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Chopra D, Guo T, Gulati K, Ivanovski S. Load, unload and repeat: Understanding the mechanical characteristics of zirconia in dentistry. Dent Mater 2024; 40:e1-e17. [PMID: 37891132 DOI: 10.1016/j.dental.2023.10.007] [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: 01/25/2023] [Revised: 09/11/2023] [Accepted: 10/05/2023] [Indexed: 10/29/2023]
Abstract
OBJECTIVES Zirconia-based dental restorations and implants are gaining attention due to their bioactivity, corrosion resistance and mechanical stability. Further, surface modification of zirconia implants has been performed at the macro-, micro- and nanoscale to augment bioactivity. While zirconia's physical and chemical characteristics have been documented, its relation to mechanical performance still needs to be explored. This extensive review aims to address this knowledge gap. METHODS This review critically compares and contrasts the findings from articles published in the domain of 'mechanical stability of zirconia\ in dentistry' based on a literature survey (Web of Science, Medline/PubMed and Scopus databases) and a review of the relevant publications in international peer-reviewed journals. Reviewing the published data, the mechanical properties of zirconia, such as fracture resistance, stress/tension, flexural strength, fatigue, and wear are detailed and discussed to understand the biomechanical compatibility of zirconia with the mechanical performance of modified zirconia in dentistry also explored. RESULTS A comprehensive insight into dental zirconia's critical fundamental mechanical characteristics and performance is presented. Further, research challenges and future directions in this domain are recommended. SIGNIFICANCE This review extends existing knowledge of zirconia's biomechanical performance and it they can be modulated to design the next generation of zirconia dental restorations and implants to withstand long-term constant loading.
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Affiliation(s)
- Divya Chopra
- The University of Queensland, School of Dentistry, Herston, QLD 4006, Australia; Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), Herston, QLD 4006, Australia
| | - Tianqi Guo
- The University of Queensland, School of Dentistry, Herston, QLD 4006, Australia; Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), Herston, QLD 4006, Australia
| | - Karan Gulati
- The University of Queensland, School of Dentistry, Herston, QLD 4006, Australia; Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), Herston, QLD 4006, Australia.
| | - Sašo Ivanovski
- The University of Queensland, School of Dentistry, Herston, QLD 4006, Australia; Centre for Orofacial Regeneration, Reconstruction and Rehabilitation (COR3), Herston, QLD 4006, Australia.
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Lv X, Pu Y, Zhang X, Jiang X, Zhang X, Shi J, Lai H. One-piece versus two-piece zirconia abutment supported single implant crown in the esthetic region: 3-Year results from a split-mouth randomized controlled clinical trial. Clin Oral Implants Res 2023; 34:1330-1341. [PMID: 37655630 DOI: 10.1111/clr.14173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES To compare the clinical, radiographic, and immunological outcomes between one-piece versus two-piece zirconia abutments supported single implant crowns in the esthetic region. MATERIALS AND METHODS The study followed a split-mouth, double-blind, and randomized controlled clinical design for a duration of 3 years. Twenty-two eligible patients with 44 implants were randomly assigned to two groups: Group 1 (one-piece zirconia abutment with zirconia base, n = 22) and Group 2 (two-piece zirconia abutment with titanium base, n = 22). The primary outcome was the technical complication rate. Additionally, survival rates, cytokines concentrations in peri-implant crevicular fluid (PICF), peri-implant conditions, marginal bone loss, and pink/white esthetics score (PES/WES) were assessed as secondary outcomes. RESULTS Twelve of 22 patients attended the 1-year follow-up (due to the COVID pandemic), and 19 patients attended the 3-year examination. Two abutments in Group 1 were fractured after 10 and 12 months in function. Additionally, one screw loosening occurred in Group 1 at 1-year follow-up. The 3-year technical complication rate was significantly higher in Group 1 than that in Group 2 (15.79% vs. 0%, p < .001). The 3-year implant survival rate was 100% in both groups. The concentration of IFN-γ in PICF was significantly upregulated in Group 2 (p = .018). Furthermore, the IL-6 concentration was positively correlated with BOP% (p = .020). CONCLUSIONS Two-piece zirconia abutments exhibited superior technical performance compared to one-piece designs during a 3-year follow-up in the anterior region. However, further long-term research is necessary to verify the immunological stability of two-piece zirconia abutments.
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Affiliation(s)
- Xiaolei Lv
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yiping Pu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillo-facial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaomeng Zhang
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xue Jiang
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Zhang
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Junyu Shi
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hongchang Lai
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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Del Castillo R, Ata-Ali J. The clinical use of computer aided designed/computer aided manufactured titanium nitride coated implant abutments: Surgical and prosthetic considerations-A case series. J ESTHET RESTOR DENT 2023; 35:1008-1021. [PMID: 36932837 DOI: 10.1111/jerd.13035] [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: 11/13/2022] [Revised: 02/12/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To describe the clinical use of nitride-coated titanium CAD/CAM implant abutments in the maxillary esthetic zone in two patients with high esthetic and functional demands and, to highlight the advantages of nitride-coated milled titanium abutments when compared to stock/custom titanium, one-piece monolithic zirconia, and hybrid metal-zirconia implant abutments. CLINICAL CONSIDERATIONS Due to the inherent mechanical and esthetic clinical challenges, single implant-supported reconstructions in the maxillary esthetic zone are a complex restorative treatment. While CAD/CAM technology has been suggested to enhance and ease implant abutment design and manufacturing, implant abutment material selection remains as a critical decision affecting restoration's long-term clinical outcomes. To date, considering the esthetic disadvantages of conventional titanium implant abutments, the mechanical limitations of one-piece zirconia abutments and the manufacturing time and costs associated with hybrid metal-zirconia abutments, no abutment material can be considered "ideal" for all clinical scenarios. Due to their biocompatibility, biomechanical characteristics (hardness and wear resistance), optical properties (yellow color), and peri-implant soft tissue esthetic integration, the use of CAD/CAM titanium nitride-coated implant abutments has been suggested as a predictable implant abutment material in mechanically challenging but esthetically demanding clinical situations, as the maxillary esthetic zone. CONCLUSIONS Two patients requiring a combined tooth-implant restorative treatment in the maxillary esthetic zone were treated using CAD/CAM nitride coated titanium implant abutments. The principal advantages of TiN coated abutments include comparable clinical outcomes to stock abutments, optimal biocompatibility, adequate fracture, wear, and corrosion resistance, reduced bacterial adhesion, and excellent esthetic integration with adjacent soft tissues. CLINICAL SIGNIFICANCE Clinical reports and short term mechanical, biological and esthetic clinical outcomes indicate that CAD/CAM nitride coated titanium implant abutments can represent a predictable restorative alternative to stock/custom and metal/zirconia implant abutments and be considered a clinical relevant option in mechanically challenging but esthetically demanding situations, as often found in the maxillary esthetic zone.
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Affiliation(s)
- Rafael Del Castillo
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | - Javier Ata-Ali
- Department of Dentistry, Faculty of Health Sciences, Universidad Europea de Valencia, Public Dental Health Service, Conselleria de Sanitat Universal i Salut Pública, Valencia, Spain
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Humm VL, Sailer I, Thoma DS, Hämmerle CHF, Jung RE, Zembic A. 13-year follow-up of a randomized controlled study on zirconia and titanium abutments. Clin Oral Implants Res 2023; 34:911-919. [PMID: 37340530 DOI: 10.1111/clr.14117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES To assess survival rates and compare technical, biological, and esthetic outcomes of customized zirconia and titanium abutments at 13 years post loading. MATERIALS AND METHODS Initially, 22 patients with 40 implants in posterior regions were included. The sites were randomly assigned to 20 customized zirconia abutments with cemented all ceramic crowns (ACC) and 20 customized titanium abutments with cemented metal ceramic crowns (MCC). At a mean follow-up of 13.4 years, patients were examined and implants/restorations assessed for survival and technical complications, as well as biological and esthetic outcomes (pocket probing depth [PPD], bleeding on probing [BOP], plaque control record [PCR], bone level [BL], papilla index [PAP], mucosal thickness, and recession (distance of the margo mucosae [MM]/margo gingivae MG)). Descriptive analyses were performed for all outcome measures. RESULTS Fifteen patients with 21 abutments (13 zirconia, 8 titanium) were examined at 13 years. The drop-out rate was 25% (patient level). The technical survival rate of the abutments was 100%. The survival rate on the restorative level (crowns) was 100%. The assessed biological outcomes (PPD, PCR, BOP, BL) and esthetic outcomes (MG, PAP) were similar. CONCLUSIONS Zirconia and titanium abutments supporting single implant-borne restorations rendered a high survival rate and minimal differences in terms of technical, biological, and esthetic outcomes at 13 years of follow-up.
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Affiliation(s)
- Viviane Laura Humm
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zürich, Zürich, Switzerland
- Private practice, Winterthur, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Occlusion, University clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel Stefan Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zürich, Zürich, Switzerland
| | | | - Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zürich, Zürich, Switzerland
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Tonin BSH, Fu J, He Y, Ye N, Chew HP, Fok A. The effect of abutment material stiffness on the mechanical behavior of dental implant assemblies: A 3D finite element study. J Mech Behav Biomed Mater 2023; 142:105847. [PMID: 37127010 DOI: 10.1016/j.jmbbm.2023.105847] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/07/2023] [Accepted: 04/10/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE This study aimed to evaluate the stress distribution and microgap formation in implant assemblies with conical abutments made of different materials under an oblique load. MATERIALS AND METHODS The mechanical behavior of an implant assembly with a titanium abutment was analyzed and compared with that of an assembly with a Y-TZP abutment using finite element analysis (FEA). A torque of 20 Ncm was first applied to the abutment screw, followed by oblique loads of 10 N-280 N applied to the prosthesis placed on the implant. The maximum stress in the abutment screw, the microgap formation process, and the critical load for bridging the internal implant space were evaluated. RESULTS No significant difference in stress distribution between the two cases was observed, with the stresses being mainly concentrated at the top half of the screw (the predicted maximum von Mises stress was approximately 1200 MPa at 280 N). The area in contact at the implant-to-abutment interface decreased with increasing load for both abutments, with the critical load for bridging the internal implant space being roughly 140 N. The maximum gap size being was approximately 470 μm with either abutment. CONCLUSION There was no significant difference in the stress distribution or microgap formed between implant assemblies with titanium and Y-TZP abutments having an internal conical connection.
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Affiliation(s)
- Bruna S H Tonin
- Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirão Preto, University of São Paulo (USP), Ribeirão Preto, SP, Brazil
| | - Jing Fu
- Department of Prosthodontics, The Affiliated Hospital of Qingdao University, School of Stomatology of Qingdao University, China
| | - Yiting He
- Department of Prosthodontics, Hospital of Stomatology, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Stomatology, Guangzhou, Guangdong, China
| | - Ning Ye
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Hooi Pin Chew
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA
| | - Alex Fok
- Minnesota Dental Research Center for Biomaterials and Biomechanics, School of Dentistry, University of Minnesota, Minneapolis, MN, USA.
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Naumann M, Scholz P, Krois J, Schwendicke F, Sterzenbach G, Happe A. Monolithic hybrid abutment crowns (screw-retained) versus monolithic hybrid abutments with adhesively cemented monolithic crowns. Clin Oral Implants Res 2023; 34:209-220. [PMID: 36692161 DOI: 10.1111/clr.14031] [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: 01/05/2022] [Revised: 12/30/2022] [Accepted: 01/02/2023] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The objective of this study is to compare monolithic hybrid abutment crowns (screw-retained) versus monolithic hybrid abutments with adhesively cemented monolithic single-tooth crowns. MATERIALS AND METHODS Twenty subjects in need of an implant-borne restoration were randomly assigned to receive either a cement-retained (CRR) or a screw-retained (SRR) implant-supported monolithic lithium disilicate (LS2 ) reconstruction. Each patient received a titanium implant with in internal conic connection. After osseointegration and second-stage surgery, healing abutments were placed for about 10 days. The type of restoration (CRR vs. SRR) was randomly assigned, and the restorations were manufactured of monolithic LS2 . Both types of restorations, CRR and SRR, were based on a titanium component (Ti-base) that was bonded to the abutment (CRR) or the crown (SRR). The follow-up period for all restoration was 36 months. Clinical outcome was evaluated according to Functional Implant Prosthetic Score (FIPS). Quality of live (OHIP) and patient's satisfaction were assessed using patient-reported outcome measures (PROMs). Primary endpoint was loss of restoration for any reason. Kaplan-Meier curves were constructed and log-rank testing was performed (p < .05). RESULTS One restoration of group CRR failed after 6 months due to loss of adhesion between Ti-base and individual abutment. No further biological or technical failures occurred. Kaplan-Meier analysis showed no significant difference between both treatment options (p = .317). There was no statistically significant difference between both types of restoration, neither for FIPS, OHIP, treatment time nor patient satisfaction (p > .05). CONCLUSION Monolithic hybrid abutment crowns (screw-retained) and monolithic hybrid abutment with adhesively cemented monolithic crowns using lithium disilicate showed no statistically significant difference for implant-based reconstructions in this pilot RCT setting.
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Affiliation(s)
- Michael Naumann
- 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, Berlin, Germany
| | - Patricia Scholz
- Clinic for Dental Prosthetics, Center for Dental, Oral and Maxillofacial Medicine, University Hospital Ulm, Ulm, Germany
| | - Joachim Krois
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Falk Schwendicke
- Department of Oral Diagnostics, Digital Health and Health Services Research, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Guido Sterzenbach
- 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, Berlin, Germany
| | - Arndt Happe
- Clinic for Dental Prosthetics, Center for Dental, Oral and Maxillofacial Medicine, University Hospital Ulm, Ulm, Germany
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Zhai Z, Nakano T, Chen Y, Watanabe S, Matsuoka T, Ishigaki S. Implant deformation and implant-abutment fracture resistance after standardized artificial aging: An in vitro study. Clin Implant Dent Relat Res 2023; 25:107-117. [PMID: 36415012 DOI: 10.1111/cid.13157] [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: 09/18/2022] [Revised: 10/27/2022] [Accepted: 11/07/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND PURPOSE Zirconia abutments have been widely adopted in clinical implant practice. The unique mechanical properties of zirconia may significantly affect the long-term prognosis of implant treatments. The purpose of this study was to investigate the influence of abutment material on implant deformation and fracture resistance of internal conical connection implant-abutment complexes of two diameters after standardized artificial aging. MATERIALS AND METHODS Thirty original abutments (one-piece titanium, one-piece zirconia, zirconia with alloy base) with two diameters (regular, narrow) were connected to internal conical connection implants and subjected to a standardized artificial aging process consisting of thermal cycling and mechanical cyclic loading. Microcomputed tomography (μCT) scans of implant bodies were performed before and after aging. 3-dimensional images of implant bodies were generated from the μCT scans and aligned for before and after aging to calculate the volumetric deformation amount. Finally, fracture resistance was measured using a mechanical static loading test for the surviving aged and 30 brand-new specimens. RESULTS All specimens survived artificial aging. No significant difference in implant deformation was found in the regular groups (p = 0.095). In narrow groups, the one-piece zirconia group showed significantly less deformation (p < 0.0001). For fracture resistance, no significant decrease was observed after aging in any group (p > 0.05). One-piece zirconia abutments showed significantly lower strength than the other two materials for both diameters (p < 0.0001). CONCLUSIONS In the regular diameter system, abutment material had no significant influence on the tested mechanical property degradation after simulated long-term oral use. The mechanical performance of narrow diameter one-piece zirconia abutments differed from the other two materials. For optimal performance, one-piece zirconia abutments should be adopted only in anterior regions.
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Affiliation(s)
- Zhihao Zhai
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Tamaki Nakano
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Yuming Chen
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Shota Watanabe
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Takashi Matsuoka
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Shoichi Ishigaki
- Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
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Saponaro PC, Karasan D, Donmez MB, Johnston WM, Yilmaz B. Prosthetic complications with monolithic or micro-veneered implant-supported zirconia single-unit, multiple-unit, and complete-arch prostheses on titanium base abutments: A single center retrospective study with mean follow-up period of 72.35 months. Clin Implant Dent Relat Res 2023; 25:99-106. [PMID: 36321480 DOI: 10.1111/cid.13149] [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: 06/29/2022] [Revised: 09/13/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The influence of prosthetic design on prosthetic complications when monolithic or micro-veneered zirconia prostheses are supported with titanium base (ti-base) abutments is not well-known. PURPOSE The purpose of this single center, retrospective study was to assess the prevalence of prosthetic complications with monolithic or micro-veneered single-unit, multi-unit, and complete-arch zirconia prostheses supported with ti-base abutments (implant level or multi-unit abutment level). MATERIAL AND METHODS This study retrospectively evaluated the electronic health record (EHR) of participants who received either monolithic or micro-veneered implant-supported single-unit, multi-unit, and/or complete-arch prostheses supported by ti-base or zirconia-ti-base hybrid abutments delivered between the years 2010 and 2021. Data were analyzed by using logistic regression and Exact Mantel-Haenszel chi-square test (α = 0.05) to assess the clinical performance of prostheses and complications including crown decementation, feldspathic porcelain chipping, prosthesis fracture, zirconia-ti-base hybrid abutment decementation, abutment screw loosening, screw fracture, abutment fracture, implant loss, and prosthesis remake. RESULTS The study included 94 participants (50 female, 44 male) with a mean age of 59.5 years (range: 24-101 years of age). The retrospective EHR evaluation yielded 82 single-unit, 51 multi-unit, and 20 complete-arch prostheses on 325 implants. Among 153 prostheses delivered, 108 were micro-veneered (47 single-unit, 41 multi-unit, and 20 complete-arch prostheses) and 45 were monolithic. The average duration was 72.35 months (6.02 years) with a follow-up period of 5-132 months. From the time of insertion to the time of EHR review, of 153 prostheses, 78.43% did not exhibit any prosthetic complication. However, 33 prostheses (21.57%) from 29 participants (30.85%) had at least one prosthetic complication. Only four patients (4.25%) experienced two or more prosthetic complications. Prosthetic design affected the probability of having a complication (p = 0.005); complete-arch prostheses had higher probability (p ≤ 0.028). Single-unit prostheses had lower probability of complication than multi-unit prostheses (p = 0.005). The most commonly observed complication was fracture of veneering material (5.88%) followed by prosthetic screw loosening (4.57%) and decementation between the zirconia and the ti-base abutment (2.61%). Micro-veneered complete-arch prostheses had higher probability of having chipping than that of not having (p < 0.001), and other micro-veneered prosthetic designs had similar probability of chipping with that of complete-arch prostheses (p ≥ 0.082). Frequency of chipping was affected by veneering (p < 0.001). Monolithic prostheses had lower probability of chipping than micro-veneered prostheses, regardless of the prosthetic design (p < 0.001). CONCLUSIONS The frequency of prosthetic complications varied depending on prosthetic design. Complete-arch prostheses had the highest probability of complications while the single-unit prostheses had the lowest. Micro-veneered prostheses had higher probability for chipping than monolithic prostheses. Probability of chipping was similar for micro-veneered single-unit, multi-unit, and complete-arch zirconia prostheses.
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Affiliation(s)
- Paola C Saponaro
- Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Mustafa Borga Donmez
- Department of Prosthodontics, Faculty of Dentistry, Istinye University, Istanbul, Turkey.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - William Michael Johnston
- Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA
| | - Burak Yilmaz
- Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
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Mechanical stability of angulated zirconia abutments supporting maxillary anterior single crowns on narrow-diameter implants. Clin Oral Investig 2023; 27:221-233. [PMID: 36161530 DOI: 10.1007/s00784-022-04715-3] [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: 04/13/2022] [Accepted: 09/07/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To investigate the fracture strength of angulated hybrid abutments supporting anterior single crowns on narrow-diameter implants (NDIs). MATERIAL AND METHODS Zirconia abutment with angulations of labial inclination 0° (TZ0Z), 15° (TZ15Z), 30° (TZ30Z) and palatal inclination 15° (TZ - 15Z) was designed on 3.3-mm titanium-zirconium (Ti-Zr) NDIs. Titanium abutment connected with Ti-Zr implant (TZ0T) and 0° zirconia abutment connected with pure titanium (Ti) implant (T0Z) were control groups. Thirty-six un-restored abutments and 36 abutments restored with highly translucent zirconia (HTZ) crowns were tested. Failure loads were compared among 6 groups, and bending moments were calculated for comparison between un-restored and restored abutments. RESULTS Failure loads of un-restored abutments were affected by the abutment angle. Sixty-seven percent samples in TZ30Z and 83% samples in TZ - 15Z group fractured at the thinnest part of the zirconia abutment and exhibited lower failure load (p < .05). Failure loads of restored abutments were close to or exceeded the maximum bite force of anterior teeth, and no differences were found among six groups (p > .05). Except TZ15Z and TZ0T group, the bending moment increased with the crown construction, especially for TZ30Z and TZ - 15Z groups (p < .001). CONCLUSIONS The fracture strength of hybrid abutments restored with HTZ crown on Ti-Zr NDIs exceeded the bite forces of anterior teeth for all the groups and were not affected by the abutment angle. CLINICAL RELEVANCE In terms of fracture strength, Ti-Zr NDIs combined with angulated hybrid abutments and HTZ crowns can be used in the anterior region.
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Zhai Z, Nakano T, Chen Y, Watanabe S, Matsuoka T, Ishigaki S. Abutment removal torque and implant conical surface morphological changes after standardized artificial aging: An in vitro study. J Prosthet Dent 2022:S0022-3913(22)00738-7. [PMID: 36528391 DOI: 10.1016/j.prosdent.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 11/17/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022]
Abstract
STATEMENT OF PROBLEM Zirconia abutments have become popular as they provide favorable esthetic outcomes. However, studies investigating how abutment material affects abutment screw torque performance and implant conical surface morphological changes in internal conical connection systems are scarce. PURPOSE The purpose of this in vitro study was to investigate the influence of abutment material on abutment removal torque and implant conical surface morphological changes in internal conical connection implant-abutment assemblies of 2 diameters after simulated long-term oral use. MATERIAL AND METHODS Thirty abutments of 3 materials (1-piece titanium, 1-piece zirconia, zirconia with alloy base) and 2 diameters (regular, narrow) made by the original manufacturer were connected to internal conical connection implants and subjected to a standardized artificial aging process consisting of thermal cycling and mechanical cyclic loading with parameters corresponding to anterior and posterior mastication scenarios simulating long-term oral use. An abutment removal torque test was done before and after aging. Morphological changes in the implant conical contact surface were observed with a scanning electron microscope (SEM). Initial and after-aging torque loss values were calculated and analyzed separately with 1-way ANOVA and Tukey HSD post hoc tests (α=.05). RESULTS All specimens survived artificial aging. For initial and after-aging torque loss, the 1-piece zirconia groups showed significantly greater values (P<.001) for both diameters. In the SEM observation, the 1-piece zirconia groups showed distinct widespread surface damage while the other groups exhibited only minor damages. CONCLUSIONS Regardless of diameter, 1-piece zirconia abutments tend to induce more abutment removal torque loss and implant conical surface morphological changes than those with metal connections, both initially and after simulated long-term oral use. Zirconia abutments with an alloy base performed similarly to 1-piece titanium abutments.
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Affiliation(s)
- Zhihao Zhai
- Clinical Fellow, Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Tamaki Nakano
- Assistant Professor, Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan.
| | - Yuming Chen
- PhD student, Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Shota Watanabe
- Clinical Fellow, Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Takashi Matsuoka
- Clinical Fellow, Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
| | - Shoichi Ishigaki
- Associate Professor, Department of Fixed Prosthodontics, Osaka University Graduate School of Dentistry, Suita, Japan
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11
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Effect of yellow anodization of titanium on the shade of lithium disilicate ceramic with different thicknesses. J Prosthet Dent 2022; 128:793.e1-793.e6. [PMID: 36116952 DOI: 10.1016/j.prosdent.2022.08.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 08/17/2022] [Accepted: 08/17/2022] [Indexed: 11/20/2022]
Abstract
STATEMENT OF PROBLEM The color of the titanium abutment can affect the shade of the definitive restoration. Methods such as anodic oxidation, which changes the gray color of implant abutment to yellow, have been advocated to mask the unesthetic gray color of the abutment. However, whether a yellow anodized titanium abutment can prevent discoloration of translucent ceramic restorations is uncertain. PURPOSE The purpose of this in vitro study was to evaluate the effect of the yellow anodization of titanium on the shade of lithium disilicate ceramic with different thicknesses by using CIEDE 2000 formulas. MATERIAL AND METHODS Sixty grade V titanium backgrounds were fabricated and divided into 2 test groups (n=30): group A was anodized to a yellow color, and group U was unanodized. Each group was subdivided into 3 subgroups (n=10) according to the thickness of the lithium disilicate ceramic cemented over it: subgroup 1 with 1-mm-thick lithium disilicate, subgroup 1.5 with 1.5-mm-thick lithium disilicate, and subgroup 2 with 2-mm-thick lithium disilicate. Each titanium background was cemented to its corresponding lithium disilicate block by using translucent resin cement. For the control group, 5-mm-thick lithium disilicate specimens were fabricated. Color measurements of the specimens were made with a spectrophotometer, and differences were calculated by using CIEDE 2000 formulas (ΔE00). Comparisons between the 2 study groups were done by using independent samples t test. Two-way ANOVA was used to assess the effect of anodization and thickness on ΔE00 with calculation of adjusted means and 95% confidence intervals (α=.05). RESULTS Statistically significant differences were found among the mean values between yellow anodized and unanodized groups in all ceramic thicknesses (P<.001 for 1 mm, P<.001 for 1.5 mm, and P<.046 for 2 mm). Yellow anodization of titanium and increasing the ceramic thickness from 1 to 2 mm decreased the ΔE00 values. CONCLUSIONS The restoration shade appeared to be improved by titanium anodization to a yellow color and by increasing the thickness of the machinable high-translucent lithium disilicate.
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Del Castillo R, Chochlidakis K, Galindo-Moreno P, Ercoli C. Titanium Nitride Coated Implant Abutments: From Technical Aspects And Soft tissue Biocompatibility to Clinical Applications. A Literature Review. J Prosthodont 2022; 31:571-578. [PMID: 34731520 DOI: 10.1111/jopr.13446] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To review the most up to date scientific evidence concerning the technical implications, soft tissue biocompatibility, and clinical applications derived from the use of titanium nitride hard thin film coatings on titanium alloy implant abutments. MATERIALS AND METHODS A review was performed to answer the following focused question: "What is the clinical reliability of nitride coated titanium alloy abutments?". A MEDLINE search between 1980 and 2021 was performed for investigations pertaining to the clinical use of nitride coated titanium alloy implant abutments (TiN) in case reports, case series, and short- and long-term non/randomized controlled clinical trials. Literature analysis led to addition evaluation of research related to the technical and biological aspects, as well as the physicochemical characteristics of TiN hard thin film coatings and their impact on titanium abutment biocompatibility, mechanical properties, macroscopic surface topography, and optical properties. Therefore, preclinical data from biomechanical and in vitro investigations were also considered as inclusion criteria. RESULTS The limited number of clinical investigations published made a systematic review and meta-analysis not possible, therefore a narrative review was conducted. TiN coatings have been applied to dental materials and instruments to improve their clinical longevity. Implant abutments are coated with titanium nitride to mask the titanium oxide surface and enhance its surface characteristics providing the TiN abutment surface with a low friction coefficient and a very high chemical inertness. TiN coating is suggested to reduce early bacterial colonization and biofilm formation and enhance fibroblast cell proliferation, attachment and adhesion when compared to Ti controls. Additionally, studies indicate that hard thin film coatings enhance the mechanical properties (hardness and wear resistance) of titanium alloy and appears as a yellow color when deposited on the titanium alloy substrate. To date, clinical investigations show that nitride coated titanium abutments provide promising short-term clinical outcomes. CONCLUSIONS Published research on nitride-coated abutments is still limited, however, the available biomedical research, mechanical engineering tests, in vitro investigations, and short-term clinical trials have, to date, reported promising mechanical, biological, and esthetic outcomes.
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Affiliation(s)
- Rafael Del Castillo
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Konstantinos Chochlidakis
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Carlo Ercoli
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
- Department of Prosthodontics and Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
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13
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Hjerppe J, Jung RE, Hämmerle CH, Özcan M, Mühlemann S. Mechanical stability of fully personalized, abutment-free zirconia implant crowns on a novel implant-crown interface. J Dent 2022; 121:104121. [PMID: 35395344 DOI: 10.1016/j.jdent.2022.104121] [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: 09/09/2021] [Revised: 03/24/2022] [Accepted: 04/03/2022] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To test the failure load and failure mode of a novel implant-crown interface specifically designed for the fabrication of fully personalized, abutment-free monolithic zirconia CAD-CAM crowns compared to conventional implant-abutment interfaces involving prefabricated or centrally manufactured abutments for zirconia CAD-CAM crowns. METHODS Implants (N=48) were divided into groups (n=12) according to different implant-abutment interface designs: (1) internal implant connection with personalized, abutment-free CAD-CAM crowns (Abut-Free-Zr), (2) internal conical connection with customized, centrally manufactured zirconia CAD-CAM abutments (Cen-Abut-Zr), (3) prefabricated titanium base abutments from manufacturer 1 (Ti-Base-1), (4) additional prefabricated titanium base abutments from manufacturer 2 (Ti-Base-2). All specimens were restored with a screw-retained monolithic zirconia CAD-CAM molar crown and subjected to thermomechanical aging (1.200.000 cycles, 49 N, 1.67 Hz, 30° angulation, thermocycling 5-50°C). Static load until failure was applied in a universal testing machine. Failure modes were analyzed descriptively under digital microscope. Mean failure load values were statistically analyzed at a significance level of p<0.05. RESULTS All specimens survived thermomechanical aging. The mean failure loads varied between 1332 N (Abut-Free-Zr) and 1601 N (Ti-Base-2), difference being significant between these groups (p<0.05). No differences between the other groups were seen. The predominant failure mode per group was crown fracture above implant connection (Abut-Free-Zr, 75%), abutment fracture below implant neck (Cen-Abut-Zr, 83%), crown fracture leaving an intact abutment (Ti-Base-1/Ti-Base-2 100%). CONCLUSIONS Implant-crown interface with fully personalized, abutment-free monolithic CAD-CAM zirconia crowns exhibited similar failure loads as conventional implant-abutment interfaces (except group Ti-Base-2) involving CAD-CAM crowns with prefabricated or centrally manufactured abutment. CLINICAL SIGNIFICANCE The new implant connection simplifies the digital workflow for all-ceramic implant reconstructions. The specific design of the implant-crown interface allows the fabrication of fully personalized, abutment-free zirconia implant crowns both in-house and in-laboratory without the need of a prefabricated abutment or central manufacturing.
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Affiliation(s)
- Jenni Hjerppe
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland.
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Christoph Hf Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Mutlu Özcan
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
| | - Sven Mühlemann
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Plattenstrasse 11, CH-8032 Zurich, Switzerland
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14
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Evaluation of Er,Cr:YSGG laser irradiation for debonding of zirconia hybrid abutment crowns from titanium bases. Lasers Med Sci 2022; 37:2675-2685. [DOI: 10.1007/s10103-022-03539-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 02/28/2022] [Indexed: 10/18/2022]
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15
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Kraus RD, Espuelas C, Hämmerle CHF, Jung RE, Sailer I, Thoma DS. Five-year randomized controlled clinical study comparing cemented and screw-retained zirconia-based implant-supported single crowns. Clin Oral Implants Res 2022; 33:537-547. [PMID: 35224774 PMCID: PMC9313572 DOI: 10.1111/clr.13913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/17/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
Objectives To compare screw‐retained and cemented all‐ceramic implant‐supported single crowns regarding biological and technical outcomes over a 5‐year observation period. Materials and methods In 44 patients, 44 two‐piece dental implants were placed in single‐tooth gaps in the esthetic zone. Patients randomly received a screw‐retained (SR) or cemented (CR) all‐ceramic single crown and were then re‐examined annually up to 5 years. Outcome measures included: clinical, biological, technical, and radiographic parameters. Data were statistically analyzed with Wilcoxon–Mann–Whitney, Wilcoxon, and Fisher's exact tests. Results During the observation period, three patients (6.8%) were loss to follow‐up. Eight restorations (18.2%, CI (8.2%, 32.7%)) were lost due to technical (6 patients, 13.6% (CI (5.2%, 27.4%)), 2 CR and 4 SR group, intergroup p = .673; implants still present) or biological complications (2 patients, 4.5% (CI (0.6%, 16.5%)), only CR group, intergroup p = .201, both implants lost). This resulted in a survival rate of 81.2% (CI (65.9%, 90.1%)) on the restorative level (18 SR; 15 CR, 3 lost to follow‐up). At the 5‐year follow‐up, the median marginal bone levels were located slightly apical relative to the implant shoulder with 0.4 mm (0.5; 0.3) (SR) and 0.4 mm (0.8; 0.3) (CR) (intergroup p = .582). Cemented restorations demonstrated a significantly higher biological complication rate (36.8%, SR: 0.0%; intergroup p = .0022), as well as a significantly higher overall complication rate (68.4%, SR: 22.7%, intergroup p = .0049). All other outcomes did not differ significantly between the two groups (p > .05). Conclusions All‐ceramic single‐tooth restorations on two‐piece dental implants resulted in a relatively low survival rate. Cemented restorations were associated with a higher biological and overall complication rate than screw‐retained restorations.
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Affiliation(s)
- Riccardo D Kraus
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Catharina Espuelas
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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16
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Sailer I, Karasan D, Todorovic A, Ligoutsikou M, Pjetursson BE. Prosthetic failures in dental implant therapy. Periodontol 2000 2022; 88:130-144. [PMID: 35103329 PMCID: PMC9305548 DOI: 10.1111/prd.12416] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Both fixed and removable implant‐supported prostheses are well‐established methods for replacing missing teeth in partially or fully edentulous patients. Numerous systematic reviews have been performed in recent years to evaluate the survival and complication rates of implant‐retained fixed dental prostheses and implant‐retained overdentures, displaying high 5‐year survival rates ranging from 97.1% for fixed dental prostheses to 95%‐100% for implant‐retained overdentures. However, the survival rates only represent the prostheses remaining in use for a defined follow‐up time, and do not account for the potential prosthetic complications that may have arisen and influence the general success of the implant treatment. The most common technical complications of fixed implant‐retained single crowns are crown fracture, fractures of ceramic implant abutments, and esthetic problems. The predominant technical complication at multiple‐unit, implant‐retained fixed dental prostheses is fracture/chipping of the veneering ceramic. Reported technical complications for implant‐retained overdentures are overdenture fracture or chipping of the veneer materials, whereas mechanical complications include implant fracture, attachment failure, and attachment housing or insert complications. To reduce the risk of such failures, a comprehensive pretreatment diagnostic work‐up is essential, including defining the prosthetic goal with the aid of a wax‐up or set‐up and the associated ideal, prosthetically oriented three‐dimensional implant position. Furthermore, selection of the ideal type of prosthesis, including the respective implant components and materials, is important for clinical long‐term treatment success.
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Affiliation(s)
- Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Ana Todorovic
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Division of Prosthodontics, Faculty of Dental Medicine, University of Belgrade, Belgrade, Serbia
| | - Maria Ligoutsikou
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Bjarni Elvar Pjetursson
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland
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17
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Lamperti ST, Wolleb K, Hämmerle CHF, Jung RE, Hüsler J, Thoma DS. Cemented versus screw-retained zirconia-based single implant restorations: 5-year results of a randomized controlled clinical trial. Clin Oral Implants Res 2022; 33:353-361. [PMID: 35051314 PMCID: PMC9305781 DOI: 10.1111/clr.13895] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 11/26/2021] [Accepted: 12/30/2021] [Indexed: 11/26/2022]
Abstract
Objectives To compare cemented and screw‐retained one‐piece zirconia‐based restorations in terms of clinical, radiographic, and technical outcomes 5 years after insertion. Materials and methods Thirty‐four patients with single‐tooth implants were randomly restored with either a cemented lithium disilicate crown on a one‐piece customized zirconia abutment (CEM, 17 patients) or a screw‐retained crown based on a directly veneered one‐piece customized zirconia abutment (SCREW, 16 patients). All patients were recalled for a baseline examination (7–10 days after crown insertion) and then annually up to 5 years. The following outcomes were assessed: marginal bone level (changes), technical, and clinical (bleeding on probing, plaque control record, probing depth, and keratinized tissue) parameters. The Mann–Whitney U‐test was used to assess differences between the two groups. Results At 5 years, 26 patients (13 in each group) were re‐examined. The survival rates on the implant and restorative levels were 100% and 82.4% (equally for both groups), respectively. At 5 years, the median marginal bone level was located at −0.15 mm (IQR: −0.89 mm; 0.27 mm) (CEM) and −0.26 mm (IQR: −0.38 mm; 0.01 mm) (SCREW) below the implant shoulder (intergroup p = .9598). The median changes between baseline and the 5‐year follow‐up amounted to −0.23 mm (CEM; intragroup p = .0002) and −0.15 mm (SCREW; intragroup p = .1465) (intergroup p = .1690). The overall technical complication rate at 5 years was 15.4% (CEM) and 15.4% (SCREW) (intergroup p = 1.00). Clinical parameters remained stable over time (baseline to 5 years). Conclusions At 5 years, screw‐retained and cemented restorations rendered largely the same clinical, technical, and radiographic outcomes. Technical complications were frequent in both groups.
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Affiliation(s)
- Sofia T Lamperti
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | | | | | - Ronald E Jung
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Jürg Hüsler
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, University of Zurich, Zurich, Switzerland.,Department of Periodontology, Research Institute for Periodontal Regeneration, College of Dentistry, Yonsei University, Seoul, Korea
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Fracture Resistance of Zirconia Abutments with or without a Titanium Base: An In Vitro Study for Tapered Conical Connection Implants. MATERIALS 2022; 15:ma15010364. [PMID: 35009516 PMCID: PMC8746020 DOI: 10.3390/ma15010364] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/22/2021] [Accepted: 01/02/2022] [Indexed: 11/16/2022]
Abstract
Dental implants with tapered conical connections are often combined with zirconia abutments for esthetics; however, the effect of the titanium base on the implant components remains unclear. This study evaluated the effects of a titanium base on the fracture resistance of zirconia abutments and damage to the tapered conical connection implants. Zirconia (Z) and titanium base zirconia (ZT) abutments were fastened to Nobel Biocare (NB) implants and Straumann (ST) implants and subjected to static load testing according to ISO 14801:2016. The experiments were performed with 3 mm of the platform exposed (P3) and no platform exposed (P0). The fracture loads were statistically greater in the titanium base abutments than the zirconia abutments for the NB and ST specimens in the P0 condition. In the P3 condition of the ST specimens, the deformation volume of the ZT group was significantly greater than the Z group. The titanium base increased the fracture resistance of the zirconia abutments. Additionally, the titanium base caused more deformation in the P3 condition. The implant joint design may also affect the amount of damage to the implants when under a load. The mechanical properties of the abutment should be considered when selecting a clinical design.
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Farrag KM, Khamis MM. Effect of anodized titanium abutment collars on peri-implant soft tissue: A split-mouth clinical study. J Prosthet Dent 2021:S0022-3913(21)00518-7. [PMID: 34756606 DOI: 10.1016/j.prosdent.2021.09.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 09/14/2021] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
STATEMENT OF PROBLEM Anodic oxidation of titanium implant abutment collars has been used to mask their unesthetic grayish color. However, the effect of anodic oxidation on the health and appearance of peri-implant soft tissues is unclear. PURPOSE The purpose of this split-mouth clinical study was to investigate the effect of anodized titanium on the health and esthetics of peri-implant soft tissues. MATERIAL AND METHODS A total of 60 osseointegrated implants placed in 30 participants were included in the present study. Each participant received 2 randomly allocated abutments, one with a pink anodized collar and the other with an unanodized one to form 2 groups: unanodized group (control group) and anodized group (experimental group). All implants were restored with lithium disilicate restorations. Evaluations of the peri-implant soft tissues were performed at the time of definitive restoration insertion (baseline) and after 3, 6, 12, and 18 months: peri-implant probing depth, soft tissue recession, modified sulcus bleeding index, modified plaque index, and modified gingival index. The esthetics of peri-implant soft tissues were evaluated by using the modified pink esthetic score. The paired t test or Wilcoxon signed-rank test was used for comparing the 2 study groups at each point of time depending on the normality of the variables (α=.05). To compare each variable at different time points within each group separately, repeated measures ANOVA or Friedman tests were used according to the normality of the variables, followed by post hoc pairwise comparisons by using the Bonferroni adjusted significance (α=.05). RESULTS Five peri-implant soft tissue indices were followed up throughout the study. No statistically significant differences were found among the mean values of the tested indices in the anodized and unanodized groups throughout the evaluation periods (P>.05). The collective mean values of the modified pink esthetic score also showed no statistically significant differences between the groups (P>.05). CONCLUSIONS Based on this split-mouth clinical study, pink anodized titanium abutment collars do not produce a clinically significant effect on the health or esthetics of peri-implant soft tissues.
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Affiliation(s)
- Khaled Mohamed Farrag
- Demonstrator of Fixed Prosthodontics, Conservative Dentistry Department, Faculty of Dentistry, Alexandria University, Alexandria, Egypt
| | - Mohamed Moataz Khamis
- Professor and Chairman, Department of Prosthodontics, Faculty of Dentistry, Alexandria University, Alexandria, Egypt.
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Pitta J, Burkhardt F, Mekki M, Fehmer V, Mojon P, Sailer I. Effect of airborne-particle abrasion of a titanium base abutment on the stability of the bonded interface and retention forces of crowns after artificial aging. J Prosthet Dent 2021; 126:214-221. [DOI: 10.1016/j.prosdent.2020.06.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 05/29/2020] [Accepted: 06/01/2020] [Indexed: 11/24/2022]
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21
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Biocompatibility of Lithium Disilicate and Zirconium Oxide Ceramics with Different Surface Topographies for Dental Implant Abutments. Int J Mol Sci 2021; 22:ijms22147700. [PMID: 34299319 PMCID: PMC8306444 DOI: 10.3390/ijms22147700] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 07/12/2021] [Accepted: 07/17/2021] [Indexed: 01/11/2023] Open
Abstract
Gingivafibroblasts were cultured on lithium disilicate, on zirconia dioxide, and on titanium with two different surface roughnesses (0.2 µm and 0.07 µm); Proliferation (MTT), Living/Dead staining, cytotoxicity (LDH), proliferation (FGF2), and inflammation (TNFα) were analyzed after 1 day and 21 days. Furthermore, alteration in cell morphology (SEM) was analyzed. The statistical analysis was performed by a Kruskal-Wallis test. The level of significance was set at p < 0.05. There were no distinct differences in cellular behavior between the tested roughness. There were slight differences between tested materials. Cells grown on zirconia dioxide showed higher cytotoxic effects. Cells grown on lithium disilicate showed less expression of TNFα compared to those grown on zirconia dioxide or titanium. These effects persisted only during the first time span. The results indicate that the two tested high-strength ceramics and surface properties are biologically suitable for transmucosal implant components. The findings may help clinicians to choose the most appropriate biomaterial as well as the most appropriate surface treatment to use in accordance with specific clinical dental applications.
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22
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Survival Rate and Deformation of External Hexagon Implants with One-Piece Zirconia Crowns. METALS 2021. [DOI: 10.3390/met11071068] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study aimed to evaluate the survival rates of several external hexagon implants directly connected to zirconia crowns after thermomechanical fatigue. The deformation of the hexagons and the integrity of zirconia crowns were also evaluated. A monolithic zirconia crown (Y-TZP) and four different external hexagon dental implants (n = 10, N = 40) were mounted together and embedded in polyurethane. The specimens were subjected to thermomechanical cycling for 2.5 × 106 cycles, at 3.0 Hz frequency, at 200 N loading. The interface of the implant/zirconia crown system, zirconia crowns integrity before and after cycling, and the implant hexagon surface were evaluated under stereomicroscopy and SEM. A nanohardness analysis was performed to verify the hardness of zirconia and implants. Statistical analysis was performed using the Kaplan-Meier test, Multi-Sample Survival Tests, Logrank Test, (p = 0.05). The data did not show significant differences in the survival rates of different implant groups. However, some crowns presented fractures (16.67%) and the external hexagon region of the implants presented plastic deformations (100%). During chewing simulation, the interface between titanium implant and zirconia abutment can promote plastic deformation in the metal and surface defects in the ceramic. In addition, the types of interface defects can be affected by the external hexagon design.
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Spitznagel FA, Bonfante EA, Vollmer F, Gierthmuehlen PC. Failure Load of Monolithic Lithium Disilicate Implant-Supported Single Crowns Bonded to Ti-base Abutments versus to Customized Ceramic Abutments after Fatigue. J Prosthodont 2021; 31:136-146. [PMID: 33870577 DOI: 10.1111/jopr.13369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This laboratory study analyzed the influence of retention mode (screw- vs cement retained) and fatigue application on the failure load of monolithic lithium-disilicate (LDS) implant-supported single crowns (ISSC). MATERIAL AND METHODS A total of 72 samples of monolithic LDS (*Ivoclar Vivadent) ISSC were divided into three groups (n = 24) according to their type of retention mode: Group Ti-CAD: Titanium base (SICvantage CAD/CAM Abutment red (SIC invent AG), screw-retained milled monolithic LDS (IPS e.max CAD*); Group Ti-P: Titanium base (SICvantage CAD/CAM Abutment red), screw-retained pressed monolithic LDS (IPS e.max Press*) and Group Ti-Cust: Titanium base with cemented press LDS (IPS e.max Press*) crown on a LDS (IPS e.max Press*) custom abutment. A mandibular first molar implant-supported single crown model was investigated (Titanium implant: SICvantage-max, SIC invent AG, diameter: 4.2 mm, length: 11.5 mm). Half of each group (n = 12) were exposed to fatigue with cyclic mechanical loading (F = 198 N, 1.2 million cycles) and simultaneous thermocycling (5-55°C). Single load to failure testing was performed, before (Subgroups Ti-CAD, Ti-P, and Ti-Cust) and after (Subgroups Ti-CAD-F, Ti-P-F, and Ti-Cust-F) fatigue. Weibull distribution was used to determine the characteristic strength and Weibull modulus differences between groups. Probability of survival at 900N load was calculated. RESULTS No samples failed during fatigue. Characteristic strength values were as follow: Ti-CAD: 3259.5N, Ti-CAD-F: 2926N, Ti-P: 2763N, Ti-P-F: 2841N, Ti-Cust: 2789N, Ti-Cust-F: 2194N. Whereas no difference was observed between pressed or milled monolithic crowns cemented to Ti-base, regardless of loading condition, fatigue decreased the characteristic strength of crowns cemented to custom abutments. Probability of survival at 900 N was not significantly different between groups. CONCLUSIONS Screw-retained pressed or milled monolithic LDS ISSC, cemented directly to Ti-base abutments or LDS crowns cemented to custom ceramic abutments resist physiological chewing forces after simulated 5-year aging in the artificial mouth and presented equally high probability of survival. However, a significant decrease in load to failure was observed in LDS crowns cemented to custom ceramic abutments after fatigue. Prospective clinical trials are needed to confirm the results of this laboratory investigation.
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Affiliation(s)
- F A Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - E A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil
| | - F Vollmer
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.,Private Practice, Tettnang, Germany
| | - P C Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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Song SR, Park KM, Jung BY. Fracture strength analysis of titanium insert-reinforced zirconia abutments according to the axial height of the titanium insert with an internal connection. PLoS One 2021; 16:e0249208. [PMID: 33793622 PMCID: PMC8016344 DOI: 10.1371/journal.pone.0249208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/14/2021] [Indexed: 11/18/2022] Open
Abstract
This study aimed to analyze fracture strength in vitro by varying the axial height of the titanium insert and the labial height of the zirconia abutment in an internal connection implant to identify the titanium insert axial height with optimal mechanical stability. Sixty implants with an internal connection system were used. Two-piece zirconia abutments were used with the titanium inserts. Combinations of different titanium insert axial heights (mm) and zirconia abutment labial heights (mm) constituted five groups: Gr1 (1–3), Gr2 (3–3), Gr3 (3–5), Gr4 (5–3), and Gr5 (5–5). After thermocycling, a fracture load test was performed with a universal testing machine. The initial deformation load and the fracture load were measured and analyzed. The fractured surface and cross-section of the specimens were examined by scanning electron microscopy (SEM). The groups of titanium inserts with axial heights of 3 mm and 5 mm showed significantly greater initial deformation load and fracture load than the group with an axial height of 1 mm (p < 0.05), but there was no significant difference between the two groups with axial heights of 3 mm and 5 mm. The labial height of the zirconia abutment had no significant influence on the initial deformation load and fracture load. In some specimens in Gr4 and Gr5, cracking or bending of the titanium insert and abutment screw was observed on SEM. The axial height of the titanium insert should be designed to not be less than 3 mm to increase the fracture strength and promote the long-term stability of implants.
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Affiliation(s)
- Seung-rye Song
- Department of Advanced General Dentistry, Dankook University College of Dentistry, Cheonan, Korea
| | - Kyeong-Mee Park
- Department of Advanced General Dentistry, Human Identification Research Institute, Yonsei University College of Dentistry, Seoul, Korea
| | - Bock-Young Jung
- Department of Advanced General Dentistry, Yonsei University College of Dentistry, Seoul, Korea
- * E-mail:
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Markarian RA, Galles DP, França FMG. Dental implant-abutment fracture resistance and wear induced by single-unit screw-retained CAD components fabricated by four CAM methods after mechanical cycling. J Prosthet Dent 2021; 128:450-457. [PMID: 33640089 DOI: 10.1016/j.prosdent.2020.08.052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 12/30/2022]
Abstract
STATEMENT OF PROBLEM Computer-aided design and computer-aided manufacturing (CAD-CAM) methodologies allow the fabrication of custom dental implant abutments with a variety of materials and techniques. Studies on the mechanical strength of such components and the wear induced at their coupling interface during mechanical cycling are sparse. PURPOSE The purpose of this in vitro study was to measure the wear patterns at the hexagonal platform of dental implants induced by the installation and mechanical cycling of custom abutments fabricated by using 4 different CAD-CAM methods and to determine the compressive static resistance of the implant-abutment combinations. MATERIAL AND METHODS A CAD software program was used to design a custom abutment for a single-unit screw-retained external hexagon dental implant crown. The same design file was used to manufacture with 4 CAM methods (N=40): milling and sintering of zirconium dioxide (ZO), cobalt-chromium (Co-Cr) sintered by selective laser melting (SLM), fully sintered machined Co-Cr alloy (MM), and machined and sintered agglutinated Co-Cr alloy powder (AM). Prefabricated titanium abutments were used as a control (TI). Each abutment was installed onto a dental implant (4.1×11 mm), and the specimens were mechanically aged (1 million cycles, 2 Hz, 100N, 37 °C). After mechanical cycling, the hexagonal connection of the dental implants was examined with a scanning electron microscope (SEM), and unused dental implants (NI) were examined as a control (n=10). The images were analyzed with a software program to quantify the areas that showed wear. The implant-abutment combinations were reassembled and submitted to a compression test (1mm/min) with a universal testing machine. The data obtained were submitted to 1-way ANOVA (α=.05). RESULTS The mean ±standard deviation fracture load (N) of the specimens of each group were 1005 ±187 (ZO), 1074 ±123 (SLM), 1033 ±109 (MM), 1019 ±149 (AM), and 923 ±129 (TI). These values were statistically similar (P=.213). The mean ±standard deviation wear of the implants in squared-pixels were 1.1 ±0.38×105 (ZO), 2.0 ±0.29×105 (SLM), 1.0 ±0.38×105 (MM), 1.1 ±0.27×105 (AM), 1.1 ±0.33×105 (TI), and 0.51 ±0.29×105 (NI). The results indicated that, although significantly higher than those in in the control group (NI), the wear values found in the groups TI, ZO, MM, and AM were significantly lower than in the SLM group (P<.001). CONCLUSIONS The CAD-CAM abutments presented the same mechanical fracture load and wear measurements as the TI group, except for the SLM material, which showed increased wear. The failure mode from the load bearing test was the fracture of the abutments for the ZO group. The implants permanently deformed or fractured for the metal abutment groups.
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Affiliation(s)
- Roberto A Markarian
- Postdoctoral fellow, Department of Implant Dentistry, São Leopoldo Mandic Institute and Dental Research Center (SLMANDIC), Campinas, Brazil.
| | | | - Fabiana M G França
- Professor, São Leopoldo Mandic Institute and Dental Research Center (SLMANDIC), Campinas, SP, Brazil
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Cárdenas R, Sánchez D, Euán R, Flores AM. Effect of fatigue loading and failure mode of different ceramic implant abutments. J Prosthet Dent 2021; 127:875-881. [PMID: 33483141 DOI: 10.1016/j.prosdent.2020.09.059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 09/22/2020] [Accepted: 09/22/2020] [Indexed: 11/18/2022]
Abstract
STATEMENT OF PROBLEM Currently many options are available for restoring a dental implant, although the ideal implant abutment for withstanding the occlusal load and the restorative material for fulfilling the esthetic need remains unclear. Zirconia (Zir) abutments offer good esthetics, but concerns still remain regarding their fracture strength, complex fabrication, and higher cost as compared with those of titanium (Ti) base abutments offering lower cost, acceptable esthetics, and a straightforward procedure. PURPOSE The purpose of this in vitro study was to evaluate the fracture strength and failure mode of single-tooth Zir and Ti base implant abutments with fatigue loading. MATERIAL AND METHODS Forty restorations were included using 4 different types of abutment-restorations. Zir abutments with lithium disilicate crowns (ZirLd); titanium base abutments with custom Zir abutments and lithium disilicate crowns (TiZirLd); titanium base abutments with monolithic lithium disilicate abutment-crowns (TiLd); titanium base abutments with monolithic polymer-infiltrated ceramic abutment-crowns (TiEn). Specimens were subjected to a progressive cyclic loading by using a custom-made mastication simulator at a frequency of 1.4 Hz starting with a load of 88 N followed by stages of 170, 210, 250, and 290 N for a maximum of 20 000 cycles each or until fracture occurred. The number of cycles, maximum load, and failure modes were recorded. Statistical analysis was done by using the Mann-Whitney U test (α=.05). RESULTS Group TiEn showed a lower resistance to fatigue, with a mean ±standard deviation of 5054 ±123.3 cycles subjected to a mean force of 170 N. Groups ZirLd and TiLd resisted higher forces without fracture 13452.6 ±7094.3 cycles, and load of 178 ±16.9 N, followed by the TiLd group with a mean ±standard deviation of 25798.6 ±5498.7 cycles, and load of 202 ±16.9 N, while the TiZirLd group showed a mean of 48235.4 cycles subjected to a mean force of 258 N. The failure mode observed in the TiEn occurred only in the ceramic, whereas in the ZirLd and TiLd group, it was above the shoulder level of the Ti base abutment. Even though the TiZirLd group was able to withstand higher loads and a higher number of cycles, the failures were catastrophic and presented fractures of the titanium-base abutment and prosthetic screw. CONCLUSIONS The TiZirLd, ZirLd, and TiLd abutment-restorations have the potential to withstand the average physiological occlusal forces that occur in the anterior region. The group with the higher fatigue resistance was TiZirLd, although care should be taken with patients presenting parafunctional habits since the failure mode can be catastrophic. Also, polymer-infiltrated ceramic is not suitable for a Ti base abutment when subjected to oblique loading.
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Affiliation(s)
- Rubén Cárdenas
- Adjunct Professor, Department of Prosthodontics, Autonomous University of Nuevo León, Monterrey, Nuevo León, Mexico; Professor, Department of Restorative Dentistry, Autonomous University of Yucatán, Mérida, Yucatán, México
| | - Diana Sánchez
- Professor, Department of Prosthodontics, Autonomous University of Nuevo León, Monterrey, Nuevo León, Mexico
| | - Raúl Euán
- Chairman, Department of Prosthodontics, Autonomous University of Nuevo León, Monterrey, Nuevo León, Mexico.
| | - Arturo M Flores
- Professor, Department of Prosthodontics, Autonomous University of Nuevo León, Monterrey, Nuevo León, Mexico
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Pitta J, Hjerppe J, Burkhardt F, Fehmer V, Mojon P, Sailer I. Mechanical stability and technical outcomes of monolithic CAD/CAM fabricated abutment-crowns supported by titanium bases: An in vitro study. Clin Oral Implants Res 2020; 32:222-232. [PMID: 33258267 DOI: 10.1111/clr.13693] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 11/08/2020] [Accepted: 11/21/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate mechanical stability (survival and complication rates) and bending moments of different all-ceramic monolithic restorations bonded to titanium bases (hybrid abutment-crowns) or to customized titanium abutments compared to porcelain-fused-to-metal crowns (PFM) after thermo-mechanical aging. MATERIAL AND METHODS Sixty conical connection implants (4.3 mm-diameter) were divided in five groups (n = 12): PFM using gold abutment (GAbut-PFM), lithium disilicate crown bonded to customized titanium abutment (TAbut+LDS), lithium disilicate abutment-crown bonded to titanium base (TiBase+LDS), zirconia abutment-crown bonded to titanium base (TiBase+ZR), polymer-infiltrated ceramic-network (PICN) abutment-crown bonded to titanium base (TiBase+PICN). Simultaneous thermocycling (5°-55°C) and chewing simulation (1,200,000-cycles, 49 N, 1.67 Hz) were applied. Catastrophic and non-catastrophic events were evaluated under light microscope, and survival and complication rates were calculated. Specimens that survived aging were loaded until failure and bending moments were calculated. RESULTS Survival rates after aging were 100% (TAbut+LDS, TiBase+LDS), 91.7% (GA-PFM), 66.7% (TiBase+ZR) and 58.3% (TiBase+PICN) and differed among the groups (p = .006). Non-catastrophic events as screw loosening (GA-PFM) and loss of retention or micro-/macro-movement (TiBase groups) were observed. Complication rates varied among the groups (p < .001). TiBase+PICN had lower bending moment than all the other groups (p < .001). CONCLUSIONS Hybrid abutment-crowns made of lithium disilicate can be an alternative to PFM-based restorations, although concerns regarding the bonded interface between the titanium base and abutment-crown can be raised. PICN and zirconia may not be recommended due to its inferior mechanical and bonding outcomes, respectively. Titanium customized abutment with bonded lithium disilicate crown appears to be the most stable combination.
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Affiliation(s)
- João Pitta
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Jenni Hjerppe
- Departments of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUH), Helsinki, Finland.,Department of Prosthodontics and Stomatognathic physiology, University of Turku, Turku, Finland
| | - Felix Burkhardt
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Vincent Fehmer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Philippe Mojon
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
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Lorusso F, Noumbissi S, Francesco I, Rapone B, Khater AGA, Scarano A. Scientific Trends in Clinical Research on Zirconia Dental Implants: A Bibliometric Review. MATERIALS 2020; 13:ma13235534. [PMID: 33291827 PMCID: PMC7730252 DOI: 10.3390/ma13235534] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Revised: 11/29/2020] [Accepted: 12/02/2020] [Indexed: 12/13/2022]
Abstract
Background: The clinical use of zirconia implants has been shown to increase steadily due to their biological, aesthetic, and physical properties; therefore, this bibliometric study aimed to review the clinical research and co-authors in the field of zirconia dental implant rehabilitation. Methods: We searched Scopus and Web of Science databases using a comprehensive search strategy to 5 October 2020, and independently paired reviewers who screened studies, and collected data with inclusion criteria restricted to clinical research only (either prospective or retrospective). Data on article title, co-authors, number of citations received, journal details, publication year, country and institution involved, funding, study design, marginal bone loss, survival rate, failure, follow-up, and the author’s bibliometric data were collected and evaluated. Results: A total of 29 clinical studies were published between 2008 and 2020 as 41.4% were prospective cohort studies and 48.3% originated from Germany. Most of the included studies had been published in Clinical Oral Implant Research (n = 12), and the most productive institution was the Medical Center of University of Freiburg. The author with the largest number of clinical studies on zirconia implants was Kohal R.J. (n = 10), followed by Spies B.C. (n = 8). Conclusions: This study revealed that zirconia implants have been more prominent in the last ten years, which is a valuable option for oral rehabilitation with marginal bone loss and survival rate comparable to titanium dental implants.
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Affiliation(s)
- Felice Lorusso
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.L.); (S.N.)
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20910, USA
| | - Sammy Noumbissi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.L.); (S.N.)
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20910, USA
| | - Inchingolo Francesco
- Department of Interdisciplinary Medicine, University of Bari Aldo Moro, 70121 Bari, Italy;
| | - Biagio Rapone
- Department of Basic Medical Sciences, Neurosciences and Sense Organs, University of Bari Aldo Moro, 70121 Bari, Italy;
| | - Ahmad G. A. Khater
- Faculty of Oral and Dental Medicine, Ahram Canadian University, 6th of October City, 8655 Giza, Egypt;
| | - Antonio Scarano
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, 31, 66100 Chieti, Italy; (F.L.); (S.N.)
- Zirconia Implant Research Group (Z.I.R.G), International Academy of Ceramic Implantology, Silver Spring, MD 20910, USA
- Correspondence: ; Tel.: +39-0871-355-4084; Fax: +39-0871-355-4099
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Papathanasiou I, Kamposiora P, Papavasiliou G, Ferrari M. The use of PEEK in digital prosthodontics: A narrative review. BMC Oral Health 2020; 20:217. [PMID: 32741366 PMCID: PMC7398079 DOI: 10.1186/s12903-020-01202-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 07/20/2020] [Indexed: 02/06/2023] Open
Abstract
Background Advanced computer-aided design and computer-aided manufacturing (CAD-CAM) technology led to the introduction of an increasing number of machinable materials suitable for dental prostheses. One of these materials is polyetheretherketone (PEEK), a high performance polymer recently used in dentistry with favorable physical, mechanical and chemical properties. The purpose of this study was to review the current published literature on the use of PEEK for the fabrication of dental prostheses with CAD-CAM techniques. Methods Electronic database searches were performed using the terms “PEEK”, “CAD-CAM”, “dental”, “dentistry” to identify studies related to the use of PEEK for the fabrication of CAD-CAM prostheses. The search period spanned from January 1990 through February 2020. Both in vivo and in vitro studies in English were eligible. Review articles and the references of the included publications were searched to identify relevant articles. Results A great number of in vitro studies are available in the current literature pointing out the noticeable properties of PEEK. The use of PEEK has been recommended for a wide range of CAD-CAM fabricated fixed and removable dental prostheses. PEEK was additionally recommended for occlusal splints, intra-radicular posts, implant abutments, customized healing abutments and provisional restorations. However, only a few clinical studies were identified. Conclusions PEEK could be considered as a viable alternative for CAD-CAM fixed and removable dental prostheses to well-established dental materials. Due to the scarcity of clinical data, clinical trials are needed to assess the long-term performance of PEEK prostheses.
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Affiliation(s)
- Ioannis Papathanasiou
- Department of Prosthodontics, Dental School, National and Kapodistrian University of Athens, Athens, Greece
| | - Phophi Kamposiora
- Department of Prosthodontics, Dental School, National and Kapodistrian University of Athens, Athens, Greece.
| | - George Papavasiliou
- Department of Prosthodontics, Dental School, National and Kapodistrian University of Athens, Athens, Greece
| | - Marco Ferrari
- Department of Prosthodontics and Dental Materials, School of Dental Medicine, University of Siena, Siena, Italy
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Survival Probability, Weibull Characteristics, Stress Distribution, and Fractographic Analysis of Polymer-Infiltrated Ceramic Network Restorations Cemented on a Chairside Titanium Base: An In Vitro and In Silico Study. MATERIALS 2020; 13:ma13081879. [PMID: 32316360 PMCID: PMC7216243 DOI: 10.3390/ma13081879] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/08/2020] [Accepted: 04/10/2020] [Indexed: 02/07/2023]
Abstract
Different techniques are available to manufacture polymer-infiltrated ceramic restorations cemented on a chairside titanium base. To compare the influence of these techniques in the mechanical response, 75 implant-supported crowns were divided in three groups: CME (crown cemented on a mesostructure), a two-piece prosthetic solution consisting of a crown and hybrid abutment; MC (monolithic crown), a one-piece prosthetic solution consisting of a crown; and MP (monolithic crown with perforation), a one-piece prosthetic solution consisting of a crown with a screw access hole. All specimens were stepwise fatigued (50 N in each 20,000 cycles until 1200 N and 350,000 cycles). The failed crowns were inspected under scanning electron microscopy. The finite element method was applied to analyze mechanical behavior under 300 N axial load. Log-Rank (p = 0.17) and Wilcoxon (p = 0.11) tests revealed similar survival probability at 300 and 900 N. Higher stress concentration was observed in the crowns’ emergence profiles. The MP and CME techniques showed similar survival and can be applied to manufacture an implant-supported crown. In all groups, the stress concentration associated with fractographic analysis suggests that the region of the emergence profile should always be evaluated due to the high prevalence of failures in this area.
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Wang T, Wang L, Lu Q, Fan Z. Influence of anodized titanium abutments on the esthetics of the peri-implant soft tissue: A clinical study. J Prosthet Dent 2020; 125:445-452. [PMID: 32204926 DOI: 10.1016/j.prosdent.2019.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 12/16/2019] [Accepted: 12/16/2019] [Indexed: 11/27/2022]
Abstract
STATEMENT OF PROBLEM The grayish appearance of a titanium abutment discolors the peri-implant soft tissue, especially if the gingiva is thin. Whether an anodized titanium abutment can prevent the discoloration is unclear. PURPOSE The purpose of this clinical study was to investigate the color change of peri-implant soft tissue surrounding a titanium abutment that had been colored by anodic oxidation. MATERIAL AND METHODS Commercially available titanium abutments were anodized to form a gold and pink titanium abutment and formed the experimental groups. Unanodized titanium and zirconia abutment were used as the control groups. Four types of abutments were fabricated for each participant who received dental implants in the anterior maxilla. The abutments and corresponding definitive crowns were inserted, and the color of the peri-implant soft tissue and contralateral gingiva were measured with a spectrophotometer. The thickness of the peri-implant soft tissue was recorded after probing with an endodontic file. RESULTS Eleven participants were included in this study. The color differences caused by all tested abutments were higher than the critical threshold of ΔE=3.7. The mean color difference (ΔE), from low to high, was the zirconia, pink-anodized titanium, gold-anodized titanium, and unanodized titanium abutment; their values of (ΔE) were 6.81, 7.63, 7.90, and 8.74, respectively. The mean thickness of the peri-implant soft tissue was 2.41 ±0.52 mm. CONCLUSIONS Within the limitation of the small sample size in this study, the gold-anodized and pink-anodized titanium abutment achieved better esthetics for peri-implant soft tissue than the unanodized titanium abutment. Zirconia was the optimal abutment material for the esthetic region.
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Affiliation(s)
- Tingting Wang
- Resident, Department of Oral Implant, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, PR China
| | - Lina Wang
- Doctoral student, Department of Oral Implant, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, PR China
| | - Qianqian Lu
- Postgraduate student, Department of Oral Implant, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, PR China
| | - Zhen Fan
- Professor, Department of Oral Implant, School & Hospital of Stomatology, Tongji University, Shanghai Engineering Research Center of Tooth Restoration and Regeneration, Shanghai, PR China.
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Alqahtani F, AlAmar M. In Vitro Comparison of Modes of Failures among Titanium and One- and Two-piece Zirconia Abutment under Static Load. Eur J Dent 2020; 14:157-160. [PMID: 32168542 PMCID: PMC7069741 DOI: 10.1055/s-0040-1702260] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives
The objective was to assess modes of failures under static load (SL) among titanium (Ti) and one- and two-piece zirconia abutment (ZA)
in vitro
.
Materials and Methods
The Ti abutments were digitally scanned for the fabrication of the one- and two-piece zirconia abutment specimens. This was done to standardize the design of the one-piece abutment and make it the blueprint of the Ti abutment. Twenty-one implant abutments and 21 implant replicas were categorized into three groups as follows: group 1 (Titanium group), group 2 (one-piece ZA group), and group 3 (two-piece ZA group). A 250K-cycle, linear fatigue-load, reaching 10 to 210 Newton (N), was put on all specimens using an all-electric dynamic test instrument and the specimens were loaded until fracture.
Statistical Analysis
Assessment of mode of fracture among the groups was done visually. Significance was based below 0.05.
Results
Screw fracture (
n
= 7) and abutment bending at the apical part (
n
= 7) occurred in the Ti group. In the one-piece zirconia group, screw and abutment fractures occurred in seven and seven cases, respectively. In the two-piece zirconia group, screw fracture (
n
= 7) above the Ti zirconia junction (transgingival segment) and abutment fracture (
n
= 7) were determined as the failure modes.
Conclusion
In conclusion, all abutments underwent failures under SL
in vitro
; and the mode of failure modes varied among the different abutment designs used.
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Affiliation(s)
- Fawaz Alqahtani
- Department of Prosthodontics, College of Dentistry, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi-Arabia
| | - Mohammed AlAmar
- Department of Prosthodontics, Ministry of Health, Riyadh, Saudi Arabia
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Pereira PHDS, Amaral M, Baroudi K, Vitti RP, Nassani MZ, Silva-Concílio LRD. Effect of Implant Platform Connection and Abutment Material on Removal Torque and Implant Hexagon Plastic Deformation. Eur J Dent 2019; 13:349-353. [PMID: 31795000 PMCID: PMC6890484 DOI: 10.1055/s-0039-1700662] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives
The aim of this study was to evaluate the plastic deformation of the hexagonal connection, and the removal torque of the implant-abutment joint of two dental implants combined with internal or external hexagonal connection implants after mechanical cycling.
Materials and Methods
Twenty-four dental implants were used in the study. Half of the implants had internal hexagonal connections (IH; Titamax II Plus) and the other half had external hexagonal connections (EH; Titamax Ti Ex). Four groups of two types of dental implant abutments (titanium: Ti, UCLA II Plus and zirconia: Zr, fabricated by CAD/CAM;
n
= 6) were investigated. The abutments received a metallic crown and the settings were submitted to mechanical cycling (MC; 10
6
cycles, axial load, 120N). The connection surface area was measured by scanning electron microscope (SEM) images. The removal torque was evaluated and the plastic deformation of the hexagonal surface of the implant was measured by comparing the images before and after MC.
Statistical Analysis
Paired-
t
test was used to analyze the data statistically at a significance level of α = 0.05.
Results
The torque values decreased for all groups after MC, and the hexagonal surface area decreased due to plastic deformation for IH and EH associated with Zr abutments.
Conclusions
Zirconia abutments showed the worst plastic deformation of the implant connection surface and torque loosening when associated with IH implant.
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Affiliation(s)
| | - Marina Amaral
- Department of Dentistry, University of Taubaté, Taubaté, Brazil
| | - Kusai Baroudi
- Department of Dentistry, University of Taubaté, Taubaté, Brazil
| | | | - Mohammad Zakaria Nassani
- Department of Prosthetic Dental Science, AlFarabi College of Dentistry and Nursing, Riyadh, Saudi Arabia
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Abstract
PURPOSE The purpose of this systematic review was to identify and summarize clinical studies related to the fracture of zirconia abutments in implant treatments. MATERIAL AND METHODS Medline, Embase, and Cochrane library searches were performed and complemented by manual searches from database inception to February 11, 2018, for title and abstract analysis. RESULTS Initially, 645 articles were obtained through database searches. Fifty-three articles were selected for full-text analysis, and 15 studies met the inclusion criteria. The selected studies were analyzed regarding fracture rate, abutment-implant connection, time point of fracture, location of critical crack, causes, managements, and preventive measures with respect to zirconia abutment fracture. CONCLUSIONS Lower fracture rates were reported for internal connection with metal component (2-piece) zirconia abutments compared with external and internal full-zirconia connection (one-piece) zirconia abutments. Overpreparation and overload should be avoided in case of zirconia abutments.
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Asgeirsson AG, Sailer I, Gamper F, Jung RE, Hämmerle CHF, Thoma DS. Veneered zirconia abutments cemented on non‐original titanium bases: 1‐year results of a prospective case series. Clin Oral Implants Res 2019; 30:735-744. [DOI: 10.1111/clr.13457] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 12/29/2022]
Affiliation(s)
- Asgeir G. Asgeirsson
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials University Clinic of Dental Medicine, University of Geneva Geneva Switzerland
| | - Felix Gamper
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Ronald E. Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Christoph H. F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine University of Zurich Zurich Switzerland
| | - Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine University of Zurich Zurich Switzerland
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36
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Pjetursson BE, Zarauz C, Strasding M, Sailer I, Zwahlen M, Zembic A. A systematic review of the influence of the implant-abutment connection on the clinical outcomes of ceramic and metal implant abutments supporting fixed implant reconstructions. Clin Oral Implants Res 2019; 29 Suppl 18:160-183. [PMID: 30306682 DOI: 10.1111/clr.13362] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this systematic review was to assess the influence of implant-abutment connection and abutment material on the outcome of implant-supported single crowns (SCs) and fixed dental prostheses (FDPs). METHODS An electronic Medline search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective and retrospective studies with a mean follow-up time of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using robust Poisson regression, and comparisons were made with multivariable Poisson regression models. RESULTS The search provided 1511 titles and 177 abstracts. Full-text analysis was performed for 147 articles resulting in 60 studies meeting the inclusion criteria. Meta-analysis of these studies indicated an estimated 5-year survival rate of 97.6% for SCs and 97.0% for FDPs supported by implants with internal implant-abutment connection and 95.7% for SCs and 95.8% for FDPs supported by implants with external connection. The 5-year abutment failure rate ranged from 0.7% to 2.8% for different connections with no differences between the types of connections. The total number of complications was similar between the two connections, yet, at external connections, abutment or occlusal screw loosening was more predominant. Ceramic abutments, both internally and externally connected, demonstrated a significantly higher incidence of abutment fractures compared with metal abutments. CONCLUSION For implant-supported SCs, both metal and ceramic abutments with internal and external connections exhibited high survival rates. Moreover, implant-supported FDPs with metal abutments with internal and external connections for also showed high survival rates.
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Affiliation(s)
- Bjarni Elvar Pjetursson
- Department of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland.,Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Cristina Zarauz
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Malin Strasding
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anja Zembic
- Clinic of Fixed and Removable Prosthodontics and Material Science, University of Zurich, Zurich, Switzerland
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Wachtel A, Zimmermann T, Sütel M, Adali U, Abou-Emara M, Müller WD, Mühlemann S, Schwitalla AD. Bacterial leakage and bending moments of screw-retained, composite-veneered PEEK implant crowns. J Mech Behav Biomed Mater 2018; 91:32-37. [PMID: 30529984 DOI: 10.1016/j.jmbbm.2018.11.027] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 11/26/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
Abstract
Due to its elastic modulus close to bone, the high-performance material PEEK (polyetheretherketone) represents an interesting material for implant-supported dental prostheses. Besides a damping effect of masticatory forces, it might have a sealing effect against bacterial leakage of the implant-abutment interface (IAI). So far, PEEK has only been used for provisional implant crowns. Therefore, the aim of the study was the evaluation of the bacterial tightness of screw-retained PEEK crowns on titanium implants with conical IAI during masticatory simulation and subsequent bending moment testing. Ten screw-retained implant crowns in the shape of an upper central incisor consisting of a PEEK crown framework veneered with composite were connected to NobelActive RP titanium implants (4.3 × 11.5 mm, Nobel Biocare AB, Göteborg, Sweden) with a tightening torque of 15 Ncm. Prior to tightening, the interior of the implant was inoculated with a bacterial suspension of Enterococcus faecium. The specimens were overmolded with indicating agar (Kanamycin-Aesculin-Azid-Agar (KAAA), Oxoid Limited, Basingstoke United Kingdom), that turns black in contact with E. faecium. The specimens were subjected to a cyclic masticatory simulation whereby a force of 50 N cm was applied at an angle of 30° to the implant axis for 1.2 million cycles. Afterwards, the specimens were subjected to a static loading test according to ISO 14801:2007 to determine the bending moment. During masticatory simulation neither a loosening of the implant screws nor any damage to the veneer or the PEEK framework occurred. Furthermore, no bacterial leakage could be observed in any of the specimens. The average maximum bending moment was measured at 352.13 ± 48.96 N cm. Regarding masticatory forces, PEEK implant crowns seem to be applicable as definitive implant-supported restorations. Furthermore, the bacterial tightness of the IAI of screw-retained one-piece PEEK implant crowns is advantageous compared to superstructures of conventional materials. Further studies are necessary to substantiate the clinical significance of these findings.
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Affiliation(s)
- Andreas Wachtel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Tycho Zimmermann
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Mona Sütel
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Ufuk Adali
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Mohamad Abou-Emara
- Beuth University of Applied Sciences, Luxemburger Str. 10, 13353 Berlin, Germany
| | - Wolf-Dieter Müller
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany
| | - Sven Mühlemann
- University of Zurich, Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Plattenstrasse 11, 8032 Zürich, Switzerland
| | - Andreas Dominik Schwitalla
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Dental Materials and Biomaterial Research, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Aßmannshauser Str. 4-6, 14197 Berlin, Germany.
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