metallic alloys. However, better marginal fit and mechanical properties can be achieved with milling technology for metals and ceramics.
PubMed: 37929684
DOI: 10.1111/clr.14198