The International Journal of Prosthodontics, 05/2014

This letter seeks to clarify an issue discussed in the recent systematic review entitled, "Should Occlusal Splints Be a Routine Prescription for Diagnosed Bruxers Undergoing Implant Therapy," by Mesko ME, Almeida RC, Porto JA, Koller CD, da Rosa WL, Boscato N (Int J Prosthodont 2014;27:201-203). I would like to congratulate my colleagues for addressing this topic and agree with their statement that more and better studies on the relationship between implant failures and bruxism are needed. I also endorse their conclusion that occlusal splints should not be routinely prescribed for all patients who have implant-supported prostheses while pointing out that similar conclusions are reported in a previous topic review.

This article describes a unique prosthetically driven protocol that uses computeraided engineering to develop sophisticated, scientific algorithms that guide the fabrication of a conversion denture using the AvaDent Digital Denture system (Global Dental Science). This system is combined with NobelClinician (Nobel Biocare) implant-planning software to optimize accuracy and to make it easier and faster to convert a denture to an immediately loaded provisional implantsupported fixed complete denture following implant placement, using a NobelGuide surgical template.

Purpose: To evaluate the survival of maxillary anterior cantilever resin-bonded metalceramic (MC) and all-ceramic (AC) fixed dental prostheses (RBFDPs). Materials and Methods: Between August 2007 and December 2009, 40 patients received 40 RBFDPs made of either cobalt-chromium-ceramic (n = 20) or glass-infiltrated alumina (In-Ceram, Vident; n = 20) and were followed up until December 2012. Restorations were adhesively cemented (Panavia 21, Kuraray). Results: Two fractures were observed with AC. No debondings were observed with MC (n = 0) but were observed with AC (n = 3). The difference in survival rates of MC and AC was not significant (MC: 100%; AC: 90%; P = .15) (Kaplan-Meier method, confidence interval = 95%). Conclusions: Cantilever AC RBFDPs could be a promising alternative to MC RBFDPs for replacement of missing anterior incisors, provided that no mechanical complications were experienced with the latter.

Purpose: To compare single-application fluoride formulations on enamel erosion and erosion-abrasion in vitro. Materials and Methods: Enamel specimens were pretreated with either sodium, tin, titanium, or sodium/calcium fluoride and subjected to either an erosion model or an erosion-abrasion model, after which optical profilometry was used to measure enamel step height loss. Results: For erosion, the titanium fluoride (P < .001) reduced enamel loss, whereas the calcium, tin, and sodium treatments showed no significant effects (P > .05). For erosion-abrasion, the titanium fluoride increased enamel loss in comparison to control (P < .001). Conclusions: Titanium fluoride has differing effects on enamel loss from erosion and erosionabrasion models.

Purpose: Confidence intervals (CIs) are integral to the interpretation of the precision and clinical relevance of research findings. The aim of this study was to ascertain the frequency of reporting of CIs in leading prosthodontic and dental implantology journals and to explore possible factors associated with improved reporting. Materials and Methods: Thirty issues of nine journals in prosthodontics and implant dentistry were accessed, covering the years 2005 to 2012: The Journal of Prosthetic Dentistry, Journal of Oral Rehabilitation, The International Journal of Prosthodontics, The International Journal of Periodontics & Restorative Dentistry, Clinical Oral Implants Research, Clinical Implant Dentistry and Related Research, The International Journal of Oral & Maxillofacial Implants, Implant Dentistry, and Journal of Dentistry. Articles were screened and the reporting of CIs and P values recorded. Other information including study design, region of authorship, involvement of methodologists, and ethical approval was also obtained. Univariable and multivariable logistic regression was used to identify characteristics associated with reporting of CIs. Results: Interrater agreement for the data extraction performed was excellent (kappa = 0.88; 95% CI: 0.87 to 0.89). CI reporting was limited, with mean reporting across journals of 14%. CI reporting was associated with journal type, study design, and involvement of a methodologist or statistician. Conclusions: Reporting of CI in implant dentistry and prosthodontic journals requires improvement. Improved reporting will aid appraisal of the clinical relevance of research findings by providing a range of values within which the effect size lies, thus giving the end user the opportunity to interpret the results in relation to clinical practice.

Purpose: The purpose of this study was to compare the capacity of different impression materials to accurately reproduce the positions of five implant analogs on a master model by comparing the resulting cast with the stainless steel master model. The study was motivated by the knowledge that distortions can occur during impression making and the pouring of casts and that this distortion may produce inaccuracies of subsequent restorations, especially long-span castings for implant superstructures. Materials and Methods: The master model was a stainless steel model with five implant analogs. The impression materials used were impression plaster (Plastogum, Harry J Bosworth), a polyether (Impregum Penta, 3M ESPE), and two polyvinyl siloxane (PVS) materials (Aquasil Monophase and Aquasil putty with light-body wash, Dentsply). Five impressions were made with each impression material and cast in die stone under strictly controlled laboratory conditions. The positions of the implants on the master model, the impression copings, and the implant analogs in the subsequent casts were measured using a coordinate measuring machine that measures within 4 μm of accuracy. Results: Statistical analyses indicated that distortion occurred in all of the impression materials, but inconsistently. The PVS monophase material reproduced the master model most accurately. Although there was no significant distortion between the impressions and the master model or between the impressions and their casts, there were distortions between the master model and the master casts, which highlighted the cumulative effects of the distortions. The polyether material proved to be the most reliable in terms of predictability. The impression plaster displayed cumulative distortion, and the PVS putty with light body showed the least reliability. Conclusions: Some of the distortions observed are of clinical significance and likely to contribute to a lack of passive fit of any superstructure. The inaccuracy of these analog materials and procedures suggested that greater predictability may lie in digital technology.

Congenital or acquired maxillary defects cause various esthetic and functional problems. Maxillary deficiency can be prosthetically restored with an obturator. Computer-aided design/computer-assisted manufacture technology, which had been used exclusively in fixed prosthodontics, is now being more widely used in other fields, including removable prosthodontics, after the introduction of software and availability of a comprehensive solution for designing and manufacturing a removable partial denture (RPD). The rapid prototyping (RP) technique enables precise fabrication of the RPD framework in a shorter time period compared to conventional methods. This case report describes the fabrication of an obturator using the RP technique in a patient who underwent hemimaxillectomy of the soft palate.

Purpose: The aims of this study were to (1) establish a biomechanical model that simulates the full-arch restoration supported by immediately loaded implants, which is customized for individual patients, and (2) clarify the effect of the implant placement and rigidity of a provisional restoration on the biomechanical response at the bone-implant interface. Materials and Methods: Three-dimensional finite element analysis models of a maxillary full-arch prosthesis supported by four immediately loaded implants were created from computed tomography data of maxillary edentulous patients. Displacements of the implants and equivalent stress on the bone around the implants under the loading conditions that simulated sleep bruxism were then calculated for these models. The effects of the implant placement angle (vertical or inclined), the reinforcement of the provisional restoration (with or without reinforcement), and the implant length on the maximum displacements of each implant were investigated, in addition to the average equivalent stress of the bone around the implant. Results: A longer implant and rigid restoration with reinforcement have the potential to reduce implant displacements and associated bone stress; however, the rigidity of the restoration had a much more significant effect on these parameters. Conclusions: The rigidity of full-arch provisional restorations supported by four immediately loaded implants should be improved by reinforcements, which could ensure the successful achievement of osseointegration by reducing load-induced micromovements of the implants.

Purpose: People with hemifacial microsomia may be missing an ear on the affected side of the face. The principal aim of the study was to develop a morphing technique and to determine whether it could be used to appropriately position an artificial ear, as well as to give an indication of prosthesis size in comparison with the natural ear. Comparisons also were made between the artificial ears being worn by the patients with their natural ears. Materials and Methods: Data from stereophotogrammetry images of the faces of 10 people were converted into stereolithographic format. Anthropometric points on the face and ear of the unaffected side were plotted. By a process of scaling, the distance between facial landmarks on the unaffected side was estimated for the affected side so as to identify where the morphed ear would be positioned once generated. Results: Generally, the morphed ears appeared to be in acceptable positions. There was a statistically significant difference between the position of the morphed and natural ears (P = .011), as well as the artificial and natural ears (P = .001), but this was unlikely to have any clinical implications. There were no significant differences among the sizes of the natural, morphed, and artificial ears (P = .072). Conclusions: Morphing appears to offer a more precise way of planning the positioning and construction of an artificial ear on patients with hemifacial microsomia than traditional methods. Differences in facial shape on either side of the face may impact on the process. This requires further study.

Purpose: The purpose of this study was to examine the relationship between skin color (shade) and tooth shade under standard and nonstandard illumination sources. Materials and Methods: Four hundred Jordanian participants (200 males, 200 females, 20 to 50 years of age) were studied. Skin colors were assessed and categorized using the L'Oreal and Revlon foundation shade guides (light, medium, dark). The Vita Pan Classical Shade Guide (VPCSG; Vident) and digital Vita EasyShade Intraoral Dental Spectrophotometer (VESIDS; Vident) were used to select shades in the middle thirds of maxillary central incisors; tooth shades were classified into four categories (highest, high, medium, low). Results: Significant gender differences were observed for skin colors (P = .000) and tooth shade guide systems (P = .001 and .050 for VPCSG and VESIDS, respectively). The observed agreement was 100% and 93% for skin and tooth shade guides, respectively. The corresponding kappa statistic values were 1.00 and 0.79, respectively (substantial agreement, P < .001). The observed agreement between skin color and tooth shades (VPCSG and VESIDS) was approximately 50%. Conclusions: The digital tooth shade guide system can be a satisfactory substitute for classical tooth shade guides and clinical shade matching. There was only moderate agreement between skin color and tooth shade.

Purpose: The purpose of this study was to determine the prosthodontic outcomes of one-piece zirconia implants and their attachment systems in edentulous participants with maxillary and mandibular overdentures after 1 year of a randomized controlled trial. Materials and Methods: Random allocation of 24 edentulous participants (age range: 45 to 86 years) into titanium (control) or zirconia (test) groups using onepiece implants and a planned unsplinted prosthodontic design was performed. Four maxillary implants (one midpalatal; three anterior crestal) and three mandibular implants (one midsymphyseal; two bilateral distal) were conventionally loaded with the overdentures. Similar attachment systems were used throughout: ball abutment-type patrices (diameter: 2.25 to 3.1 mm as part of the one-piece implants) and custommade plastic matrices (with or without metal housings depending on the patrix size). Prosthodontic outcomes were documented during the first year of the clinical trial. Results: Following three deaths and two dropouts, there were 19 participants who were available at the 1-year recall. Of these participants, 3 had early maxillary implant failure and had to be converted to conventional maxillary complete dentures opposing mandibular implant overdentures. There were 79 maintenance events, 34 in the titanium (control) group and 45 in the zirconia (test) group. Patrix loss occurred as a result of three zirconia implant fractures (one mandibular and two crestal maxillary implants). Maintenance events were principally the replacement of matrices and overdenture fracture. Although relines and replacement overdentures also occurred, overall there were no significant differences in prosthodontic maintenance between the control and test groups. A six-field prosthodontic-success analysis table showed no statistically significant difference between the two groups; however, 50% of participants in each group were allocated to the retreatment (repair) field, which produced a low prosthodontic success rate. Conclusions: Removable overdentures can be used on both one-piece titanium and zirconia implants with these attachment systems, due to no difference in prosthodontic maintenance and success. Before recommending routine use of a "metal-free" overdenture treatment option in clinical practice, consideration must be given to the success of the implants themselves.

This study aimed to investigate the pressure distribution beneath the denture bases of removable partial dentures (RPDs) with different occlusal rest designs (ORDs) by in vivo measurement. Four types of detachable occlusal rests (mesial and distal, distal, mesial, and nonrest) were placed on the direct abutment teeth of distal extension RPDs in four patients with free-end edentulous mandibles. Pressure measurements were obtained by using thin and flexible tactile sensors. The results showed significant variances with different ORDs in all four patients (P < .05), leading to the conclusion that the pressure distribution on the residual ridge beneath the RPD base was dependent on the ORD.

The relationship of the convergence angle (CA) to the height of the axial walls is the most important factor for providing retention and resistance in tooth preparation for a complete crown. Several studies have shown that the ideal CA is difficult to achieve in clinical practice. The technique described in this article allows for the determination of the CA during the tooth preparation procedure, based on an instrument developed and created by the authors.

One of the purposes of prosthodontic treatment is to prevent overeruption of opposing teeth, but there is currently minimal literature describing the efficacy of removable partial dentures (RPDs) in performing this function. This study investigated overeruption following RPD treatment. The study participants were 33 patients treated with RPDs, and overeruption was evaluated by comparing the surface computeraided design data of dental casts made at two different time points-before and after RPD treatment. Overeruption was observed in 38.1% of teeth opposed by the RPD, which was much less than the proportion of teeth that overerupted when not opposed by the RPD.

This study assessed whether buccopalatal implant position, biotype, platform switching, and pre-implant bone augmentation affects the level of the midbuccal mucosa (MBM). Ninety patients with a single-tooth implant in the esthetic zone were included. The level of the MBM was measured on photographs taken 1 year after crown placement. The factors analyzed only explained 22% of the level of the MBM. The more an implant was placed to the buccal, the more the MBM was positioned apically. A comparable phenomenon was observed in cases with a thick biotype and cases that underwent pre-implant bone augmentation. Platform switching did not affect the level of the MBM.

Purpose: To establish an alternative method to design and fabricate an obturator prosthesis within the maxillectomy defect using a computer-aided design (CAD) and rapid prototyping (RP) technique and to evaluate the functional results of this technique. Materials and Methods: Eleven patients with acquired maxillary defects resulting from head and neck cancers were treated using a protocol based on threedimensional (3D) reconstruction, CAD, and RP technologies to fabricate obturator prostheses. To evaluate the quality of the obturator prostheses and the patients' satisfaction, the Obturator Functioning Scale (OFS) of the Memorial Sloan-Kettering Cancer Center was applied. Results: Each patient received an individualized obturator that exactly matched the static shape and fit of the defect. Clinical modifications were required to improve border contours. The patients showed good results in all fields of functional outcomes and social acceptance. The OFS scores were comparable with those reported in other studies using traditional maxillectomy impression methods. Conclusions: This study combined CAD with RP technology to explore an alternative and feasible method for manufacturing individualized obturators for patients after maxillary resection. It has shown significant clinical value, especially for use in developing countries.