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6. EAO Consensus Conference 2021, online, 11 Feb 2021 - 12 Feb 2021; Clinical oral implants research 32(S21), 336-341 (2021). doi:10.1111/clr.13797 special issue: "Special Issue: The 6th EAO Consensus Conference 2021 / edited by: Irena Sailer, Björn Klinge, Henning Schliephake", Published by Wiley-Blackwell, Oxford

To assess the influence of bonding system and restorative material on the marginal integrity and pull-off forces of monolithic all-ceramic crowns bonded to titanium base (Ti-base) abutments.A total of 108 Ti-bases were sandblasted and divided into 9 experimental groups (n = 12 each) according to the combination of crown material (polymer-infiltrated ceramic network [PI], lithium disilicate [LD], and zirconia [ZI]) and bonding system (Multilink Hybrid Abutment [mh], PANAVIA V5 [pv], RelyX Ultimate [ru]), with their respective primers. After bonding the crowns to the Ti-base abutments, the restorations were screw-retained on implants and thermomechanically aged (1,200,000 cycles, 49 N, 1.67 Hz; 5°C to 55°C). Marginal integrity and bonding failure were evaluated under a light microscope, and pull-off forces (N) were calculated. Chi-square tests for marginal integrity, as well as one-way and two-way ANOVA for the pull-off forces, were applied (α = .05).PI presented higher marginal integrity than LD (P = .023). The bonding system pv revealed higher marginal integrity than mh (P = .005) and ru (P = .029). Differences in pull-off forces were found between restorative material and resin cement (P.001), with the highest values for ZI + ru (598 ± 192 N), PI + pv (545 ± 114 N), LD + mh (532 ± 116 N), and PI + ru (528 ± 81 N). Specimens with marginal integrity revealed higher pull-off forces than those with alteration (P = .006). Specimens presenting bonding failures (micromovements) showed lower pull-off forces than those without bonding failures (P.001).The tested CAD/CAM materials show favorable bonding performances with different bonding systems; nevertheless, a specific bonding system has to be recommended for each restorative material.

OBJECTIVES: The main objective of the study was to compare the accuracy of full-arch digital implant impressions for fixed dental prosthesis under in vitro and in vivo conditions. MATERIALS AND METHODS: Eight patients (five women and three men) with at least one edentulous arch and with 4-6 osseointegrated implants participated in this study. For each edentulous arch (n = 10), experimental screw-retained titanium bar with attached four scan bodies was fabricated. The bar containing four scan bodies was screw-retained intraorally on implants and scanned with Trios 3 intraoral scanner eight times (IOS group, in vivo). Then, the bar was attached to the master cast and scanned eight times again with the same intraoral scanner (MIOS group, in vitro). Finally, the bar with scan bodies was scanned 8 times with a laboratory scanner (reference). Precision and trueness were calculated for 3 distances and 3 angles between the scan bodies (1-2, 1-3, and 1-4) in IOS and MIOS groups. RESULTS: Precision and trueness for the largest distance (1-4) were found to be 44 ± 18 µm and 32 ± 19 µm for the IOS group and 31 ± 16 µm and 30 ± 14 µm for MIOS group, respectively. Precision and trueness for the angle between the most distant scan bodies (1-4) were 0.22 ± 0.14° and 0.18 ± 0.10° for the IOS group and 0.16 ± 0.11° and 0.07 ± 0.05° for MIOS group, respectively. CONCLUSIONS: Intraoral conditions moderately affected the precision and trueness of Trios 3 (3Shape) intraoral scanner. Results of in vitro accuracy studies cannot be directly transferred to the clinical field.

Monolithic zirconia implant-supported restorations connected to titanium bases or titanium inserts are increasing in popularity due to their application in a full digital workflow. These prefabricated abutments are connected to the all-ceramic superstructure by adhesive cementation. Although limited clinical data on the outcomes of this type of restoration are available, a few laboratory studies have shown possible debonding issues. This case report presents a bonding failure of a fixed dental prosthesis supported by titanium bases after short clinical use. A treatment alternative is also proposed using the available digital dental technology.

Purpose of Review The aim of this case report was to illustrate the clinical procedure integrating augmented reality (AR) for complex patient cases requiring full mouth rehabilitation. Recent Findings The introduction of AR technology to the fields of medicine and dentistry has led to numerous applications in education, surgery, and esthetics. Recently, a new AR software was introduced in esthetic dentistry which allows for real-time smile projection and thus improves communication with patients and the dental laboratory. Summary The presented case shows a patient with multiple missing teeth, diastemata, and an impaired masticatory and phonetic ability. After reconstruction of the posterior zone, the AR software was used for the conception of the esthetic zone, integrating the patient into the decision-making process. The result was an esthetic rehabilitation applying palatal and buccal veneers which corresponded to the chosen AR design. The patient appreciated the opportunity to pre-visualize a possible final outcome in an interactive way which increased his confidence in the chosen treatment. Further studies are needed to assess the precision and reproducibility of the described protocol.

The tasks of Working Groups 1 to 6 at the 4th Consensus Meeting of the Oral Reconstruction Foundation were to elucidate clinical recommendations for implant-supported full-arch rehabilitations in edentulous patients. Six systematic/narrative reviews were prepared to address the following subtopics: (1) the influence of medical and geriatric factors on implant survival; (2) the prevalence of peri-implant diseases; (3) the influence of material selection, attachment type, interarch space, and opposing dentition; (4) different interventions for rehabilitation of the edentulous maxilla; (5) different interventions for rehabilitation of the edentulous mandible; and (6) treatment choice and decision-making in elderly patients. Consensus statements, clinical recommendations, and implications for future research were determined based on structured group discussions and plenary session approval.

Purpose To evaluate the effect of cementation protocols on the bonding interface stability and pull-out forces of temporary implant-supported crowns bonded on a titanium base abutment (TiB) or on a temporary titanium abutment (TiA). Materials and methods A total of 60 implants were restored with PMMA-based CAD/CAM crowns. Five groups (n = 12) were created: Group 1 = TiB/SRc: crown conditioned with MMA-based liquid (SR Connect, Ivoclar Vivadent); Group 2 = TiB/50Al-MB: crown airborne particle-abraded with 50-μm Al2O3 and silanized (Monobond Plus, Ivoclar Vivadent); Group 3 = TiB/30SiOAl-SRc: crown airborne particle-abraded with 30-μm silica-coated Al2O3 (CoJet, 3M ESPE) and conditioned with MMA-based liquid (SR Connect); Group 4 = TiB/30SiOAl-MB: crown airborne particle-abraded with 30- μm silica-coated Al2O3 (CoJet) and silanized (Monobond Plus); and Group 5 = TiA/TA-PMMA: crown manually enlarged, activated, and rebased with PMMA resin (Telio Lab, Ivoclar Vivadent). Specimens in the TiB groups were cemented using a resin cement (Multilink Hybrid Abutment, Ivoclar Vivadent). After aging (120,000 cycles, 49 N, 1.67 Hz, 5°C to 55°C, 120 seconds), bonding interface failure was analyzed (50x). Pull-out forces (N) (0.5 mm/minute) and modes of failure were registered. Chi-square and Kruskal-Wallis tests were used to analyze the data (α = .05). Results Bonding failure after aging varied from 0% (Group 5) to 100% (Groups 1, 2, and 4) (P .05). Conclusion The cementation protocol had an effect on the bonding interface stability and pull-out forces of PMMA-based crowns bonded on a titanium base. Airborne particle abrasion of the crown internal surface and conditioning it with an MMA-based liquid may be recommended to improve retention of titanium base temporary restorations. Yet, for optimal outcomes, conventional temporary abutments might be preferred.

PURPOSE To test the accuracies of different methods of digital vertical dimension augmentation (VDA) by comparison with a clinical situation. MATERIALS AND METHODS Bite registrations with approximately 5 mm of VDA were made in the incisor regions of 10 subjects (mean VDA 4.5 mm). The conventional maxillary and mandibular stone casts in maximum intercuspation (MICP) and VDA bite registrations were digitized for all subjects using a laboratory scanner (control group). Lateral portraits were taken of all subjects to locate the position of the condylar axis. Four different digital VDA methods were compared to the control group: 100% rotation of the mandible referring to the lateral picture (100RL); 85% rotation and 15% translation referring to the lateral picture (85R15TL); 100% rotation in normal mounting mode of the Trios virtual articulator (100R); and jaw-motion analysis (JMA) equipment. The amount of VDA for each experimental group was compared to the control group. The augmented distances between the central incisors and the second molars were measured using 3D analyzing software. The ratio of the augmented distances between the posterior and anterior regions (P/A ratio) was calculated. One-way analysis of variance and multiple comparisons via least significant difference test were carried out to determine statistical significance. RESULTS The P/A ratio of each group was as follows: Control = 0.61; 100RL = 0.55; 85R15TL = 0.61; 100R = 0.53; JMA = 0.52. Significant differences were observed for control vs JMA and for 85R15TL vs JMA (P < .05). The addition of translational movement was the primary factor for increasing the accuracy of digital VDA, with the lateral picture being a secondary factor. CONCLUSION VDA using a virtual articulator with 100% rotation induces an error when compared to the clinical situation. When a clinician performs digital VDA, the setting of 85% rotation and 15% translation produces results closer to the real clinical condition.

In recent years, numerous new dental materials have been introduced as alternatives to metal-ceramics for restorations on teeth and implants. This position paper presents the current evidence and respective clinical recommendations of the European Association for Osseointegration (EAO), one of the scientific partners of the International Journal of Prosthodontics, on material selection for single crowns (SCs) and multiple-unit implant-supported fixed dental prostheses (FDPs). Metal-ceramic restorations can be utilized in most clinical indications and are preferred to ceramic restorations in incidences such as long clinical implant crowns; cantilever implant restorations where one implant is supporting two crowns; implant-supported FDPs with extension units extending more than 7 to 8 mm (premolar size); implant-supported FDPs with more than two pontics; and implant-supported FDPs with small connector diameters due to limited intraocclusal space. Veneered or monolithic zirconia-ceramic and veneered or monolithic reinforced glass-ceramic implant-supported SCs are indicated for most SC cases in both the anterior and posterior areas. Today, implant-supported zirconia-ceramic FDPs that are conventionally veneered cannot be considered the material of first priority due to the pronounced risk for fracture of the framework and catastrophic fracture of the veneering material. Monolithic zirconia FDPs are a promising alternative to veneered implant-supported zirconia-ceramic FDPs. The mechanical stability of the translucent and shaded zirconia differs significantly between the grades of translucency. This must always be considered when clinical indications are recommended. As this specific area of prosthodontics is evolving fast, numerous studies evaluating different material options in implant prosthodontics are currently performed worldwide, and future consensus meetings will refine the present recommendations. The EAO will therefore regularly publish updated position papers on relevant topics.

This in vitro study evaluated technical outcomes of monolithic zirconia implant-supported fixed dental prostheses (iFDPs) supported by different designs of titanium base abutments after aging and static load testing.Sixty three-unit monolithic zirconia (yttrium oxide partially stabilized tetragonal zirconia polycrystals; Y-TZP)iFDPs were produced and divided into four groups: group A-conical titanium base abutments for the prosthesis; group B-cylindrical titanium base abutments for the crown; group C-conical titanium base abutment for the prosthesis and cylindrical titanium base abutment for the crown; group D-cylindrical titanium base abutments for the prosthesis. The samples were subjected to an aging protocol and to continuous static loading until failure and analyzed visually and with specific software. The technical outcomes comprised the occurrence of debonding, screw loosening, deformation and fracture, abutment deformation and fracture, implant deformation and fracture, zirconia chipping and fracture, and bending moments. The Pearson chi-squared test (χAfter aging, a higher percentage of debonding (P = .042) and micromovement (P = .034) was recorded in group C (P = .042). The conical titanium base abutments had a higher debonding (P = .049) and a higher macromovement rate (P = .05). The static load test showed higher bending moments in group D (P = .001) and lower bending moments in group A (P = .001). Debonding was highest in group C (P = .001) and lowest in group A (P = .002). Complete loss of retention rate was highest in group C (P = .001). The conical titanium base abutment had the highest debonding rate (P = .001) and complete loss of retention (P = .001). The micromovement rate was the highest for cylindrical titanium base abutments for the crown (P = .001). The lowest screw loosening, zirconia chipping, and fracture rate (P = .001) and the highest screw deformation (P = .004) were recorded in group A. The screw deformation rate was lowest in the cylindrical titanium base abutments for the crown (P = .008).The mixed titanium base abutment design comprising one conical and one cylindrical abutment in Y-TZP iFDPs led to the highest debonding rate. The cylindrical titanium base abutment for the prosthesis provided a lower percentage of debonding and the highest load resistance.

This in vitro research aimed to quantitatively evaluate the enamel and dentin tissue removal and the residual adhesion surface area (RAS) after different margin designs and locations for indirect partial restorations (IPR).A human molar was scanned using a Micro-CT and the STL file obtained was used to 3D-print 50 resin-tooth replicas. IPR standardized preparations were performed. The specimens were randomly assigned to 5 groups (n = 10), according to preparation and margin location to the dental equator (DE): 1) Rounded shoulder above the DE (SA); 2) Hollow chamfer above the DE (CA); 3) Butt joint above the DE (BJ); 4) Rounded shoulder below the DE (SB); 5) Chamfer below the DE (CB). Then, the tooth replicas were scanned and each STL file was aligned and superimposed to the original STL model file. Data of enamel and dentin volume removal and RAS were assessed and statistically analyzed (one-way ANOVA and Kruskal-Wallis tests for the two dental substrates respectively). Significance was set at p0.05.Differences in dental tissue reductions were related to the margin location. Above the equator, SA, CA, and BJ performed comparably (p0.05). Below the equator, CB was significantly more conservative in enamel reduction than SB (p0.05) and showed the highest enamel adhesive surface exposure among the tested preparations (p0.05).When the preparation margin is placed above DE, BJ determines a greater exposure of dentin, reducing the adhesive surface in enamel. Below DE, SB seems to be more aggressive in terms of tissue removal compared to CB.The results of this in vitro study suggest that in teeth requiring partial restoration with the margin below the dental equator, a chamfer preparation would be more conservative than a shoulder preparation. When above the equator, preparations with flat designs would expose more dentine providing a worse substrate for adhesion.

STATEMENT OF PROBLEM Clinical trials are needed to evaluate the digital and conventional fabrication technology for providing fixed partial dentures (FPDs). PURPOSE The purpose of the second part of this clinical study was to compare the laboratory production time for tooth-supported, 3-unit FPDs by means of computer-aided design and computer-aided manufacturing (CAD-CAM) systems and a conventional workflow. In addition, the quality of the 3-unit framework of each treatment group was evaluated clinically. MATERIAL AND METHODS For each of 10 participants, a 3-unit FPD was fabricated. Zirconia was used as the framework material in the CAD-CAM systems and included Lava C.O.S. CAD software (3M) and centralized CAM (group L); CARES CAD software (Institut Straumann AG) and centralized CAM (group iT); and CEREC Connect CAD software (Dentsply Sirona) and centralized CAM (group C). The noble metal framework in the conventional workflow (group K) was fabricated by means of the traditional lost-wax technique. All frameworks were evaluated clinically before veneering. The time for the fabrication of the cast, the 3-unit framework, and the veneering process was recorded. In addition, chairside time during the clinical appointment for the evaluation of the framework was recorded. The paired Wilcoxon test together with appropriate Bonferroni correction was applied to detect differences among treatment groups (α=.05). RESULTS The total effective working time (mean ±standard deviation) for the dental technician was 220 ±29 minutes in group L, 217 ±23 minutes in group iT, 262 ±22 minutes in group C, and 370 ±34 minutes in group K. The dental technician spent significantly more time in the conventional workflow than in the digital workflow, independent of the CAD-CAM systems used (P

STATEMENT OF PROBLEM Clinical trials are needed to evaluate digital and conventional technologies for providing fixed partial dentures. PURPOSE The purpose of the first part of this clinical study was to test whether complete-arch digital scans were similar to or better than complete-arch conventional impressions regarding time efficiency and participant and clinician perceptions. MATERIAL AND METHODS Ten participants in need of a posterior tooth-supported 3-unit fixed partial denture were included. Three intraoral digital scanners and subsequent workflows (Lava C.O.S.; 3M [Lava], iTero; Align Technology Inc [iTero], Cerec Bluecam; Dentsply Sirona [Cerec]) were compared with the conventional impression method using polyether (Permadyne; 3M) and the conventional workflow. A computer-generated randomization list was used to determine the sequence of the tested impression procedures for each participant. The time needed for the impression procedures, including the occlusal registration, was assessed. In addition, the participant and clinician perceptions of the comfort and difficulty of the impression were rated by means of visual analog scales. Data were analyzed with the nonparametric paired Wilcoxon test together with an appropriate Bonferroni correction to detect differences among the impression systems (α=.05). RESULTS The total time for the complete-arch impressions, including the preparation (powdering) and the occlusal registration, was shorter for the conventional impression than for the digital scans (Lava 1091 ±523 seconds, iTero 1313 ±418 seconds, Cerec 1702 ±558 seconds, conventional 658 ±181 seconds). The difference was statistically significant for 2 of the 3 digital scanners (iTero P=.001, Cerec P

The aim of this study was to investigate the effects of saliva contamination and the cleaning of the bond surface of titanium base (ti-base) abutments on the bonding stability and retention force values. The bond surface of the ti-base abutments was treated with airborne-particle abrasion. After contamination, the ti-base abutments underwent different cleaning protocols: water spray (H2O), alcohol (ALC), suspension of zirconium particles (SZP), reapplied airborne-particle abrasion (APA), and a control condition without contamination and cleaning (CTR). All lithium disilicate crowns were bonded to the ti-base abutments using a primer and a self-curing composite. Bonded specimens underwent thermo-mechanical aging. Bond failure analysis and pull-off testing were performed. Bond failure occurred more frequently in groups H2O, ALC, SZP, and APA (p &lt, 0.05). Significant differences in retention force values were only found between CTR and ALC (p &lt, 0.05). Specimens which did not show bond failure after ageing had higher retention force values than the specimens that showed bond failure (p &lt, 0.05). Saliva contamination with cleaning can degrade the bonding properties to titanium. For the retention force values, only the protocol with alcohol after contamination could not restore the values.

OBJECTIVES To evaluate mechanical stability (survival and complication rates) and bending moments of different all-ceramic monolithic restorations bonded to titanium bases (hybrid abutment-crowns) or to customized titanium abutments compared to porcelain-fused-to-metal crowns (PFM) after thermo-mechanical aging. MATERIAL AND METHODS Sixty conical connection implants (4.3 mm-diameter) were divided in five groups (n = 12): PFM using gold abutment (GAbut-PFM), lithium disilicate crown bonded to customized titanium abutment (TAbut+LDS), lithium disilicate abutment-crown bonded to titanium base (TiBase+LDS), zirconia abutment-crown bonded to titanium base (TiBase+ZR), polymer-infiltrated ceramic-network (PICN) abutment-crown bonded to titanium base (TiBase+PICN). Simultaneous thermocycling (5°-55°C) and chewing simulation (1,200,000-cycles, 49 N, 1.67 Hz) were applied. Catastrophic and non-catastrophic events were evaluated under light microscope, and survival and complication rates were calculated. Specimens that survived aging were loaded until failure and bending moments were calculated. RESULTS Survival rates after aging were 100% (TAbut+LDS, TiBase+LDS), 91.7% (GA-PFM), 66.7% (TiBase+ZR) and 58.3% (TiBase+PICN) and differed among the groups (p = .006). Non-catastrophic events as screw loosening (GA-PFM) and loss of retention or micro-/macro-movement (TiBase groups) were observed. Complication rates varied among the groups (p

Die DVT generiert dreidimensionale Daten in digitaler Form. Dies ermoglicht, die gewonnenen komplexen Informationen einerseits automatisiert auszuwerten und andererseits konsequent und vollstandig digital weiter zu verwenden. Beide Aspekte werden im vorliegenden Kapitel behandelt. Die automatisierte Bilddatenauswertung steckt fur die DVT noch in den Anfangen. Wir erwarten fur die Zukunft einen schrittweisen Einzug in die Praxis. In medizinischen Bereichen ist dies schon erkennbar: Bei der „Kapselendoskopie“ mittels „Kamerapille“ werden mehrere Tausend Fotos aus dem Magen-Darm-Trakt erzeugt. Diese werden vor der Befundung automatisiert vorsortiert. Der volldigitale Workflow unter Einbezug der DVT hingegen ist z. B. in der Implantologie schon in der klinischen Anwendung etabliert. Ein vollstandiger In-House-Workflow, wie im Bereich der Inlay- und Kronenherstellung oft schon etabliert, ist bei dieser Anwendung aber noch die Ausnahme.

Purpose: To evaluate survival, complication rates, and bending moments of one- and two-piece zirconia implants restored with different abutment materials and lithium disilicate crowns after aging, compared to titanium implants restored with titanium base-supported lithium disilicate crowns. Materials and methods: Sixty anterior crowns were either screwretained on two-piece titanium implants (C) and two-piece zirconia implants (T1, T2, T3) or cemented on one-piece zirconia implants (T4), resulting in 5 groups with 12 specimens each. For the screw-retained crowns, different abutment materials and implant connections were tested: titanium base with internal conical connection and horizontal joint component (C and T2), zirconia with internal hexagonal connection and horizontal joint component (T1), and polyetherketoneketone with internal hexagonal connection and horizontal joint component (T3). After artificial aging with thermocycling (5°C to 50°C) and chewing simulation (1,200,000 cycles, 49 N, 1.67 Hz), the surviving specimens were loaded until fracture, and the bending moments were calculated. Survival rates and respective differences during aging were analyzed with the Kaplan-Meier log-rank test, while complication rates were compared with chi-square tests. Bending moment data were evaluated using the Kruskal-Wallis test (α = .05). Results: Survival rates after artificial aging ranged from 75% (T1) to 100% (C and T4) without significant differences between the groups (P > .05). Only 41.5% of the surviving specimens were free of complications, while the remaining presented screw-loosening, loss of retention of crowns, or cracks on the crown or implant level. The complication rates varied significantly among the groups (P < .05). The mean bending moments were 173.7 × 20.1 (C), 114.5 × 20.1 (T1), 171.1 × 46.1 (T2), 258.1 × 147.4 (T3), and 194.7 × 30.9 Ncm (T4), and group T1 exhibited significantly lower median bending moment values than the other groups (P < .001). Conclusion: The zirconia one- and two-piece implants presented high survival rates after aging, yet the number of technical complications was high. New prosthetic solutions, such as titanium bases or polyetherketoneketone abutments, may offer a comparable treatment option to restore two-piece zirconia implants.

Statement of problem Published data have shown that a mechanical surface treatment of titanium surfaces increases bonding potential. However, most of the studies are based on shear or tensile tests performed on flat-surfaced specimens and do not take into consideration the retention given by the titanium base (ti-base) axial walls and the thermomechanical loading seen in a clinical setting. Purpose The purpose of this in vitro study was to evaluate the influence of different airborne-particle abrasion (APA) methods of the ti-base surface on the stability of the bonded interface and retention forces between these titanium bases and lithium disilicate crowns after thermomechanical aging. Material and methods Sixty internal connection implants (Conelog) were restored with lithium disilicate crowns and bonded to the corresponding ti-bases (Conelog). The ti-bases were divided into 4 groups (n=15), 3 experimental groups applying different APA methods, 30-μm silica-modified Al2O3 particles (CoJet) (30-SiO-AlO), 50-μm Al2O3 (Cobra Aluoxyd) (50-AlO), 110-μm silica-modified Al2O3 particles (Rocatec Plus) (110-SiO-AlO), and 1 control group (NoT). Ti-bases were airborne-particle abraded (10 seconds, 0.25 MPa at a 10-mm distance) under standardized conditions in a custom-made APA device. All crowns were cemented with a resin cement (Multilink Hybrid Abutment). After aging (1 200 000 cycles, 49 N, 1.67 Hz; 5 °C-55 °C, 120 seconds), all specimens were assessed for the presence of bond failures by optical microscopy (×50). The retention forces (N) were tested by using a pull-off test (0.5mm/min). Modes of failure were classified (Type 1, 2, or 3). An additional ti-base representing each group was prepared for surface roughness (μm) calculation (Ra, Rc, Rz) with a noncontact laser profilometer, and representative scanning electron microscope (SEM) images were recorded (×1000). Chi-squared tests were performed to analyze the bonded interface failure and modes of failure, and a Kruskal-Wallis test was selected to evaluate retention force values (α=.05). Results The percentages of bonding failure after aging were 73.3% (NoT), 40% (30-SiO-AlO), 6.7% (50-AlO), and 40% (110-SiO-AlO). The stability of the bonded interface was influenced by the APA method applied (P Conclusions Airborne-particle abrasion of the titanium surface increased the bond stability and retention forces between the ti-base and the respective crown. The use of 50-μm Al2O3 provided the most stable bonded interface among the different treatments.

Purpose To analyze the influence of material selection, attachment type, interarch space, and opposing dentition on the prosthetic outcomes of fixed and removable implant complete prostheses (FCIPs and RCIPs, respectively). Materials and methods This review was designed as an overview of systematic reviews. An electronic database search was performed to identify scientific literature that reported on FCIPs and RCIPs. The last search was performed in January 2020. The final inclusion of systematic reviews for data extraction was decided by consensus of the authors. The included studies were analyzed qualitatively. Results A total of 21 systematic reviews (FCIP: n = 11, RCIP: n = 10) out of 5,733 articles initially identified were included for data extraction and interpretation. High overall 5-year and 10-year prosthesis survival rates were shown for FCIPs and RCIPs (93.3% to 100% and 96.9% to 100%, respectively). Chipping/fracture of the veneering material was the most frequent technical complication for FCIPs, and attachment-related complications were the main technical problems for RCIPs. For FCIPs, the effect of prosthetic material was not significant on the technical complications nor the survival rates. No studies were identified that provided direct information on the effect of interarch space in FCIPs and RCIPs. Conclusions Both FCIPs and RCIPs obtained high overall survival rates, but technical complications cannot be avoided with either prosthesis type. No prosthetic material can be considered as the material of choice over another. Attachment type has no influence on the overall clinical outcomes of RCIPs. The influence of opposing dentition and the required prosthetic space were not investigated sufficiently.

Purpose This study examined a new 3D volumetric analysis method for the assessment of baseline-to-12-month changes of the soft tissue volume at early and immediately placed tapered implants after loading with ceramic single crowns. Materials and methods Eligible patients with one incisor, canine, or premolar to be extracted were included. The patients were divided randomly into early-placement or immediate-placement groups. Tapered implants (BLT, Institut Straumann) were placed after the extractions. In the early-placement group, the implants were placed 8 weeks after extraction. In the immediate-placement group, the implants were placed immediately after the extraction. All implants healed transmucosally, and the final crowns were inserted after healing (baseline). Impressions were made at screening, baseline, and 12 months after crown insertion (Permadyne, 3M). The casts were scanned (Imetric 4D) and aligned, and a superimposed area of interest (AOI) (labial/buccal aspects) was defined to assess the volumetric changes (GOM Inspect). Specific software (3Matic, Materialise NV) was used for volumetric analysis. The vertical mucosal recession was measured at each time point. Repeated-measures one-way analysis of variance and the Tukey method were used for statistical analysis (SPSS 22, IBM). Results Twenty tapered implants (16 regular and four narrow) were placed in 20 patients (12 men and 8 women) in the early-placement (EP; n = 10) and immediate-placement (IP; n = 10) groups, respectively. Threedimensional volumetric analysis revealed soft tissue volume loss in both groups of 10.0 ± 16.5 mm3 (EP) and 24.3 ± 21.3 mm3 (IP) between baseline and 12 months (P = .6). The analysis also revealed local differences in the changes, displaying both localized gain and loss in both groups. Conclusion With this novel 3D analysis method, true volumetric soft tissue differences, ie, both localized gain and loss, were specified between the treatment groups.

A 61-year-old healthy patient was referred for prosthetic rehabilitation in the maxilla and mandible. The primary wish of the very anxious patient was to improve the masticatory function and his aesthetic appearance with the least invasiveness and as efficiently as possible. Furthermore, he desired to receive a reliable long-term solution. The patient had no general medical restrictions and was a non-smoker. At the time of the first clinical examination, the patient presented nearly edentulous, with a few root remnants in the mandible and remaining wisdom teeth in the maxilla. The main objective of the treatment, hence, was to improve both his chewing function and the stability of the prostheses without invasive surgeries. After the removal of the root remnants and one of the two wisdom teeth (18), two new complete dentures were fabricated. Thereafter, 6 diameter reduced mini implants (SLA® one-piece self-tapping Straumann® Mini Implants made of Roxolid®, with a diameter of 2.4 mm and a length of 10 mm) were inserted in the maxilla, and 4 mini implants (SLA® one-piece self-tapping Straumann® Mini Implants made of Roxolid®, with a diameter of 2.4 mm and a length of 10 mm) were inserted in the mandible. After the implant insertion with good primary stability, the two new complete dentures were transferred into two implant-supported removable dental prostheses and retained by means of the transmucosal integrated attachment system of the mini implants (Optiloc®). At the 3-month follow-up visit, the patient was very satisfied with the outcomes, both from a functional and aesthetic point of view.

Smile reconstruction is achieved using rigorous and detailed methodologies that are technically demanding and both time and cost intensive. These methodologies do not include the patient during the primary conception phase. New digital technologies using augmented reality (AR) offer the option of immediate diagnosis and pre-visualization of the potential outcome before the start of treatment. A 22-year-old patient with a congenitally missing maxillary right canine, peg-shaped maxillary lateral incisors, and multiple visible diastemas required an esthetic rehabilitation. An AR virtual mock-up using specialized software was used to preview and modify the restoration proposal in real time. Using the novel 'CAD-link' workflow, the final AR proposal could be imported into CAD software and transformed into a digital wax-up with the new virtual wax copy function. After a minimally invasive preparation, the final veneer reconstructions were precisely planned according to the previously developed design proposal and bonded according to the well-known adhesive protocol. The workflow described in this article links AR with CAD/CAM technology and is expected to be time and cost efficient. This patient-centered approach involves the patient from the very beginning and is therefore an excellent communication tool between the patient and the restorative team.

PURPOSE To evaluate the influence of different cements on the color outcomes of CAD/CAM lithium-disilicate implant crowns cemented to titanium-base abutments utilizing spectrophotometric analysis. MATERIALS AND METHODS A clinical situation with a missing lateral incisor was mimicked using a maxillary plastic model. Titanium-base-supported monolithic lithium disilicate crowns with identical designs were fabricated using a laboratory CAD/CAM system. The crowns were cemented with three provisional cements and with six definitive cements on both nonsandblasted and sandblasted titanium-base abutments for a total of 15 test groups. As a control group, identical crowns were attached with try-in paste on composite die abutments that duplicated the shape of the titanium-base abutments. The colors of the labial surfaces of the crowns and the peri-implant artificial soft tissue were measured with a spectrophotometer and recorded in CIE L*a*b* parameters. Color differences between the test and control groups were calculated as: ΔE = ([ΔL*]2 + [Δa*]2 + [Δb*]2)1/2. Kruskal-Wallis test was used to compare ΔE values across different groups. RESULTS The median ΔE values reported for crowns cemented with different definitive cements on titanium-base abutments ranged from 1.4 to 2.9 for the crown surface and from 1.7 to 1.9 on the peri-implant artificial soft tissue; when the titanium-base abutments were sandblasted, the respective median ΔE values ranged from 0.8 to 4.0 and from 1.4 to 2.2. Ceramic crowns cemented with Multilink HO 0 cement presented significantly (P < .01) lower ΔE values than the other cement types for the crown surface independent of sandblasting and for the artificial soft tissue surface when the titanium abutments were sandblasted (P = .011). CONCLUSION Within the limitations of this study, Multilink HO 0 (Ivoclar Vivadent) cement showed the most favorable masking ability and the most favorable color outcome among the evaluated definitive cements. Cements of more opaque shades appeared in general to be more favorable in terms of masking the gray color of the titanium-base abutments.

BACKGROUND There is limited knowledge regarding the strength of zirconia abutments with internal and external implant abutment connections and zirconia abutments supported by a titanium resin base (Variobase, Straumann) for narrow diameter implants. OBJECTIVES To compare the fracture strength of narrow diameter abutments with different types of implant abutment connections after chewing simulation. MATERIAL AND METHODS Hundred and twenty identical customized abutments with different materials and implant abutment connections were fabricated for five groups: 1-piece zirconia abutment with internal connection (T1, Cares-abutment-Straumann BL-NC implant, Straumann Switzerland), 1-piece zirconia abutment with external hex connection (T2, Procera abutment-Branemark NP implant, Nobel Biocare, Sweden), 2-piece zirconia abutments with metallic insert for internal connection (T3, Procera abutment-Replace NP implant, Nobel Biocare), 2-piece zirconia abutment on titanium resin base (T4, LavaPlus abutment-VarioBase-Straumann BL-NC implant, 3M ESPE, Germany) and 1-piece titanium abutment with internal connection (C, Cares-abutment-Straumann BL-NC implant, Straumann, Switzerland). All implants had a narrow diameter ranging from 3.3 to 3.5 mm. Sixty un-restored abutments and 60 abutments restored with glass-ceramic crowns were tested. Mean bending moments were compared using ANOVA with p-values adjusted for multiple comparisons using Tukey's procedure. RESULTS The mean bending moments were 521 ± 33 Ncm (T4), 404 ± 36 Ncm (C), 311 ± 106 Ncm (T1) 265 ± 22 Ncm (T3) and 225 ± 29 (T2) for un-restored abutments and 278 ± 84 Ncm (T4), 302 ± 170 Ncm (C), 190 ± 55 Ncm (T1) 80 ± 102 Ncm (T3) and 125 ± 57 (T2) for restored abutments. For un-restored abutments, C and T4 had similar mean bending moments, significantly higher than those of the three other groups (p

The aim of this study was to examine 10 different shades of pink ceramic to determine which one best matches the mean color of human gingiva. Bar-shaped zirconia samples were fabricated and veneered with 1 of 10 pink zirconia veneering ceramics. The color of the gingiva at the central maxillary incisors of 20 healthy volunteers was compared to the pink veneering ceramics using a spectrophotometer (Spectroshade, MHT). The obtained color parameters L*, a*, and b* (CIELAB) of the gingiva and the ceramics were used to calculate the color difference (ΔE). Mean ΔE values were descriptively analyzed and compared to the threshold value for visibility of color differences of gingiva (ΔE = 3.1). The lowest pink ceramic ΔE value obtained (closest to the mean ΔE of all the volunteers' gingiva) was 6.2. All the tested ceramics exhibited a color difference above the threshold value for visibility.

To evaluate the bending moments and failure modes of zirconia meso-abutments bonded to titanium bases restored with different monolithic all-ceramic crowns after aging, and to compare them to titanium abutments restored with all-ceramic crowns.Forty-eight internal conical connection implants (Conelog, Camlog 4.3 mm diameter) were restored with four different computer-aided design/computed-aided manufacturing (CAD/CAM) abutment-crown combinations (n = 12). Thirty-six customized zirconia meso-abutments were bonded to titanium bases (Conelog Titanium Base CAD/CAM crown, Camlog) and divided into three groups according to the different crown materials: (T1) monolithic lithium-disilicate (e-max CAD, Ivoclar), (T2) monolithic PICN (polymer-infiltrated ceramic network [Enamic, Vita]), and (T3) monolithic zirconia (Lava Plus, 3M ESPE). Twelve titanium customized abutments restored with monolithic lithium-disilicate (e-max CAD, Ivoclar) crowns served as the control group (C). The crowns were equal maxillary central incisors and were adhesively bonded with a resin-based cement (Panavia 21, Kuraray). All samples were embedded in acrylic holders. After aging (1,200,000 cycles, 49 N, 1.67 Hz, 5°C to 50°C, 120 seconds), static load was applied until failure. Bending moments were calculated for comparison of the groups. Data were statistically treated with one-way analysis of variance (ANOVA) followed by Tukey post hoc test (P.05). Failure modes were analyzed descriptively.The means of the bending moments were 356.4 ± 20.8 Ncm (T1), 357.7 ± 26.3 Ncm (T2), 385.5 ± 21.2 Ncm (T3), and 358.8 ± 25.3 Ncm (C). Group T3 revealed significantly higher mean bending moments than the other groups (P.05). No differences were found between zirconia meso-abutments supported by titanium bases and customized titanium abutments when lithium-disilicate crowns were used (P.05). No failures were identified during and after aging. After static load, failures occurred due to fracture of the abutment in the internal connection in all the groups.Zirconia meso-abutments bonded to titanium bases showed similar mechanical stability compared with customized titanium abutments. Regarding the crown material, all three tested ceramics (lithium-disilicate, PICN, and zirconia) revealed very good stability when used in the monolithic state.

Statement of problem Three-dimensional visualization for pretreatment diagnostics and treatment planning is necessary for surgical and prosthetic rehabilitations. The reliability of a novel 3D facial camera is unclear. Purpose The purpose of this clinical study was to evaluate the reliability of a novel medical facial camera system in capturing the 3D geometry of the face in a single exposure. Material and methods Twelve edentulous participants (7 women and 5 men; mean age: 74.6 years) were included, and digital images for facial reconstruction were captured using a custom-made static capturing system (Medusa Static; Disney Research Zurich). Eight extraoral soft-tissue facial landmarks were identified, which included the right outer canthus (OCR), left outer canthus (OCL), right cheilion (CmR), left cheilion (CmL), pronasale nostril tip, subnasale, philtrum, and gnathion (GN). Interlandmark distances of OCR-OCL, OCR-CmR, OCL-CmL, OCR-GN, OCL-GN, CmR-CmL, pronasale nostril tip–GN, and subnasale-GN were measured clinically and then on the 3D digital reconstructions. The absolute differences between the digital and clinical measurements were recorded. The intraclass correlation coefficient was applied to evaluate the reliability of digital measurement and interexaminer reliability. Results The mean ±standard deviation difference between the clinical and digital measurements was 1.95 ±0.33 mm. Intraclass correlation coefficients computed for the 2 examiners against clinical measurements were all above 0.5. The interexaminer reliability coefficient of digital measurement was above 0.909. Conclusions The 3D facial geometry obtained from the novel medical facial camera system was found to be reliable and clinically acceptable. Inconsistencies in measurements for a few specific facial landmarks may arise, but these can be avoided by thorough examiner calibration before undertaking the digital measurements.

The recent evolution of digital technologies in dentistry has enabled virtual 3D diagnostic analysis of a dentition before treatment, allowing for virtual, minimally invasive treatment planning. In this report, an extensively worn dentition was 3D virtual analyzed at an increased vertical dimension of occlusion. Virtual waxing (exocad DentalCAD; Exocad) and subsequent analysis of the need for minimally invasive preparations were performed. Areas of each tooth without adequate clearance for the minimal thickness of a definitive restoration (set at 1.5 mm in the software), including the amount of tooth substance to be removed (GOM Inspect; GOM), were visualized in color. A preparation guide was virtually designed according to this diagnostic plan (3-matic; Materialise) and 3D printed (Connex3 Objet260; Stratasys) from resin (VeroMagenta RGD851; Stratasys). The teeth were minimally prepared using the guide, and the amount of preparation was validated by superimposing the scan of the prepared model on the initial scan and comparing it with the diagnostic plan.

The development of titanium bonding bases allows for the use of implant-supported monolithic reconstructions in a digital workflow. Different base configurations are available according to each clinical indication. In this case report, the selection of titanium bonding bases for crowns was considered for a multiple-unit fixed dental prosthesis (FDP).

OBJECTIVES: Working Group 5 was assigned the task to review the current knowledge in the area of digital technologies. Focused questions on accuracy of linear measurements when using CBCT, digital vs. conventional implant planning, using digital vs. conventional impressions and assessing the accuracy of static computer-aided implant surgery (s-CAIS) and patient-related outcome measurements when using s-CAIS were addressed. MATERIALS AND METHODS: The literature was systematically searched, and in total, 232 articles were selected and critically reviewed following PRISMA guidelines. Four systematic reviews were produced in the four subject areas and amply discussed in the group. After emendation, they were presented to the plenary where after further modification, they were accepted. RESULTS: Static computer-aided surgery (s-CAIS), in terms of pain & discomfort, economics and intraoperative complications, is beneficial compared with conventional implant surgery. When using s-CAIS in partially edentulous cases, a higher level of accuracy can be achieved when compared to fully edentulous cases. When using an intraoral scanner in edentulous cases, the results are dependent on the protocol that has been followed. The accuracy of measurements on CBCT scans is software dependent. CONCLUSIONS: Because the precision intraoral scans and of measurements on CBCT scans and is not high enough to allow for the required accuracy, s-CAIS should be considered as an additional tool for comprehensive diagnosis, treatment planning, and surgical procedures. Flapless s-CAIS can lead to implant placement outside of the zone of keratinized mucosa and thus must be executed with utmost care. ispartof: CLINICAL ORAL IMPLANTS RESEARCH vol:29 pages:436-442 ispartof: location:Denmark status: published

PURPOSE This study aims to test whether or not veneering of the submucosal part of zirconia abutments with pink dental ceramic affects radiographic and technical outcomes of implant-supported single crowns (ISSC). MATERIALS AND METHODS Single tooth implants were randomly restored with either pink-veneered zirconia abutments (test; n = 10) or non-veneered zirconia abutments (control group; n = 10) and all-ceramic crowns. At baseline (crown insertion), and 6- and 12-month radiographic and technical evaluations were performed including standardized x-rays and modified United States Public Health Service criteria (technical). Survival and complication rates were assessed for implants and restorations. Robust linear mixed model analysis was performed to investigate the effect of group and time-point on radiographic outcomes. RESULTS At 1 year, the survival rate for implants was 100% and 95% for ISSC. Most of the implants were placed subcrestally. Therefore, mean marginal bone levels decreased in both groups between implant insertion and baseline (p .005). At 6 months, one minor chipping occurred in the test group. At 1 year, three crowns (control) exhibited occlusal roughness. In addition, one abutment fracture occurred (test). The differences between test and control group were not statistically significantly different for any of the evaluated outcome measures (p > .05). CONCLUSIONS Veneering of the submucosal part of zirconia abutments did not affect biological and technical outcomes of ISSCs. Technical complications of the reconstructions, however, were frequent, resulting in a rate of 75% of the crowns being complication free.

Statement of problem An evaluation of user satisfaction and image quality of a novel handheld purpose-built mobile camera system for 3-dimensional (3D) facial acquisition is lacking. Purpose The purpose of this pilot clinical study was to assess and compare the effectiveness between a handheld mobile camera system designed for facial acquisition and a fixed static camera arrangement by comparing the time effectiveness and the operator and participant preference for the 2 techniques of image capture. Material and methods Completely edentulous participants (n=12: women=7, men=5; mean age: 74.6 years) were included in this pilot study. Images were captured with and without the prostheses in situ while maintaining “serious” and “full-smile” facial expressions. Images were captured using a mobile and a static system. The working times for the participant installation and image captures were recorded. Operator and participant perceptions of the entire experience were recorded by using visual analog scale questionnaires. Nonparametric tests were used for statistical analyses (α=.05). Results The installation time was significantly shorter for the mobile system (static=24 ±13 seconds; mobile=10 ±10 seconds), but the differences in the image capture times were not statistically significant (static: 29 ±5 seconds; mobile: 40 ±18 seconds). Operator preference was in favor of the mobile system with regard to working time (P=.002), difficulty in using (installation: P=.002; handling: P=.045), and camera weight (P=.002); however, they preferred the static arrangement for image quality (P=.003) and comfort (P=.013). The participants rated the entire photographic experience favorably, and 10 of 12 participants preferred the static camera over the mobile one. Conclusions Despite the complexity of the installation, the static system was evaluated better for image quality; the mobile system was easier in installation and handling. The operators preferred the mobile system, and the participants preferred the static system.

Adhesive cementation is a useful procedure not only for cementing restorations onto teeth but also for attaching new ceramic restorations to existing restorations to improve their esthetics and/or function. This clinical report presents a technique for modifying an existing nonsatisfactory implant-supported fixed dental prosthesis by means of adhesively cemented veneers and onlays bonded to the pre-existing metal-ceramic surface with resin cement. This modification may avoid the replacement of the fixed dental prosthesis, reducing both treatment costs and time while fulfilling the patient's demands.

To test whether or not pink veneering of the submucosal part of zirconia abutments influences clinical, microbiological and histological outcomes of cemented implant-supported single crowns (ISSC).A total of 20 patients with one single-tooth implant in the esthetic zone were included. Implants were randomly restored with either pink-veneered zirconia abutments (test group; n = 10) or non-veneered white zirconia abutments (control group; n = 10) and with adhesively cemented all-ceramic crowns. At the 6-month follow-up, soft tissue biopsies were prepared for histological evaluation and microbiological samples were collected around abutments and the respective contra-lateral teeth (in 10 of 20 patients). One year after the initiation of loading, clinical parameters were assessed. Robust linear mixed model and cumulative linked mixed model analyses were performed to investigate the effect of group and time-point on clinical and biological outcomes.Clinical evaluations revealed stable peri-implant soft tissues in terms of probing pocket depth, but a high BOP index (87.5% control; 80.0% test). No statistically significant differences were observed between the test and control group for any outcome measure (P 0.05). No major biological complications occurred during the observation period. Histological samples revealed a remarkable degree of inflammation in both groups without clear differences in qualitative histological features. Microbiological evaluation demonstrated a slightly higher bacterial count at implants compared to natural teeth at one year of loading without marked differences between groups.Limited by a small sample size and a relatively short observation period, pink-veneered zirconia abutments exhibited similar clinical, histological and microbiological outcomes as non-veneered zirconia abutments supporting cemented single crowns.

OBJECTIVES To evaluate the discoloration of the mucosa caused by different ceramic and metal-based materials. MATERIAL AND METHODS On six pig maxillae, trap-door flaps were prepared bilaterally. Different ceramic and metal-based specimens were placed underneath the flap. To simulate increasing mucosal thicknesses (MC), connective tissue grafts (CTGs) were harvested. Spectrophotometric measurements were performed prior to flap elevation (TBL ) and for each material under the flap alone (1 mm MC) (TMC1 ), with a 1-mm CTG (2-mm MC) (TMC2 ) and with a 2-mm CTG (3-mm MC) (TMC3 ). Tested materials were as follows: Zr1 (zirconia), Zr2 (zirconia + pink ceramic), Zr3 (zirconia), Zr4 (fluorescent zirconia), Zr5 (zirconia), Zr6 (high translucent zirconia), Zr7 (low translucent zirconia) and Zr8 (low translucent zirconia), Gol (gold alloy), Ti1 (titanium alloy), Ti2 (anodized gold-shaded titanium alloy) and Ti3 (anodized pink-shaded titanium alloy). Color differences (ΔE) were calculated comparing the measurement of the native tissue (TBL ) and the measurements with varying mucosal thicknesses (TMC1-3 ). RESULTS For ceramic materials, the median ΔE values for the different time-point comparison ranged as follows: 3.80 (Zr4) - 7.47 (Zr2) (pooled); 3.15 (Zr4) - 8.13 (Zr2) (TBL -TMC1 ); 3.39 (Zr4) - 7.24 (Zr2) (TBL -TMC2 ); 4.31 (Zr8) - 6.99 (Zr2) (TBL -TMC3 ). For metal-based materials, the median ΔE values were as follows: 4.20 (Gol) - 5.82 (Ti3) (pooled); 3.21 (Gol) - 13.56 (Ti1) (TBL -TCM1 ); 4.0 (Ti1) - 5.27 (Gol) (TBL -TCM2 ); 3.11 (Ti1) - 5.11 (Gol) (TBL -TCM2 ). The comparison of the materials and the time points showed in the nonparametric linear mixed model a significant interaction effect between material and time point (P < 0.001). The side was not a significant main effect, nor as term in an interaction with the other two effects. CONCLUSIONS Reconstructive materials result in an evident discoloration of the mucosal tissue, tending to decrease with increasing mucosal thickness. The use of fluorescent zirconia (ceramic materials) or gold alloy (metal-based materials) lead to the least discoloration.