Purpose: The purpose of this retrospective study was to assess performance, together with biological and technical complications, of implant-supported removable partial dentures (ISRPD) in mandibular Kennedy class I situations with implants placed in the anterior or posterior position.

Methods: 23 subjects with two endosseous implants to support a bilateral-free-ending mandibular removable denture were examined. Eight subjects had implants in the premolar (anterior) region and 15 subjects implants in the molar (posterior) region. Biological and technical complications were recorded from the patients’ medical record. Patients filled out a validated questionnaire regarding their appreciation of oral health related quality of life (OHIP-NL49) and a VAS score on overall satisfaction.

Results: Over a mean follow-up period of 8 years (median 8 years, range 3–16 years) the cumulative implant survival rate was 91.7% (SE 0.05). Mean peri-implant bone loss was 0.9 mm (SD 1.0 mm). Scores for bleeding on probing, plaque and mucosal health were generally low, but significantly worse for posteriorly placed implants. Significantly more biological complications occurred in the posterior group (X²(1) = 3.9; p = 0.048). In 65% of the cases no technical complications were registered. Mean overall OHIP score was 16.1 (SD 18.4) and patients were highly satisfied (VAS: 8.4; SD 2.1).

Conclusions: Within the limitations of this retrospective study, in case of a Kennedy class I situation in the mandible, an ISRPD is a viable treatment option with a high implant survival rate and satisfied patients after a maximum of 16 years. Technical and biological complications should be anticipated. Anteriorly placed implants performed slightly better.

Purpose: The purpose of this in vitro study was to compare and analyze the three-dimensional marginal and internal fit of PEKK and zirconia copings.

Methods: Two acrylic models of the right maxillary canine, first molar were fabricated as master dies and duplicated by one-step dual viscosity impressions. Five stone replicas from each model were digitized with a blue-light scanner and copings were machined from Pekkton and Zirconia blanks. The inner surface of all the copings and two original acrylic models were digitized by a highly accurate optical scanner. By superimposing the digitized coping data with the CAD-reference die three-dimensionally, visual fit-discrepancies were drawn by calculating the root mean square (RMS) and visualized on a color-difference map. Each calculated RMS-value was statistically analyzed by 3-way ANOVA. In addition, Student's t-test was conducted in order to verify the significance (α = .05) of fit-discrepancies based on the type of abutment tooth and the materials.

Results: Mean RMS-values for marginal fit (internal fit) ranged from 51.64 ± 1.5 (36.12 ± 1.34) to 69.62 ± 8.11 (41.6 ± 1.63) μm. Differences in marginal fit (canine: P = .001; molar: P = .047) and internal fit (canine: P = .017; molar: P = .046) were statistically significant.

Results: The results of the 3-way ANOVA showed statistically significant differences in the RMS values of the two groups for the material (P < .001), the types of the abutment tooth (P < .001), and the measured region (P < .001).

Conclusions: The marginal and internal fit of both PEKK and zirconia copings of both canine and molar were within the clinically acceptable range. However, the PEKK presented better fitness compared with the zirconia.

Purpose: A lingualized occlusion (LO) for complete dentures reduces lateral inferences and occlusal force contacts and direction; thus, LO is theorized to be more suitable for patients with compromised ridges than fully bilateral balanced articulation (FBBA). However, no studies have yet provided evidence to support LO in edentate patients with compromised alveolar ridges. The purpose of this study was to compare LO and FBBA in edentulous individuals with compromised ridges.

Methods: Sixty edentulous individuals were randomly allocated into groups and received dentures with either LO or FBBA. Following delivery, several denture-related satisfaction variables were measured using 100 mm visual analogue scales; oral health-related quality of life (OHRQoL) was also assessed using the Oral Health Impact Profile (OHIP). Sub-group analyses of the effect of moderate and severe mandibular bone loss were also carried out.

Results: No significant differences were detected between LO and FBBA with the primary outcome. At 6 months, participants with severely atrophied mandibles and FBBA rated their satisfaction with retention of mandibular dentures significantly lower than those with LO (median LO: 86, FBBA: 58.5, p = 0.03). They also had significantly lower OHRQoL for the domain of Pain (median LO: 4, FBBA: 5, p = 0.02). General satisfaction and total OHIP scores significantly improved between baseline and 6 months only for the LO subjects with severely atrophied mandibles (satisfaction: p = 0.003, OHIP total score: p = 0.0007).

Conclusions: The results indicate that the LO occlusal scheme with hard resin artificial teeth is more efficient for patients with severely resorbed mandibular ridges.

Purpose: The purpose of this study was to investigate the biomechanical behavior of immediately loaded implants in an edentulous mandible according to the “All-on-Four” concept.

Methods: A 3D-finite element model of an edentulous mandible was constructed. Four implants were placed between the bilateral mental foramen according to “All-on-Four” concept. A framework made of titanium or acrylic resin between the bilateral first molars was modeled. Immediate loading and a delayed loading protocol were simulated. A vertical load of 200 N was applied at the cantilever or on the abutments region of the distal implants, simulating the absence of a cantilever.

Results: The peak principal compressive strains in the immediate loading models resulted in 24.0–35.8% and 26.4–39.0% increases compared with the delayed loading models under non-cantilever loading and cantilever loading, respectively. The loading position greatly affected the principal compressive and tensile strain values. The peak principal compressive strains in non-cantilever loading resulted in a 45.3–52.6% reduction compared with those in cantilever loading. The framework material did not influence the peak compressive and tensile strain. The maximum micromotion at the bone–implant interface in the immediate loading models was 7.5–14.4 μm.

Conclusions: Mandibular fixed full-arch prostheses without cantilevers may result in a favorable reduction of the peri-implant bone strain during the healing period, compared with cantilevers. The maximum micromotion was within the acceptable limits for uneventful implant osseointegration in the immediate loading models. Framework material did not play an important role in reducing the peri-implant bone strain and micromotion at the bone–implant interface.

Purpose: Oral appliances (OAs) are commonly used as a noninvasive treatment for obstructive sleep apnea syndrome (OSAS). These devices are worn during sleep and create mandibular anterior traction to enlarge the upper airway. Continuous use of the device is essential for the success of OA therapy, but some patients stop using the OA for various reasons. The purpose of this research was to investigate complications in OA therapy that might prevent continuous use of these devices.

Methods: The progress of 90 OSAS patients who visited Tokushima University Hospital and underwent OA therapy was investigated with a mailed questionnaire. All patients had been receiving OA therapy for more than 12 months.

Results: Forty patients responded to the questionnaire and of these, 22 were not wearing their OA during sleep. The average period before stopping OA therapy was 9.6 months. Answers from 38 patients who were treated with two-piece Herbst^®-type oral appliances were analyzed. The main reasons for stopping OA therapy were: (1) it was bothersome to use; and (2) it did not effectively prevent sleep apnea. Comparison of OA complications between current OA users and nonusers revealed significant differences for the items “difficulty sleeping” and “stifling feeling”. OA users recorded better scores for sleep quality than nonusers.

Conclusions: The results of this study indicate that patients discontinued OA therapy because the appliance was “bothersome to use” and because it had “little or no effect” rather than because they experienced the typical complications of OA therapy.

Purpose: To evaluate the effect of geometry on the displacement and the strain distribution of anterior implant-supported zirconia frameworks under static load using the 3D digital image correlation method.

Methods: Two groups (n = 5) of 4-unit zirconia frameworks were produced by CAD/CAM for the implant-abutment assembly. Group 1 comprised five straight configuration frameworks and group 2 consisted of five curved configuration frameworks. Specimens were cemented and submitted to static load up to 200 N. Displacements were captured with two high-speed photographic cameras and analyzed with video correlation system in three spacial axes U, V, W. Statistical analysis was made using the nonparametric Mann–Whitney test.

Results: Up to 150 N loads, the vertical displacements (V axis) were statistically higher for curved frameworks (−267.83 ± 23.76 μm), when compared to the straight frameworks (−120.73 ± 36.17 μm) (p = 0.008), as well as anterior displacements in the W transformed axis (589.55 ± 64.51 μm vs 224.29 ± 50.38 μm for the curved and straight frameworks), respectively (p = 0.008). The mean von Mises strains over the surface frameworks were statistically higher for the curved frameworks under any load.

Conclusion: Within the limitations of this in vitro study, it is possible to conclude that the geometric configuration influences the deformation of 4-unit anterior frameworks under static load. The higher strain distribution and micro-movements of the curved frameworks reflect less rigidity and increased risk of fractures associated to FPDs.

Purpose: To evaluate the shear bond strengths of two gingiva-colored materials (an indirect composite material and a denture base acrylic resin) to zirconia ceramics and determine the effects of surface treatment with various priming agents.

Methods: A gingiva-colored indirect composite material (CER) or denture base acrylic resin (PAL) was bonded to zirconia disks with unpriming (UP) or one of seven priming agents (n = 11 each), namely, Alloy Primer (ALP), Clearfil Photo Bond (CPB), Clearfil Photo Bond with Clearfil Porcelain Bond Activator (CPB + Act), Metal Link (MEL), Meta Fast Bonding Liner (MFB), MR. bond (MRB), and V-Primer (VPR). Shear bond strength was determined before and after 5000 thermocycles. The data were analyzed with the Kruskal–Wallis test and Steel-Dwass test.

Results: The mean pre-/post-thermalcycling bond strengths were 1.0–14.1 MPa/0.1–12.1 MPa for the CER specimen and 0.9–30.2 MPa/0.1–11.1 MPa for the PAL specimen. For the CER specimen, the ALP, CPB, and CPB + Act groups had significantly higher bond strengths among the eight groups, at both 0 and 5000 thermocycles. For the PAL specimen, shear bond strength was significantly lower after thermalcycling in all groups tested. After 5000 thermocycles, bond strengths were significantly higher in the CPB and CPB + Act groups than in the other groups.

Conclusions: For the PAL specimens, bond strengths were significantly lower after thermalcycling in all groups tested. The MDP functional monomer improved bonding of a gingiva-colored indirect composite material and denture base acrylic resin to zirconia ceramics.

Purpose: The study determined (i) the effects of electrical discharge machining (EDM) on the shear-bond strength (SBS) of the bond between luting resin and zirconia ceramic and (ii) zirconia ceramic's flexural strength with the three-point bending (TPB) test.

Methods: Sixty 4.8 mm × 4.8 mm × 3.2 mm zirconia specimens were fabricated and divided into four groups (n = 15): SBG: sandblasted + silane, TSCG: tribochemical silica coated + silane, LTG: Er:YAG laser treated + silane, EDMG: EDM + silane. The specimens were then bonded to a composite block with a dual-cure resin cement and thermal cycled (6000 times) prior to SBS testing. The SBS tests were performed in a universal testing machine. The SBS values were statistically analyzed using ANOVA and Tukey's test. To determine flexural strength, sixty zirconia specimens were prepared and assigned to the same groups (n = 15) mentioned earlier. After surface treatment TPB tests were performed in a universal testing machine (ISO 6872). The flexural strength values were statistically analyzed using ANOVA and Tukey's test (α = 0.05).

Results: The bond strengths for the four test groups (mean ± SD; MPa) were as follows: SBG (Control), 12.73 ± 3.41, TSCG, 14.99 ± 3.14, LTG, 7.93 ± 2.07, EDMG, 17.05 ± 2.71. The bond strength of the EDMG was significantly higher than those of the SBG and LTG (p < 0.01). The average flexural strength values for the groups SBG (Control), TSCG, LTG and EDMG were 809.47, 800.47, 679.19 and 695.71 MPa, respectively (p > 0.05).

Conclusions: The EDM process improved the SBS. In addition, there was no significant adverse effect of EDM on the flexural strength of zirconia.

Purpose: Dental shade matching by using digital images may be feasible when suitable color features are properly manipulated. Separating the color features into feature spaces facilitates favorable matching. We propose using support vector machines (SVM), which are outstanding classifiers, in shade classification.

Methods: A total of 1300 shade tab images were captured using a smartphone camera with auto-mode settings and no flash. The images were shot at angled distances of 14–20 cm from a shade guide at a clinic equipped with light tubes that produced a 4000 K color temperature. The Group 1 samples comprised 1040 tab images, for which the shade guide was randomly positioned in the clinic, and the Group 2 samples comprised 260 tab images, for which the shade guide had a fixed position in the clinic. Rectangular content was cropped manually on each shade tab image and further divided into 10 × 2 blocks. The color features extracted from the blocks were described using a feature vector. The feature vectors in each group underwent SVM training and classification by using the “leave-one-out” strategy.

Results: The top one and three accuracies of Group 1 were 0.86 and 0.98, respectively, and those of Group 2 were 0.97 and 1.00, respectively.

Conclusions: This study provides a feasible technique for dental shade classification that uses the camera of a mobile device. The findings reveal that the proposed SVM classification might outperform the shade-matching results of previous studies that have performed similarity measurements of ΔE levels or used an S, a*, b* feature set.

Purpose: To compare the accuracy (trueness, precision) of direct and indirect scanning CAD/CAM methods.

Methods: A master cast with prepared abutments and edentulous parts was created from polymethyl methacrylate (PMMA). A high-resolution industrial scanner was used to create a reference model. Polyvinyl-siloxane (PVS) impressions and digital impressions with three intraoral scanners (iTero, Cerec, Trios) were made (n = 10 for each) from the PMMA model. A laboratory scanner (Scan CS2) was used to digitize the sectioned cast made from the PVS impressions. The stereolithographic (STL) files of the impressions (n = 40) were exported. Each file was compared to the reference using Geomagic Verify software. Six points were assigned to enable virtual calliper measurement of three distances of varying size within the arch. Methods were compared using interquartile range regression and equality-of-variance tests for precision, and mixed-effects linear regression for trueness.

Results: The mean (SD) deviation of short distance measurements from the reference value was −40.3 (79.7) μm using the indirect, and 22.3 (40.0) μm using the direct method. For the medium distance, indirect measurements deviated by 5.2 (SD: 111.3) μm, and direct measurements by 115.8 (SD: 50.7) μm, on average; for the long distance, the corresponding estimates were −325.8 (SD: 134.1) μm with the indirect, and −163.5 (SD: 145.5) μm with the direct method. Significant differences were found between the two methods (p < 0.05).

Conclusions: With both methods, the shorter the distance, the more accurate results were achieved. Virtual models obtained by digital impressions can be more accurate than their conventional counterparts.

Purpose: Studies of effective methods for the easy removal of denture adhesives from a denture base are not well represented in the literature. We previously assessed the removability of denture adhesives by immersing within denture cleaners, showing that some cleaners have a weak effect, insufficiently effective in daily use. In this study, we prepared a cellulase, as a potential component for denture adhesive removers, and we examined whether the addition of cellulase to denture cleaners is effective in the removal of cream denture adhesives.

Methods: We prepared the cellulase Meicelase as one component for the liquefaction of denture adhesives. We used two denture cleaners and two cream adhesives. After the immersion of plates in sample solutions, we evaluated the area of the sample plate still covered with adhesives. Biofilm removal assay was also performed using denture cleaners containing cellulase.

Results: The addition of cellulase accelerated the removal of cream adhesives in immersion experiments to a rate faster than that of water and denture cleaners. However, it did not influence the removability of Candida albicans biofilms from acrylic resin specimens.

Conclusion: Cellulase hastened the liquefaction of cream adhesives.

Purpose: The low masticatory efficiency of denture prostheses impairs the ability of wearers to consume high-fiber foods. Hence, artificial teeth with high masticatory efficiency are required. This study aimed to establish an occlusal surface design for posterior artificial teeth in denture prostheses that is compatible with the existing artificial teeth arrangement and that has high masticatory efficiency for the comminution of raw vegetables.

Methods: A masticatory simulator for occluding complete dentures was used to evaluate the masticatory efficiency of four occlusal surface designs, i.e., with parallel grooves occluding at right angles to the opposing teeth, groove depths of 1 and 0.5 mm, and inter-groove distances of 1, 2, and 3 mm. Raw carrots, rice, raw lettuce, chicken breasts, and peanuts were used as test foods to evaluate food comminution.

Results: Grooved occlusal surface designs with a 1-mm groove depth and a 2- or 3-mm inter-groove distance demonstrated significantly greater masticatory efficiency than the conventional occlusal form (p < 0.05).

Conclusions: The superiority of grooved designs over the conventional design was particularly evident for lettuce and raw carrots in this study, both of which are considered difficult foods to chew with complete dentures.

Purpose: We assessed whether the soleus H reflex was depressed or facilitated in association with voluntary teeth clenching during muscle fatigue.

Methods: A total of 13 and 9 healthy adult subjects were instructed to perform right-side tiptoe standing for 5 (TS1) and 10 min (TS2) to induce the soleus muscle fatigue. Electromyograms (EMGs) were recorded from the bilateral masseter as well as the right-side soleus muscles. H reflex was evoked using a surface electrode. The isometric muscle strength during plantar flexion was measured. We tested two dental occlusal conditions (1) with maximal voluntary teeth clenching (MVTC) and (2) at mandibular rest position (RP). H reflex was evoked before and after TS1 and TS2. The isometric muscle strength during plantar flexion was measured before and after TS1 and TS2.

Results: Mean amplitudes of H reflex with MVTC before and after TS1 were significantly larger than that with RP before and after TS1. The mean peak torque (PT) during isometric plantar flexion was observed significant differences in all subjects. The mean amplitude of H reflex with MVTC before TS2 was significantly larger than that with RP before TS2. No significant difference between RP after TS2 and MVTC after TS2. The mean PT with MVTC before TS2 was significantly larger than that with RP before TS2. There was no significant difference between RP and MVTC after TS2.

Conclusion: The present study demonstrated that teeth clenching could facilitate H reflex regardless of the degree of muscle fatigue.

Purpose: Dual-cure core build-up resins have been developed to take advantages of both self and light-cured resin. The aim of present study was to determine the polymerization characteristics of self and dual-cured modes of dual-cure core build-up composites evaluating degree of conversion (DC) and crosslink density by measurement of glass-transition temperature (Tg) and hardness decrease in ethanol.

Methods: Clearfil Dc Core Automix (CLF) and Grandio Core Dc (GR) core build-up resins were selected. Twelve specimens for both composites were polymerized using quartz-halogen-tungsten light curing unit (QTH) and 12 specimens polymerized chemically. DC was determined by ATR-FTIR spectroscopy. TG/DTA analysis was performed to determine Tg. Microhardness value of specimens was determined by Vickers-tester before and after specimens stored in absolute ethanol for 24 h.

Results: One-way ANOVA showed no different DC values between dual and self-cured mode of GR and dual-cured CLF composites had higher DC than self-cured mode. Tg and percentage of softening in ethanol values of GR and CLF revealed significant difference between self and dual-cured mode.

Conclusions: In comparison of GR and CLF, DC showed no statistical difference in both curing modes. However, dual and self-cured GR has statistically higher Tg values and lower percentage of softening in ethanol than CLF. Polymerization characteristics of dual-cure core build-up composites have superiority in dual-cured mode than self-cured.

Purpose: We previously investigated the effects of team-based learning (TBL) on fixed prosthodontic education and reported that TBL could have higher efficiency with high student satisfaction than traditional lecture. In the current report, we introduced flipped classroom to the fixed prosthodontic education and compared their effectiveness based on the final examination score in addition to TBL.

Methods: Participants were 41 students from Tokushima University School of Dentistry who attended a fixed prosthodontics course. The first six classes adopted the flipped classroom style while the latter eight classes adopted TBL. To evaluate the relationship between learning styles and their effectiveness, we compared results from the term-end examination between the curriculum covered by flipped classroom and TBL-style classes. To draw comparisons, a referential examination with the same questions was conducted to eight faculty members who had not attended any of these classes.

Results: Term-end examination results showed that TBL classes had slightly higher scores than flipped classroom classes. Referential examination results also showed higher scores for the same curriculum and no significant interaction was found between class formats and the term-end and referential examination scores. Analysis revealed no noticeable difference in the effectiveness of the class formats.

Conclusion: Our previous study reported that TBL had higher efficiency than traditional style lecture. In the current study, there was no statistical difference in the examination score between flipped classroom and TBL. Therefore, we conclude that both styles are highly effective than traditional style lecture and constitute valid formats for clinical dental education.

Purpose: Implant supported full-arch immediate prosthesis (also called the immediate Brånemark protocol) revolutionized dental clinical practice due to the aesthetic/functional benefits it offers to the patient. This work presents a simplified and efficient technique for implant supported full-arch immediate prosthesis fabrication.

Methods: After diagnosing the necessity of the protocol, the implants were installed with a minimum torque of 35 N cm. For implant impression, the use of previously prepared castable cylinders (dispensing with impression posts), and a U-shaped acrylic (Mello technique) generated a cast without distortion. The Brånemark protocol was fabricated on this cast without the metal test specimen.

Conclusion: The simplified technique proposed in this article for Brånemark protocol fabrication seemed to be effective.