Fracture resistance of monolithic zirconia crowns with different occlusal thicknesses in implant prostheses

Effect of abutment types and resin cements on the esthetics of implant-supported restorations

PURPOSE

The aim of the study was to evaluate the optical properties of new generation (3Y-TZP) monolithic zirconia (MZ) with different abutment types and resin cement shades.

MATERIALS AND METHODS

A1/LT MZ specimens were prepared (10 × 12 × 1 mm, N = 30) and divided into 3 groups according to cement shades as transparent (Tr), yellow (Y) and opaque (O). Abutment specimens were obtained from 4 different materials including zirconia (Group Z), hybrid (Group H), titanium (Group T) and anodized yellow titanium (Group AT). MZ and abutment specimens were then cemented. L^*, a^*, and b^* parameters were obtained from MZ, MZ + abutment, and MZ + abutment + cement. ΔE₀₀₁^* (between MZ and MZ + abutment), ΔE₀₀₂^* (between MZ and MZ + abutment + cement) and ΔE₀₀₃^* (between MZ + abutment and MZ + abutment + cement) values were calculated. Statistical analyses included 2-way ANOVA, Bonferroni, and Paired Sample t-Tests (P < .05).

RESULTS

Abutment types and resin cements had significant effect on L^*, a^*, b^*, ΔE₀₀₁^*, ΔE₀₀₂^*, and ΔE₀₀₃^* values (P < .001). Without cementation, whereas zirconia abutment resulted in the least discoloration (ΔE₀₀₁^* = 0.68), titanium abutment caused the most discoloration (ΔE₀₀₁^* = 4.99). The least ΔE₀₀₂^* = 0.68 value was seen using zirconia abutment after cementation with yellow shaded cement. Opaque shaded cement caused the most color change (ΔE₀₀₃^* = 5.24). Cement application increased the L^* values in all groups.

CONCLUSION

The least color change with/without cement was observed in crown configurations created with zirconia abutments. Zirconia and hybrid abutments produced significantly lower ΔE₀₀₂^* and ΔE₀₀₃^* values in combination with yellow shaded cement. The usage of opaque shaded cement in titanium/anodized titanium groups may enable the clinically unacceptable ΔE₀₀^* value to reach the acceptable level.

The effect of nonthermal argon plasma surface treatment on the fracture resistance of monolithic zirconia restorations containing tetragonal and cubic grains

PURPOSE

The aim of this study was to investigate the effect of nonthermal argon plasma (NP) surface treatment on the fracture resistance of monolithic zirconia restorations with different microstructures.

METHODS

Twenty restorations were prepared from each of two tetragonal and two cubic zirconia materials (80 restorations in total). The restorations were then divided into two subgroups (n = 10) for each material according to the surface treatment applied: air abrasion or NP. The surface topography of the treated groups was examined using a scanning electron microscope. All restorations were fixed to metal dies with resin cement, subjected to thermal cycling, and then underwent fracture resistance testing with a universal testing device. Two-way ANOVA and Bonferroni tests were used for statistical analysis of the data (α = 0.05).

RESULTS

The type of surface treatment and the type of zirconia material were shown to significantly affect the fracture resistance of the restorations. The air-abraded groups showed significantly higher fracture resistance (N) than the NP groups (P < 0.001).

CONCLUSION

The results of this study suggest that air abrasion surface treatment has a more favorable effect on the fracture resistance of tetragonal and cubic zirconia restorations than NP surface treatment.

Patient Satisfaction with Implant-Supported Monolithic and Partially Veneered Zirconia Restorations

The digital workflow and the application of Computer-Aided Manufacturing (CAM) to prosthodontics present the clinician with the possibility of adopting new materials that confer several advantages. Especially in the case of zirconia, these innovations have profoundly changed daily practice. This paper compares the satisfaction and perception of patients who received implant-supported single crowns (SC) and fixed partial dentures (FPD) made from zirconia, either monolithic or partially veneered, after 3 years of follow-up; the success and survival rate of these restorations were also measured. Forty patients, who had been previously treated with implant-supported SC or FPD, either monolithic or partially veneered, and submitted to a yearly maintenance program, were recalled 3 years after their treatment and requested to complete an 8-question questionnaire regarding their perceptions of the treatment. Any mechanical or biological complication that had occurred from the time of delivery was also recorded. Patients that experienced ≥1 complication were less likely to be prone to repeat the treatment. The 3-year success rate was 92.6% for monolithic restoration and 92.3% for partially veneered restoration, while the survival rate was 100% for both restorations. The 3-year follow-up found that monolithic and partially veneered zirconia restorations are both well-accepted treatment options, and patients preferred the veneered restorations (0.76, p < 0.05) from an aesthetic point of view. According to our results, monolithic and veneered zirconia restorations are both reliable treatment options and are both equally accepted by patients.

Full-Crown Versus Endocrown Approach: A 3D-Analysis of Both Restorations and the Effect of Ferrule and Restoration Material

PURPOSE

To assess stress distribution in full-crowns with a composite buildup and endocrowns under axial or oblique loads, both with different ferrules (1 or 2 mm) and ceramic materials (glass ceramic or hybrid ceramic).

MATERIALS AND METHODS

Sixteen models were analyzed with finite element analysis. No-separation contacts were considered between restoration/resin cement and resin cement/tooth. The contact between the fixation cylinder and the root was considered perfectly bonded. The axial load was applied to the occlusal surface and the oblique load was applied to the buccal cusp. The resulting tensile stresses were shown for the crown, the cement layer and the tooth.

RESULTS

Almost all factors influenced the stress distribution significantly in the crown and the cement layer, as well as the tooth. The only exception was found under oblique loading by the restoration material and the type of crown that were of no significant influence on the stress distribution in the tooth.

CONCLUSIONS

Under axial load, the endocrown showed the least tensile stresses in the tooth, but under oblique loads, the full-crown showed less tensile stresses than the endocrown. With the hybrid ceramic material, lower stresses were found in the crown, but higher stresses were present in the cement layer. The 2 mm ferrule is beneficial for reducing the resulting tensile stresses in all modalities.

Comparison of Different Cervical Finish Lines of All-Ceramic Crowns on Primary Molars in Finite Element Analysis

This study aimed to conduct a stress analysis of four types of cervical finish lines in posterior all-ceramic crowns on the primary roots of molar teeth. Four different types of finish lines (shoulder 0.5 mm, feather-edged, chamfer 0.6 mm, and mini chamfer 0.4 mm) and two all-ceramic crown materials (zirconia and lithium disilicate) were used to construct eight finite element primary tooth models with full-coverage crowns. A load of 200 N was applied at two different loading angles (0° and 15°) so as to mimic children’s masticatory force and occlusal tendency. The maximum stress distribution from the three-dimensional finite element models was determined, and the main effect of each factor (loading type, material, and finish line types) was evaluated in terms of the stress values for all of the models. The results indicated that the loading type (90.25%) was the main factor influencing the maximum stress value of the primary root, and that the feather-edged margin showed the highest stress value (p = 0.002). In conclusion, shoulder and chamfer types of finish lines with a 0.4–0.6 mm thickness are recommended for deciduous tooth preparation, according to the biomechanical analysis.

Hierarchy of restorative space required for different types of dental implant prostheses

BACKGROUND

Management of the full and partially edentulous arch requires an understanding regarding the amount of vertical and horizontal restorative space that is needed for different types of dental implant prostheses. Failure to design a prosthetic construct without considering space issues can result in a rehabilitation with diminished stability, poor esthetics, and inadequate contours. Therefore, available restorative volume must be computed before initiating therapy to ensure proper prosthesis design.

TYPES OF STUDIES REVIEWED

The authors searched the dental literature for articles that addressed space requirements for different types of dental implant prostheses and found a few on this subject.

RESULTS

The dental literature indicates there is a 3-dimensional hierarchy of restorative space necessary for different types of implant constructs. The minimum amount of vertical space required for implant prostheses is as follows: fixed screw-retained (implant level): 4 through 5 millimeters; fixed screw-retained (abutment level): 7.5 mm; fixed cement-retained: 7 through 8 mm; unsplinted overdenture: 7mm; bar overdenture: 11 mm; and fixed screw-retained hybrid: 15mm. These dimensions represent the minimal amount of vertical rehabilitative space that can accommodate the above implant prostheses. With respect to horizontal space, computations are needed to account for the discrepancy between an implant and tooth position.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Restorative spaces for each type of prostheses are restoration specific and should be considered during treatment planning to facilitate proper case selection and enhance patient satisfaction.

Does Diamond Stone Grinding Change the Surface Characteristics and Flexural Strength of Monolithic Zirconia?

PURPOSE

The present study evaluated the effect of grinding on the surface morphology, mean roughness, crystalline phase, flexural strength, and Weibull modulus of monolithic (MZ) and conventional (CZ) zirconias.

METHODS AND MATERIALS

CZ and MZ bars and square-shaped specimens were distributed into three subgroups, combining grinding (G) and irrigation (W) with distilled water: Ctrl (Control: no grinding, 20 × 4 × 1.2 mm and 12 × 1.2 mm), DG (dry grinding, 20 × 4 × 1.5 mm and 12 × 1.5 mm), and WG (grinding with irrigation, 20 × 4 × 1.5 mm and 12 × 1.5 mm). The grinding (0.3 mm) was performed on a standardized device using a low-rotation wheel-shaped diamond stone. The four-point flexural strength test was performed on the EMIC 2000 machine (5 KN, 0.5 mm/min). Scanning electron microscopy (SEM) was used to evaluate the surface morphology. An X-ray diffractometer (XRD) was used to obtain the crystalline structures that were analyzed by the Rietveld method. Flexural strength (FS) values were subjected to the Shapiro-Wilk test and two-way analysis of variance followed by the Tukey's test (for all tests, α=0.05).

RESULTS

Grinding, either with or without irrigation, did not change the FS of the MZ but increased the FS of the CZ. Both MZ and CZ showed similar morphologic patterns after grinding, and in the WG groups, the grinding was more aggressive. The MZ had greater monoclinic content in all groups; grinding without irrigation caused the smallest t→m transformation.

CONCLUSION

The grinding, when necessary, should be carried out without irrigation for conventional and monolithic zirconias.

Current status on lithium disilicate and zirconia: a narrative review

Background

The introduction of the new generation of particle-filled and high strength ceramics, hybrid composites and technopolymers in the last decade has offered an extensive palette of dental materials broadening the clinical indications in fixed prosthodontics, in the light of minimally invasive dentistry dictates. Moreover, last years have seen a dramatic increase in the patients’ demand for non-metallic materials, sometimes induced by metal-phobia or alleged allergies. Therefore, the attention of scientific research has been progressively focusing on such materials, particularly on lithium disilicate and zirconia, in order to shed light on properties, indications and limitations of the new protagonists of the prosthetic scene.

Methods

This article is aimed at providing a narrative review regarding the state-of-the-art in the field of these popular ceramic materials, as to their physical-chemical, mechanical and optical properties, as well as to the proper dental applications, by means of scientific literature analysis and with reference to the authors’ clinical experience.

Results

A huge amount of data, sometimes conflicting, is available today. Both in vitro and in vivo studies pointed out the outstanding peculiarities of lithium disilicate and zirconia: unparalleled optical and esthetic properties, together with high biocompatibility, high mechanical resistance, reduced thickness and favorable wear behavior have been increasingly orientating the clinicians’ choice toward such ceramics.

Conclusions

The noticeable properties and versatility make lithium disilicate and zirconia materials of choice for modern prosthetic dentistry, requiring high esthetic and mechanical performances combined with a minimal invasive approach, so that the utilization of such metal-free ceramics has become more and more widespread over time.

Fracture Resistance of Monolithic Zirconia Crowns on Four Occlusal Convergent Abutments in Implant Prosthesis

Adjusting implant abutment for crown delivery is a common practice during implant installation. The purpose of this study was to compare the fracture resistance and stress distribution of zirconia specimens on four occlusal surface areas of implant abutment. Four implant abutment designs [occlusal surface area (SA) SA100, SA75, SA50, and SA25] with 15 zirconia prostheses over the molar area per group were prepared for cyclic loading with 5 Hz, 300 N in a servo-hydraulic testing machine until fracture or automatic stoppage after 30,000 counts. The minimum occlusal thickness of all specimens was 0.5 mm. Four finite element models were simulated under vertical or oblique 10-degree loading to analyze the stress distribution and peak value of zirconia specimens. Data were statistically analyzed, and fracture patterns were observed under a scanning electron microscope. Cyclic loading tests revealed that specimen breakage had moderately strong correlation with the abutment occlusal area (r = 0.475). Specimen breakage differed significantly among the four groups (P = 0.001). The lowest von Mises stress value was measured for prosthesis with a smallest abutment occlusal surface area (SA25) and the thickest zirconia crown. Thicker zirconia specimens (SA25) had higher fracture resistance and lowest stress values under 300 N loading.

Fracture Resistance of Monolithic Zirconia Crowns in Implant Prostheses in Patients with Bruxism

The aim of this study is to determine the minimum required thickness of a monolithic zirconia crown in the mandibular posterior area for patients with bruxism. Forty-nine full zirconia crowns, with seven different occlusal thicknesses of 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, and 1.0 mm, were made by using a computer-aided design/computer-aided manufacturing system (CAD/CAM). Seven crowns in each group were subjected to cyclic loading at 800 N and 5 Hz in a servohydraulic testing machine until fracture or completion of 100,000 cycles. Seven finite element models comprising seven different occlusal thicknesses of 0.4, 0.5, 0.6, 0.7, 0.8, 0.9, and 1.0 mm were simulated using three different loads of vertical 800 N, oblique 10 degrees 800 N, and vertical 800 N + x N torque (x = 10, 50, and 100). The results of cyclic loading tests showed that the fracture resistance of the crown was positively associated with thickness. Specimen breakage differed significantly according to the different thicknesses of the prostheses (p < 0.01). Lowest von Mises stress values were determined for prostheses with a minimal thickness of 1.0 mm in different loading directions and with different forces. Zirconia specimens of 1.0 mm thickness had the lowest stress values and high fracture resistance and under 800 N of loading.

Evaluation of reliability of zirconia materials to be used in implant-retained restoration on the atrophic bone of the posterior maxilla: A finite element study

PURPOSE

Zirconia materials have been used for implant-retained restorations, but the stress distribution of zirconia is not entirely clear. The aim of this study is to evaluate the stress distribution and risky areas caused by the different design of zirconia restorations on the atrophic bone of the posterior maxilla.

MATERIALS AND METHODS

An edentulous D4-type bone model was prepared from radiography of an atrophic posterior maxilla. Monolithic zirconia and zirconia-fused porcelain implant-retained restorations were designed as splinted or non-splinted. 300-N occlusal forces were applied obliquely. Stress analyses were performed using a 3D FEA program.

RESULTS

According to stress analysis, the bone between the 1) molar implant and the 2) premolar in the non-splinted monolithic zirconia restoration model was stated as the riskiest area. Similarly, the maximum von Mises stress value was detected on the bone of the non-splinted monolithic zirconia models.

CONCLUSION

Splinting of implant-retained restorations can be more critical for monolithic zirconia than zirconia fused to porcelain for the longevity of the bone.

3D FEA Study On Implant Threading Role on Selection of Implant and Crown Materials

AIM

This study deeply investigates the effect of dental implant threading and material selection on the mandibular bone under two different crown materials (Translucent Zirconia and Porcelain fused to metal).

METHODS

Two different designs of single piece dental implants were supporting dummy crown above simplified bone geometry in two finite element models. Models components were created by general-purpose CAD/CAM engineering package and then assembled inside ANSYS before meshing and assigning materials. Compressive loading of 100 N and 45º oblique loading of 50 N were tested.

RESULTS

Twenty-four case studies were analysed, and their results were compared. Micro thread reduces implant maximum Von Mises stress by about 50 to 70% than regular thread one. Oblique loading of 50 N will produce 4 to 5 times more maximum Von Mises values on implant body than 100 N vertical loading. Zero or negligible effect on the cortical bone was recorded when exchanging the tested crown material. Although titanium implant can also reduce cortical bone, Von Mises stress by 50 to 100% in comparison to reinforced PEKK (poly ether-ketone-ketone) or PEEK (poly-ether-ether-ketone).

CONCLUSIONS

Reinforced PEKK and PEEK implants can represent a good alternative to titanium implants. Zirconia crown distributes the applied load better than Porcelain fused to a metal one. Regardless of the implant material, an implant with the micro thread has superior behaviour in comparison to a regular one. Zirconia crown above titanium implant with the micro thread may represent the best option for patient bone.

Effect of thickness and surface modifications on flexural strength of monolithic zirconia

STATEMENT OF PROBLEM

A recommended minimum thickness for monolithic zirconia restorations has not been reported. Assessing a proper thickness that has the necessary load-bearing capacity but also conserves dental hard tissues is essential.

PURPOSE

The purpose of this in vitro study was to evaluate the effect of thickness and surface modifications on monolithic zirconia after simulated masticatory stresses.

MATERIAL AND METHODS

Monolithic zirconia disks (10 mm in diameter) were fabricated with 1.3 mm and 0.8 mm thicknesses. For each thickness, 21 disks were fabricated. The specimens of each group were further divided into 3 subgroups (n=7) according to the surface treatments applied: untreated (control), airborne-particle abrasion with 50-μm Al₂O₃ particles at a pressure of 400 kPa at 10 mm, and grinding with a diamond rotary instrument followed by polishing. The biaxial flexure strength was determined by using a piston-on-3-balls technique in a universal testing machine. Flexural loading was applied with a 1.4-mm diameter steel cylinder, centered on the disk, at a crosshead speed of 0.5 mm/min until fracture occurred. X-ray diffraction (XRD) and scanning electron microscopy (SEM) analyses were performed. The data were statistically analyzed with 2-way ANOVA, Tamhane T2, 1-way ANOVA, and Student t tests (α=.05).

RESULTS

The 1.3-mm specimens had significantly higher flexural strength than the 0.8-mm specimens (P<.05). Airborne-particle abrasion significantly increased the flexural strength (P<.05). Grinding and polishing did not affect the flexural strength of the specimens (P>.05).

CONCLUSIONS

The mean flexural strength of 0.8-mm and 1.3-mm thick monolithic zirconia was greater than reported masticatory forces. Airborne-particle abrasion increased the flexural strength of monolithic zirconia. Grinding did not affect flexural strength if subsequently polished.