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Aim: To evaluate CAD/CAM milling vibrations related to zirconia disk design, framework, and location of digital crown nesting during zirconia soft milling., Materials and Methods: In the present in vitro study, 25 round zirconia disks of 98 mm (R group) and 15 D-shaped zirconia disks of 71 mm (D group) were placed in a 5-axis CAD/CAM milling unit. The R group had 3 crown milling sites (n = 75) and the D group had 2 crown milling sites (n = 30). In the R group, site A was located 57 mm, site B was 92 mm, and site C was 123 mm from the machine holder attachment. In the D group, site A was 57 mm and site C was 123 mm from the machine holder attachment. A vibration meter (VB-8200; Lutron) was connected to the disk holder, and data (mm/second) were collected during the milling process at the different nesting locations. One-way ANOVA with post-hoc tests and Bonferroni correction for multiple tests were used to compare the groups (α = 0.05)., Results: In the R group, site C exhibited the highest mean vibration values compared with site A (P = 0.001). The first and second cutting tools (2.5 and 1 mm) exhibited statistically significant differences between the D and R groups at milling sites A and C (P < 0.001 and P = 0.003, respectively)., Conclusions: Milling vibration increased as the distance between the machine holder arm and a digitally nested site increased. Round zirconia disks induced higher vibration values compared with D-shaped disks.

A failed implant site is prone to reduced alveolar bone volume, both horizontally and vertically. The present study assessed the outcome of using cancellous bone block allografts for ridge reconstruction following the removal of failed implants associated with severe bone loss. Individuals presenting with failed implants and massive bone loss were included. Cancellous bone block allografts were used for reconstruction of the atrophic alveolar ridge. Radiographic evaluation at 6 months postgrafting revealed favorable bone healing, allowing implant placement. Bone biopsy samples were taken during implant placement. Twenty-four blocks and 58 implants were placed in 16 patients. Over a mean follow-up time of 40 ± 15 months, the mean bone gain was 5 ± 0.5 mm horizontally and 7 ± 0.5 mm vertically. Block and implant survival rates were 96% (1 block failed) and 95% (3 implants failed), respectively. Histomorphometrically, the mean percentage of newly formed bone was 40%, with 20% residual cancellous block allograft and 40% marrow and connective tissue. Cancellous bone block allograft is a viable treatment alternative for reconstructing the alveolar ridge to achieve a successful second reimplantation, even in the presence of initial severe bone loss.

Marginal fit is an important clinical factor that affects restoration longevity. The accuracy of three polyvinyl siloxane putty-wash impression techniques was compared by marginal fit assessment using the nondestructive method. A stainless steel master cast containing three abutments with three metal crowns matching the three preparations was used to make 45 impressions: group A = single-step technique (putty and wash impression materials used simultaneously), group B = two-step technique with a 2-mm relief (putty as a preliminary impression to create a 2-mm wash space followed by the wash stage), and group C = two-step technique with a polyethylene spacer (plastic spacer used with the putty impression followed by the wash stage). Accuracy was assessed using a toolmaker microscope to measure and compare the marginal gaps between each crown and finish line on the duplicated stone casts. Each abutment was further measured at the mesial, buccal, and distal aspects. One-way analysis of variance was used for statistical analysis. P values and Scheffe post hoc contrasts were calculated. Significance was determined at .05. One-way analysis of variance showed significant differences among the three impression techniques in all three abutments and at all three locations (P < .001). Group B yielded dies with minimal gaps compared to groups A and C. The two-step impression technique with 2-mm relief was the most accurate regarding the crucial clinical factor of marginal fit.