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Clinical Implant Dentistry and Related... Aug 2023Peri-implant mucosal integration is becoming a critical aspect for long term implant health and can be triggered the selection of implant components. The aim of this... (Review)
Review
Peri-implant mucosal integration is becoming a critical aspect for long term implant health and can be triggered the selection of implant components. The aim of this review is therefore to investigate the evidence concerning implant connection and abutment characteristics (abutment materials, design, handling) as predisposing or precipitating factor for peri-implant mucositis and peri-implantitis. Although the evidence that these features can directly predispose/precipitate peri-implant diseases is limited, there are -few- studies showing a potential role of the implant connection, trans-mucosal configuration, and handling in the development of early bone loss and/or peri-implantitis. With bone level implants, conical internal connections (with inherent platform switching) might be preferred over internal flat-flat and external connections to decrease the risk of early bone loss and potentially the risk of peri-implant disease. Moreover, there is a trend suggesting moving the prosthetic interface coronally (to the juxta-mucosal level) as soon as possible to reduce the number of disconnections and to limit the risk of cements remnants. This can be achieved by choosing a tissue-level implant or to place a trans-mucosal abutment (one abutment-one time approach) to optimize the peri-implant soft tissue seal. In absence of evidence for the biocompatibility regarding several restorative materials, biocompatible materials such as titanium or zirconia should be preferred in the trans-mucosal portion. Finally, higher implants (≥2mm) with an emergence angle below 30° seem more favourable. It should however be noted that some of this information is solely based on indirect information (such as early bone loss) and more research is needed before making firm recommendations about abutment choice. [Correction added on 13 March 2023, after first online publication: 'longer implants (≥2mm)' was changed to 'higher implants (≥2mm)' in this version.].
Topics: Humans; Peri-Implantitis; Dental Implants; Dental Implant-Abutment Design; Precipitating Factors; Dental Abutments
PubMed: 36825512
DOI: 10.1111/cid.13185 -
Dental Materials Journal Jan 2020This review scientifically compares the properties of zirconia and titanium, but does not identify the best among them as an implant material. Surface treatment and... (Review)
Review
This review scientifically compares the properties of zirconia and titanium, but does not identify the best among them as an implant material. Surface treatment and modification to improve tissue bonding and inhibit bacterial adhesion are not considered in this review. The mechanical properties of titanium are superior to those of zirconia; some studies have shown that zirconia can be used as a dental implant, especially as an abutment. Extensive surface treatment research is ongoing to inhibit bacterial adhesion and improve osseointegration and soft tissue adhesion phenomena which make it difficult to evaluate properties of the materials themselves without surface treatment. Osseointegration of titanium is superior to that of zirconia itself without surface treatment; after surface treatment, both materials show comparable osseointegration. The surface morphology is more important for osseointegration than the surface composition. To inhibit bacterial adhesion, zirconia is superior to titanium, and hence, more suitable for abutments. Both materials show similar capability for soft tissue adhesion.
Topics: Dental Abutments; Dental Implants; Dental Materials; Osseointegration; Surface Properties; Titanium; Zirconium
PubMed: 31666488
DOI: 10.4012/dmj.2019-172 -
BioMed Research International 2021The present study was aimed at reviewing the studies that used finite element analysis (FEA) to estimate the biomechanical stress arising in removable partial dentures... (Review)
Review
The present study was aimed at reviewing the studies that used finite element analysis (FEA) to estimate the biomechanical stress arising in removable partial dentures (RPDs) and how to optimize it. A literature survey was conducted for the English full-text articles, which used only FEA to estimate the stress developed in RPDs from Jan 2000 to May 2021. In RPDs, the retaining and supporting structures are subjected to dynamic loads during insertion and removal of the prosthesis as well as during function. The majority of stresses in free-end saddle (FES) RPDs are concentrated in the shoulder of the clasp, the horizontal curvature of the gingival approaching clasp, and the part of the major connector next to terminal abutments. Clasps fabricated from flexible materials were beneficial to eliminate the stress in the abutment, while rigid materials were preferred for major connectors to eliminate the displacement of the prosthesis. In implant-assisted RPD, the implant receive the majority of the load, thereby reducing the stress on the abutment and reducing the displacement of the prosthesis. The amount of stress in the implant decreases with zero or minimal angulation, using long and wide implants, and when the implants are placed in the first molar area.
Topics: Algorithms; Biomechanical Phenomena; Dental Abutments; Dental Implants; Denture Design; Denture, Partial, Removable; Finite Element Analysis; Humans; Stress, Mechanical
PubMed: 34485518
DOI: 10.1155/2021/5699962 -
European Cells & Materials Aug 2019Epithelium attachment to the tooth or abutment surface is necessary to form a biological seal preventing pathogens and irritants from penetrating the body and reaching... (Review)
Review
Epithelium attachment to the tooth or abutment surface is necessary to form a biological seal preventing pathogens and irritants from penetrating the body and reaching the underlying soft tissues and bone, which in turn can lead to inflammation and subsequent bone resorption. The present review investigated oral wound closure and the role of micro-environment, saliva, crevicular fluid and microbiota in wound healing. The importance of the junctional epithelium (peri-implant epithelium) attachment to the abutment surface was investigated. Current research focuses on macro-design, surface-topography, surface-chemistry, materials, coatings and wettability to enhance attachment, since these optimised surface properties are expected to promote keratinocyte attachment and spreading through hemi-desmosome formation. Detailed studies describing the extent of junctional epithelium attachment - e.g. barrier function, hemi-desmosomes, epithelium quality, composition of the external basement membrane or ability of the epithelium to resist microbial penetration and colonisation - are not yet reported in animals due to ethical considerations, scalability, expense, technical challenges and limited availability of antibodies. In vitro studies generally include relatively simple 2D culture models, which lack the complexity required to draw relevant conclusions. Additionally, human organotypic 3D mucosa models are being developed. The present review concluded that more research using these organotypic mucosa models may identify relevant parameters involved in soft-tissue-abutment interactions, which could be used to study different macro-shapes and surface modifications. Such studies would bridge the gap between clinical, animal and traditional in vitro cell culture studies supporting development of abutments aiming at improved clinical performance.
Topics: Animals; Cell Adhesion; Dental Abutments; Epithelial Cells; Gingiva; Humans; Wound Healing
PubMed: 31410840
DOI: 10.22203/eCM.v038a06 -
Journal of Esthetic and Restorative... Nov 2019The unavoidable extraction of teeth in the esthetic area can be overcome through different treatment modalities. Recently, immediate implants appeared as a minimally...
OBJECTIVE
The unavoidable extraction of teeth in the esthetic area can be overcome through different treatment modalities. Recently, immediate implants appeared as a minimally invasive approach to resolving these cases; however, immediate implant loading is not always possible or indicated. In these cases, an innovative approach through customized healing abutments could be used to preserve the soft tissue contour, eliminating the need for reopening surgery and the use of provisional restorations to condition the mucosal contour.
CLINICAL CONSIDERATIONS
The present cases describe a simplified chairside approach to use customized healing abutments for immediate implants placed after tooth extraction in the anterior and posterior areas in order to maintain the soft tissue contours while reducing the clinical steps until delivering the final restorations.
CONCLUSIONS
This technique seems to be effective to guide the soft tissue healing around dental implants allowing a natural emergence profile with implant-supported restorations, reducing the number of treatment steps.
CLINICAL SIGNIFICANCE
The use of customized healing abutments prepares soft tissue for the prosthetic stage preserving its contours and eliminating the need for reopening surgery.
Topics: Dental Abutments; Dental Implantation, Endosseous; Dental Implants; Dental Implants, Single-Tooth; Dental Prosthesis, Implant-Supported; Humans; Immediate Dental Implant Loading; Tooth Extraction
PubMed: 31268244
DOI: 10.1111/jerd.12512 -
Journal of Clinical and Experimental... Apr 2022The main objective of the present systematic review is to know the mechanical and functional properties of PEEK (polyetheretheretherketone) abutment and to find out if... (Review)
Review
BACKGROUND
The main objective of the present systematic review is to know the mechanical and functional properties of PEEK (polyetheretheretherketone) abutment and to find out if it is a potential substitute for titanium abutments.
MATERIAL AND METHODS
An electronic search was conducted in 5 databases: Medline (Pubmed), SciELO, Cochrane, Web of Science (WOS) and Google Scholar. Studies published from 2018 to 2020 and written in English were included. The protocol of this systematic review was registered in PROSPERO (ID 274834). Subsequently, data extraction and quality analysis were performed according to the modified CONSORT guidelines.
RESULTS
Initially, a total of 976 articles were obtained. Using Mendeley Desktop, duplicates were discarded, reducing the number of articles to 483. After reading abstracts, 448 articles were excluded. Finally, 35 full-text articles were analysed, of which 5 articles were included in this systematic review.
CONCLUSIONS
The available evidence shows that PEEK implant abutments do not have sufficient biomechanical requirements to replace the definitive titanium abutment. However, it is considered as an alternative and provisional material, especially if placed in the anterior region. Abutment, polyetheretheretherketone, titanium, dynamic fatigue, fracture toughness, loss of torque.
PubMed: 35419181
DOI: 10.4317/jced.59466 -
Dentistry Journal Jul 2022Recently, tissue-level implants with a convergent collar have been introduced. While different studies have investigated the outcomes of this implant design in the...
Recently, tissue-level implants with a convergent collar have been introduced. While different studies have investigated the outcomes of this implant design in the rehabilitation of single teeth, its use in full-arch rehabilitation has yet to be investigated. The present case report describes the clinical outcomes of a full-arch immediate loading rehabilitation using tissue-level implants, with and without using implant-abutment units, with 2 years of follow-up. A female patient with mandibular terminal dentition and a high level of bone resorption (distal areas with a few millimeters of residual bone in the vertical dimension and both distal and anterior areas with narrow crestal bone in the horizontal dimension) was seen at the C.I.R Dental School, Turin, Italy. The patient was seeking to be rehabilitated with fixed prosthodontics, and she was found eligible for an immediate loading implant full-arch rehabilitation. Four implants were inserted in the same appointment. The two anterior implants were inserted straight and connected directly to the prosthesis (no abutments); the two distal implants were tilted in order to avoid the alveolar nerve and connected to two 30° angulated abutments. Two years post-implant placement, all of the implants were successfully integrated, resulting in an implant survival rate of 100%. The peri-implant soft tissues were stable at all the implant sites. No differences were highlighted between those implants with and without abutments. Within the limitations of the present clinical report, implant full-arch rehabilitations with tissue-level implants both with and without implant-abutment units showed optimal outcomes after two years of follow-up. Further research is encouraged to confirm whether this implant design may be a valid alternative to traditional implants in this type of rehabilitation, with or without implant-abutment units.
PubMed: 35877390
DOI: 10.3390/dj10070116 -
Journal of Oral Science Oct 2022The purpose of this review is to search for complications of dental implant superstructures and consider the issues involved. This narrative review was performed by... (Review)
Review
The purpose of this review is to search for complications of dental implant superstructures and consider the issues involved. This narrative review was performed by searching through PubMed databases and review articles that were published after 1990. Misfitting of the superstructure can result in loosening of screws, reduced preload, and in some cases, significant stress around the implant. External connection modalities and single implant prostheses have been reported to have more loose or broken abutment screws. In addition, when zirconia abutment was used for platform shifting, the rate of fracture of the abutment was considered to be high. Additionally, it was reported that men were significantly at an increased risk of abutment fracture. As for the retention mechanism of implant overdenture, stud attachment (Locator type) should receive more attention to wear and damage of retention parts than other attachments. The causes of the complications of implant superstructures have not been clarified in some cases, and further verification is required. Verification of complications is considered important to obtain a long-term prognosis for superstructures of implants. It will be necessary to further verify complications of implants in the future.
Topics: Dental Abutments; Dental Implants; Dental Prosthesis, Implant-Supported; Dental Stress Analysis; Denture, Overlay; Humans; Male
PubMed: 35989295
DOI: 10.2334/josnusd.21-0534 -
Hua Xi Kou Qiang Yi Xue Za Zhi = Huaxi... Jul 2022This study aimed to evaluate and compare the settling effect of implant-abutment assembly and the torque loss before and after cyclic loading in three types of abutments.
OBJECTIVES
This study aimed to evaluate and compare the settling effect of implant-abutment assembly and the torque loss before and after cyclic loading in three types of abutments.
METHODS
Thirty internal hexagon fixtures were randomly divided into three groups (=10). Group A used original abutments, group B used pre-machined cast abutments, and group C used compatible abutments. In addition, the abutment morse taper angle was measured using an image measuring instrument. Removal torque values (RTVs) were recorded using a digital torque meter before and after cyclic loading. All samples were tested in a universal testing machine with a vertical load between 0 and 250 N for 100 000 cycles of 10 Hz. The settling effect was measured after cyclic loading. Paired test was performed for intragroup analysis of removal torque loss before and after cycling and one-way ANOVA. Subsequently, Tukey's honestly significant difference test was used for intergroup comparison (α=0.05).
RESULTS
The paired -test showed signi⁃ficant differences in the intragroup RTVs before and after cycling (<0.001). ANOVA showed significant differences in the mean of removal torque loss after cycling (=0.009), the abutment morse taper angle (<0.001), and the settling values (=0.01) among different groups. However, no significant difference was found between compatible abutments and pre-machined cast abutments.
CONCLUSIONS
The screw removal torque was significantly reduced for all groups in this study after cyclic loading. Differences could be found in the internal accuracy of implant-abutment assembly among different groups. Within the limitations of this study, the results showed the original abutments exhibited lower percentages of torque reduction after cyclic loading than the casting abutments and the compatible abutments.
PubMed: 38596956
DOI: 10.7518/hxkq.2022.04.006 -
Materials (Basel, Switzerland) Mar 2020Osseointegration are often suffering from oral conditions, especially, the micro gap at the implant-abutment connection represents a site for bacterial plaque... (Review)
Review
INTRODUCTION
Osseointegration are often suffering from oral conditions, especially, the micro gap at the implant-abutment connection represents a site for bacterial plaque aggregation, leading to increased inflammatory cells and causing peri-implantitis.
AIM
The aim of this narrative review was to describe the different kinds of implant-abutment connections and their ability to reduce bacterial leakage and thus prevent peri-implantitis.
MATERIALS AND METHODS
The following databases were consulted: Pubmed, Scopus, Cochrane Library, and Research gate and a total of 528 articles were found. After reading the abstract and titles, 473 items were excluded. The remaining articles (n = 55) were assessed for full-text eligibility. Thirty-three studies were included in the review.
RESULTS AND CONCLUSIONS
We selected 22 clinical trials and 11 reviews, examining a total sample of 2110 implants. From the review, it was clear that there exists a relationship between the implant-abutment interface and bacterial leakage. All the connections presented an amount of micro-gap and bacterial micro-leakage, though conical and mixed connection systems seemed to behave better. Moreover, both connections seemed to have a better load distribution and the mixed system also had anti-rotational properties which are very useful during the positioning of the prosthesis.
PubMed: 32138368
DOI: 10.3390/ma13051131