Anterior esthetic rehabilitation on teeth and dental implants optimized with Procera technology: a case report

Compatible CAD-CAM titanium abutments for posterior single-implant tooth replacement: A retrospective case series

STATEMENT OF PROBLEM

In addition to the original abutments provided by implant companies, compatible computer-aided design and computer-aided manufacturing (CAD-CAM) abutments are also available from different manufacturers. However, the combination of abutments and implant systems from different manufacturers may lead to mechanical problems between components. Little has been reported on the clinical performance of this treatment option.

PURPOSE

The purpose of this retrospective case series was to evaluate the outcome of compatible CAD-CAM titanium abutments (TiAs) for posterior single-implant tooth replacement (PSITR) up to 6 years after insertion.

MATERIAL AND METHODS

Eighty-one patients (34 men, 47 women) who received PSITR restored with compatible CAD-CAM TiAs and had a final recall examination between May 2014 and April 2015 were included in this study. Clinical and radiographic examinations were documented. Retrospective evaluation of the patient records was also performed. Correlations between bone-level changes and variables were calculated using the Spearman correlation.

RESULTS

Implant and prosthesis survival rates were 100%. Twenty technical complications were observed, including 9 decementations of the crown, 6 screw loosenings, and 5 ceramic fractures. Periimplant mucositis was diagnosed in 36 patients (44.4%) and periimplantitis in 6 patients (7.4%). Correlation analysis showed a significant effect of the extent of periodontal bone loss of the remaining teeth on the marginal bone-level changes around implants (r=0.548, P<.001).

CONCLUSIONS

Compatible CAD-CAM TiAs provide a viable treatment option for PSITR. However, in light of relatively high screw-loosening and decementation rates, choosing appropriate cements and abutment manufacturers is essential to improve the clinical performance of this treatment option.

Fracture mode during cyclic loading of implant-supported single-tooth restorations

STATEMENT OF PROBLEM

Fracture of veneering ceramics in zirconia-based restorations has frequently been reported. Investigation of the fracture mode of implant-supported ceramic restorations by using clinically relevant laboratory protocols is needed.

PURPOSE

This study compared the mode of fracture and number of cyclic loads until veneering fracture when ceramic and metal ceramic restorations with different veneering ceramics were supported by implants.

MATERIAL AND METHODS

Thirty-two implant-supported single-tooth restorations were fabricated. The test group was composed of 16 ceramic restorations of zirconia abutment-retained crowns with zirconia copings veneered with glass-ceramics (n=8) and feldspathic ceramics (n=8). The control group was composed of 16 metal ceramic restorations of titanium abutment-retained crowns with gold alloy copings veneered with glass (n=8) and feldspathic ceramics (n=8). The palatal surfaces of the crowns were exposed to cyclic loading of 800 N with a frequency of 2 Hz, which continued to 4.2 million cycles or until fracture of the copings, abutments, or implants. The number of cycles and the fracture modes were recorded. The fracture modes were analyzed by descriptive analysis and the Mann-Whitney test (α=.05). The differences in loading cycles until veneering fracture were estimated with the Cox proportional hazards analysis.

RESULTS

Veneering fracture was the most frequently observed fracture mode. The severity of fractures was significantly more in ceramic restorations than in metal ceramic restorations. Significantly more loading cycles until veneering fracture were estimated with metal ceramic restorations veneered with glass-ceramics than with other restorations.

CONCLUSIONS

The metal ceramic restorations demonstrated fewer and less severe fractures and resisted more cyclic loads than the ceramic restorations, particularly when the metal ceramic crowns were veneered with glass-ceramics.

Reliability and fatigue failure modes of implant-supported aluminum-oxide fixed dental prostheses

OBJECTIVES

To investigate failure modes and reliability of implant-supported aluminum-oxide three-unit fixed dental prostheses (FDPs) using two different veneering porcelains.

MATERIAL AND METHODS

Thirty-six aluminum-oxide FDP frameworks were computer-aided designed and computer-aided manufactured and either hand-veneered(n = 18) or over-pressed(n = 18). All FDPs were adhesively luted to custom-made zirconium-oxide-abutments attached to dental implant fixtures (regular platform 4 × 13 mm). Specimens were stored in water before mechanical testing. A step-stress accelerated life test (SSALT) with three load/cycles varying profiles was developed based on initial single-load-to-failure testing. Failure was defined by veneer chipping or chipping in combination with framework fracture. SSALT was performed on each FDP inclined 30° with respect to the applied load direction. For all specimens, failure modes were analyzed using polarized reflected light microscopy and scanning electron microscopy. Reliability was computed using Weibull analysis software (Reliasoft).

RESULTS

The dominant failure mode for the over-pressed FDPs was buccal chipping of the porcelain in the loading area of the pontic, while hand-veneered specimens failed mainly by combined failure modes in the veneering porcelain, framework, and abutments. Chipping of the porcelain occurred earlier in the over-pressed specimens (350 N/85 k, load/cycles) than in the hand-veneered ones (600 N/110 k) (profile I). Given a mission at 300 N load and 100 or 200 k cycles, the computed Weibull reliability (two-sided at 90% confidence bounds) was 0.99(1/0.98) and 0.99(1/0.98) for hand-veneered FDPs and 0.45(0.76/0.10) and 0.05(0.63/0) for over-pressed FDPs, respectively.

CONCLUSIONS

In the range of average clinical loads (300-700 N), hand-veneered aluminum-oxide FDPs showed significantly less failure by chipping of the veneer than the over-pressed. Hand-veneered FDPs under fatigue loading failed at loads ≥600 N.

The influence of surface topography of ceramic abutments on the attachment and proliferation of human oral fibroblasts

As different implant abutments are introduced to obtain a sufficient soft tissue barrier, the aim of this study was to determine the effect of three different surface modifications of densely sintered high-purity aluminium oxide on morphology, attachment and proliferation of human gingival fibroblasts. Fibroblasts were cultured on pressed aluminium oxide, milled, and then sintered to full density (1), on pressed, densely sintered (2), and on pressed, densely sintered and then polished surfaces (3). The different surfaces were analyzed using a confocal laser scanner, an atomic force microscope and a scanning electron microscope. The cell profile areas were measured using a semiautomatic interactive image analyzer and the figures were expressed as percent of attachment. The polished specimens had the smoothest surfaces and the roughest were the milled surfaces in terms of height deviation. No difference was found in the spacing between the peaks on the polished surfaces compared to the milled surfaces. Fibroblasts on the milled ceramic appeared to follow the direction of the fine irregularities on the surface. The analyses showed the polished surfaces had significantly higher percentages of initial cell attachment than the other surfaces (P < 0.05). After 3 days of cell culture, significantly more cells were attached to the milled and sintered surfaces than to the polished one, possibly indicating higher proliferation capacity on those types of surfaces.