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    Enhanced Antibacterial Effect on Zirconia Implant Abutment by Silver Linear-Beam Ion Implantation
    (MDPI, 2023-01-13) Yang, Yang; Liu, Mingyue; Yang, Zhen; Lin, Wei-Shao; Chen, Li; Tan, Jianguo; Prosthodontics, School of Dentistry
    Peri-implant lesions, such as peri-implant mucositis and peri-implantitis, are bacterial-derived diseases that happen around dental implants, compromising the long-term stability and esthetics of implant restoration. Here, we report a surface-modification method on zirconia implant abutment using silver linear-beam ion implantation to reduce the bacterial growth around the implant site, thereby decreasing the prevalence of peri-implant lesions. The surface characteristics of zirconia after ion implantation was evaluated using energy dispersive spectroscopy, X-ray photoelectron spectroscopy, and a contact-angle device. The antibacterial properties of implanted zirconia were evaluated using Streptococcus mutans and Porphyromonas gingivalis. The biocompatibility of the material surface was evaluated using human gingival fibroblasts. Our study shows that the zirconia surface was successfully modified with silver nanoparticles by using the ion-implantation method. The surface modification remained stable, and the silver-ion elution was below 1 ppm after one-month of storage. The modified surface can effectively eliminate bacterial growth, while the normal gingiva’s cell growth is not interfered with. The results of the study demonstrate that a silver-ion-implanted zirconia surface possesses good antibacterial properties and good biocompatibility. The surface modification using silver-ion implantation is a promising method for future usage.
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    Bead-anchored surgical templates for static computer-assisted implant surgery: A dental technique
    (Wiley, 2022-10) Orgev, Ahmet; Pellerito, John; Polido, Waldemar; Morton, Dean; Lin, Wei-Shao; Prosthodontics, School of Dentistry
    This technique report describes an alternative method to stabilize surgical templates throughout full-arch static computer-assisted implant surgery (FA s-CAIS). In FA s-CAIS, remaining teeth, mucosa, existing implants, custom occlusal device, bone, or any combination thereof, could be used as an initial positioning mechanism to position surgical templates. Different anchoring mechanisms are then used to stabilize the surgical templates during surgery. In this report, a novel design of surgical templates using remaining dentition and opposing occlusal surfaces as initial positioning mechanism followed by the combination of bone block fixation screw and stainless-steel beads as secondary anchoring mechanisms is described. The advantages, limitations, and comparisons with surgical templates using other anchoring mechanisms are also discussed.
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    The effects of manufacturing technologies on the surface accuracy of CAD-CAM occlusal splints
    (Wiley, 2022) Orgev, Ahmet; Levon, John A.; Chu, Tien-Min G.; Morton, Dean; Lin, Wei-Shao; Prosthodontics, School of Dentistry
    Purpose To investigate the effects of the manufacturing technologies on the surface (cameo and intaglio) accuracy (trueness and precision) of computer-aided design and computer-aided manufacturing (CAD-CAM) occlusal splints. Materials and methods The digital design of the master occlusal splint was designed in a CAD software program. Six groups (n = 10) were tested in this study, including Group 1 – Milling (Wax), Group 2 – Heat-polymerizing, Group 3 – Milling (M series), Group 4 – Milling (DWX-51/52D), Group 5 – 3D-printing (Cares P30), and Group 6 – 3D-printing (M2). The study samples were placed in a scanning jig fabricated from putty silicone and Type III dental stone. The study samples were then scanned with a laboratory scanner at the intaglio and cameo surfaces, and the scanned files were exported in standard tessellation language (STL) file format. The master occlusal splint STL file, was used as a reference to compare with all scanned samples at the intaglio and cameo surfaces in a surface matching software program. Root mean square (RMS, measured in mm, absolute value) values were calculated by the software for accuracy comparisons. Group means were used as the representation of trueness, and the standard deviation for each group was calculated as a measure of precision. Color maps were recorded to visualize the areas of deviation between study samples and the master occlusal splint file. The data were normalized and transformed to rank scores, and one-way ANOVA was used to test for the differences between the groups. Pairwise comparisons were made between different groups. Fishers least square differences were used to account for the family-wise error rate. A 5% significance level was used for all the tests. Results The null hypotheses were rejected. The manufacturing technologies significantly affected the trueness of occlusal splints at both intaglio and cameo surfaces (p < 0.001). At the cameo surfaces, Group 1 – Milling (Wax) (0.03 ± 0.02 mm), Group 3 – Milling (M series) (0.04 ± 0.01 mm), and Group 4 – Milling (DWX-51/52D) (0.04 ± 0.01 mm) had the smallest mean RMS values and highest trueness. Group 3 had the smallest standard deviation and highest precision among all groups (p < 0.001, except p = 0.005 when compared with Group 2). Group 5 had the largest standard deviation and lowest precision among all groups (p < 0.001). At the intaglio surfaces, Group 1 – Milling (Wax) (0.06 ± 0.01 mm) had the smallest RMS values and highest trueness among all groups (p < 0.001), and Group 2 – Heat-polymerizing (0.20 ± 0.03 mm) and Group 5 – 3D-printing (Cares P30) (0.15 ± 0.05 mm) had significantly larger mean RMS and standard deviation values than all other groups (p < 0.001), with lowest trueness and precision. In the color maps, Group 2 – Heat-polymerizing and Group 5 – 3D-printing (Cares P30) showed the most discrepancies with yellow and red (positive discrepancies) in most areas, and Group 1 – Milling (Wax) showed the best and most uniform surface matching with the most area in green. Conclusion The manufacturing technologies significantly affected the trueness and precision of occlusal splints at both intaglio and cameo surfaces. The 5-axis milling units and industrial-level CLIP 3D-printer could be considered to achieve surface accuracy of occlusal splints.
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    The trueness of scans using one intraoral scanner in different partially edentulous conditions
    (Wiley, 2023) Majeed-Saidan, Ahmad; Dutra, Vinicius; Levon, John A.; Chu, Tien-Min G.; Morton, Dean; Alfaraj, Amal; Lin, Wei-Shao; Prosthodontics, School of Dentistry
    Purpose To investigate the trueness of intraoral scanning in 8 commonly seen partially edentulous conditions. Materials and methods A maxillary dentoform was modified into the 8 commonly seen partially edentulous conditions. Each modification was scanned with a laboratory desktop scanner. Each modification was then scanned 10 times (n = 10) with an intraoral scanner. All scans were exported as STL files and then imported into a surface matching software using the best-fit alignment method. The dimensional differences between the study STL files from the intraoral scanner were compared to the corresponding reference STL files. The measurements were calculated as the root mean square (RMS) and defined as the trueness of the intraoral scans. In addition to the RMS values, qualitative assessments were completed on the color maps. The color maps produced by the surface matching software were used to visualize the areas of deviation between scans from the intraoral scanner and their corresponding reference files. One-way analysis of variance (ANOVA), followed by pair-wise comparisons using Fisher's Protected Least Significant Difference were utilized to compare the differences between the groups in RMS values (α = 0.05). Results Partially edentulous condition significantly affected the trueness of the intraoral scans. Group 8 (Class IV) had significantly lower RMS (0.1878 ± 0.0455 mm) than all other groups (p < 0.001). Group 2 (Class II) and Group 7 (Class III modification I) are not significantly different from each other (Group 2: 0.5758 ± 0.0300 mm; Group 7: 0.5602 ± 0.0231 mm, p = 0.571), while they both had significantly higher RMS than all other groups (p < 0.001). The remaining groups showed the RMS values were within the range of 0.3001 ± 0.0891 mm (Group 6 – Class III with Long Edentulous Span) and 0.4541 ± 0.1039 mm (Group 1 – Class I). Conclusion Different partially edentulous conditions affected the trueness of the scans generated from the selected intraoral scanner. Class IV edentulous condition had the highest intraoral scan trueness. It is unknown if RMS values are clinically significant, and the validity of using intraoral scans directly for PRDP fabrication will need further studies.
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    The effects of additive manufacturing technologies and finish line designs on the trueness and dimensional stability of 3D-printed dies
    (Wiley, 2023) Lai, Yi-Cheng; Yang, Chao-Chieh; Levon, John A.; Chu, Tien-Min G.; Morton, Dean; Lin, Wei-Shao; Prosthodontics, School of Dentistry
    Purpose To evaluate the effects of 5 manufacturing technologies and 2 finish line designs on the trueness and dimensional stability of 3D-printed definitive dies at finish line regions under different storage conditions and time. Material and methods Preparation of light chamfer and round shoulder finish lines were adopted individually on two mandibular first molar typodont teeth and digitalized as standard tessellation language (STL) files. A total of 240 samples (192 AM definitive dies and 48 definitive conventional stone dies) in 20 groups (n = 12) were manufactured based on 2 finishing line designs (chamfer and shoulder), 5 manufacturing technologies (4 additively manufactured technologies and conventional stone die), and 2 storage conditions (light exposure and dark). The 4 additively manufactured (AM) technologies include a DLP 3D-printer, an economic LED 3D-printer, a CLIP 3D-printer, and an SLA 3D-printer. All the study samples were distributed into two storage conditions. Subsequently, samples were digitalized to STL files at 3 different time points (within 36 hours, 1-month, and 3-months). A surface matching software was used to superimpose the sample STL files onto the corresponding original STL files with the best-fit alignment function. The trueness of each printed and stone definitive dies and their dimensional stabilities were measured by the root mean square (RMS, in mm). A linear mixed-effects model was used to test the effects of the finish line design, manufacturing technology, storage condition, and storage time on RMS values (α = 0.05). Results While finish line designs had no significant effects [F(1, 220) = 0.85, p < 0.358], the manufacturing technologies [F(3, 220) = 33.02, p < 0.001], storage condition [F(1, 220) = 4.11, p = 0.044], and storage time F(2, 440) = 10.37, p < 0.001] affected the trueness and dimensional stability of 3D-printed dies at finish line regions. No significant interactions were found among the 4 factors. For the manufacturing technologies, Type IV stone groups and LCD 3D-printer groups had significantly higher RMS values than the other 3 printers (p < 0.001) with no significant differences between Type IV stone and LCD 3D-printer groups (p = 0.577). DLP 3D-printer groups had higher RMS values than both SLA 3D-printer groups and CLIP 3D-printer groups (p < 0.001). There were no significant differences between SLA 3D-printer groups and CLIP 3D-printer groups, p = 0.671. For the effects of storage conditions, RMS values were significantly higher in the groups stored with the direct light exposure than the ones stored in the dark, p = 0.044. In terms of the effects of storage time, the RMS values were significantly higher after 1-month storage, p = 0.002; and 3-month storage, p < 0.001, than the ones at the immediate postmanufacturing stage. However, the RMS values after 1-month and 3-month storage were not significantly different from each other (p = 0.169). Conclusions Manufacturing technologies, storage conditions, and storage time significantly affected the trueness and dimensional stability of 3D-printed dies at finish line regions, while finish line designs had no significant effects. Among the AM technologies tested, all have produced either comparable or truer 3D-printed dies than the Type IV dental stone dies, and the CLIP and SLA 3D-printers produced the best outcomes. 3D-printed dies showed significant distortion after 1-month and 3-months storage, especially under light exposure storage conditions. These findings may negate the clinical need to preserve 3D-printed dies, and digital data should be preserved instead.
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    Duplicating Complete Dentures with Conventional and Digital Methods: Comparisons of Trueness and Efficiency
    (MDPI, 2022) Chen, Li; Li, Deli; Zhou, Jianfeng; Lin, Wei-Shao; Tan, Jianguo; Prosthodontics, School of Dentistry
    Background: A complete denture (CD) can be duplicated with a conventional or digital protocol. However, there are no comparative studies of these methods. This study aimed to compare the trueness and efficiency of conventional and digital CD duplication methods. Methods: A mandibular CD was digitized as the virtual reference model and duplicated using five methods (n = 10). The trueness (root mean square (RMS)) was calculated for the whole denture and across the dentition, cameo denture extension, and intaglio portions. The manual labor time spent during denture duplication was also recorded at different steps. The trueness and labor time comparisons were statistically analyzed among the five groups (α = 0.05). Results: The conventional group was the least true with the largest RMS (mean, 95% CI) in all of the comparisons. The four digital groups yielded similar trueness values across the dentition, cameo denture extension, and intaglio areas, yet they had a significant difference in the whole denture comparison between the Digital-CBCT-SLA printer (0.17, 0.15-0.19 mm) and Digital-Laboratory Scanner-SLA printer (0.13, 0.11-0.15 mm). The conventional protocol required longer trimming and finishing time (7.55 ± 1.02 min), as well as total labor time (27.64 ± 1.72 min) than the other four digital techniques. Conclusions: The conventional CD duplication method was less true and efficient than digital techniques.
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    The Fracture Resistance of Additively Manufactured Monolithic Zirconia vs. Bi-Layered Alumina Toughened Zirconia Crowns When Cemented to Zirconia Abutments. Evaluating the Potential of 3D Printing of Ceramic Crowns: An In Vitro Study
    (MDPI, 2021-10-08) Zandinejad, Amirali; Revilla-León, Marta; Methani, Mohammad Mujtaba; Khanlar, Leila Nasiry; Morton, Dean; Prosthodontics, School of Dentistry
    (1) Background: This study compared the fracture resistance of additively manufactured monolithic zirconia and bi-layered alumina toughened zirconia crowns on implants. (2) Methods: Maxillary model with a dental implant replacing right second bicuspid was obtained. Custom abutments and full-contour crowns for additively manufactured monolithic zirconia and bi-layered alumina reinforced zirconia crowns (n = 10) were fabricated. The crowns were cemented to implant-supported zirconia abutments and the assembly fixed onto resin blocks. Fracture resistance was measured using a universal testing machine at a crosshead speed of 2 mm/min. A Kruskal-Wallis test was used to analyze the data. (3) Results: Although additively manufactured monolithic zirconia crowns demonstrated a higher mean fracture resistance than bi-layered alumina toughened zirconia crowns, statistical analysis revealed no significant difference in fracture resistance between the two groups. All specimens fractured at the implant-abutment interface. (4) Conclusions: Additively manufactured bi-layered alumina toughened zirconia crowns demonstrated similar fracture resistance to additively manufactured monolithic zirconia crowns when cemented to implant-supported zirconia abutments.
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    Pyk2 deficiency enhances bone mass during midpalatal suture expansion
    (Wiley, 2020-11) Sun, Jun; Eleniste, Pierre P.; Utreja, Achint; Turkkahraman, Hakan; Liu, Sean Shih-Yao; Bruzzaniti, Angela; Prosthodontics, School of Dentistry
    OBJECTIVE: To determine if Pyk2 deficiency increases midpalatal suture bone mass and preserves sutural integrity after maxillary expansion. SETTING AND SAMPLE: Thirty-six male Pyk2 knockout (KO) and control (WT) mice at 6 weeks of age. MATERIALS AND METHODS: Mice received nickel-titanium spring expanders delivering 0 g (no intervention control), 10 or 20 g force for 14 days. High-resolution micro-CT was used to determine bone volume/tissue volume (BV/TV), sutural width and intermolar width. Effects on osteoclasts, chondrocytes and suture morphology were determined by histomorphometry. RESULTS: Pyk2-KO controls (0 g) had 7% higher BV/TV compared with WT controls. Expanded Pyk2-KO maxillae also exhibited 12% (10 g) and 18% (20 g) higher BV/TV than WT mice. Although bone loss following expansion occurred in both genotypes, BV/TV was decreased to a greater extent in WT maxillae (-10% at 10g; -22% at 20 g) compared with Pyk2-KO maxillae (-11% only at 20 g). Expanded WT maxillae also showed a greater increase in sutural width, intermolar width and fibrous connective tissue width compared with expanded Pyk2-KO maxillae. Moreover, osteoclast number was increased 77% (10 g) and 132% (20 g) in expanded WT maxillae, but remained unchanged in expanded Pyk2-KO, compared to their respective controls. Cartilage area and chondrocyte number were increased to the same extent in expanded WT and Pyk2-KO sutures. CONCLUSIONS: These findings suggest that midpalatal suture expansion increases osteoclast formation in WT but not Pyk2-KO mice, leading to higher BV/TV in expanded Pyk2-KO maxillae. These studies suggest Pyk2-targeted strategies may be beneficial to increase bone density and preserve sutural integrity during maxillary expansion.
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    Extrinsic Characterization Sustainability in Zirconia Reinforced Lithium Silicate Ceramics
    (2021-04-08) Gadah, Thrya; May, Jaren; Levon, John; Chu, Tien-Min G; Gregory, Richard; Wei Shao, Lin; Feitosa, Sabrina
    ABSTRACT OBJECTIVE. To investigate the effect of aging on the surface roughness and the color sustainability of externally characterized zirconia reinforced lithium silicate glass-ceramics treated with different surface protocols. METHODS. Sixty blocks (12-mm X 14-mm; 1.5-mm) of pre-crystalized zirconia reinforced-lithium silicate glass-ceramic (Vita Suprinity, Vita Zahnfabrick, Germany) CAD/CAM were crystalized and treated with different surface protocols, as extrinsic characterization (EC), mechanical polishing (MP), glaze layer (GL), surface adjustment (SA) and no treatment – control group (CG). Experimental groups (n=10) were divided as follow: CG; EC-MP-GZ; EC-GZ; EC-MP; EC-GZ-SA-GZ; EC-GZ-SA-MP and submitted to thermocycling (5,000 cycles, 5-55C) and toothbrushing simulation (5,000 cycles). Surface roughness (Ra and Rq), color change (CIED2000) and biofilm growth were evaluated. Statistical analysis was performed with a two-sided 5% significance level for all tests. RESULTS. For the parameter RaX, the control differed from EC-GZ and EC-MP (p = 0.04). For the parameter RqX, EC-GZ presented higher surface roughness compared than EC-MP-GZ and the group EC-GZ-SA-MP (p=0.02). EC-MP (p<0.01) and the EC-GZ-SA-MP (p<0.01) showed higher color change E00 after aging, while CG and EC-MP-GZ the least. For the biofilm growth, no significant group effect on bacteria counts was found (p=0.089). CONCLUSION. The aging protocol affected the surface roughness, and color of externally characterized zirconia reinforced lithium silicate glass-ceramics submitted to different surface treatment protocols. In the present study, when the mechanical polishing was performed before glaze application, the slightest color change and surface roughness were observed compared to the other surface treatments. Bacteria were not able to grow in the material surface, under the conditions tested in the present study.
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    Virtual Facial Simulation of Prosthetic Outcome for Static Computer-Aided Implant Surgery and CAD-CAM Prostheses
    (Allen Press, 2022-02) Harris, Bryan T.; Yang, Chao-Chieh; Morton, Dean; Lin, Wei-Shao; Prosthodontics, School of Dentistry