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The fixed/detachable implant provisional prosthesis.

Interim modification and management of a complete denture following surgical uncovering of dental implants can be time-intensive and may fail to provide adequate patient benefit until the definitive prosthesis can be completed. Inadequate interim management can result in functional and tissue difficulties. Modification of the conventional complete denture to a fixed/detachable provisional prosthesis in a one-stage procedure provides the patient an opportunity to experience a fixed prosthesis. The incorporation of fixed, provisional cylinders to the existing denture base using autopolymerizing acrylic resin with a closed-mouth technique is described. The peripheral regions are reduced and the distal extension shortened to resemble a fixed/detachable prosthesis. This conversion technique can provide patient satisfaction and comfort until delivery of the definitive prosthesis. Esthetic concerns, home care problems, or patient difficulties with the provisional prosthesis can be rectified in the final prosthesis.

Dental Abutments↗

Accelerated aging affects color stability of provisional restorative materials.

PURPOSE: The color stability of two shades each of five acrylic resin and seven resin composite provisional restorative materials was evaluated by reflection spectrophotometry following in vitro accelerated aging. MATERIALS AND METHODS: Specimens of provisional restorative materials were polymerized according to manufacturers' instructions and aged in an artificial aging chamber with exposure to a total ultraviolet irradiation of 60 kJ/m2. Color was measured by CIE L*a*b* on a reflection spectrophotometer before and after aging. Color change (delta E*) was calculated and analyzed statistically. RESULTS: Statistically significant changes in color were observed after accelerated aging. Nine of the 12 provisional materials tested showed perceptible color change of at least one of the shades tested. The most color-stable materials were the acrylic, Alike, and the resin composites, Luxatemp and Protemp Garant, which had no perceptible color changes under these conditions. CONCLUSIONS: Some acrylic resin and composite provisional materials change color significantly and perceptibly when exposed to in vitro accelerated aging conditions.

Acrylic Resins↗

Color stability of provisional restorative materials after accelerated aging.

PURPOSE: Color of 11 provisional restorative materials (4 acrylic resins and 7 resin composites) was evaluated by reflection spectrophotometry immediately after fabrication, after aging for 15 kJ/m(2), and after aging for 60 kJ/m(2) to determine relative color stability under experimental aging conditions. MATERIALS AND METHODS: Specimens of provisional restorative materials were polymerized according to manufacturers' instructions and aged in an artificial aging chamber with exposure to a total ultraviolet irradiation of 60 kJ/m(2) in increments of 15 kJ/m(2). Color was measured by CIE L*a*b* on a reflection spectrophotometer before and after aging. Color change (Delta E*) was calculated and analyzed statistically by analysis of variance with repeated measures after 15 and 60 kJ/m(2) intervals of aging. RESULTS: Statistically significant changes in color were observed after accelerated aging at both the initial and final aging intervals. Five of the 11 provisional materials tested showed perceptible color change (Delta E* from 3.6 to 9.3) after accelerated aging of 15 kJ/m(2). Seven of the 11 provisional materials tested showed perceptible color change (Delta E* from 3.4 to 9.4) after accelerated aging of 60 kJ/m(2). CONCLUSIONS: Clinically perceptible color changes (Delta E* Delta 3.3) can be expected in some acrylic resin and composite resin provisional materials after accelerated aging.

Acrylic Resins↗

Use of an immediate provisional implant to support a full-arch interim restoration: a clinical report.

The use of provisional implants as the sole or adjunct mean of stabilization for interim fixed partial dentures has gained popularity in implant prosthodontic treatment. These implants can be used between submerged implants during the healing phase to provide support for interim fixed or removable partial dentures. In this clinical report, a provisional implant used to provide support for a full-arch fixed interim restoration is described. Positioned between adjacent conventional implants, the provisional implant was placed during the same surgical procedure. As a result, an immediate acrylic fixed partial denture supported by natural teeth and the provisional implant provided a comfortable and esthetic interim restoration during the osseointegration period.

Dental Implantation, Endosseous↗

Fracture resistance of fiber-reinforced PMMA interim fixed partial dentures.

PURPOSE: To compare different fiber reinforcements on fracture toughness of interim polymethyl methacrylate materials and then use the best combination to determine the optimal position for fiber placement in an interim 3-unit fixed partial denture (FPD). MATERIALS AND METHODS: In the first stage of the study, five groups of notched fracture toughness specimens were fabricated and loaded to failure (Instron): (1) unreinforced (control); (2) reinforced with pre-impregnated silanized E-glass fibers (Fibrestick); (3) cold plasma-treated woven polyethylene fibers (Ribbond triaxial); (4) pre-impregnated silanized plasma-treated woven polyethylene fibers (Construct); and (5) 1.0-mm-diameter stainless steel wire. In the second stage, the optimal position (occlusal, middle, or cervical third of pontic) for reinforcement with glass fibers (regimen 2) was tested by loading a 3-unit FPD to failure. All groups were compared with analysis of variance (alpha < 0.05). RESULTS: The fracture toughness (in MPam(1/2)) for each reinforced group (Fibrestick 2.74 +/- 0.12, Construct fibers 2.59 +/- 0.28, Ribbond triaxial 2.13 +/- 0.20, and orthodontic wire 1.66 +/- 0.09) was statistically greater (p< 0.05) than for the unreinforced group (control = 1.25 +/- 0.006). Fracture loads for FPDs were greatest when the fiber reinforcements were placed in the cervical third (cervical = 1165 N). CONCLUSIONS: The use of fiber and, to a lesser extent, orthodontic wire is an effective method to reinforce interim restoration resins.

Analysis of Variance↗

Root resorption leading to linkage of dentinal collagen and gingival fibers? A case report.

A maxillary central incisor in a 55-year-old Caucasian female was extracted in modified block as part of a histologic study of gingival responses to subgingival crown placement. The facial portion of this block showed preclinical pocket depth of 1.0 mm with moderate gingival inflammation. The block was extracted 2 weeks after crown placement and prepared for histologic evaluation. Histologic responses to subgingival crown placement were, among others: gingival recession (1.0 mm), reformation of crevicular depth (0.7 mm) and remodelling of the gingival and periodontal attachment apparatus. Histologic evaluations of the gingival unit using cellular and connective tissue stains revealed an area of root resorption immediately apical to the junctional epithelium at a portion of the facial surface. Root resorption had progressed into dentin. Gingival connective tissue abutted the dentinal surface. Collagen stains showed the presence of tufts of collagen fibrils which appeared to arise from the dentin. These fibrillar elements seemed to splice with collagen fibrils found in the gingival connective tissue. The specimen thus suggests the possibility of a fiber linkage attachment involving exposed dentinal fibers as part of gingival repair following injury.

Collagen↗

Adaptation of resinous restorative materials to acid etched enamel surfaces.

The purpose of this paper was to study by means of scanning electron (SEM) and optical microscopy the adaptation of the low-viscous non-composite. Nuva-Seal and of the three high-viscous composite restorative materials Adaptic, Compocap and Concise to phosphoric acid etched enamel surfaces from symmetric areas of pairs of contralateral human permanent anterior teeth. The SEM study demonstrated that the two types of material equally well reproduce the details of the enamel surface; the light microscopic observations showed that the length and shape of resin tags in the enamel surface are independent of the materials examined. The observations seem to allow the conclusion that bonding of composite restorative resins to phosphoric acid etched enamel surfaces is not conditioned by the employment of an intermediate film of a low-viscous non-composite resin.

Composite Resins↗

Effect of composite resin restorations in monkeys teeth with experimentally induced pulpitis.

The short- and long-term pulpal reactions to composite resin restorations using differenct cavity lining materials have been assessed in monkey teeth with experimentally induced pulpitis. The inflammation was induced by filling cavities with soft human carious dentin and amalgam for 1 week. Healing of the inflammation and formation of reparative dentin was generally found independent of the lining materials used. The long-term response to cavities restored with carious dentin and amalgam was also healing of the primarily induced pulpal inflammation in most instances.

Animals↗

Effect of IRM on human dental pulp.

IRM has been shown to be superior to conventional ZnOE cements. This study is a biotechnical investigation of IRM's effect on the dental pulp with respect to its sealing capacity. Enamel-dentin test bodies with IRM fillings were used in the in vitro part, where insufficiencies in sealing were detected with compressed air. The in vivo part included 44 buccal cavities in intact premolars. In teeth in which the material effect of IRM was tested, the IRM fillings were sealed off from the saliva by acid etch and composite resin. The observation intervals were 1, 7 and 28 days. Histologic changes such as capillary dilatations and presence of inflammatory cells in the pulp adjacent to the dentinal tubules involved in the cavity preparation were registered. The in vitro test showed no leakage in five cases out of six. After extreme temperature cycling, the leakage was comparable with that of zinc-containing amalgam of traditional alloy. The pulpal changes were mild and mainly ascribed to the material effect of IRM, since no evidence was found of leakage of biologic importance.

Dental Bonding↗

Microleakage of IRM used to restore endodontic access preparations.

The effect on microleakage of varying the powder-to-liquid ratio (P/L) of IRM used to restore endodontic access preparations was evaluated. Crowns of noncarious, nonrestored extracted human teeth were used in this study. Microleakage was measured using a fluid filtration technique prior to access preparation to obtain control measurements. After access preparation, IRM restorations were placed using P/L of 2, 3, 4, 5, and 6 g/ml, using the manufacturer's recommended dispensing scoop and dropper, and using 2 P/L in a new capsulated IRM delivery system (IRM CAPS). Microleakage measurements were made after various time intervals and after thermal stress. The results indicated that the lower P/L provided the best seals. All groups demonstrated significant microleakage measurements after thermal stress. Significantly greater microleakage measurements were obtained with the P/L of 6 g/ml and the manufacturer's recommended dispensing scoop and dropper. A P/L of 2 g/ml demonstrated less microleakage than the other groups tested.

Dental Leakage↗

Influence of endodontic materials on the bonding of composite resin to dentin.

We assessed the bond strength of a composite resin to dentin that had been in contact with different materials. Flat dentin surfaces in freshly extracted human teeth were covered for 15 min or 48 h with a 1-mm layer of a variety of materials. The products were mechanically removed and a composite resin cylindrical specimen bonded to the dentin surface using the Prisma universal bond system. After 7 days immersion at 37 degrees C in water, the tensile bond strength was tested. The results were compared with those on dentin surfaces not in contact with any endodontic material. Statistical analysis showed that some materials (Grossmans Cement, IRM, Maisto's slowly resorbable paste) reduced the strength of the bond or even precluded bonding. It is necessary to develop techniques that will eliminate this when restoring endodontically treated teeth.

Adhesiveness↗

Treatment of large periapical lesions by inserting a drainage tube into the root canal.

Long-term drainage and depressurization is performed by inserting a stainless steel tube into the root canal of teeth with persisting periapical exudation. This article presents 2 cases of large periapical lesions showing a complete healing of bone after the drainage tube procedure. The tube allows lasting drainage, relieves the pressure and modifies the local apical environment so the host defense mechanism can exert repair process.

Adolescent↗

Pulp exposure after stepwise versus direct complete excavation of deep carious lesions in young posterior permanent teeth.

The aim was to assess the prevalence of pulp exposure after stepwise versus direct complete excavation of permanent posterior teeth with deep carious lesions. The material, representing 116 patients aged 6-16 yrs (mean = 10.2 yrs), consisted of 127 teeth with radiographs revealing carious lesions to such a depth that pulp exposure could be expected if direct complete excavation was performed. Teeth with clinical symptoms, other than transient pain shortly before treatment, were not accepted. The teeth were randomly selected for either treatment procedure. Stepwise excavation implied removal of the bulk of carious tissue and application of calcium hydroxide, followed by sealing of the cavity with zinc-oxide eugenol cement. After a period of 8-24 weeks the rest of the carious dentin was removed and the cavity sealed with calcium hydroxide, zinc-oxide-eugenol (ZOE) and a restorative material. Direct complete excavation entailed removal of all carious dentin followed by sealing as mentioned above. In case of pulp exposure, pulp treatment was performed. The pulp was exposed in 40 of the teeth treated by direct complete excavation. The corresponding figure for those treated by stepwise excavation was 17.5%. The difference was statistically significant. The teeth with no pulp exposure after direct or stepwise excavation showed normal clinical and radiographic conditions at the last check-up (mean = 43 months).

Adolescent↗

Immediate provisional for single-tooth implant replacement with Brånemark system: preliminary report.

BACKGROUND: The success of osseointegrated implants ad modum Brånemark for single-tooth restorations is documented. Future developments should aim at improving the benefits to patients by decreasing treatment time, minimizing surgical stages, and maximizing esthetic outcomes. Using knowledge from studies of immediate implant placement, one-stage, immediate loading protocols, the authors developed the immediate provisional. PURPOSE: The purpose of this study was to develop a protocol to provide an immediate solution for restoring a single missing tooth in the esthetic zone. The protocol should be simple, predictable, cost effective, and allow the use of other techniques to improve esthetic outcome. MATERIALS AND METHOD: This prospective clinical study included 24 patients treated from August 1999 to October 2000. Single-tooth implant replacement was done according to immediate provisional protocol. Thirteen of the 24 patients had immediate implant placement after tooth extraction. All implants were placed in the esthetic zone. During surgery, emphasis was placed on obtaining primary stability by achieving bicortical anchorage and maximum insertion torque of at least 40 Ncm. CeraOne (Nobel Biocare) abutments were used, and provisional crowns were fabricated immediately before wound closure. The occlusion was protected by adjacent teeth. RESULTS: Within the follow-up period of between 1 month and 15 months, all fixtures in the 24 patients were stable. Crestal bone loss greater than one thread-width was not detected. The esthetic result was considered satisfactory by all patients. CONCLUSIONS: The implant placement and restoration protocol used in this study showed promising initial results for both the immediate implant and healed extraction site groups. The desirable goals of patient satisfaction, excellent esthetic outcomes, and no increase in treatment cost were achieved in this protocol. Further studies to elucidate the potential of the immediate provisional protocol are justified.

Adolescent↗

Preliminary report of immediately loaded Altiva Natural Tooth Replacement dental implants.

BACKGROUND: Osseointegration may be described as a direct contact between living bone and an alloplastic implant. It is thought that a period of undisturbed healing is required to ensure osseointegration. The length of the healing period is dependent on a number of factors, such as implant material, surface configuration, site preparation technique, bone quality, healing capacity of the osteotomy, and implant design. Elimination of the healing period offers distinct advantages in terms of cost of therapy and convenience to patients. Recently, a new one-piece implant design was proposed that provides improved stability of the implant to allow immediate support of an interim prosthesis. PURPOSE: This article presents the initial clinical experiences when the Altiva Natural Tooth Replacement one-piece implant was used in a human clinical trial. MATERIALS AND METHODS: This was a prospective multicenter study of the placement and immediate loading of the one-piece implant. A total of 142 implants were placed in the jaws of 93 patients. Implants were placed consecutively and were followed at specified intervals in three private clinical practices. Clinical performance was recorded relative to implant survival and prosthesis support. RESULTS: The implant survival rate was 93.7%, with similar responses in the maxilla (95.0%) and the mandible (92.7%). When implant failure occurred, it was observed as mobility without infection within 3 to 5 weeks of implant insertion. CONCLUSIONS: On the basis of this trial, there is promising evidence that this implant design can succeed at rates similar to other designs that require conventional healing times.

Adult↗