Download PDF
ZWR - Das Deutsche Zahnärzteblatt 2020; 129(11): 551-563
DOI: 10.1055/a-1277-2646
Fortbildung
Prothetik

Oberflächengüte von CAD/CAM-gefrästen Implantatstegen aus Titan und Kobalt-Chrom

Peter Gehrke
,
Carsten Fischer
,
Kai Schmenger
,
Jochen Dinkel
,
Octavio Weinhold
,
Günter Dhom
› Further Information
Also available at
    Permissions and Reprints

Die Fixierung von implantatgetragenem Zahnersatz auf CAD/CAM-gefertigten Stegen findet zunehmend Anwendung in der Implantatprothetik. Sowohl funktionelle als auch biologische Gesichtspunkte entscheiden über den Erfolg einer solchen Versorgung. Aus biologischer Sicht ist, wie bei Abutments und einteiligen Implantaten, der transmukosale Anteil des Stegs von besonderem Interesse, da er idealerweise die Anhaftung von Weichgewebe unterstützt, jedoch die mechanische Plaqueanlagerung minimiert. Funktionelle Stege sollten einen spannungsfreien Sitz und optimale Retentionseigenschaften besitzen. Beide Aspekte korrelieren direkt mit den Materialeigenschaften dieser Suprakonstruktionen. Trotz ihrer vermehrten klinischen Verwendung sind derzeit nur wenige Informationen über ihre Oberflächentopografie verfügbar. Der vorliegende Beitrag erläutert die Möglichkeiten zur Herstellung von CAD/CAM-generierten Implantatstegen und zeigt die aktuellen Ergebnisse zur Oberflächenrauheit und Charakterisierung dieser Suprakonstruktionen.
Kernaussagen

  • Unterschiede der Makro- und Mikrogeometrie CAD/CAM-gefräster Stege unterschiedlicher Hersteller geben initiale Hinweise auf deren mögliches Verhalten in vivo sowie über die zugrunde liegenden Produktions- und Fräsabläufe.

  • Sa-Rauheitswerte im transmukosalen Stegbereich von Sa 0,2 – 0,4 µm bieten optimale Voraussetzungen für die dichte Anlagerung des periimplantären Weichgewebes, ohne vermehrte Bakterien- und Plaqueanlagerung.

  • Je nach Hersteller müssen einige CAD/CAM-Stege zur Einhaltung dieses kritischen Grenzwertes manuell nachbearbeitet und/oder poliert werden.

  • Klinische Studien unter Zuhilfenahme profilometrischer Daten könnten helfen, die Oberflächenqualität CAD/CAM-gefertigter Stege weiter zu verbessern sowie notwendige manuelle Nachbearbeitungszeiten und den damit verbundenen Aufwand zu reduzieren.

  • Eindeutige Grenzwerte zur klinischen Akzeptanz und Nomenklatur von transmukosalen CAD/CAM-generierten Oberflächen sind wünschenswert.



Publication History

Article published online:
19 November 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • Literatur

  • 1 Naert I, De Clercq M, Theuniers G. et al. Overdentures supported by osseointegrated fixtures for the edentulous mandible: a 2.5-year report. Int J Oral Maxillofac Implants 1988; 3: 191-196
    PubMedGoogle Scholar
  • 2 Kuoppala R, Napankangas R, Raustia A. Outcome of implant-supported overdenture treatment-a survey of 58 patients. Gerodontology 2012; 29: e577-e584
    CrossrefPubMedGoogle Scholar
  • 3 Rinke S, Rasing H, Gersdorff N. et al. Implant-supported overdentures with different bar designs: A retrospective evaluation after 5–19 years of clinical function. J Adv Prosthodont 2015; 7: 338-343
    CrossrefPubMedGoogle Scholar
  • 4 Rentsch-Kollar A, Huber S, Mericske-Stern R. Mandibular implant overdentures followed for over 10 years: patient compliance and prosthetic maintenance. Int J Prosthodont 2010; 23: 91-98
    PubMedGoogle Scholar
  • 5 Cune M, Burgers M, van Kampen F. et al. Mandibular overdentures retained by two implants: 10-year results from a crossover clinical trial comparing ball-socket and bar-clip attachments. Int J Prosthodont 2010; 23: 310-317
    PubMedGoogle Scholar
  • 6 Meijer HJ, Raghoebar GM, Batenburg RH. et al. Mandibular overdentures supported by two Branemark, IMZ or ITI implants: a ten-year prospective randomized study. J Clin Periodontol 2009; 36: 799-806
    CrossrefPubMedGoogle Scholar
  • 7 Meijer HJ, Raghoebar GM, Batenburg RH. et al. Mandibular overdentures supported by two or four endosseous implants: a 10-year clinical trial. Clin Oral Implants Res 2009; 20: 722-728
    CrossrefPubMedGoogle Scholar
  • 8 Krennmair G, Suto D, Seemann R. et al. Removable four implant-supported mandibular overdentures rigidly retained with telescopic crowns or milled bars: a 3-year prospective study. Clin Oral Implants Res 2012; 23: 481-488
    CrossrefPubMedGoogle Scholar
  • 9 Dantas Ide S, Souza MB, Morais MH. et al. Success and survival rates of mandibular overdentures supported by two or four implants: a systematic review. Braz Oral Res 2014; 28: 74-80
    PubMedGoogle Scholar
  • 10 Burns DR, Unger JW, Coffey JP. et al. Randomized, prospective, clinical evaluation of prosthodontic modalities for mandibular implant overdenture treatment. J Prosthet Dent 2011; 106: 12-22
    CrossrefPubMedGoogle Scholar
  • 11 Krennmair G, Weinlander M, Piehslinger E. [Retention components used in implant supported restorations]. Deutsche Zahnärztliche Zeitschrift 2014; 69: 326-335
    PubMedGoogle Scholar
  • 12 Stoumpis C, Kohal RJ. To splint or not to splint oral implants in the implant-supported overdenture therapy? A systematic literature review. J Oral Rehabil 2011; 38: 857-869
    CrossrefPubMedGoogle Scholar
  • 13 Paniz G, Stellini E, Meneghello R. et al. The precision of fit of cast and milled full-arch implant-supported restorations. Int J Oral Maxillofac Implants 2013; 28: 687-693
    CrossrefPubMedGoogle Scholar
  • 14 Jemt T, Back T, Petersson A. Precision of CNC-milled titanium frameworks for implant treatment in the edentulous jaw. Int J Prosthodont 1999; 12: 209-215
    PubMedGoogle Scholar
  • 15 Miyazaki T, Hotta Y, Kunii J. et al. A review of dental CAD/CAM: current status and future perspectives from 20 years of experience. Dent Mater J 2009; 28: 44-56
    CrossrefPubMedGoogle Scholar
  • 16 van Noort R. The future of dental devices is digital. Dent Mater 2012; 28: 3-12
    CrossrefPubMedGoogle Scholar
  • 17 Beuer F, Schweiger J, Huber M. et al. Technical report: precisely fitting bars on implants in five steps-a CAD/CAM concept for the edentulous mandible. J Prosthodont 2014; 23: 333-336
    CrossrefPubMedGoogle Scholar
  • 18 Katsoulis J, Mericske-Stern R, Yates DM. et al. In vitro precision of fit of computer-aided design and computer-aided manufacturing titanium and zirconium dioxide bars. Dent Mater 2013; 29: 945-953
    CrossrefPubMedGoogle Scholar
  • 19 Katsoulis J, Walchli J, Kobel S. et al. Complications with computer-aided designed/computer-assisted manufactured titanium and soldered gold bars for mandibular implant-overdentures: short-term observations. Clin Implant Dent Relat Res 2015; 17 Suppl 1: e75-e85
    CrossrefPubMedGoogle Scholar
  • 20 Ortorp A, Jemt T. CNC-milled titanium frameworks supported by implants in the edentulous jaw: a 10-year comparative clinical study. Clin Implant Dent Relat Res 2012; 14: 88-99
    CrossrefPubMedGoogle Scholar
  • 21 Lowe LG, Shcherbukhin VM. An implant-supported, cobalt-chromium milled bar and nonflanged attachment-retained overdenture to rehabilitate the edentulous mandible. J Prosthet Dent 2009; 102: 46-51
    CrossrefPubMedGoogle Scholar
  • 22 Takahashi T, Gunne J. Fit of implant frameworks: an in vitro comparison between two fabrication techniques. J Prosthet Dent 2003; 89: 256-260
    CrossrefPubMedGoogle Scholar
  • 23 Torsello F, di Torresanto VM, Ercoli C. et al. Evaluation of the marginal precision of one-piece complete arch titanium frameworks fabricated using five different methods for implant-supported restorations. Clin Oral Implants Res 2008; 19: 772-779
    CrossrefPubMedGoogle Scholar
  • 24 Quirynen M, Bollen CM, Papaioannou W. et al. The influence of titanium abutment surface roughness on plaque accumulation and gingivitis: short-term observations. Int J Oral Maxillofac Implants 1996; 11: 169-178
    PubMedGoogle Scholar
  • 25 Bollen CM, Lambrechts P, Quirynen M. Comparison of surface roughness of oral hard materials to the threshold surface roughness for bacterial plaque retention: a review of the literature. Dent Mater 1997; 13: 258-269
    CrossrefPubMedGoogle Scholar
  • 26 Quirynen M, Marechal M, Busscher HJ. et al. The influence of surface free energy and surface roughness on early plaque formation. An in vivo study in man. J Clin Periodontol 1990; 17: 138-144
    CrossrefPubMedGoogle Scholar
  • 27 Happe A, Roling N, Schafer A. et al. Effects of different polishing protocols on the surface roughness of Y-TZP surfaces used for custom-made implant abutments: a controlled morphologic SEM and profilometric pilot study. J Prosthet Dent 2015; 113: 440-447
    CrossrefPubMedGoogle Scholar
  • 28 Wennerberg A, Sennerby L, Kultje C. et al. Some soft tissue characteristics at implant abutments with different surface topography. A study in humans. J Clin Periodontol 2003; 30: 88-94
    CrossrefPubMedGoogle Scholar
  • 29 Wennerberg A, Albrektsson T. On implant surfaces: a review of current knowledge and opinions. Int J Oral Maxillofac Implants 2010; 25: 63-74
    PubMedGoogle Scholar
  • 30 Abrahamsson I, Zitzmann NU, Berglundh T. et al. The mucosal attachment to titanium implants with different surface characteristics: an experimental study in dogs. J Clin Periodontol 2002; 29: 448-455
    CrossrefPubMedGoogle Scholar
  • 31 Gehrke P, Dinkel J, Fischer C. et al. Surface roughness and necessity of manual refinishing requirements of CAD/CAM-manufactured titanium and cobalt-chrome bars – A pilot study. The Open Dentistry Journal 2019; 13: 316-326
    CrossrefPubMedGoogle Scholar
  • 32 Gehrke P, Kaiser W, Fischer C. et al. Comparative Analysis of Surface Topography of Custom CAD/CAM ZirconiaAbutments by means of Optical Profilometry. Preprints 2017; DOI: 10.20944/preprints201709.0093.v1. 2017090093 doi:10.20944/preprints201709.0093.v1
    CrossrefPubMedGoogle Scholar
  • 33 Albrektsson T, Wennerberg A. Oral implant surfaces: Part 1-review focusing on topographic and chemical properties of different surfaces and in vivo responses to them. Int J Prosthodont 2004; 17: 536-543
    PubMedGoogle Scholar
  • 34 Quirynen M, van der Mei HC, Bollen CM. et al. An in vivo study of the influence of the surface roughness of implants on the microbiology of supra- and subgingival plaque. J Dent Res 1993; 72: 1304-1309
    CrossrefPubMedGoogle Scholar
  • 35 Sawase T, Wennerberg A, Hallgren C. et al. Chemical and topographical surface analysis of five different implant abutments. Clin Oral Implants Res 2000; 11: 44-50
    CrossrefPubMedGoogle Scholar
  • 36 Rompen E, Domken O, Degidi M. et al. The effect of material characteristics, of surface topography and of implant components and connections on soft tissue integration: a literature review. Clin Oral Implants Res 2006; 17 (Suppl. 02) 55-67
    CrossrefPubMedGoogle Scholar
  • 37 Stout K. ed. Development of Methods for the Characterisation of Roughness in three Dimensions. 1st ed. Oxford: Butterworth/Heinemann; 2006
    Google Scholar
  • 38 Rimondini L, Fare S, Brambilla E. et al. The effect of surface roughness on early in vivo plaque colonization on titanium. J Periodontol 1997; 68: 556-562
    CrossrefPubMedGoogle Scholar
  • 39 Fernandez M, Delgado L, Molmeneu M. et al. Analysis of the misfit of dental implant-supported prostheses made with three manufacturing processes. J Prosthet Dent 2014; 111: 116-123
    CrossrefPubMedGoogle Scholar
  • 40 Passos SP, Gressler May L, Faria R. et al. Implant-abutment gap versus microbial colonization: Clinical significance based on a literature review. J Biomed Mater Res B Appl Biomater 2013; 101: 1321-1328
    CrossrefPubMedGoogle Scholar
  • 41 Bollen CM, Papaioanno W, Van Eldere J. et al. The influence of abutment surface roughness on plaque accumulation and peri-implant mucositis. Clin Oral Implants Res 1996; 7: 201-211
    CrossrefPubMedGoogle Scholar