Esteban
Pérez Pevida

Autores · Sara Varas-Orozco, Esteban Pérez-Pevida, Jordi Martínez-López, José Manuel Mendes, J. Gil-Mur, Aritza Brizuela-Velasco

This study compared three internal surface treatments of zirconia copings-silane alone (control), airborne-particle abrasion followed by silane, and high-temperature hydrofluoric acid etching followed by silane-regarding initial pull-out retention strength, retention after thermocycling, failure mode assessed by scanning electron microscopy (SEM), and surface wettability. Sixty-three monolithic zirconia copings were allocated to three groups (n = 21) according to surface treatment and cemented to titanium bases with a self-adhesive resin cement. Initial pull-out tests were performed. A subset (n = 10 per group) underwent thermocycling followed by repeat testing. Failure modes were analysed by SEM, and wettability was measured using the sessile drop method. Surface roughness and crystalline phase were additionally characterized by white-light interferometry and X-ray diffraction (XRD), respectively. High-temperature acid etching produced significantly higher initial pull-out forces than airborne-particle abrasion and silane alone, with mean values 125% higher than control and 42.6% higher than airborne-particle abrasion. After thermocycling, acid-etched specimens maintained the highest retention, whereas airborne-particle abrasion showed critical loss. SEM revealed predominantly cement remnants on zirconia in the acid-etched group, indicating a stronger zirconia-cement interface. Acid etching also yielded significantly lower contact angles, reflecting improved wettability. High-temperature hydrofluoric acid etching followed by silanization provided superior and more stable retention, more favourable failure modes, and improved wettability.

Autores · Alicia Martín-Martín, Esteban Pérez-Pevida, Saray Férnandez-Hernández, Jaime Lubillo-Valdeón, Aritza Brizuela‐Velasco

Background/Objectives: The aim of the present study is to evaluate the influence of the healing abutment height on secondary implant stability measured by resonance frequency analysis. In this prospective observational clinical study of 30 implants, the secondary stability of the implant was measured via resonance frequency analysis of the abutment during the osseointegration process. Methods: Two groups were compared: a <4 group (n = 15), with a space between the healing abutment and the antagonist of <4 mm, and a ≥4 group (n = 15), with a space of ≥4 mm. Results: Statistically significant differences (p < 0.05) in the implant stability values obtained at surgery (T0) and at the eighth week of osseointegration (T8) were observed between the two groups, with higher values for the <4 group. Pearson’s correlation analysis revealed a trend towards a significant relationship with the mean force (−0.6546) and a linear inverse relationship, so that by decreasing the distance between the abutment and the contact with the antagonist, the secondary implant stability values increased. A comparison of the mesial and distal peri-implant marginal bone levels at T0 and T8 did not reveal statistically significant differences (p > 0.05). A greater healing abutment height, placing it closer to the antagonist, increases and accelerates secondary stability, as measured by resonance frequency analysis. Conclusions: The results of the study support the recommendation of using high healing abutments, placing the abutment close to the opposing occlusal plane, according to biomechanical criteria.

Autores · Aritza Brizuela‐Velasco, Saray Férnandez-Hernández, José Gaviria-de la Puerta, Francisco T Barbosa, Igone Porto Gómez, Iker Bellanco-de la Pinta, Esteban Pérez-Pevida, Daniel Robles

Coautores Doctor&Cols · Daniel Robles Cantero

This study aims to analyze the field of dental implant biomechanics using a novel AI-powered bibliometric approach.By leveraging machine learning and natural language processing, we mapped key research trends, identified dependent and independent variables, and highlighted commonly used testing procedures.This analysis seeks to pinpoint underexplored areas in biomechanics research and offer a roadmap for future studies.We conducted a systematic review of 1,512 full-text articles from the PubMed database.Using the Rapid Automatic Keyword Extraction (RAKE) algorithm, key concepts were identified and classified into three categories: dependent variables, independent variables, and procedures.Advanced co-occurrence analysis was then applied to visualize the interrelations between these terms and their prevalence across the body of literature.Our analysis revealed that the most frequently studied independent variable is loading type, while the most prominent dependent variable is loading transfer, and the most employed procedure is insertion torque measurement.The study also uncovered a reliance on in vitro methodologies, indicating the need for more in vivo research to bridge the gap between laboratory findings and clinical practice.Several important biomechanical factors, such as bone quality and implant connection type, remain underexplored despite their potential clinical impact.Our findings reveal critical knowledge gaps in the field of dental implant biomechanics and underscore the importance of in vivo research to improve clinical outcomes.By combining bibliometric analysis with AI-driven keyword extraction, this study introduces a reproducible, scalable approach to mapping research landscapes in dental science.

Autores · Esteban Pérez-Pevida, Iván Monteagudo-Villalobos, David Chávarri-Prado, Alejandro Estrada-Martínez, Miguel Beltrán-Guijarro, Markel Diéguez-Pereira, Aritza Brizuela-Velasco

Coautores Doctor&Cols · Markel Diéguez Pereira, David Chávarri Prado, Alejandro Estrada Martínez, Miguel Beltrán Guijarro, Iván Monteagudo

Resonance frequency analysis (RFA) has been used as a diagnostic method to measure implant stability at all stages of healing. In addition to evaluating the status of the peri-implant marginal bone, it can also indicate the most appropriate time to load the implant. This in vitro study aimed to evaluate the efficacy of RFA as a diagnostic method for the detection of peri-implant marginal bone loss (MBL). Forty bone-level Klockner Vega implants were placed in a polyurethane block with elastic properties similar to those of the maxillary bone. The insertion torque and primary implant stability at the time of placement were measured using an RFA device. A circumferential peri-implant defect was created by removing the cortical bone portion in each implant using a trephine. The stability values were measured again using RFA. The stability values measured using RFA were lower after the creation of the circumferential peri-implant defect, indicating a statistically significant decrease in implant stability. The results of the study tend to show a relationship between peri-implant marginal bone loss and modifications in implant stability measured by RFA.

Autores · Saray Férnandez-Hernández, Javier Gil, Daniel Robles, Esteban Pérez-Pevida, Mariano Herrero‐Climent, Aritza Brizuela‐Velasco

Coautores Doctor&Cols · Daniel Robles Cantero

Treating the surfaces of dental implants in an alkaline medium allows us to obtain microstructures of sodium titanate crystals that favor the appearance of apatite in the physiological environment, producing osteoconductive surfaces. In this research, 385 discs made of titanium used in dental implants underwent different NaOH treatments with a 6M concentration at 600 °C and cooling rates of 20, 50, 75, and 115 °C/h. Using high-resolution electron microscopy, the microstructures were observed, and the different crystal sizes were determined and compared with control samples (those without biomimetic treatment). Roughness, wettability, surface energy and the sodium content of the surface were determined. The different surfaces were cultured with human osteoblastic cells; cell adhesion was determined at 3 and 14 days, and the degree of mineralization was determined at 14 days via alkaline phosphatase levels. Variations in the microstructure and size of sodium titanate crystals in NaOH solutions rich (1 g/L) or low in calcium (approximately 100 ppm) were determined. The results show that as the cooling rate increases, the size of the crystals decreases (from 0.4 μm to 0.8 μm) except for the case of 115 °C/h, when the rate is too fast for crystalline nucleation to occur on the surface of the titanium. The thermochemical treatment does not influence the roughness or the cooling rate since a Sa of 0.21 μm is maintained. However, the presence of titanate causes a decrease in the contact angle from 70° to 42° and, in turn, causes an increase in the total surface energy from 35 to 49.5 mJ/m2, with the polar component standing out in this energy increase. No variations were observed in the thermochemical treatments in the presence of sodium, which was around 1200 ppm. It was observed that as the size of the crystals decreases, cell adhesion increases at 3 days and decreases at 14 days. This is because finer crystals on the surface are already in the mineralization process, as

Autores · Quintas-Hijós J, Pérez-Pevida E, Albert-López MJ

Coautores Doctor&Cols · Maria Josep Albert López, Jacobo Quintas Hijós

OBJECTIVES: To determine the most effective combination of abutment height and timing of placement in reducing marginal bone loss (MBL). MATERIALS AND METHODS: 54 patients received at least one single screw-retained crown on an implant replacing a posterior tooth (60 implants). Implants were divided into six groups based on intermediate abutment height (1.5 mm, 2 mm, 3 mm) and timing of placement (immediate: surgery 1; delayed: surgery 2): Group A3I (height 3, surgery 1), Group A2I (height 2, surgery 1), Group A15I (height 1.5, surgery 1), Group A3D (height 3, surgery 2), Group A2D (height 2, surgery 2), Group A15D (height 1.5, surgery 2). Mesial and distal linear radiographic measurements were taken at five follow-up points: implant surgery, crown placement (T1), and 3 (T2), 6 (T3), and 12 months after loading (T4). Partial and total MBL were compared between groups. RESULTS: After 12 months, the lowest MBL was found in groups A3I (0.13 ± 0.11 mm) and A2I (0.24 ± 0.11 mm), with no statistical difference between them. Groups A15I (0.70 ± 0.12 mm), A3D (0.66 ± 0.11 mm), A2D (0.62 ± 0.12 mm), and A15D (0.78 ± 0.11 mm) showed significantly higher MBL than groups 1 and 2, with no statistical difference among them. CONCLUSIONS: Immediate abutments of 2-3 mm resulted in lower MBL compared to 1.5 mm immediate abutments or any delayed abutments. CLINICAL RELEVANCE: This study provides data on the optimal combination of intermediate abutment height and placement timing in preventing MBL. CLINICAL TRIAL REGISTRATION: Clinical trial registration number: NCT06667531. link: https://clinicaltrials.gov/study/NCT06667531 .

Autores · Alba Belanche Monterde, Javier Flores‐Fraile, Esteban Pérez-Pevida, Álvaro Zubizarreta‐Macho

Clear aligner treatment seems to be a good option for the periodontal patient by the reason of being removable. Multibracket appliances are more difficult to mantain clean and some bacteria might prefer to adhere on the archwire. A systematic review was carried out using 4 electronic databases (Pubmed-Medline, Scopus, Cochrane and Web of Science). The selected trials included quantitative (Shannon index, Simpson index, relative abundances) and/or qualitative (alpha and beta diversity) analysis in patients using clear aligners and multibracket appliances. Initially, a total of 123 articles were found after selecting clinical trials. The inclusion and exclusion criteria were applied by two authors. Finally, 20 articles were selected for the systematic review. The results showed that clear aligner treatment produced less dysbiosis in the selected bacteria compared to multibracket appliances. However, some microbiological changes were observed in some articles during clear aligner use. Oral dysibiosis was related with intestinal dysbiosis, inflammatory response and even cancer. The Firmicutes/Bacteroidetes ratio showed to have a very important role in this development. Periodontitis is also a bacterial disease and clear aligners were recommended to periodontal risk patients. Clear aligner treatment obtained less supra and subgingival biofilm changes compared with multibracket appliances but some bacteria were altered during treatment.

Autores · Daniel Robles, Saray Férnandez-Hernández, Miquel Punset, Meritxell Molmeneu, Javier Gil, Esteban Pérez-Pevida, Artiza Velasco

Coautores Doctor&Cols · Daniel Robles Cantero

PURPOSE: To evaluate the biomechanical behavior, implant stability, micromotion under loading, and peri-implant bone microstrain of short dental implants (4 mm) compared with longer implants (6, 8, and 10 mm), particularly in high crownto- implant (C/I) ratio scenarios, and to assess the effect of prosthetic splinting as a biomechanical strategy. MATERIALS AND METHODS: A total of 50 implants with internal connections (4-, 6-, 8-, and 10-mm implants) were placed in 9 fresh bovine ribs and restored with standardized polymethyl methacrylate (PMMA) crowns to achieve C/I ratios of 1.22 for 10-mm implants, 1.77 for 8-mm implants, 2.7 for 6-mm implants, and 4.55 for 4-mm implants. A maximum of six implants were placed in each rib, with a 6-mm distance between implants in all cases. Using resonance frequency analysis (RFA) and controlled loading (50 N, 6-degree angulation), implant stability and micromotion were evaluated via image-based analysis. Subsequently, a subset of 4-mm implants was tested with a splinted PMMA bridge. Finite element analysis (FEA) using models consistent with the in vitro setup was performed to evaluate bone microstrain, von Mises stress, and displacement. RESULTS: Implant stability (implant stability quotient [ISQ] values) increased significantly with implant length, with the 10-mm group having the highest values (mean ISQ = 68.4) (P < .05). Micromotion and FEA displacement were inversely correlated with implant length and positively correlated with the C/I ratio. The 4-mm implants had significantly higher micromotion and microstrain values, but splinting significantly reduced both parameters and achieved a performance comparable to that of longer implants. Von Mises stress values in the peri-implant bone and abutments were highest in the 4-mm group. CONCLUSIONS: Short dental implants correlate with poorer values for implant stability than conventional implants. High C/I ratios in short implants are associated with increased micromovement and micro

Autores · Oscar Javier Valencia-Blanco, Esteban Pérez-Pevida, Daniel Robles, Enrique Montalvillo, Javier Gil, Aritza Brizuela‐Velasco

Coautores Doctor&Cols · Daniel Robles Cantero

Objective. The aim of this in vitro study was to compare the physical and mechanical properties of two resins used for provisional prostheses: a direct self-curing dimethacrylate resin and a 3D-printed resin, in order to assess their potential for different clinical applications. Methods. Flexural strength, microhardness, wear resistance, and water absorption were evaluated in accordance with ISO 4049 and ISO 10477. Samples were analyzed using scanning electron microscopy, X-ray spectroscopy, and mechanical testing, including flexural, wear, and scratch assays. Results. The 3D-printed resin demonstrated superior flexural strength (128 ± 2 MPa vs. 127 ± 16 MPa), microhardness (19.45 HV vs. 8.10 HV, p < 0.05), and wear resistance (mean wear area: 0.030 mm2 vs. 0.047 mm2) compared to the self-curing dimethacrylate composite. However, it exhibited significantly higher water absorption (55.98 µg/mm3 vs. 15.0 µg/mm3), which may compromise its long-term durability in humid environments. Conclusions. Overall, the 3D-printed resin shows promising mechanical performance, but its high-water absorption remains a limitation for extended use. Further studies are required to evaluate its degradation and behavior under intraoral conditions. Clinical relevance. For the time being, self-curing resins remain the preferred choice for long-term provisional prostheses.

Autores · Oier Montalbán-Vadillo, Esteban Pérez-Pevida, Iratxe Viteri-Agustín, David Chávarri-Prado, Alejandro Estrada-Martínez, Markel Diéguez-Pereira, Fernando Sánchez-Lasheras, Aritza Brizuela-Velasco

Coautores Doctor&Cols · Markel Diéguez Pereira, Alejandro Estrada Martínez, David Chávarri Prado

Background: Although xenografts have shown successful results in GBR procedures due to their osteoconductive properties, many authors have opted to add co-adjuvant drugs to favor osteogenesis and differentiate cells into an osteoblastic lineage. Metformin has been shown to have bone-protective properties, regulating osteoclast differentiation, as well as the ability to promote osteoblast mineralization and differentiation. The present study aimed to evaluate the effect of the local application of a 1% metformin solution on bone neoformation in the treatment of an experimental bone defect in a guided bone regeneration animal model with a particulated bovine hydroxyapatite xenograft with hyaluronate. Methods: With this purpose in mind, two critical defects with 8 mm diameter and 0.5 mm depth were created in eight male New Zealand rabbit calvarias. Titanium cylinders were fixed in each defect and filled with particulate hydroxyapatite of bovine origin and sodium hyaluronate, with sterile injectable saline added to the control group and sterile 1% metformin solution added to the test group. At 6 weeks, the animals were euthanized, and samples were obtained and prepared for histomorphometric analysis. Results: A higher percentage of new bone formation was observed in the metformin samples than in the control samples, both in the region closest to the animal's calvaria and in the most distal region analyzed. A higher average bone–biomaterial contact percentage was observed in the samples, with metformin in both the proximal and distal regions. There was no statistically significant difference in the mean value in either region in both parameters. Conclusion: The local application of a 1% metformin solution in an animal model of guided bone regeneration with particulate bovine hydroxyapatite and hyaluronate resulted in greater bone neoformation and xenograft osseointegration than in the control group.

Autores · Miguel Beltrán-Guijarro, Esteban Pérez-Pevida, David Chávarri‐Prado, Alejandro Estrada-Martínez, Markel Diéguez-Pereira, Fernando Sánchez Lasheras, Aritza Brizuela‐Velasco

Coautores Doctor&Cols · Miguel Beltrán Guijarro, Markel Diéguez Pereira, Alejandro Estrada Martínez, David Chávarri Prado

This study aims to analyse, using a finite element analysis, the effects of Ti-base abutment height on the distribution and magnitude of transferred load and the resulting bone microstrain in the bone-implant system. A three-dimensional bone model of the mandibular premolar section was created with an implant placed in a juxta-osseous position. Three prosthetic models were designed: a 1 mm-high titanium-base (Ti-base) abutment with an 8 mm-high cemented monolithic zirconia crown was designed for model A, a 2 mm-high Ti-base abutment with a 7 mm-high crown for model B, and a 3 mm-high abutment with a 6 mm-high crown for model C. A static load of 150 N was applied to the central fossa at a six-degree angle with respect to the axial axis of the implant to evaluate the magnitude and distribution of load transfer and microstrain. The results showed a trend towards a direct linear association between the increase in the height of the Ti-base abutments and the increase in the transferred stress and the resulting microstrain to both the prosthetic elements and the bone/implant system. An increase in transferred stress and deformation of all elements of the system, within physiological ranges, was observed as the size of the Ti-base abutment increased.

Autores · David Chávarri-Prado, Andoni Jones, Esteban Pérez-Pevida, Markel Diéguez-Pereira, Alejandro Estrada-Martínez, Rodrigo Cabezón-Palacios

Coautores Doctor&Cols · Andoni Jones, Markel Diéguez Pereira, Alejandro Estrada Martínez, David Chávarri Prado

Sinus floor augmentation is one of the most common approaches to obtain sufficient bone availability for placing implants in cases with severe bone atrophy in the posterior maxilla. Several bone substitutes are indicated for sinus augmentation, but they may achieve different clinical outcomes. This study aims to compare bovine bone mineral (BBM) with freeze-dried bone allograft (FDBA) in a two-stage lateral window sinus grafting approach. Twenty patients received a lateral window sinus elevation with either FDBA or BBM. Postoperative graft height was measured with CBCT. Implants were placed 6 months later, at which time biopsy samples were taken for histologic analysis and new CBCT scans were performed to measure graft height. The mean height reduction at 6 months was 20.27% ± 4.94% for FDBA samples and 5.36% ± 2.41% for BBM samples. The histologic analysis revealed a mean ratio of newly formed bone of 43.70% ± 5.29% for the FDBA group and 38.11% ± 4.03% for the BBM group. The FDBA group also showed a higher amount of residual biomaterial (17.25% ± 10.10%) and connective tissue (14.63% ± 4.38%) compared to the BBM group (15.53% ± 5.42% and 13.11% ± 4.42%, respectively). The differences between groups were statistically significant for the height reduction and newly formed bone (P ≤ .05) but not for the amounts of residual biomaterial and nonmineralized connective tissue (P ≥ .05). Six months after performing a lateral window sinus elevation, the percentage of newly formed bone was significantly higher when using FDBA than when using BBM, although the graft height reduction was also significantly higher for the FDBA group.

Autores · Rodrigo Quevedo García, Sara Arnaiz Díez, Esteban Pérez-Pevida, Maria Lourdes del Río Solá

Background. The aim of this study is to determine the atheromatous plaques’ prevalence in orthopantomography and their relationship with periodontal disease and missing teeth. Material and Methods. Orthopantomographs of 1,254 patients over 18 years of age from Clínica Arlanza in Lerma, Burgos, were examined between 2017 and 2021. A Planmeca ProOne® orthopantomograph (68 kV, 7 mA, and 10 sg) was used. Statistical analysis was carried out using SPSS Statistics® version 25. The results of the categorical variables were described as frequencies (%). Contingency tables were made with the qualitative variables, and the chi-square test was applied to study the relationship among them. The measure of statistical power used was the relative risk (RR), which was described with its respective 95% confidence interval (CI). Student’s t-test was applied to study the relationship between the qualitative variable “presence or absence of atheroma plaque” and the quantitative variable “number of teeth.” Results. A 6.2% prevalence of atheroma plaques was obtained from 1,079 selected X-rays. The risk in patients with periodontal disease increased as periodontal disease worsened. The risk in patients with periodontal disease increased as periodontal disease worsened as follows: healthy patients vs. periodontal patients with less than 30% bone loss in radiography: RR 0.434, 95% CI 0.181–1.041, p=0.053 healthy patients vs. patients with between 30%–60% bone loss: RR 0.177, 95% CI 0.075–0.418, id="M2">p<0.05 healthy patients vs. patients with more than 60% bone loss: RR 0.121, 95% CI 0.041–0.355, id="M3">p<0.05 . Patients with calcifications on their orthopantomograms had a lower mean teeth number (20.9 teeth) compared to patients without calcifications (24 teeth), which was statistically significant, t (1077) = −3.125, id="M4">p<0.05 . Conclusions. Orthopantomography can be considered a screening method to detect patients at increased cardiovascular risk who are referred for individualize

Autores · Marta Sanjuán Álvarez, Daniel Robles, Javier Gil, Saray Férnandez-Hernández, Esteban Pérez-Pevida, Aritza Brizuela‐Velasco

Coautores Doctor&Cols · Daniel Robles Cantero

Objectives: Hybrid implants commonly exhibit decreased corrosion resistance and fatigue due to differences in compressive residual stresses between the smooth and rough surfaces. The main objective of this study was to investigate the influence of an annealing heat treatment to reduce the residual stresses in hybrid implants. Methodology: Commercially pure titanium (CpTi) bars were heat-treated at 800 °C and different annealing times. Optical microscopy was used to analyze the resulting grain growth kinetics. Diffractometry was used to measure residual stress after heat treatment, corrosion resistance by open circuit potential (EOCP), corrosion potentials (ECORR), and corrosion currents (ICORR) of heat-treated samples, as well as fatigue behavior by creep testing. The von Mises distribution and the resulting microstrains in heat-treated hybrid implants and in cortical and trabecular bone were assessed by finite element analysis. The results of treated hybrid implants were compared to those of untreated hybrid implants and hybrid implants with a rough surface (shot-blasted). Results: The proposed heat treatment (800 °C for 30 min, followed by quenching in water at 20 °C) could successfully homogenize the residual stress difference between the two surfaces of the hybrid implant (−20.2 MPa). It provides better fatigue behavior and corrosion resistance (p ˂ 0.05, ANOVA). Stress distribution was significantly improved in the trabecular bone. Heat-treated hybrid implants performed worse than implants with a rough surface. Clinical significance: Annealing heat treatment can be used to improve the mechanical properties and corrosion resistance of hybrid surface implants by homogenizing residual stresses.

Autores · Esteban Pérez-Pevida

Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn Email Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Esteban Pèrez-Pevida; The One Trephine-One Osteotome (OTOO) Protocol: A modified minimally invasive approach for transcrestal sinus-floor elevation. J Oral Implantol 2024; doi: https://doi.org/10.1563/aaid-joi-D-24-00050 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search Search Dropdown Menu toolbar search search input Search input auto suggest Search

Autores · Chávarri-Prado D, Brizuela-Velasco A, Diéguez-Pereira M, Chento-Valiente Y, Estrada-Martínez A, Pérez-Pevida E, Álvarez-Arenal Á

Coautores Doctor&Cols · David Chávarri Prado, Markel Diéguez Pereira, Alejandro Estrada Martínez

Purpose: The aim of this study was to measure and compare the retention degrees of different attachment systems before and after 1 year of mastication and removal/insertion simulations. Materials and methods: A 4 × 10-mm implant embedded in self-curing acrylic resin was placed inside a rectangular metal frame installed in a plastic container with artificial saliva at 37°C. Three different attachment systems were connected to the implants: Dalbo Classic, Locator (with blue, pink, and clear inserts), and Klockner Rotula. A loading test at 100 N and 1.25 Hz frequency was repeated 10 times for each attachment (changing the matrix component or plastic insert) until a total of 300,000 cycles and 1,095 removal/insertion sequences. The retention force was assessed at baseline until the end of the test (1 year) after 3-month intervals of simulation. One-way analysis of variance (ANOVA) and post hoc Tukey test (P < .05) were performed for statistical analyses. Results: Klockner Rotula showed the highest retention values at the beginning (69.6 ± 9.2 N; 7.1 ± 0.9 kg) and the end of the test (51.4 ± 5.4 N; 5.2 ± 0.6 kg), while Dalbo Classic showed the lowest values both at the beginning (13.1 ± 1.7 N; 1.3 ± 0.2 kg) and the end of the test (6.7 ± 1.6 N; 0.7 ± 0.2 kg). Locator with clear insert exhibited the lowest retention loss ratio (20.4%), while Locator with blue insert showed the highest (50.8%). At the end of the test, all attachment systems showed a significant decrease in retention force in comparison with the initial retention (P < .001). Conclusion: Locator attachments with clear and pink inserts and the Klockner Rotula attachment system showed retention forces > 20 N (2 kg) after 1 year of mastication and prosthesis insertion/removal simulation. All attachment systems showed a progressive loss of retention, which was higher for Locator attachments with blue and pink inserts and Dalbo Classic. The Klockner Rotula attachment system showed the highest retention values both at the beginning and the end of the test.

Autores · Juan Carlos Vara, Juan J. Delgado, Alejandro Estrada-Martínez, Esteban Pérez-Pevida, Aritza Brizuela‐Velasco, Begoña M. Bosch, Román A. Pérez, Javier Gil

Coautores Doctor&Cols · Alejandro Estrada Martínez

The placement of bone–level dental implants can lead to the detachment of particles in the surrounding tissues due to friction with the cortical bone. In this study, 60 bone–level dental implants were placed with the same design: 30 made of commercially pure grade 4 titanium and 30 made of Ti6Al4V alloy. These implants were placed in cow ribs following the company’s placement protocols. Particles detached from the dental implants were isolated and their size and specific surface area were characterized. The irregular morphology was observed by scanning electron microscopy. Ion release to the medium was determined at different immersion times in physiological medium. Cytocompatibility studies were performed with fibroblastic and osteoblastic cells. Gene expression and cytokine release were analysed to determine the action of inflammatory cells. Particle sizes of around 15 μM were obtained in both cases. The Ti6Al4V alloy particles showed significant levels of vanadium ion release and the cytocompatibility of these particles is lower than that of commercially pure titanium. Ti6Al4V alloy presents higher levels of inflammation markers (TNFα and Il–1β) compared to that of only titanium. Therefore, there is a trend that with the alloy there is a greater toxicity and a greater pro-inflammatory response.

Autores · Miquel Punset, Aritza Brizuela‐Velasco, Esteban Pérez-Pevida, Mariano Herrero‐Climent, José María Manero, Javier Gil

The use of a PMMA composite with graphene is being commercialized for application as dental prostheses. The different proportions of fibers provide a wide range of colors that favors dental esthetics in prostheses. However, there are no studies that have explained the influence that graphene has on the mechanical properties. In this contribution, we studied the PMMA and PMMA material with graphene fibers (PMMA-G) in the form of discs as supplied for machining. The presence of graphene fibers has been studied by Raman spectroscopy and the Shore hardness and Vickers micro hardness were determined. Mechanical compression tests were carried out to obtain the values of maximum strength and Young’s modulus (E) and by means of pin-on-disc wear tests, the specific wear rate and the friction coefficients were determined following the established international standards. Finally, the samples were characterized by field emission scanning electron microscopy (FESEM) to characterize the graphene’s morphology inside the PMMA. The results showed the presence of graphene in PMMA and was estimated in an amount of 0.1027% by weight in G-PMMA. The Shore hardness and Vickers microhardness values did not show statistically significant differences. Differences were observed in the compression maximum strength (129.43 MPa for PMMA and 140.23 for PMMA-G) and E values (2.01 for PMMA and 2.89 GPa for PMMA-G) as well as in the lower wear rate for the G-PMMA samples (1.93 × 10−7 for PMMA and 1.33 × 10−7 mm3/N·m) with a p < 0.005. The coefficients of friction for PMMA-G decreased from 0.4032 for PMMA to 0.4001 for PMMA-G. From the results obtained, a slight content in graphene produced a significant improvement in the mechanical properties that could be observed in the prosthesis material. Therefore, we can state that the main attraction of this material for dental prosthesis is its esthetics.

Autores · Markel Diéguez-Pereira, David Chávarri‐Prado, Iratxe Viteri-Agustín, Oier Montalbán-Vadillo, Esteban Pérez-Pevida, Aritza Brizuela‐Velasco

Coautores Doctor&Cols · Markel Diéguez Pereira, David Chávarri Prado

BACKGROUND: Implantoplasty reduces both implant diameter and the thickness of its walls, subsequently reducing the ability of the implant to resist fracture in response to functional load. In combination with an increase in the crown-implant ratio due to bone loss, this could increase the lever effect, which in presence of high masticatory forces or parafunctional habits, could lead to complications such as fracture of the implant or loosening of the prosthetic screw. OBJECTIVES: To determine the elastic limits of internal connection, dental implants of different designs and diameters after an implantoplasty. MATERIALS AND METHODS: This in vitro study included 315 tapered internal connection titanium dental implants, the threads of which were removed with an industrial milling machine-for standardized implantoplasty (IMP1; n = 105)-or with the conventional approach-manually, using high-speed burs (IMP2; n = 105). The remaining 105 implants were used as controls. The final implant diameters were recorded. The quality of the newly polished surfaces was assessed by scanning electron microscopy. All implants were subjected to a mechanical pressure resistance test. A Tukey's test for multiple comparisons was used to detect differences in the elastic limit and final implant diameters between the implant groups. RESULTS: There were statistically significant differences in the elastic limit between the IMP1, IMP2, and control groups (p < 0.05). Furthermore, the implant diameter was significantly smaller in the IMP1 and IMP2 groups (p < 0.05). Scanning electron microscopy revealed smooth implant surfaces in the IMP1 and IMP2 groups, with some titanium particles visible in the IMP1 group. CONCLUSIONS: Implantoplasty significantly decreased the elastic limit of internal connection titanium dental implants, especially in those with a smaller diameter (3-3.5 mm).

Autores · Esteban Pérez-Pevida, David Chávarri‐Prado, Markel Diéguez-Pereira, Alejandro Estrada-Martínez, Oier Montalbán-Vadillo, Antonio Jiménez-Garrudo

Coautores Doctor&Cols · Markel Diéguez Pereira, Alejandro Estrada Martínez, David Chávarri Prado

Background and Objective . Marginal bone loss around dental implants is one of the most prevalent complication, and its biomechanical impact may be critical for treatment prognosis. The objective of this study was to evaluate the influence of marginal bone loss around dental implants in the occlusal load transfer to the bone in terms of magnitude of stress and strain and distribution of such transferred stress. Methods . Three models of a single internal connection bone level‐type implant inserted into a posterior mandible bone section were constructed using a 3D finite element software: one control model without marginal bone loss and two test models, both with a circumferential peri‐implant bone defect, one with a 3 mm high defect and the other one 6 mm high. A 150 N static load was tested on the central fossa at 6° relative to the axial axis of the implant. Results. The results showed differences in the magnitude of strain and stress transferred to the bone between models, being the higher strain found in the trabecular bone around the implant with greater marginal bone loss. Stress distribution differed between models, being concentrated at the cortical bone in the control model and at the trabecular bone in the test models. Conclusion . Marginal bone loss around dental implants under occlusal loading influences the magnitude and distribution of the stress transferred and the deformation of peri‐implant bone, being higher as the bone loss increases.

Autores · Wenceslao Piedra‐Cascón, Delaram Mostafavi, Juan Ruiz-de-Gopegui, Esteban Pérez-Pevida, Daniel Robles, Marta Revilla‐León

Coautores Doctor&Cols · Daniel Robles Cantero

Protocols with static computer-aided implant placement provide more tangible clinical advantages than conventional implant placement methods. A technique to manufacture a dual-material implant surgical guide by using a vat-polymerization printer is described. The implant surgical guide combined a resilient intaglio and hard exterior surface. The technique should minimize the clinical adjustments needed to ensure fit and improve patient comfort.

Autores · Barberá-Millán J, Larrazábal-Morón C, Enciso-Ripoll J-J, Pérez-Pevida E, Chávarri-Prado D, Gómez-Adrián M-D

Coautores Doctor&Cols · Javier Barberá Millán, David Chávarri Prado

La estabilidad primaria es un determinante clave de la osteointegración. Este estudio in vitro compara la técnica de osteodensificación (OD) con la técnica convencional de infrafresado (UD) en hueso de baja densidad, colocando 55 implantes cónicos de conexión interna por grupo en tibia de cerdo. Los implantes colocados con OD mostraron un torque de inserción medio significativamente mayor (21,72 ± 17,14 Ncm frente a 8,87 ± 6,17 Ncm) y valores ISQ (RFA) superiores (69,75 ± 6,79 frente a 65,16 ± 7,45), demostrando que la osteodensificación mejora la estabilidad primaria en hueso de baja densidad.

Autores · Andoni Jones, David Chávarri‐Prado, Markel Diéguez-Pereira, Alejandro Estrada-Martínez, Miguel Beltrán-Guijarro, Esteban Pérez-Pevida

Coautores Doctor&Cols · Miguel Beltrán Guijarro, Markel Diéguez Pereira, Alejandro Estrada Martínez, David Chávarri Prado

The purpose of this study was to determine the prevalence of favorable anatomy for palatal emergence of an immediate flapless implant in the maxillary central incisor post-extraction site. Implants were virtually placed into maxillary central incisor sites using 3-dimensional implant planning software. Following a strict implant placement criterion to keep a safe distance to the buccal plate and other anatomical structures, sockets were assessed to determine their suitability for an implant emerging from the palatal aspect. From 321 patients included in this study, 62.3% presented a suitable socket anatomy for an immediate implant to be placed with an angulation suitable for a screw-retained crown. In 29% of the cases, the implants had to be labially tilted to maintain a minimum distance to the buccal plate; 8.7% were unsuitable for immediate implants due to anatomic limitations. The position and angulation for an immediate implant in the maxillary central incisor socket should be carefully assessed preoperatively with 3-dimensional images, as many sites will not be candidates for a palatal emergence and thus a screw-retained restoration.

Autores · Aritza Brizuela‐Velasco, Ángel Álvarez‐Arenal, Esteban Pérez-Pevida, Iker Bellanco-de la Pinta, Héctor De Llanos-Lanchares, Ignacio González-González, Carolina Larrazábal-Morón

Background . Although the long‐term success rate of dental implants is currently close to 95%, it is necessary to provide more evidence on the factors related to the failure of osseointegration and survival. Purpose . To establish the risk factors associated with the failure of osseointegration and survival of dental implants with an internal connection and machined collar and to establish a predictive statistical model. Materials and Methods . An analytical, retrospective, and observational clinical study of a sample of 297 implants with a follow‐up of up to 76 months. Independent variables related to the implant, patient, and surgical and rehabilitative procedures were identified. The dependent variables were failure of osseointegration and failure of implant survival after prosthetic loading. A survival analysis was carried out by applying the Kaplan‐Meier model (significance for p < 0.05). The log‐rank test and the Cox regression analysis were applied to the factors that presented differences. Finally, the regression logit function was used to determine whether it is possible to predict the risk of implant failure according to the analyzed variables with the data obtained in this study. Results . The percentages of osseointegration and survival were 97.6 and 97.2%, respectively. For osseointegration, there were significant differences according to gender ( p = 0.048), and the risk of nonosseointegration was 85% lower in women. Regarding survival, the Cox analysis converged on only two factors, which were smoking and treatment with anticoagulant drugs. The risk of loss was multiplied by 18.3 for patients smoking more than 10 cigarettes per day and by 28.2 for patients treated with anticoagulants. Conclusions . The indicated risk factors should be considered, but the analysis of the results is not sufficient to create a predictive model.

Autores · Viteri-Agustín I, Brizuela-Velasco A, Lou-Bonafonte JM, Jiménez-Garrudo A, Chávarri-Prado D, Pérez-Pevida E, Benito-Garzón L, Gruber R

Coautores Doctor&Cols · David Chávarri Prado

Purpose: Compaction of particulated grafts is done manually; thus, the effect of compression force on bone regeneration remains unclear. The aim of this study was to evaluate the impact of two different compression forces on the consolidation of particulated bovine hydroxyapatite. Materials and Methods: Two titanium cylinders were fixed on the calvarium of eight New Zealand rabbits. Both defects were filled with particulated bovine hydroxyapatite subjected to a compression force of 0.7 kg/cm2 or 1.6 kg/cm2 before being covered with a resorbable collagen membrane. A handheld device that uses a spring to control the compression force applied by the plugger was used. At 6 weeks, histomorphometry of the area immediately adjacent to the calvaria bone and to the collagen membrane was performed. Results: It was shown that next to the calvaria, the bone volume per tissue volume (BV/TV) was 29.0% ± 8.8% and 27.6% ± 8.2% at low and high compression force, respectively; the bone-to-biomaterial contact (BBC) was 58.2% ± 25.0% and 69.3% ± 22.9%, respectively (P > .05). In the corresponding area next to the collagen membrane, BV/TV was 4.9% ± 5.1% and 5.7% ± 4.7%, and the BBC was 18.3% ± 20.8% and 20.1% ± 15.9%, respectively (P > .05). In addition, the number and area of blood vessels were not significantly affected by compression force. Conclusion: Both compression forces applied resulted in similar consolidation of bovine hydroxyapatite expressed by new bone formation and vascularization based on a rabbit calvaria augmentation model.

Autores · David Chávarri-Prado, Aritza Brizuela-Velasco, Pablo Ortiz-de-Urbina-Comerón, Markel Diéguez-Pereira, Alejandro Estrada-Martínez, Esteban Pérez-Pevida

Coautores Doctor&Cols · David Chávarri Prado, Markel Diéguez Pereira, Alejandro Estrada Martínez

La estabilidad primaria es un requisito importante para la supervivencia y éxito de los implantes durante la osteointegración. En los últimos años, los implantes inmediatos postextracción han demostrado ser una opción de tratamiento exitosa y predecible para la reposición de dientes con mal pronóstico, pero surge la duda de si dichos implantes alcanzan valores de estabilidad primaria comparables a aquellos colocados en hueso maduro. Comparar la estabilidad primaria de implantes inmediatos colocados en alveolos postextracción con la de implantes colocados en hueso maduro. Se llevó a cabo un estudio clínico retrospectivo, con los datos recogidos sobre 175 implantes, colocados en 175 pacientes. Todos los implantes colocados pertenecían al modelo Essential Cone (Klockner Implant System) y se dividieron en dos grupos: implantes inmediatos (Grupo A, n=31) e implantes colocados en hueso maduro (Grupo B, n=144). La estabilidad primaria de todos los implantes se midió mediante torque de inserción y análisis de frecuencia de resonancia con Osstell ISQ. No se encontraron diferencias estadísticamente significativas respecto a la estabilidad medida a través del torque de inserción (26,29+10,07 Vs 25,76+9,72 N/cm) pero sí que se encontraron diferencias significativas en la medida de la estabilidad primaria mediante AFR, siendo inferiores los valores correspondientes a los implantes colocados en los alveolos post exodoncia (60,74 ± 6,17 en sentido VL y 62,19 ± 7.64 en sentido MD frente a 68,34 ± 6.26 en sentido VL y 69,29 ± 7.98 en sentido MD obtenidos en los implantes colocados en hueso maduro). El torque de inserción de los implantes inmediatos es similar al de los implantes colocados en hueso maduro, pero sus valores ISQ son significativamente inferiores, lo que demuestra un mayor grado de micromovimiento, y por consiguiente, un mayor riesgo de fracaso durante el período de osteointegración.

Autores · David Chávarri‐Prado, Aritza Brizuela‐Velasco, Markel Diéguez-Pereira, Esteban Pérez-Pevida, Antonio Jiménez-Garrudo, Iratxe Viteri-Agustín, Alejandro Estrada-Martínez, Oier Montalbán-Vadillo

Coautores Doctor&Cols · Markel Diéguez Pereira, Alejandro Estrada Martínez, David Chávarri Prado

Background: This study aimed to evaluate the effect of the implant design and the presence of cortical bone in the primary stability, as well as analyze the differences between the stability measurements obtained by two different resonance frequency analysis (RFA) devices. Material and Methods: A total of 80 Klockner implants of two different models [40 Essential Cone implants (group A) and 40 Vega implants (group B)] were used. The implants were placed in two polyurethane blocks that simulated the mechanical properties of the maxillary bone. One block featured a layer of cortical bone that was absent from the other block. The primary stability of all implants was measured by insertion torque and RFA using two different devices: Penguin RFA and Osstell IDX. Results: Primary stability was superior in the cortical bone in both torque and RFA. In the block containing cortical bone, group A implants obtained a greater insertion torque than did group B. The insertion torque was lesser in the bone lacking cortex. Regarding the ISQ of the implants, group A presented higher values in the block with cortical bone, but the values were lower in the block without cortical bone. There were no significant differences between the values obtained from the Osstell IDX and Penguin RFA. Conclusions: The presence of cortical bone positively influences the primary stability of dental implants. The design of the implant also has a statistically significant influence on implant primary stability, although the impact depends on whether there is coronal cerclage or not. There were no statistically significant differences in the implant stability measurements obtained by two different devices.

Autores · David Chávarri‐Prado, Aritza Brizuela‐Velasco, Ángel Álvarez‐Arenal, Markel Diéguez-Pereira, Esteban Pérez-Pevida, Iratxe Viteri-Agustín, Alejandro Estrada-Martínez

Coautores Doctor&Cols · Markel Diéguez Pereira, Alejandro Estrada Martínez, David Chávarri Prado

Objectives: To determine the effect of mechanical loading of bone on the stability and histomorphometric variables of the osseointegration of dental implants using an experimental test in an animal model. Materials and Methods: A total of 4 human implants were placed in both tibiae of 10 New Zealand rabbits (n = 40). A 6-week osseointegration was considered, and the rabbits were randomly assigned to two groups: Group A (Test group) included 5 rabbits that ran on a treadmill for 20 min daily during the osseointegration period; Group B (Controls) included the other 5 that were housed conventionally. The monitored variables were related to the primary and secondary stability of the dental implants (implant stability quotient—ISQ), vertical bone growth, bone to implant contact (BIC), area of regenerated bone and the percentage of immature matrix. Results: The results of the study show a greater vertical bone growth (Group A 1.26 ± 0.48 mm, Group B 0.32 ± 0.47 mm, p < 0.001), higher ISQ values (Group A 11.25 ± 6.10 ISQ, 15.73%; Group B 5.80 ± 5.97 ISQ, 7.99%, p = 0.006) and a higher BIC (Group A 19.37%, Group B 23.60%, p = 0.0058) for implants in the test group, with statistically significant differences. A higher percentage of immature bone matrix was observed for implants in the control group (20.68 ± 9.53) than those in the test group (15.38 ± 8.84) (p = 0.108). A larger area of regenerated bone was also observed for the test implants (Group A 280.50 ± 125.40 mm2, Group B 228.00 ± 141.40 mm2), but it was not statistically significant (p = 0.121). Conclusions: The mechanical loading of bone improves the stability and the histomorphometric variables of the osseointegration of dental implants.

Autores · Pérez-Pevida E, Cherro R, Camps-Font O, Piqué N

Purpose: To assess the effects of drilling protocol and bone density on the primary stability of implants with different macrogeometries currently used in clinical practice. Materials and Methods: This in vitro study compared the designs of two implants: Biomimetic Coral, a parallel-walled design with a slightly expanded platform and a symmetric progressive thread; and tapered Biomimetic Ocean, a reverse coronal design with an asymmetric progressive thread. The drilling alternatives were grouped according to the standard sequence for each type, plus an extra drill for hard bone, using laminated blocks with different densities. The insertion torques and implant stability quotient (ISQ) values were obtained with a surgical motor and resonance frequency analysis (RFA), respectively. Results: A total of 120 implants (n = 60 Ocean, n = 60 Coral) were inserted and analyzed without registering any deviation from the protocol. The Coral implants presented significantly higher insertion torque values (P < .001), consistent with optimal osseointegration, for the standard drill, the dense bone drill, and the screw tap. Insertion torque was not affected by the drilling sequence (P = .124), and the effect of interaction between the implant design and drilling sequence was not significant (P = .940). Statistically significant differences were observed in insertion torque values due to the type of implant but not due to the bone density. The ISQ values were significantly higher (P < .001) for the Coral design. In both the Ocean and Coral implants, ISQ was affected by the drilling sequence (P < .001), as the ISQ values were higher in the standard sequence with screw tap drilling than in the standard sequence with a dense bone drill. A positive correlation was found between the insertion torque and ISQ values. Conclusion: The macrogeometry of the implant and the drilling sequence have a significant effect on both primary stability values (ISQ and insertion torque). The values for the Coral implant were statistically higher but still within the range required to achieve proper osseointegration. These results support the drilling sequence recommended by the manufacturer for this type of implant, using larger-diameter drills and screw taps in sites with harder or cortical bone.

Autores · Aritza Brizuela‐Velasco, Yelko Chento-Valiente, David Chávarri‐Prado, Esteban Pérez-Pevida, Markel Diéguez-Pereira

Coautores Doctor&Cols · Markel Diéguez Pereira, David Chávarri Prado

Dental zirconia possesses concentrations of radionuclides, but their possible radioactivity is unknown. The purpose of this in vitro study was to evaluate the radioactivity and radionuclide concentration in dental zirconia. Three specimens were obtained from commonly used dental yttria-stabilized tetragonal zirconia polycrystal materials: Vita In-Ceram YZ, Zirkonzahn, and Zirkonzahn Prettau-producing a powder for the evaluation of radioactivity through gamma spectrometry. For the determination of radioactivity, a group of radionuclides (Ac-228, Pb-212, Tl-208, Pb-214, Bi-214, and Be-7) was evaluated. The measurements of all the specimens reported that most activity came from the decay chain of uranium, radium, and thorium, obtaining a radioactivity of 11.082 Bq/kg for Vita In-Ceram YZ, <11.63 Bq/kg for Zirkonzahn, and <34.91 Bq/kg for Zirkonzahn Prettau. Although all specimens contained radionuclides, their radioactivity was below the limit established by the International Atomic Energy Agency.

Autores · Markel Diéguez-Pereira, David Chávarri‐Prado, Alejandro Estrada-Martínez, Esteban Pérez-Pevida, Aritza Brizuela‐Velasco

Coautores Doctor&Cols · Markel Diéguez Pereira, Alejandro Estrada Martínez, David Chávarri Prado

Objective . Long‐term clinical data on the success and complication rates of monolithic or minimally veneered zirconia implant‐supported restorations are lacking. Hence, the purpose of this retrospective clinical study was to analyze the complications of monolithic or partially veneered zirconia implant‐supported restorations up to 5 years follow‐up. Material and Methods . Single crowns, bridges, and full‐arch rehabilitations were included. The selection process was achieved by reviewing data from the prosthetic laboratory and excluding cases in which zirconium and full‐ceramic coating restorations were used. A total of 154 restorations were included (82 monolithic and 72 with buccal ceramic stratification). All the complications encountered, and the solutions applied, were explained. Results . A total of 93 restorative units had a follow‐up of between 24 and 60 months, and 61 restoration units had a follow‐up of between 12 and 24 months. A total of 7 complications were encountered (14.58% of cases; 95.45% per prosthetic unit). The technical complication rate was 2.08% (one case of minor chipping in one prosthetic unit); regarding the mechanical complications, four decementations (8.33% of the cases) and two screw loosening (4.17% of the cases) were encountered. Conclusions . Considering the limitations of this study, it can be concluded that monolithic or partially veneered zirconia implant‐supported restorations have a good clinical behavior during a follow‐up period of up to 5 years.

Autores · Dieguez-Pereira M, Brizuela-Velasco A, Chavarri-Prado D, Perez-Pevida E, deLlanos-Lanchares H, Alvarez-Arenal A

Coautores Doctor&Cols · Markel Diéguez Pereira, David Chávarri Prado

Purpose: To evaluate and compare the effects of two restorative materials with different stiffness on peri-implant bone microstrain and implant micromovements during occlusal loading in implant-supported single and adjacent splinted crowns. Materials and Methods: Two 3 × 10-mm implants were inserted into the tibia of four rabbits. During the osseointegration process, prosthetic restorations were performed. Before suturing the flap, each implant's position and direction were obtained by fastening two splinted transfer abutments, onto which implant analogs were placed and fastened; the splinted transfer abutments were subsequently unfastened. Splinted transfer abutment/analog complexes were cast using type IV plaster to obtain eight different working models. Two single mandibular premolar crowns of monolithic zirconia and acrylate polymer composite were generated using CAD/CAM technology, and 16 adjacent splinted crowns (eight of each material) with the same design were also generated. After 6 weeks of implant osseointegration, the animals were sacrificed. Tibial sections with the implants were extracted, and prosthetic restorations were fastened to the implants. Static loading tests were performed with 100-N force application and an inclination of 6 degrees over the central fossa of the premolars. Implant micromovement was measured using an image analysis technique. Bone microstrain was quantified using two strain gauges placed on the crestal bone around the implants. Data were analyzed using two-way analysis of variance. Results: The mean implant micromovement values were lower for monolithic zirconia single and splinted crowns (61.5 ± 26.3 μm and 57.7 ± 8.8 μm, respectively) than for acrylate polymer composite-based single and splinted crowns (78.9 ± 37.3 μm and 59.61 ± 11.5 μm, respectively). No significant differences between the materials were noted. Bone microstrain around the implants was lower for splinted crowns (303.7 ± 281.3 με for acrylate polymer composite; 312.4 ± 226.8 με for monolithic zirconia) than for single crowns (539.7 ± 8.8 με for acrylate polymer composite; 574.6 ± 271.9 με for monolithic zirconia). Conclusion: Using restorative materials of different stiffness did not significantly affect the micromovement of already-osseointegrated implants supporting single or splinted crowns. Independent of material stiffness, single crowns transfer significantly more microstrain than splinted crowns.

Autores · Esteban Pérez-Pevida, Aritza Brizuela‐Velasco, David Chávarri‐Prado, Markel Diéguez-Pereira, Antonio Jiménez-Garrudo, Oier Montalbán-Vadillo, Iratxe Viteri-Agustín, Alejandro Estrada-Martínez, Gorka Santamaría-Arrieta

Coautores Doctor&Cols · Markel Diéguez Pereira, Alejandro Estrada Martínez, David Chávarri Prado

BACKGROUND/PURPOSE: The use of osteotomes as a technique for densification and expansion of the residual ridge is one of the most widely used procedures to achieve adequate peri-implant bone quantity and density. The aim of this study was to evaluate the influence of time and the elastic deformation of peri-implant bone in the primary stability of implants placed using osteotomes. MATERIALS AND METHODS: In each of 10 fresh fragments of cow rib, two implants were placed using osteotomes. The insertion torque and initial implant stability quotient (ISQ) values were measured. In the control implants, the immediate removal torque was measured, while in the test implants, after 15 min of placement, ISQ values were measured again, and the removal torque was measured. RESULTS: There were significant differences between the ISQ values and between the insertion torque and removal torque at 15 min. The ISQ values (perpendicular/parallel) increased between the initial moment (64.4 ± 9/70.3 ± 5.9) and 15 min (66/71.4 ± 6.4). The removal torque at 15 min (12.4 ± 5.8) was lower than the insertion torque (15.9 ± 5.9). Compression of the trabeculae in contact with the implant placed using osteotomes was observed, as well as a greater number of trabecular fractures in the implants placed using conventional drilling. CONCLUSION: There is an increase in ISQ values of dental implants placed using osteotomes after 15 min of placement.

Autores · Brizuela-Velasco A, Jiménez-Garrudo A, Viteri-Agustín I, Chávarri-Prado D, Pérez-Pevida E, Diéguez-Pereira M, Montalbán-Vadillo O, Bellanco-de la Pinta I, Chento-Valiente Y, Solaberrieta-Méndez E, Lou-Bonafonte JM

Coautores Doctor&Cols · Markel Diéguez Pereira, David Chávarri Prado

Durante los procesos de regeneración ósea guiada en los maxilares, cuyo objetivo es recuperar o preservar el tejido de soporte para la colocación de implantes sobre los que se retienen prótesis dentales, se emplean diversos biomateriales de injerto particulado de distintos orígenes (animal o sintético). Actualmente, la presión de compactación de este material en el lecho receptor es manual y depende del clínico, aunque existe evidencia científica sobre los efectos de las diferentes fuerzas compresivas en la angiogénesis y el pronóstico de la regeneración de las zonas injertadas. El objetivo del presente estudio es diseñar, calibrar y verificar in vitro un instrumento de compactación de uso clínico que permita aplicar una presión de compactación controlada y precisa sobre el biomaterial de injerto particulado y estandarizar el procedimiento. El instrumento diseñado es un compactador de precisión de tamaño adecuado para un manejo clínico intra y extraoral correcto, fabricado en material esterilizable por autoclave. El rango de compresión que permite (0–1,82 N) se encuentra dentro de las fuerzas que se aplican habitualmente en cirugía, determinadas mediante un test específico realizado sobre 8 cirujanos orales. La calibración del instrumento la ha realizado una empresa acreditada independiente. Palabras clave: regeneración ósea, compactación, instrumento, compactador, biomaterial particulado, injerto óseo.

Autores · Levi Cuadrado-González, Antonio Jiménez-Garrudo, Aritza Brizuela‐Velasco, Esteban Pérez-Pevida, David Chávarri‐Prado, Markel Diéguez-Pereira, José María Pacho-Martínez

Coautores Doctor&Cols · Markel Diéguez Pereira, David Chávarri Prado

Maxillary sinus elevation procedures are widely used in oral surgery and implant dentistry in those cases with insufficient bone height resulting from bone atrophy and pneumatized maxillary sinuses, which precludes dental implant insertion.1Sinus augmentation therapy generates sufficient bone height to enable the placement of posterior maxillary implants and, since its introduction by Boyne and James,2 has proved a highly predictable procedure.The most common complication involved in sinus elevation augmentation is membrane perforation. The incidence of this event ranges from 10%–56%.3The use of collagen membranes for sealing sinus perforations has been shown to be a predictable method for managing these complications.4 The classic mode uses a resorbable collagen membrane as a new wall, enabling accurate placement of the regeneration material and avoiding the displacement of the graft particles into the sinus cavity.5In this context, we planned to devise a modification to the Loma Linda pouch technique described by Proussaefs and Lozada.3 This “hammock” approach immobilizes the collagen membrane as far as possible, promotes greater blood supply, thereby increasing vital bone formation.When perforation occurs during elevation of the Schneiderian membrane, elevation of the membrane from the internal sinus walls must be completed (Figure 1).Once the final regenerating cavity has been prepared, 2 horizontal perforations are made, using a lance-shaped drill bur, through the palatal mucosa reaching the palatal sinus wall surpassing it up to the cavity. These perforations must be made over the height required for placing the future dental implants. Afterwards, the 2 corresponding horizontal perforations are made in the buccal sinus wall above the lateral window created for sinus lift procedure (Figures 2 and 3).A resorbable collagen membrane is prepared (Jason; Botiss Biomaterials, Zossen, Germany) by making 2 perforations at its narrowest side with a nonresorbable 4/0 she

Autores · Saray Férnandez-Hernández, Lorena Brenes-Ortega, David Chávarri‐Prado, Felipe J. Fernández-González, Esteban Pérez-Pevida, Antonio Jiménez-Garrudo, Aritza Brizuela‐Velasco

Coautores Doctor&Cols · David Chávarri Prado

El objetivo de este trabajo fue determinar la disminución del dolor y la mejora de la función en los procesos artrósicos de la ATM mediante el empleo de hialuronato de sodio o corticoides. Realización de una revisión sistemática conforme a la metodología PICO del Centro de Medicina Basada en la Evidencia de Oxford. Se formula una pregunta dirigida al objetivo fijado y se elabora una estrategia de búsqueda, empleando términos MeSH y palabras clave específicas derivados de la pregunta en la base de datos de MEDLINE de enero de 1985 hasta abril del 2016. Se consultan un total de 43 artículos, incluyendo finalmente 7 estudios clínicos controlados y aleatorizados que cumplían los criterios de inclusión y se realiza una evaluación crítica del nivel de evidencia. Se estudiaron trabajos que comparasen la eficacia del hialuronato de sodio con los corticoides en la inyección articular de las patologías artrósicas de la ATM. No se encontraron diferencias significativas en la realización de la inyección con hialuronato de sodio y corticoides. Es necesario realizar estudios con una muestra y un tiempo de seguimiento mayor. A largo plazo podría ser más eficaz el hialuronato de sodio debido a los posibles efectos adversos de los corticoides, sin embargo, no se han demostrado cambios óseos con ninguno de los tratamientos.

Autores · Aritza Brizuela‐Velasco, Esteban Pérez-Pevida, Antonio Jiménez-Garrudo, Francisco Javier Gil-Mur, José María Manero, Miquel Punset, David Chávarri‐Prado, Markel Diéguez-Pereira, Francesca Monticelli

Coautores Doctor&Cols · Markel Diéguez Pereira, David Chávarri Prado

The objective of the study is to characterise the mechanical properties of Ti-15Zr binary alloy dental implants and to describe their biomechanical behaviour as well as their osseointegration capacity compared with the conventional Ti-6Al-4V (TAV) alloy implants. The mechanical properties of Ti-15Zr binary alloy were characterised using Roxolid© implants (Straumann, Basel, Switzerland) via ultrasound. Their biomechanical behaviour was described via finite element analysis. Their osseointegration capacity was compared via an in vivo study performed on 12 adult rabbits. Young’s modulus of the Roxolid© implant was around 103 GPa, and the Poisson coefficient was around 0.33. There were no significant differences in terms of Von Mises stress values at the implant and bone level between both alloys. Regarding deformation, the highest value was observed for Ti-15Zr implant, and the lowest value was observed for the cortical bone surrounding TAV implant, with no deformation differences at the bone level between both alloys. Histological analysis of the implants inserted in rabbits demonstrated higher BIC percentage for Ti-15Zr implants at 3 and 6 weeks. Ti-15Zr alloy showed elastic properties and biomechanical behaviours similar to TAV alloy, although Ti-15Zr implant had a greater BIC percentage after 3 and 6 weeks of osseointegration.

Autores · Felipe J. Fernández-González, Jorge Cabero-López, Aritza Brizuela‐Velasco, Iván Suazo Galdames, Esteban Pérez-Pevida, Teresa Cobo, Oier Montalban, Markel Diéguez-Pereira, David Chávarri‐Prado, Iker Bellanco de la Pinta, Antonio Jiménez-Garrudo

Coautores Doctor&Cols · Markel Diéguez Pereira, David Chávarri Prado

Background: For patients whose centric relation (CR) has not been considered at the start and during treatment, the task of achieving an occlusal scheme that works together with the temporomandibular joint, the muscles, and the structures of the stomatognathic apparatus becomes a major concern. Objective: This study aims to describe a reproducible, predictable and to date unreported procedure of selective grinding guided by an occlusal splint and to analyze condylar position (CP) based on the skeletal pattern. Methods: A total of 72 symptomatic patients (38 females and 34 males) were classified into three groups: hyperdivergent, intermediate and hypodivergent. CP was quantified by mounted casts on a measures condyle displacement (MCD) device. Helkimo index was also performed in order to assess the severity of the temporomandibular joint (TMJ) disorders attending to clinical dysfunction, occlusal state and anamnestic dysfunction. Once the stability had been obtained, the splint was progressively reduced until the maximum intercuspation (MIC) was achieved. Results: The vertical displacement was found to be significantly different between the hyperdivergent and other two groups ( p <0.01). Comparisons of MCD analysis before and after the selective grinding procedure identified a statistically significant difference in the horizontal and vertical CP ( p <0.01) between the different groups whereas the Helkimo Index showed a clear improvement of TMJ disorders. Conclusion: All facial types, specially the hyperdivergent face type, showed a reduction in condylar displacement (CD) and less craniomandibular symptoms using this procedure, making it an excellent technique for clinicians.

Autores · Fernández-Hernández S, Brenes-Ortega L, Chávarri-Prado D, Fernández-González FJ, Pérez-Pevida E, Jiménez-Garrudo A, Brizuela-Velasco A

Coautores Doctor&Cols · David Chávarri Prado

El objetivo de este trabajo fue determinar la disminución del dolor y la mejora de la función en los procesos artrósicos de la ATM mediante el empleo de hialuronato de sodio o corticoides. Revisión sistemática conforme a la metodología PICO del Centro de Medicina Basada en la Evidencia de Oxford. Búsqueda en MEDLINE de enero de 1985 hasta abril de 2016 con términos MeSH específicos. Se consultaron 43 artículos, incluyendo finalmente 7 estudios clínicos controlados y aleatorizados que cumplían los criterios de inclusión. No se encontraron diferencias significativas entre la inyección con hialuronato de sodio y corticoides. Es necesario realizar estudios con muestra y seguimiento mayores. A largo plazo podría ser más eficaz el hialuronato de sodio debido a los posibles efectos adversos de los corticoides; sin embargo, no se han demostrado cambios óseos con ninguno de los tratamientos.

Autores · Esteban Pérez-Pevida, Aritza Brizuela‐Velasco, David Chávarri‐Prado, Antonio Jiménez-Garrudo, Fernando Sánchez Lasheras, Eneko Solaberrieta, Markel Diéguez-Pereira, Felipe J. Fernández-González, Borja Dehesa-Ibarra, Francesca Monticelli

Coautores Doctor&Cols · Markel Diéguez Pereira, David Chávarri Prado

The objective of the present study is to evaluate how the elastic properties of the fabrication material of dental implants influence peri-implant bone load transfer in terms of the magnitude and distribution of stress and deformation. A three-dimensional (3D) finite element analysis was performed; the model used was a section of mandibular bone with a single implant containing a cemented ceramic-metal crown on a titanium abutment. The following three alloys were compared: rigid (Y-TZP), conventional (Ti-6Al-4V), and hyperelastic (Ti-Nb-Zr). A 150-N static load was tested on the central fossa at 6° relative to the axial axis of the implant. The results showed no differences in the distribution of stress and deformation of the bone for any of the three types of alloys studied, mainly being concentrated at the peri-implant cortical layer. However, there were differences found in the magnitude of the stress transferred to the supporting bone, with the most rigid alloy (Y-TZP) transferring the least stress and deformation to cortical bone. We conclude that there is an effect of the fabrication material of dental implants on the magnitude of the stress and deformation transferred to peri-implant bone.