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da Silva AMP, Horta Dos Santos FA, Mota RF, Teixeira MKS, Telles DM, Lourenço EJV. Clinical and radiographic outcomes of a two-piece ceramic implant: one year results from a prospective clinical trial. Clin Oral Investig 2024; 28:380. [PMID: 38886209 DOI: 10.1007/s00784-024-05783-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 06/11/2024] [Indexed: 06/20/2024]
Abstract
OBJECTIVE To describe the clinical and radiographic performance and survival rate of a new two-piece ceramic implant system after at least 12 months of follow-up. MATERIALS AND METHODS Sixty-five implants were placed and followed up for at least 12 months (12.3 ± 1.5), in 50 patients. The implants were installed both in fresh extraction sockets and in healed sites and received provisional restoration when the clinical insertion torque was greater than 35Ncm. The primary results describe the survival rate of these implants. Clinical performance was evaluated through the evaluation of the Pink Esthetic Score (PES) and the degree of satisfaction of the patients. Bone loss was measured through radiographic measurements of the marginal bone loss in the mesial (MBLM) and distal (MBLD) sites. RESULTS The survival rate was 98.5%. The average MBLM was 0.24 mm (± 0.53) and the MBLD was 0.27 mm (± 0.57). A statistical difference was observed only when comparing immediate implants with delayed ones (MBLM - p = 0.046 and MBLD - p = 0.028) and when they received immediate provisionalization or not (MBLM - p = 0.009 and MBLD - p = 0.040). The PES before the intervention (T0) was 13.4 (± 0.8) and the PES at T2 (12-month follow-up) was 12.9 (± 1.5) (p = 1.14). CONCLUSION The new two-piece ceramic implant used in the present study showed predictable and reliable results, similar to those found with titanium implants after one year of follow-up. CLINICAL RELEVANCE These implants can be used as an alternative to titanium implants in terms of the marginal bone loss and the degree of patient satisfaction.
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Affiliation(s)
- Alexandre Marques Paes da Silva
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | | | - Rodrigo Franco Mota
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | - Mayla Kezy Silva Teixeira
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil.
| | - Daniel Moraes Telles
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
| | - Eduardo José Veras Lourenço
- Department of Prosthodontics, Faculty of Odontology, Rio de Janeiro State University, Boulevard 28 de Setembro 157, 2o Andar, Vila Isabel, Rio de Janeiro, RJ, 20551-030, Brazil
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Kohal RJ, Schikofski T, Adolfsson E, Vach K, Patzelt SBM, Nold J, Wemken G. Fracture Resistance of a Two-Piece Zirconia Implant System after Artificial Loading and/or Hydrothermal Aging-An In Vitro Investigation. J Funct Biomater 2023; 14:567. [PMID: 38132821 PMCID: PMC10743638 DOI: 10.3390/jfb14120567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/29/2023] [Accepted: 12/11/2023] [Indexed: 12/23/2023] Open
Abstract
The purpose of the present study was to assess the fracture resistance of a two-piece alumina-toughened zirconia implant system with a carbon-reinforced PEEK abutment screw. METHODS Thirty-two implants with screw-retained zirconia abutments were divided into four groups of eight samples each. Group 0 (control group) was neither loaded nor aged in a chewing simulator; group H was hydrothermally aged; group L was loaded with 98 N; and group HL was subjected to both hydrothermal aging and loading in a chewing simulator. One sample of each group was evaluated for t-m phase transformation, and the others were loaded until fracture. A one-way ANOVA was applied to evaluate differences between the groups. RESULTS No implant fracture occurred during the artificial chewing simulation. Furthermore, there were no statistically significant differences (p > 0.05) between the groups in terms of fracture resistance (group 0: 783 ± 43 N; group H: 742 ± 43 N; group L: 757 ± 86 N; group HL: 740 ± 43 N) and bending moment (group 0: 433 ± 26 Ncm; group H: 413 ± 23 Ncm; group L: 422 ± 49 Ncm; group HL: 408 ± 27 Ncm). CONCLUSIONS Within the limitations of the present investigation, it can be concluded that artificial loading and hydrothermal aging do not reduce the fracture resistance of the investigated implant system.
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Affiliation(s)
- Ralf-Joachim Kohal
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (T.S.); (J.N.); (G.W.)
| | - Tim Schikofski
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (T.S.); (J.N.); (G.W.)
| | - Erik Adolfsson
- RISE Research Institutes of Sweden, 431 53 Mölndal, Sweden;
| | - Kirstin Vach
- Medical Center—University of Freiburg, Institute for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, 79104 Freiburg, Germany;
| | - Sebastian Berthold Maximilian Patzelt
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (T.S.); (J.N.); (G.W.)
- Private Dental Clinic, 78658 Zimmern ob Rottweil, Germany
| | - Julian Nold
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (T.S.); (J.N.); (G.W.)
| | - Gregor Wemken
- Medical Center—University of Freiburg, Center for Dental Medicine, Department of Prosthetic Dentistry, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany; (T.S.); (J.N.); (G.W.)
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Khaohoen A, Sornsuwan T, Chaijareenont P, Poovarodom P, Rungsiyakull C, Rungsiyakull P. Biomaterials and Clinical Application of Dental Implants in Relation to Bone Density-A Narrative Review. J Clin Med 2023; 12:6924. [PMID: 37959389 PMCID: PMC10649288 DOI: 10.3390/jcm12216924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Titanium has been the material of choice for dental implant fixtures due to its exceptional qualities, such as its excellent balance of rigidity and stiffness. Since zirconia is a soft-tissue-friendly material and caters to esthetic demands, it is an alternative to titanium for use in implants. Nevertheless, bone density plays a vital role in determining the material and design of implants. Compromised bone density leads to both early and late implant failures due to a lack of implant stability. Therefore, this narrative review aims to investigate the influence of implant material/design and surgical technique on bone density from both biomechanical and biological standpoints. Relevant articles were included for analysis. Dental implant materials can be fabricated from titanium, zirconia, and PEEK. In terms of mechanical and biological aspects, titanium is still the gold standard for dental implant materials. Additionally, the macro- and microgeometry of dental implants play a role in determining and planning the appropriate treatment because it can enhance the mechanical stress transmitted to the bone tissue. Under low-density conditions, a conical titanium implant design, longer length, large diameter, reverse buttress with self-tapping, small thread pitch, and deep thread depth are recommended. Implant material, implant design, surgical techniques, and bone density are pivotal factors affecting the success rates of dental implant placement in low-density bone. Further study is required to find the optimal implant material for a clinical setting's bone state.
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Affiliation(s)
- Angkoon Khaohoen
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| | - Tanapon Sornsuwan
- Department of Restorative Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok 65000, Thailand;
| | - Pisaisit Chaijareenont
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| | - Pongsakorn Poovarodom
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| | - Chaiy Rungsiyakull
- Department of Mechanical Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Pimduen Rungsiyakull
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
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Kohal RJ, von Schierholz C, Nold J, Spies BC, Adolfsson E, Vach K, Burkhardt F. Influence of loading and aging on the fracture strength of an injection-molded two-piece zirconia implant restored with a zirconia abutment. Clin Oral Implants Res 2023; 34:105-115. [PMID: 36444693 DOI: 10.1111/clr.14022] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/31/2022] [Accepted: 11/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To investigate the fracture strength and potential phase transformation of an injection-molded two-piece zirconia implant restored with a zirconia abutment after loading and/or aging. METHODS Thirty-two two-piece zirconia implants (4.0 mm diameter) restored with zirconia abutments were embedded according to ISO 14801 and divided into four groups (n = 8/group): Three groups were either exclusively hydrothermally treated (group HT; 85°C), dynamically loaded (group DL; 107 cycles; 98 N), or subjected to both treatments simultaneously (group DL/HT). One group remained untreated (group 0). A sample from each group was cross-sectioned and examined by scanning electron microscopy for possible crystal phase transformation. The remaining samples were then loaded to fracture in a static loading test. A one-way ANOVA was used for statistical analyses. RESULTS During dynamic loading, three implants of group DL and six implants of group DL/HT fractured at a load of 98 N. The fracture strength of group DL/HT (108 ± 141 Ncm) was significantly reduced compared to the other groups (group 0: 342 ± 36 Ncm; HT: 363 ± 49 Ncm; DL: 264 ± 198 Ncm) (p < .05). Fractures from group 0 and HT occurred at both implant and abutment level, whereas implants from group DL and DL/HT fractured only at implant level. A shallow monoclinic transformation zone of approximately 2 μm was observed following hydrothermal treatment. CONCLUSIONS Within the limitations of this study, it can be concluded that dynamic loading and the combination of loading and aging reduced the fracture strength of the implant abutment combination. Hydrothermal treatment caused a shallow transformation zone which had no influence on the fracture strength.
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Affiliation(s)
- Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Christopher von Schierholz
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Julian Nold
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | - Benedikt C Spies
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
| | | | - Kirstin Vach
- Faculty of Medicine, Medical Center - University of Freiburg, Institute for Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Felix Burkhardt
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, University of Freiburg, Freiburg, Germany
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Zhang F, Monzavi M, Li M, Čokić S, Manesh A, Nowzari H, Vleugels J, Van Meerbeek B. Fracture analysis of one/two-piece clinically failed zirconia dental implants. Dent Mater 2022; 38:1633-1647. [PMID: 36064469 DOI: 10.1016/j.dental.2022.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 08/13/2022] [Accepted: 08/18/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Analyzing factors that may have led to fracture of zirconia implants by macro/micro-fractography. METHODS Six one-piece and ten two-piece full-ceramic zirconia implants from two manufacturers, Z-Systems and CeraRoot, were retrieved after clinical failure. The time-to-failure ranged from 3 to 49 months. Optical and scanning electron microscopy (SEM) were used to analyze the fracture planes at the macro- and microscopic level. Treatment planning, surgical protocol, fracture-origin location and characteristic fracture features were assessed. RESULTS The fracture of all implants seemed to have been primarily due to overload in bending mode, while the fracture-initiation sites varied for the one- and two-piece implants. The fracture of all one-piece implants originated in the constriction region between two threads in the endosseous implant part. For two-piece implants, the abutment neck, internal abutment-implant connections and inner threads were found to be the main fracture-initiation sites. Surface defects at the root area for one-piece implants and damages at the abutment surface for two-piece implants were connected to the fracture origins. Importantly, the clinical failures of implants were often found to result from combined effects related to patient aspects, treatment planning/protocols, a high bending moment at the weakest link, implant-surface conditions and specific implant designs. SIGNIFICANCE This study provided information to be considered for future optimization of treatment planning and the surgical protocol for zirconia implants. Optimization of the surface conditions and the zirconia-starting powder were also suggested.
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Affiliation(s)
- Fei Zhang
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, B-3001 Leuven, Belgium`; KU Leuven, Department of Oral Health Sciences, BIOMAT - Biomaterials Research Group & UZ Leuven (University Hospitals Leuven), Dentistry, Kapucijnenvoer 7 block a, B-3000 Leuven, Belgium.
| | - Mona Monzavi
- Periodontics and Ceramic Implantology (private Practice), 1401N Tustin Ave Suite #345, Santa Ana, CA 92705, USA
| | - Maoyin Li
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, B-3001 Leuven, Belgium`
| | - Stevan Čokić
- KU Leuven, Department of Oral Health Sciences, BIOMAT - Biomaterials Research Group & UZ Leuven (University Hospitals Leuven), Dentistry, Kapucijnenvoer 7 block a, B-3000 Leuven, Belgium
| | - Al Manesh
- Mission Dental Implant Center (private Practice), 26800 Crown Valley Pkwy Ste 425, Mission Viejo, CA 92691, USA
| | - Hessam Nowzari
- Periodontics and Implant Dentistry (private practice), 120 S Spalding Dr #201, Beverlyhills, CA 90210, USA
| | - Jef Vleugels
- KU Leuven, Department of Materials Engineering, Kasteelpark Arenberg 44, B-3001 Leuven, Belgium`
| | - Bart Van Meerbeek
- KU Leuven, Department of Oral Health Sciences, BIOMAT - Biomaterials Research Group & UZ Leuven (University Hospitals Leuven), Dentistry, Kapucijnenvoer 7 block a, B-3000 Leuven, Belgium
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Chopra D, Jayasree A, Guo T, Gulati K, Ivanovski S. Advancing dental implants: Bioactive and therapeutic modifications of zirconia. Bioact Mater 2022; 13:161-178. [PMID: 35224299 PMCID: PMC8843948 DOI: 10.1016/j.bioactmat.2021.10.010] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/22/2021] [Accepted: 10/06/2021] [Indexed: 12/16/2022] Open
Abstract
Zirconium-based implants have gained popularity in the dental implant field owing to their corrosion resistance and biocompatibility, attributed to the formation of a native zirconia (ZrO2) film. However, enhanced bioactivity and local therapy from such implants are desirable to enable the earlier establishment and improved long-term maintenance of implant integration, especially in compromised patient conditions. As a result, surface modification of zirconium-based implants have been performed using various physical, chemical and biological techniques at the macro-, micro-, and nano-scales. In this extensive review, we discuss and detail the development of Zr implants covering the spectrum from past and present advancements to future perspectives, arriving at the next generation of highly bioactive and therapeutic nano-engineered Zr-based implants. The review provides in-depth knowledge of the bioactive/therapeutic value of surface modification of Zr implants in dental implant applications focusing on clinical translation.
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Affiliation(s)
| | | | | | - Karan Gulati
- Corresponding authors. School of Dentistry, University of Queensland, 288 Herston Road, Herston QLD, 4006, Australia.
| | - Sašo Ivanovski
- Corresponding authors. School of Dentistry, University of Queensland, 288 Herston Road, Herston QLD, 4006, Australia.
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Spitznagel FA, Balmer M, Wiedemeier DB, Jung RE, Gierthmuehlen PC. Clinical outcomes of all-ceramic single crowns and fixed dental prostheses supported by ceramic implants: A systematic review and meta-analyses. Clin Oral Implants Res 2021; 33:1-20. [PMID: 34665900 PMCID: PMC9297865 DOI: 10.1111/clr.13871] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/17/2021] [Accepted: 09/28/2021] [Indexed: 02/07/2023]
Abstract
Objective To analyze the clinical outcomes of all‐ceramic single crowns (SCs) and fixed dental prostheses (FDPs) supported by ceramic implants. Materials and Methods Based on a focused question and customized PICO framework, electronic (Medline/EMBASE/Cochrane) and manual searches for studies reporting the clinical outcomes of all‐ceramic SCs and FDPs supported by ceramic implants ≥12 months were performed. The primary outcomes were reconstruction survival and the chipping proportion. The secondary outcomes were implant survival, technical complications, and patient‐related outcome measurements. Meta‐analyses were performed after 1, 2, and 5 years using random‐effect meta‐analyses. Results Eight of the 1,403 initially screened titles and 55 full texts were included. Five reported on monolithic lithium disilicate (LS2) SCs, one on veneered zirconia SCs, and two on veneered zirconia SCs and FDPs, which reported all on cement‐retained reconstructions (mean observation: 12.0–61.0 months). Meta‐analyses estimated a 5‐year survival rate of 94% (95% confidence interval [CI]: 82%–100%) for overall implant survival. Reconstruction survival proportions after 5 years were: monolithic LS2, 100% (95%CI: 95%–100%); veneered zirconia SCs, 89% (95%CI: 62%–100%); and veneered zirconia FDPs 94% (95%CI: 81%–100%). The chipping proportion after 5 years was: monolithic LS2, 2% (95%CI: 0%–11%); veneered zirconia SCs, 38% (95%CI: 24%–54%); and veneered zirconia FDPs, 57% (95%CI: 38%–76%). Further outcomes were summarized descriptively. Conclusions Due to the limited data available, only tendencies could be identified. All‐ceramic reconstructions supported by ceramic implants demonstrated promising survival rates after mid‐term observation. However, high chipping proportions of veneered zirconia SCs and, particularly, FDPs diminished the overall outcome. Monolithic LS2 demonstrated fewer clinical complications. Monolithic reconstructions could be a valid treatment option for ceramic implants.
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Affiliation(s)
- Frank Akito Spitznagel
- Department of Prosthodontics, School of Dentistry, Heinrich-Heine-University, Düsseldorf, Germany
| | - Marc Balmer
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel B Wiedemeier
- Statistical Services, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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Burkhardt F, Spies BC, Riemer L, Adolfsson E, Doerken S, Kohal RJ. Fracture resistance and crystal phase transformation of a one- and a two-piece zirconia implant with and without simultaneous loading and aging-An in vitro study. Clin Oral Implants Res 2021; 32:1288-1298. [PMID: 34352139 DOI: 10.1111/clr.13825] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To evaluate the influence of artificial aging on the transformation propagation and fracture resistance of zirconia implants. METHODS One-piece (with integrated implant abutment, 1P; regular diameter [4.1mm]; n = 16) and two-piece (with separate implant abutment, 2P; wide diameter [5 mm]; n = 16) zirconia implants were embedded according to ISO 14801. A two-piece titanium-zirconium implant (Ti-Zr; 4.1 mm diameter) served as a control (n = 16). One subgroup (n = 8) of each system was simultaneously dynamically loaded (107 cycles; 98N) and hydrothermally aged (85°C, 58 days), while the other subgroup (n = 8) remained untreated. Finally, specimens were statically loaded to fracture. Potential crystal phase transformation was examined at cross sections using scanning electron microscopy (SEM). A multivariate linear regression model was applied for statistical analyses. RESULTS The fracture resistance of 1P (1,117 [SD = 38] N; loaded/aged: 1,009 [60] N), 2P (850 [36] N; loaded/aged: 799 [84] N), and Ti-Zr implants (1,338 [205] N; loaded/aged: 1,319 [247] N) was not affected significantly by loading/aging (p = .171). However, when comparing the systems, they revealed significant differences independent of loading/aging (p ≤ .001). Regarding the crystal structure, a transformation zone was observed in SEM images of 1P only after aging, while 2P showed a transformation zone even before aging. After hydrothermal treatment, an increase of this monoclinic layer was observed in both systems. CONCLUSIONS The Ti-Zr control implant showed higher fracture resistance compared to both zirconia implants. Loading/aging had no significant impact on the fracture resistance of both zirconia implants. The wide-body 2P zirconia implant was weaker than the regular body 1P implant.
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Affiliation(s)
- Felix Burkhardt
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
| | - Benedikt C Spies
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
| | - Lennart Riemer
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
| | | | - Sam Doerken
- Medical Center - University of Freiburg, Institute for Medical Biometry and Statistics, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
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Microstructure and Young’s modulus evolution during re-sintering of partially sintered alumina-zirconia composites (ATZ ceramics). Ann Ital Chir 2021. [DOI: 10.1016/j.jeurceramsoc.2021.01.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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10
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Souza JCM, Pinho SS, Braz MP, Silva FS, Henriques B. Carbon fiber-reinforced PEEK in implant dentistry: A scoping review on the finite element method. Comput Methods Biomech Biomed Engin 2021; 24:1355-1367. [PMID: 33616450 DOI: 10.1080/10255842.2021.1888939] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Objective: The aim of the present study was to perform an integrative systematic review on the stress distribution assessed by finite element analysis on dental implants or abutments composed of carbon fiber-reinforced PEEK composites.Method: An electronic search was performed on PUBMED and ScienceDirect using a combination of the following search terms: PEEK, Polyetheretherketone, FEA, FEM, Finite element, Stress, Dental implant and Dental abutment.Results: The findings reported mechanical properties and the stress distribution through implant and abutment composed of PEEK and its fiber-reinforced composites. Unfilled PEEK revealed low values of elastic modulus and strength that negatively affected the stress distribution through the abutment and implant towards to the bone tisues. The incorporation of 30% carbon fibers increased the elastic modulus and strength of the PEEK-matrix composites although some studies reported no statistic differences in stress magnitude when compared to unfilled PEEK. However, an increase in short carbon fibers up to 60% revealed an enhancement on the stress distribution through abutment and implants towards to the bone tissues. PEEK veneering onto titanium core structures can also be a strategy to control the stress distribution at the implant-to-bone interface.Conclusions: The stiffness and strength of PEEK-matrix composites can be increased by the improvement of the carbon fibers' network. Thus, the content, shape, dimensions, and chemical composition of fibers are key factors to improve the stress distribution through abutment and implants composed of PEEK-matrix composites.
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Affiliation(s)
- Júlio C M Souza
- Center for Microelectromechanical Systems (CMEMS-UMinho), University of Minho, 4800-058 Guimarães, Braga, Portugal.,Dept. of Dental Sciences, School of Dentistry, University Institute of Health Sciences (IUCS), CESPU, 4585-116 Gandra PRD, Portugal
| | - Sofia S Pinho
- Dept. of Dental Sciences, School of Dentistry, University Institute of Health Sciences (IUCS), CESPU, 4585-116 Gandra PRD, Portugal
| | - Maria Pranto Braz
- Dept. of Dental Sciences, School of Dentistry, University Institute of Health Sciences (IUCS), CESPU, 4585-116 Gandra PRD, Portugal
| | - Filipe S Silva
- Center for Microelectromechanical Systems (CMEMS-UMinho), University of Minho, 4800-058 Guimarães, Braga, Portugal
| | - Bruno Henriques
- Center for Microelectromechanical Systems (CMEMS-UMinho), University of Minho, 4800-058 Guimarães, Braga, Portugal.,Ceramic and Composite Materials Research Group (CERMAT), Departmenf of Mechanical Engineering (EMC), Federal University of Santa Catarina (UFSC), 88040-900 Florianópolis/SC, Brazil
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Del Rio Silva L, Velôso DV, Barbin T, Borges GA, Presotto AGC, Mesquita MF. Can ceramic veneer spark erosion and mechanical cycling affect the accuracy of milled complete-arch frameworks supported by 6 implants? J Prosthet Dent 2020; 126:772-778. [PMID: 33087248 DOI: 10.1016/j.prosdent.2020.05.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 11/25/2022]
Abstract
STATEMENT OF PROBLEM Milling is a well-established method for manufacturing prosthetic frameworks. However, information about the influence of ceramic veneer and spark erosion on the accuracy of the all-on-six complete-arch fixed frameworks manufactured from different materials is lacking. PURPOSE The purpose of this in vitro study was to compare the accuracy of milled complete-arch fixed frameworks with zirconia, cobalt-chromium, and titanium at different steps of their manufacturing process and the influence of mechanical cycling. MATERIAL AND METHODS Fifteen milled complete-arch fixed frameworks, supported by 6 implants, were made in zirconia, cobalt-chromium, and titanium (n=5). The fit was measured by the single-screw test protocol. Stress was measured by photoelastic analysis. The loosening torque was evaluated by tightening the screws, retightening them after 10 minutes, and then evaluating the loosening torque 24 hours later. Thereafter, all frameworks received ceramic veneer, and the previous tests were repeated. Cobalt-chromium and titanium frameworks received spark erosion after ceramic veneer, and all analyses were repeated. Before and after mechanical cycling, loosening torque was evaluated. The results were subjected to 2-way repeated-measures ANOVA and the Bonferroni test (α=.05). RESULTS Titanium presented higher fit values than zirconia (P=.037) and similar to cobalt-chromium frameworks (P>.05) at baseline. After ceramic veneer, higher fit levels were observed for zirconia (P=.001) and cobalt-chromium (P=.008). Titanium showed higher stress values (P<.05) regardless of time. Baseline for all materials presented lower stress values (P<.05). Higher loosening torque values were found for the titanium group at baseline (P<.001) and after ceramic veneer (P<.001). Spark erosion improved fit and loosening torque values only for cobalt-chromium (P<.05). Mechanical cycling did not influence the loosening torque (P>.05). CONCLUSIONS Titanium milled complete-arch fixed frameworks presented poorer fit values than zirconia, although the loosening torque at baseline was higher. Ceramic veneer increased the fit levels for zirconia and cobalt-chromium, decreased the loosening torque values for cobalt-chromium, and enhanced stress levels. Spark erosion can be a reliable technique to improve fit and loosening torque for cobalt-chromium frameworks. Mechanical cycling did not decrease loosening torque.
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Affiliation(s)
- Letícia Del Rio Silva
- PhD student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Daniele Valente Velôso
- PhD student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Thaís Barbin
- PhD student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Guilherme Almeida Borges
- PhD student, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Anna Gabriella Camacho Presotto
- Research Fellow, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil
| | - Marcelo Ferraz Mesquita
- Full Professor, Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP), Piracicaba, Brazil.
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Reliability of an injection-moulded two-piece zirconia implant with PEKK abutment after long-term thermo-mechanical loading. J Mech Behav Biomed Mater 2020; 110:103967. [PMID: 32851978 DOI: 10.1016/j.jmbbm.2020.103967] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 01/18/2023]
Abstract
Zirconia implants are appreciated in some clinical indications in light of their aesthetic appearance and good biocompatibility. The aim of this work was to evaluate the performance of a newly developed two-piece zirconia/polyether ketone ketone (PEKK) implant-abutment combination after long-term cyclic loading in a hydrothermal environment, using a new protocol adapted from two available ISO standards. Sixteen implants (n = 8/group) were embedded according to ISO 14801 and divided into two groups: implants in the Observational Group (OG) were cyclically loaded for 60 days (98 N, 10 million loading cycles, 2 Hz) in 85 °C water in a chewing simulator, while non-loaded/non-aged implants (as-received) constituted the Control Group (CG). After 4.7 million loading cycles, one OG implant fractured in the chewing simulator. The surviving implants were compared to CG implants by X-ray diffraction (XRD) to investigate potential ageing as suggested by ISO 13356, but also μ-Raman spectroscopy, Focused-Ion-Beam - Scanning-Electron-Microscopy (FIB-SEM), and load-to-fracture. Ageing was shown to have limited influence on the evaluated zirconia implant, with increased monoclinic content after loading/ageing being to a shallow transformed zone of ~2 μm at the implant surface. However, OG implants showed a significantly decreased fracture load of 751 ± 231 N (CG: 995 ± 161 N; p = .046). These values enable clinical application, but the fact that one failure was recorded during cyclic fatigue along with the significant decrease in strength after cyclic loading/ageing suggest that there may be room for further optimization of especially the PEKK abutment. Furthermore, good agreement was observed between the fracture modes of the implant that failed during the cyclic fatigue experiment and the in vivo failure of one implant during pre-clinical trials, validating the interest of the in vitro protocol used in this work to check the reliability of zirconia implant.
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Koller M, Steyer E, Theisen K, Stagnell S, Jakse N, Payer M. Two-piece zirconia versus titanium implants after 80 months: Clinical outcomes from a prospective randomized pilot trial. Clin Oral Implants Res 2020; 31:388-396. [PMID: 31944420 DOI: 10.1111/clr.13576] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 01/08/2020] [Accepted: 01/08/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To prospectively evaluate, as part of an ongoing randomized pilot trial, the clinical outcomes of two-piece zirconia implants in comparison with titanium implants 80 months after delivery of all-ceramic (lithium disilicate) single-tooth restorations. MATERIAL AND METHODS The original sample included 31 (16 zirconia and 15 titanium) implants in 22 healthy patients. In addition to evaluating implant survival and success, a number of clinical or radiographic parameters were statistically analyzed: plaque index (PI), bleeding on probing (BOP), pink esthetic score (PES), and marginal bone loss (MBL). Both implant groups were compared using a Mann-Whitney U test. RESULTS Three implants (2 zirconia and 1 titanium) had been lost, so that 28 implants (14 zirconia and 14 titanium) in 21 patients could be evaluated after a mean of 80.9 (SD: 5.5) months. All surviving implants had remained stable, in the absence of any fixture or abutment fractures and without any chipping, fracture, or debonding of crowns. The zirconia implants were associated with PI values of 11.07% (SD: 8.11) and the titanium implants with 15.20% (SD: 15.58), the respective figures for the other parameters being 16.43% (SD: 6.16) or 12.60% (SD: 7.66) for BOP; 11.11 (SD: 1.27) or 11.56 (SD: 1.01) for PES; and 1.38 mm (SD: 0.81) or 1.17 mm (SD: 0.73) for MBL. CONCLUSIONS No significant differences were found between the clinical outcomes of two-piece zirconia and titanium implants based on the aforementioned parameters after 80 months of clinical service. Our results should be interpreted with the limited sample size in mind.
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Affiliation(s)
- Martin Koller
- Division of Preventive and Operative Dentistry, Endodontics, Periodontology, Prosthodontics, Restorative Dentistry and Implantology, Department of Dental Medicine and Oral Health, School of Dentistry, Medical University Graz, Graz, Austria
| | - Elisabeth Steyer
- Division of Preventive and Operative Dentistry, Endodontics, Periodontology, Prosthodontics, Restorative Dentistry and Implantology, Department of Dental Medicine and Oral Health, School of Dentistry, Medical University Graz, Graz, Austria
| | - Kerstin Theisen
- Division of Preventive and Operative Dentistry, Endodontics, Periodontology, Prosthodontics, Restorative Dentistry and Implantology, Department of Dental Medicine and Oral Health, School of Dentistry, Medical University Graz, Graz, Austria
| | - Sami Stagnell
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, School of Dentistry, Medical University Graz, Graz, Austria
| | - Norbert Jakse
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, School of Dentistry, Medical University Graz, Graz, Austria
| | - Michael Payer
- Division of Oral Surgery and Orthodontics, Department of Dental Medicine and Oral Health, School of Dentistry, Medical University Graz, Graz, Austria
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Bethke A, Pieralli S, Kohal RJ, Burkhardt F, von Stein-Lausnitz M, Vach K, Spies BC. Fracture Resistance of Zirconia Oral Implants In Vitro: A Systematic Review and Meta-Analysis. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E562. [PMID: 31991565 PMCID: PMC7040771 DOI: 10.3390/ma13030562] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 12/27/2022]
Abstract
Various protocols are available to preclinically assess the fracture resistance of zirconia oral implants. The objective of the present review was to determine the impact of different treatments (dynamic loading, hydrothermal aging) and implant features (e.g., material, design or manufacturing) on the fracture resistance of zirconia implants. An electronic screening of two databases (MEDLINE/Pubmed, Embase) was performed. Investigations including > 5 screw-shaped implants providing information to calculate the bending moment at the time point of static loading to fracture were considered. Data was extracted and meta-analyses were conducted using multilevel mixed-effects generalized linear models (GLMs). The Šidák method was used to correct for multiple testing. The initial search resulted in 1864 articles, and finally 19 investigations loading 731 zirconia implants to fracture were analyzed. In general, fracture resistance was affected by the implant design (1-piece > 2-piece, p = 0.004), material (alumina-toughened zirconia/ATZ > yttria-stabilized tetragonal zirconia polycrystal/Y-TZP, p = 0.002) and abutment preparation (untouched > modified/grinded, p < 0.001). In case of 2-piece implants, the amount of dynamic loading cycles prior to static loading (p < 0.001) or anatomical crown supply (p < 0.001) negatively affected the outcome. No impact was found for hydrothermal aging. Heterogeneous findings of the present review highlight the importance of thoroughly and individually evaluating the fracture resistance of every zirconia implant system prior to market release.
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Affiliation(s)
- Annalena Bethke
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.B.); (S.P.); (F.B.); (M.v.S.-L.)
| | - Stefano Pieralli
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.B.); (S.P.); (F.B.); (M.v.S.-L.)
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany;
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany;
| | - Felix Burkhardt
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.B.); (S.P.); (F.B.); (M.v.S.-L.)
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany;
| | - Manja von Stein-Lausnitz
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.B.); (S.P.); (F.B.); (M.v.S.-L.)
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Stefan-Meier-Str. 26, 79104 Freiburg, Germany;
| | - Benedikt Christopher Spies
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.B.); (S.P.); (F.B.); (M.v.S.-L.)
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany;
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