Fracture resistance of titanium and zirconia abutments: An in vitro study

Monolithic Hybrid Abutment Crowns (Screw-Retained) Versus Monolithic Hybrid Abutments With Monolithic Crowns (Adhesively Cemented): Three-Year Data of a Prospective Clinical Split-Mouth Study

OBJECTIVES

This study compares the restoration of single-tooth implants with screw-retained lithium-disilicate hybrid-abutment crowns and single-tooth lithium-disilicate crowns adhesively bonded to hybrid abutments with regard to objective clinical and subjective patient-specific evaluation criteria over a time of observation of 3 years.

MATERIALS AND METHODS

Two bone-level implants were placed in contralateral sides of the same jaw in 10 patients, each with two single-tooth gaps. After osseointegration, implants were uncovered and an impression was taken. In accordance with the split-mouth design, one implant in each patient was restored with a screw-retained hybrid abutment crown and the other implant with a hybrid abutment and an adhesively bonded single-tooth crown. The restorations were randomly allocated to the implants. Prefabricated titanium bases were used. The ceramic abutments and restorations were fabricated monolithically with pressed lithium-disilicate ceramic. An objective evaluation (survival, technical, or biological complications, FIPS) by the practitioner and a subjective evaluation (satisfaction, OHIP) by the patient were carried out after 3, 6, 12, 24, and 36 months after restoration placement.

RESULTS

Both restoration types showed a survival rate of 100% after 3 years of observation. No technical or biological complications occurred. No significant difference was observed between the two types of restoration neither for objective (survival, technical or biological complications, FIPS) nor subjective (satisfaction, OHIP) evaluation criteria (p > 0.05).

CONCLUSION

No statistically significant differences were observed between screw-retained and cemented pressed lithium-disilicate restorations on bone-level implants for both objective and subjective evaluation criteria, respectively.

CLINICAL SIGNIFICANCE

Monolithic hybrid-abutment crowns (screw-retained) and monolithic hybrid abutments with single-tooth crowns (cemented) made of pressed lithium disilicate can be used to successfully restore single implants.

The Fracture Resistance Comparison between Titanium and Zirconia Implant Abutments with and without Ageing: Systematic Review and Meta-Analysis

Implant abutments are essential components of implant prosthetic restorations. The golden standard for abutment material is titanium; however, due to its properties, the esthetic result can be compromised. The most popular esthetic material alternatives are one- and two-piece zirconia. The study aimed to answer the questions of whether zirconia abutments can be used interchangeably with titanium in both anterior and posterior regions and how aging of the abutment affects durability. For this study, an electronic search of MEDLINE (PubMed) and Scopus (Embase) was conducted. The PRISMA guidelines were followed, and a systematic review was registered with PROSPERO. The search revealed 4031 results, of which 17 studies were selected. The strongest material for abutments is titanium, closely followed by two-piece zirconia. One-piece zirconia abutments were the weakest. The cyclic loading above 1,000,000 cycles decreased the fracture resistance of the abutments. Differences in implant diameter, angulation, and restoration affected the fracture strength of all compared materials. The main mode of failure for titanium abutments was screw bending or screw fracture. One-piece zirconia most often presented catastrophic failure with internal hexagon fracture below the implant neck. Two-piece zirconia exhibits a combination of failure modes. Two-piece zirconia abutments may be suitable for use in the posterior region, given their comparable fracture resistance to titanium abutments. Despite the fact that one-piece zirconia is capable of withstanding forces that exceed those exerted during mastication, it is recommended that it be employed primarily in the anterior dentition due to its propensity for unfavorable failure modes.

Clinical Factors on Dental Implant Fractures: A Systematic Review

Dental implant fractures pose a significant challenge to long-term treatment success. This systematic review aims to comprehensively examine the clinical factors influencing dental implant fractures (IFs). Furthermore, strategies to choose the right type of implant and prevent this complication are addressed. A systematic search was conducted across PubMed, Scopus, and Web of Science databases. Eligible studies included retrospective case-control, prospective cohort studies, and clinical trials. The initial search yielded 361 articles, of which 312 were excluded being these reviews, case reports, irrelevant, or written in languages other than English. This left 49 articles, with only 6 meeting the eligibility criteria for an in-depth review. These studies, all retrospective case-control, examine implant characteristics, patient demographics, surgical and prosthetic variables, biomechanical and functional factors, clinical and procedural variables, complications and maintenance issues. The risk of bias was assessed as low using the ROBINS-I tool. Key findings suggest a correlation between implant diameter and structural resistance, with wider implants demonstrating reduced fracture risk. Additionally, posterior regions, especially molars and premolars, exhibit higher susceptibility to IFs due to increased masticatory forces. Implant design and material may considerably influence fracture risk, with conical implants and screw-retained prostheses showing higher vulnerability. Biomechanical overload, particularly in patients with bruxism, emerges as a primary contributing factor to IFs. Prosthesis type significantly influences fracture incidence, with cantilever prostheses posing a higher risk due to increased stress. Peri-implant bone loss is strongly associated with IFs, emphasizing the need for meticulous preoperative assessments and individualized management strategies. Future research should prioritize larger and heterogeneous populations with long-term follow-up and standardized methodologies to enhance the generalizability and comparability of findings. Randomized controlled trials and biomechanical studies under controlled conditions are also essential to elucidate the complex interactions contributing to IFs and developing effective prevention strategies. Additionally, integrating patient-reported outcomes may offer a comprehensive understanding of the impact of IFs on quality of life.

Comparison of De-Torque and Failure Load Evaluation of Selective-Laser-Sintered CoCr, CAD-CAM ZrO, and Machined Implant Abutment/Restoration

AIM

This study aimed to compare the torque loss, fracture load, compressive strength, and failure types of selective-laser-sintered cobalt chromium (SLM-Co-Cr), computer-aided design and computer-aided manufacturing zirconium oxide (CAD-CAM-ZrO), and machined titanium (Ti) implant abutments.

METHODS

Thirty endosseous dental implants were vertically embedded with machined Ti (control group), CAD-CAM-ZrO, and SLM-Co-Cr abutments. Abutment fabrication involved CAD-CAM milling and SLM technology. The de-torque assessment included preload reverse torque values (RTVs), cyclic loading, and post-RTVs using a customized protocol. Fracture load assessment employed ISO-14801 standards, and statistical analysis was conducted using ANOVA and Tukey Post hoc tests (p < 0.05).

RESULTS

In pre-load RTVs, SLM-Co-Cr showed the lowest mean torque loss (24.30 ± 2.13), followed by machined Ti (27.33 ± 2.74) and CAD-CAM-ZrO (22.07 ± 2.20). Post-load RTVs decreased for all groups. Fracture load and compressive strength were highest for SLM-Co-Cr, with significant differences among groups (p < 0.001). Fracture types included abutment failures in SLM-Co-Cr and machined Ti, while CAD-CAM-ZrO exhibited crown separation with deformation.

CONCLUSION

SLM-Co-Cr-fabricated implant abutments exhibited superior stability and resistance to rotational forces, higher fracture loads, and greater compressive strength compared to CAD-CAM-ZrO and machined Ti.

An In Vitro Investigation of the Role of Implant Abutment Materials on the Fracture Resistance and Failure Mode of Implant-Supported Restorations

BACKGROUND

Implant-supported restorations have gained popularity in modern dentistry, and the choice of abutment material is crucial for their long-term success. This in vitro study aimed to evaluate the fracture resistance and failure mode of implant-supported restorations using different abutment materials.

METHODS

Ninety standardized implant-supported restorations were included in the study. Abutments made of titanium, zirconia, and a hybrid material (titanium base with a zirconia veneer) were evaluated. Standardized abutments were fabricated, and screw-retained restorations were fabricated using a resin-based composite material. Cyclic loading was applied using a universal testing machine to simulate masticatory forces. Fracture resistance was measured in terms of the number of cycles to failure (NCF), and failure modes were analyzed.

RESULTS

The findings indicate that zirconia abutments exhibited higher fracture resistance compared to titanium and hybrid abutments. Longer implants demonstrated higher fracture resistance, suggesting improved stability and resistance to mechanical forces. Increased loading angles resulted in decreased fracture resistance of implant-supported restorations, emphasizing the need for proper occlusal adjustment. Central loading showed higher fracture resistance than lateral and posterior loading locations. The distribution of failure modes varied among the abutment materials, with bulk prosthesis fracture being the most common in the titanium group, while abutment fracture was predominant in the zirconia and hybrid groups.

CONCLUSION

This in vitro study demonstrated that the choice of abutment material significantly influenced the fracture resistance and failure mode of implant-supported restorations. Zirconia abutments exhibited the highest fracture resistance, followed by hybrid and titanium abutments. The failure mode analysis revealed different patterns of failure for each abutment material.

Load, unload and repeat: Understanding the mechanical characteristics of zirconia in dentistry

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.

Zirconia Dental Implants as a Different Alternative to Titanium: A Literature Review

Aim

This article aims to provide an overview of the scientific evidence comparing zirconium dental implants with titanium implants.

Materials and Methods

A comprehensive literature review was conducted using the MEDLINE database accessed through PubMed and Scopus. The search included the keywords "dental implant," "zirconia dental implant," and "titanium dental implant" without any date restrictions.

Results

The review examined research articles focusing on the physical and chemical characteristics of titanium and zirconia dental implants. Additionally, studies investigating the strength and translucency of zirconia, as well as the osseointegration of both materials, were analyzed. However, no conclusive evidence demonstrating the superiority of either material was found in the current literature.

Conclusion

Taking into account the findings of this narrative study, no significant differences were identified between zirconium and titanium dental implants. Further scientific research is required to establish a definitive recommendation regarding the use of one material over the other.

Surface modifications of zirconia with plasma pretreatment and polydopamine coating to enhance the bond strength and durability between zirconia and titanium

The aim of this study was to assess the shear bond strength and durability between plasma-pretreated and polydopamine (PDA)-coated zirconia and titanium. Four groups were prepared according to the different surface treatments (untreated ZrO₂, plasma-pretreated ZrO₂, PDA-coated ZrO₂, and plasma-pretreated and PDA-coated ZrO₂ (PP+PDA-ZrO₂). The surface topography and roughness, contact angle, and elemental analysis of the coatings of the four groups were investigated, and the bond strength and durability of the specimens were evaluated based on shear bond strength and thermocycle tests. Physical and chemical characterization results confirmed that PDA coatings can be successfully formed on zirconia substrates. The roughness and hydrophilicity were significantly higher in the PP+PDA-ZrO₂ group_, which demonstrated better shear bond strength and durability between zirconia and titanium. The plasma pretreatment of zirconia substrates can enhance the stability of the PDA coating layer, and hybrid surface modifications can provide several bonding advantages for clinical use.

Influence of cold atmospheric-pressure-plasma in combination with different pretreatment methods on the pull-off tensile load in two-piece abutment-crowns: an in-vitro study

BACKGROUND

In implant prosthetic dentistry, the adhesive connection of individualized ceramic crowns and prefabricated titanium bases leads to several benefits. However, the durability of the bonding could be a weak point and especially depends on sufficient surface pretreatment. Cold atmospheric-pressure plasma (CAP) is a pretreatment method that should improve the surface properties without physical damage. Thus, the purpose of this study was to investigate the influence of CAP treatment on pull-off tensile load in two-piece abutment crowns.

METHODS

Eighty zirconia crowns and titanium bases were divided into eight groups (n = 10) according to their surface pretreatment prior to cementation with Panavia V5: no treatment (A); sandblasting (B); 10-MDP primer (C); sandblasting and primer (D); CAP (AP); sandblasting and CAP (BP); CAP and primer (CP); sandblasting, CAP and primer (DP). The specimens were thermocycled (5°/55°, 5000 cycles), and then the pull-off tensile load (TL) was measured. Statistical analyses were performed using three-way ANOVA with Tukey post-hoc and Fisher's exact tests.

RESULTS

The results showed that the TL was highest in group D (p < 0.0001). Some combinations of different treatments led to effects that were greater than the sum of the individual effects. These effects were modified by interactions. Only in combination with primer, CAP treatment had a small but positive significant effect (group CP vs. C and CP vs. AP, p < 0.0001) which however did not come close to the strong interaction effect that resulted from the combination of sandblasting and primer.

CONCLUSION

Within the limitations of this study, CAP treatment cannot be recommended in this specific field of indication due to its unreliable influence on TL in combination with other pretreatment methods.

Evaluation of the effect of anodization-colored titanium abutments and zirconia substructure thickness on zirconia substructure color: An In vitro study

BACKGROUND AND AIM

The aim of this study is to evaluate the effect of anodized titanium abutments and zirconia substructure thickness on the color of zirconia substructure.

MATERIALS AND METHODS

In this study, an electrochemical anodization setup was prepared for titanium coloring. Commercial titanium, anodization-colored yellow and pink titanium, and zirconia were used as different abutment specimens. Thirty zirconia discs in 0.7, 0.9, and 1.1 mm thickness were prepared from zirconia blocks as zirconia substructure specimens (n = 10). Zirconia substructure specimens of different thicknesses were placed on abutment specimens of different colors and L*, a*, b* values were measured with a spectrophotometer device. Color difference (ΔE) was calculated according to the CIELab formula by comparing the L*, a*, and b* values obtained on the zirconia abutment with the L*, a*, and b* values obtained on the other abutments. Statistical analyzes were performed with two-way analysis of variance and Tukey Honestly Significant Difference (HSD)test (p < 0.05).

RESULTS

The increase in the thickness of the substructure resulted in a statistically significant difference on ΔE, L*, a*, and b* values (p < 0.001). The effect of abutment color had no significant effect on ΔE values. The highest ΔE value was 18.10 at zirconia substructure with 0.7 mm thickness when paired with pink-anodized titanium abutment specimens.

CONCLUSION

The thickness of zirconia substructure and the color of titanium abutments affect zirconia substructure color.

A five-year randomised controlled trial comparing zirconia-based versus metal-based implant-supported single-tooth restorations in the premolar region

OBJECTIVES

To compare 5-year biological, technical, aesthetic, and patient-reported outcomes of single-tooth implant-supported all-ceramic versus metal-ceramic restorations.

MATERIALS AND METHODS

Thirty patients with 63 premolar agenesis participated in the 5-year follow-up. The prosthetic treatment on single-tooth implants were randomly assigned to all-ceramic crowns on zirconia abutments (AC=31) or metal-ceramic crowns on metal abutments (MC=32). All patients were recalled to clinical examinations at baseline, 1, 3, and 5 years after prosthetic treatments. Biological, technical, and aesthetic outcomes including complications, were clinically and radiographically registered. The patient-reported outcomes were recorded using OHIP-49 questionnaire before treatment and at each follow-up examination.

RESULTS

At 5-year examination, the survival rate was 100% for implants and 100 % for AC and 97% for MC crowns and abutments. The marginal bone loss after 5-years was minor and not significantly different (p= 0.056) between AC (mean: 0.3, SD: 1.1) and MC restorations (mean: -0.1, SD: 0.4). The success rate of the implants based on marginal bone loss was 77.4% for AC- and 93.7% for MC-restorations. The marginal adaptation was significantly better for MC than for AC restorations (p=0.025). The aesthetic outcomes and patient-reported outcomes between AC and MC restorations were not significantly different.

CONCLUSIONS

The biological, aesthetic and patient-reported outcomes for implant-supported AC and MC restorations were successful and with no significant difference after 5-years. The marginal adaptation of the MC crowns cemented on titanium abutments showed significantly better fit than restorations based on zirconia crowns cemented on zirconia abutments.

Effect of Different Customized Abutment Types on Stress Distribution in Implant-Supported Single Crown: A 3D Finite Element Analysis

PURPOSE

The purpose was to investigate stress distribution among 4 different customized abutment types: titanium abutment (Ti), titanium hybrid-abutment-crown (Ti-Hybrid), zirconia abutment with titanium base (Zir-TiBase), and zirconia hybrid-abutment-crown with titanium base (Zir-Hybrid-TiBase).

MATERIALS AND METHODS

To achieve this purpose, 4 types of abutment configurations were simulated. A static load of 200 N (vertical) and 100 N (oblique) were applied to the models. The volume average, maximum, and stress distribution of von Mises stress, including percentage difference, were analyzed with three-dimensional finite element analysis.

RESULTS

According to the volume average von Mises stress, the Ti and Zir-TiBase comparison group showed that the Zir-TiBase group dominantly generated the higher value at Ti-base (22.57 MPa) and screw (17.68 MPa). To evaluate the effect of the hybrid-abutment-crown on volume average von Mises stress by comparing the Ti-Hybrid and Zir-Hybrid-TiBase groups, it was revealed that the combination of abutment and crown in the Ti-Hybrid group generated the worst stress concentration at the screw (12.42 MPa), while in the Zir-Hybrid-TiBase group presented stress concentration at the implant (8.90 MPa).

CONCLUSIONS

A titanium base improved stress distribution at implant in zirconia abutment with titanium base by absorbing stress itself. Customized titanium hybrid-abutment-crown and zirconia hybrid-abutment-crown with titanium base created concentrated stress at screw and implant; respectively. Both abutment types should be cautiously used and maintenanced regularly. This article is protected by copyright. All rights reserved.

Fatigue Resistance of Cast-on Implant Abutment Fabricated with Three Different Alloys

OBJECTIVES

 This study aimed to evaluate fatigue resistance of cast-on implant abutment using three alloys.

MATERIALS AND METHODS

 Forty specimens of implant-supported crowns were prepared; Group 1 (TA) stock titanium abutments, Group 2 (GS) abutment cast with 40% gold alloy, Group 3 (GP) abutment cast with palladium alloy, and Group 4 (CN) abutment cast with nickel-chromium alloy. Specimens were cyclic loaded at 20 Hz, starting from 200 N (5,000 cycles), followed by stepwise loading of 400, 600, 800, 1,000, 1,200, 1,400, 1,600, and 1,800 N (30,000 cycles/step). Specimens were loaded until failure or reached 245,000 cycles.

STATISTICAL ANALYSIS

 The withstand cycles were analyzed using one-way analysis of variance and Weibull survival analysis. Fracture surfaces were examined using scanning electron microscopy.

RESULTS

 The results of withstand cycles were TA (189,883 ± 22,734), GS (195,028 ± 22,371), GP (187,662 ± 22,555), and CN (200,350 ± 30,851). The statistical analysis showed no significant difference between the groups (p = 0.673).

CONCLUSION

 Although CN has higher Weibull characteristic strength which means greater durability, its lower Weibull modulus demonstrated less structural reliability. Consistent failures at implant fixture level were also found in CN group.

Hydrothermal aging affects the three-dimensional fit and fatigue lifetime of zirconia abutments

OBJECTIVE

Evaluate the effect of aging using two different methods on the three-dimensional fit of zirconia abutments at the implant-abutment connection and estimate the probability of survival of anterior crowns supported by straight and 17-degree angled abutments.

MATERIALS AND METHODS

Two different zirconia abutment designs, straight and 17-degree angled abutments (n = 63/group), were evaluated in the current study. The abutments were randomly allocated into three experimental groups according to laboratory aging condition (134°C, 2.2 bar, 20 h): (i) control, (ii) autoclave aging, and (iii) hydrothermal reactor aging. Crystalline content was determined by X-Ray diffraction (XRD) and Raman spectroscopy, and microstructure was analyzed using field-emission gun scanning electron microscope (FEG-SEM). Implant-abutment volume misfit was determined in the straight abutments by micro-computed tomography using the silicone replica technique. For fatigue testing, abutments were torqued to the implants and connected to standardized maxillary incisor zirconia crowns. The assemblies were subjected to step-stress accelerated life testing (SSALT) in water until fracture or suspension. The use level probability Weibull curves and probability of survival for a mission of 50,000 cycles at 50, 100, 150 and 200 N were calculated and plotted. Fractured samples were analyzed using a stereomicroscope and scanning electron microscope.

RESULTS

The crystalline spectra depicted a zirconia system primarily composed of the tetragonal phase. Laboratory aging yielded a 20%- and 37%-increase in the monoclinic content for abutments aged in autoclave and hydrothermal reactor relative to control, respectively. A fully crystalline matrix with a regular grain size was observed in the FEG-SEM for control abutments, with a considerable presence of intergranular defects. While autoclave aging triggered no significant alteration to the microstructure, defect population was reduced after hydrothermal reactor aging. Control abutments presented a significantly higher volume misfit (2.128 ± 0.54 mm3) relative to aged abutments using autoclave (1.244 ± 0.48 mm3) or hydrothermal reactor (1.441 ± 0.41 mm3). The beta (β) values indicated that failures were predominantly controlled by material strength rather than fatigue damage accumulation for all groups, except for straight control abutments. Irrespective of aging, the probability of survival of straight and angled zirconia abutments was up to 95% (95-100%) at 50 and 100 N. A 50N-increase in the load resulted in wider range of survival estimate, with straight autoclave abutments percentage significantly lower probability of survival (77%) than angled hydrothermal reactor abutments (99%). At 200N, angled hydrothermal reactor (97%) or autoclave (82%) aged abutments demonstrated the highest probability of survival, angled control (71%) and straight hydrothermal reactor (69%) abutments intermediate values, and straight autoclave (23%) and control (7%) abutments the lowest estimate. The failure mode predominantly involved abutment and/or abutment screw fracture for both straight and angled abutments.

CONCLUSIONS

Hydrothermal aging significantly influenced volume misfit, as well as the probability of survival of zirconia abutments at higher loads for both angled and straight abutments.

Mechanical in vitro fatigue testing of implant materials and components using advanced characterization techniques

Implants of different material classes have been used for the reconstruction of damaged hard and soft tissue for decades. The aim is to increase and subsequently maintain the patient's quality of life through implantation. In service, most implants are subjected to cyclic loading, which must be taken particularly into consideration, since the fatigue strength is far below the yield and tensile strength. Inaccurate estimation of the structural strength of implants due to the consideration of yield or tensile strength leads to a miscalculation of the implant's fatigue strength and lifetime, and therefore, to its unexpected early fatigue failure. Thus, fatigue failure of an implant based on overestimated performance capability represents acute danger to human health. The determination of fatigue strength by corresponding tests investigating various stress amplitudes is time-consuming and cost-intensive. This study summarizes four investigation series on the fatigue behavior of different implant materials and components, following a standard and an in vitro short-time testing procedure, which evaluates the material reaction in one enhanced test set-up. The test set-up and the applied characterization methods were adapted to the respective application of the implant with the aim to simulate the surrounding of the human body with laboratory in vitro tests only. It could be shown that by using the short-time testing method the number of tests required to determine the fatigue strength can be drastically reduced. In future, therefore it will be possible to exclude unsuitable implant materials or components before further clinical investigations by using a time-efficient and application-oriented testing method.

Titanium Base Abutments in Implant Prosthodontics: A Literature Review

Implant abutments are essential components in restoring dental implants. Titanium base abutments were introduced to overcome issues related to existing abutments, such as the unesthetic appearance of titanium abutments and the low fracture strength of ceramic abutments. This study aimed to comprehensively review studies addressing the mechanical and clinical behaviors of titanium base abutments. A search was performed on PubMed/MEDLINE, Web of Science, Google Scholar, and Scopus databases to find articles that were published in English until December 2020 and that addressed the review purpose. A total of 33 articles fulfilled the inclusion criteria and were included for data extraction and review. In vitro studies showed that titanium base abutments had high fracture strength, adequate retention values, particularly with resin cement, and good marginal and internal fit. Although the clinical assessment of titanium base abutments was limited, they showed comparable performance with conventional abutments in short-term evaluation, especially in the anterior and premolar areas. Titanium base abutments can be considered a feasible treatment option for restoring dental implants, but long-term clinical studies are required for a better assessment.

Implant-abutment screw removal torque values between customized titanium abutment, straight titanium abutment, and hybrid zirconia abutment after a million cyclic loading: an in vitro comparative study

PURPOSE

The aim of this study was to compare removal torque values after mechanical cyclic loading and bending moment after the static compression testing of customized titanium abutment compared with prefabricated and hybrid abutments.

MATERIALS AND METHODS

The study was developed according to ISO 14801:2016. Sixty implants were divided into three groups equally: Straight titanium abutment group, Customized titanium abutment group, and Hybrid zirconia abutment group. Abutments were fabricated with zirconia restoration. Forty five implants underwent for cyclic loading. The removal torque values were measured after a fatigue test was conducted at 0 cycles (control), 50,000 cycles and 1,000,000 cycles. In the second experiment, 15 implants were divided into the same groups. Then, bending moments were investigated.

RESULTS

The mean initial removal torque value was significantly higher than 50,000 cycles and 1,000,000 cycles (P < 0.001). The comparison of mean removal torque value between types of abutments was not significantly different (P > 0.05), and the bending moments of all abutments were not significantly different (P > 0.05).

CONCLUSIONS

From the boundary of this in-vitro study, it could be concluded that customized titanium abutment and hybrid abutment were not significantly different in terms of removal torque values after the fatigue test. The bending moment between types of abutment were not significantly different. Thus, it could be concluded that abutment type does not significantly influence abutment stability or fracture strength.

Esthetic, mechanical, and biological outcomes of various implant abutments for single-tooth replacement in the anterior region: a systematic review of the literature

Background

The choice of the appropriate implant abutment is a critical step for a successful outcome. Titanium abutments have demonstrated high survival rates, due to their excellent biocompatibility and high mechanical strength, although they often result in a grayish discoloration of the peri-implant mucosa. This esthetic concern culminated in the introduction of ceramic abutments. The aim of this review was to assess the esthetic, mechanical, and biological outcomes as well as the survival of the different types of abutments used for single-implant restorations in the anterior area.

Material and methods

An electronic search was conducted in Medline, Embase, and Cochrane Central databases using the appropriate Mesh terms and predetermined eligibility criteria. The quality of the studies was assessed using the ROB 2 tool. The last search was conducted on 18th of March 2020.

Results

From the 2074 records initially identified, 23 randomized controlled trials (32 publications) were included for qualitative analysis. Data were classified based on study information, specific characteristics of the intervention and comparator, and information related to the outcome measures. Seven studies exhibited an overall low risk of bias, while twelve studies raised some concerns.

Conclusions

The rate of abutment failure was low and was associated with the ceramic abutments, especially those with internal connection. Limited correlation was noted between soft tissue thickness and color difference. Titanium abutments caused significantly more discoloration to the soft tissues than ceramic abutments, while hueing (gold or pink) slightly improved their color performance. Zirconia allowed a better color match than titanium or gold abutments, still discolored slightly the soft tissues. The submucosally modified zirconia abutments exhibited encouraging results. No significant difference was reported between materials or different types of retention on recession, papillary fill, and biological outcomes.

Comparison of the shear bond strength of composite resins with zirconia and titanium using different resin cements

PURPOSE

The shear bond strength of conventional zirconia (3Y-TZP), translucent zirconia (5Y-PSZ), and titanium alloy (Ti6Al4V) thermocycled using different phosphate monomer resin cements were investigated.

METHODS

In this study, 120 specimens of 3Y-TZP, 5Y-PSZ, and Ti6Al4V were cemented to nanocomposite resin cylinders using PANAVIA™ V5 and Rely X™ U200. The bond area and resin cement thickness were controlled as per ISO 29022:2013 and 4049:2009. Each resin cement group was used with/without the Clearfil ceramic primer plus. The shear bond strength of the 12 groups was statistically analyzed using two and one-way ANOVA to determine the properties of the different materials and resin cements (α = 0.05). The mode of failure was observed using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS).

RESULTS

The titanium alloy groups showed better shear bond strength than the zirconia groups (p < 0.05). PANAVIA™ V5 without primer showed significantly lower shear bond strength than other cements in zirconia and titanium alloy specimens (p < 0.05). Titanium alloy with Rely X™ U200 with a Clearfil ceramic primer plus showed the highest shear bond strength (6.37 ± 1.60 MPa). SEM images showed mixed failures in zirconia groups and cohesive failures in titanium alloy groups.

CONCLUSIONS

The titanium alloy showed better shear bond strength than zirconia when the Clearfil ceramic primer plus was used. The primer solution containing MDP and resin cement with phosphoric methacrylate ester showed similar shear bond strength with 3Y-TZP and 5Y-PSZ. The resin cement without phosphate monomers demonstrated the least shear bond strength.

Biomechanical effects of dental implant diameter, connection type, and bone density on microgap formation and fatigue failure: A finite element analysis

BACKGROUND AND OBJECTIVE

Understanding fatigue failure and microgap formation in dental implants, abutments, and screws under various clinical circumstances is clinically meaningful. In this study, these aspects were evaluated based on implant diameter, connection type, and bone density.

METHODS

Twelve three-dimensional finite element models were constructed by combining two bone densities (low and high), two connection types (bone and tissue levels), and three implant diameters (3.5, 4.0, and 4.5 mm). Each model was composed of cortical and cancellous bone tissues, the nerve canal, and the implant complex. After the screw was preloaded, vertical (100 N) and oblique (200 N) loadings were applied. The relative displacements at the interfaces between implant, abutment, and screw were analyzed. The fatigue lives of the titanium alloy (Ti-6Al-4V) components were calculated through repetitive mastication simulations. Mann-Whitney U and Kruskal-Wallis one-way tests were performed on the 50 highest displacement values of each model.

RESULTS

At the implant/abutment interface, large microgaps were observed under oblique loading in the buccal direction. At the abutment/screw interface, microgap formation increased along the implant diameter under vertical loading but decreased under oblique loading (p < 0.001); the largest microgap formation occurred in the lingual direction. In all cases, the bone-level connection induced larger microgap formation than the tissue-level connections. Moreover, only the bone-level connection models showed fatigue failure, and the minimum fatigue life was observed for the implant diameter of 3.5 mm.

CONCLUSIONS

Tissue-level implants possess biomechanical advantages compared to bone-level ones. Two-piece implants with diameters below 3.5 mm should be avoided in the posterior mandibular area.

Dental implant-abutment fracture resistance and wear induced by single-unit screw-retained CAD components fabricated by four CAM methods after mechanical cycling

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.

Effect of fatigue loading and failure mode of different ceramic implant abutments

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.

Influence of Screw Channel Angulation on the Fracture Resistance of Zirconia Abutments: An In Vitro Study

PURPOSE

The aim of this study was to investigate the effect of implant screw channel angulation on the fracture resistance of zirconia abutments without artificial aging.

MATERIALS AND METHODS

Ten implant replicas were embedded in a jig of autopolymerizing acrylic resin. Using a surveyor and a metallic platform, the implant replicas were mounted centrally and with an angulation of 30°. A maxillary left central incisor crown was fabricated from pattern resin and scanned. The digital design of a monolithic zirconia implant abutment-crown was completed using a 3D imaging software. For all specimens of this group (ASC₂₅ ), the screw channel was positioned at 25° to the lingual. Following fabrication, the samples were attached onto the embedded implant replicas and manually torqued to 35 Ncm as recommended by the manufacturer. The monolithic zirconia implant abutment-crowns were mounted in a metallic platform, positioned perpendicular to the indenter, and subjected to loading until failure. Crosshead speed was set at 0.5 mm/min for the universal testing machine. Data from a similar in vitro study where straight zirconia custom abutments (ASC₀ ) were subjected to static load until failure was used as a control group. An unpaired Student's t-test was used to determine if fracture resistance based on load at failure and maximum load in each group were significantly different from each other (ASC₂₅ vs ASC₀ ). Statistical significance level was inferred at p ≤ 0.05 RESULTS: Group ASC₂₅ fractured at a mean (SD) load of 215.49 (47.10) N and a mean (SD) maximum load of 420.50 (17.18) N. Group ASC₀ fractured at a mean (SD) load of 534.04 (133.77) N and a mean (SD) maximum load of 762.69 (109.59) N. The difference was statistically significant for both mean load and mean maximum load at failure (p ≤ 0.05). The survival rate of 0° zirconia abutments was significantly higher than that of 25° ASC zirconia abutments.

CONCLUSIONS

Within the limitations of this in vitro study the mean fracture load was significantly higher in the group with a straight channel angulation.

Immunohistochemical assessment of the peri-implant soft tissue around different abutment materials: A human study

BACKGROUND

Soft tissue reaction to dental implant abutments influences the sustainability of restoration. Several abutment materials, such as titanium and gold alloy, have been introduced for strength and esthetic solutions. Zirconia and titanium-base abutments have also become popular in recent years due to high esthetic demands.

PURPOSE

To investigate the immune cell infiltration into the soft tissue in response to different abutment materials.

MATERIALS AND METHODS

Twenty dental implants were placed in the posterior regions of 17 patients. Titanium, zirconia, gold alloy, and titanium-base were randomly selected for each patient on the day of surgery. After 8 weeks of healing, the abutments were removed along with 1 mm of peri-implant soft tissue. Immunohistochemical assessment was performed using labeled streptavidin-biotin to identify T cells, B cells, macrophages, plasma cells, and microvascular infiltration.

RESULTS

Gold alloy demonstrated an overall higher inflammatory cell infiltration and highest number of CD3⁺ , CD20⁺ , and CD 68⁺ cells (P value <.05). The number of plasma cell and new microvascular infiltrations among abutment materials was not significantly different.

CONCLUSION

Titanium, titanium-base, and zirconia abutments showed comparable infiltration profiles; gold alloy abutments showed the highest B-cell, T cell, and macrophage infiltration. None of the abutment materials caused clinical inflammation; hence, they can be effectively used.

Implant Volume Loss, Misfit, Screw Loosening, and Stress In Custom Titanium and Zirconia Abutments

Abstract The aim of this study was to verify the effect of the implant volume loss, vertical misfit between abutment and prosthetic platform, prosthetic screw loosening torque, and screw stress distribution in titanium and zirconia abutments. Ten CAD/CAM system custom abutments of each material were milled and attached to the titanium implants. The implant volume loss was evaluated by microtomography, the vertical misfit with optical microscopy, and digital torque wrench measured the prosthetic screw loosening. All experimental analyses were performed before and after mechanical cycle (1,000,000 cycles, 100 N/2 Hz). Virtual models of the structures were created for finite element analysis, and the stress on the screw obtained with von Mises procedure. Data were analyzed using an independent t-test, two-way ANOVA for repeated measures, and Tukey’s HSD test (a=0.05). There was no significant difference in the implant volume loss for the two abutment materials (p=0.662). Titanium abutments provided higher loosening torque values after mechanical cycling (p<0.001). Lesser marginal misfit was obtained with titanium abutments before and after mechanical cycling (p<0.001). The stress distribution on the screw was similar between abutment materials. In conclusion, CAD/CAM custom titanium abutment reduced the marginal misfit and increased the torque maintenance of prosthetic screws when compared to CAD/CAM custom zirconia abutment.

Effects of material and coefficient of friction on taper joint dental implants

PURPOSE

The aim of this study was: (1) to compare the coefficients of friction between commercially pure titanium (cpTi), titanium (Ti) alloy, and yttria-stabilized zirconia (YSZ) and: (2) to investigate the dynamic behavior of an implant system before, during, and after loading, by transient dynamic three-dimensional finite element analysis (FEA).

METHODS

Coefficients of friction were measured by a ball-on-disk frictional wear testing device. The preload in the screw shaft was calculated from geometric parameters. Two abutment model designs were created, namely a Ti alloy abutment model with a porcelain-fused-to-metal super structure and a YSZ abutment model with a porcelain-fused-to-zirconia super structure. Transient dynamic three-dimensional FEA was performed on ANSYS Workbench Ver. 15.0.

RESULTS

The coefficients of friction of YSZ/cpTi, YSZ/Ti alloy, Ti alloy/cpTi, and Ti alloy/Ti alloy were 0.4417, 0.3455, 0.3952, and 0.3489, respectively. The preload generated in the abutment screw of the FEA model was set to be 158 N. Significantly differences were not found in the maximum von Mises equivalent stress between the Ti alloy and YSZ abutment models before, during, and after loading.

CONCLUSION

The findings indicate differences in the coefficients of friction of cpTi, Ti alloy, and YSZ before, during, and after loading. Fractures caused by stress did not depend on the use of different materials (Ti alloy and YSZ) at the abutment.

In vitro study of surface alterations to polyetheretherketone and titanium and their effect upon human gingival fibroblasts

STATEMENT OF PROBLEM

Soft-tissue attachment to different surfaces may play a pivotal role in the long-term success of dental implants. However, studies on the issue, especially on newer materials, are sparse.

PURPOSE

The purpose of this in vitro study was to evaluate the viability and adhesion of human gingival fibroblasts (HGFs) on different implant abutment materials with specific surface modifications.

MATERIAL AND METHODS

One hundred and fifty specimens in 6 experimental groups were evaluated: smooth-machined titanium alloy (Ti), laser-modified titanium (TiL), smooth-machined polyetheretherketone (PEEK) (P), laser-modified PEEK (PL), plasma-treated PEEK (PP), laser- and plasma-treated PEEK (PLP). Machined Ti was considered as the control group. Surface roughness (S_a), water contact angle (WCA), and X-ray photoelectron spectroscopy (XPS) were measured. HGF attachment and proliferation were observed at 1, 3, and 7 days after cell seeding. Comparison of the means among the groups was performed with 1-way analysis of variance (ANOVA) with post hoc comparison using the Tukey test (α=.05).

RESULTS

S_a values of the laser modified groups were significantly higher than those of the nonmodified (smooth-machined) groups (P<.001). WCAs were significantly different among PEEK groups, and plasma-sprayed groups had the lowest WCAs. XPS analysis of both Ti and PEEK groups showed laser treatment did not have any significant effect on the surface composition of the PEEK as the same bonds with similar ratio/fraction were detected in the spectrum of the modified specimens. Scanning electron microscopy (SEM) revealed more functionally oriented HGF cells on the laser-grooved surfaces. On the first, third, and seventh day of proliferation, the titanium groups showed no significant differences (P>.05). On the first and third days of proliferation, the plasma sprayed groups (PP, PLP) showed significantly greater proliferation than all experimental groups (P<.001). On the seventh day of proliferation, statistically significant differences were observed between all PEEK groups and between all PEEK groups and the Ti group (P<.001), with the exception of the PL and P groups and the PLP and Ti groups (P>.05).

CONCLUSIONS

Laser-modified titanium and PEEK surfaces led to guided gingival fibroblast attachment. Plasma treatment of PEEK surfaces increased the wettability of this polymer and improved proliferation of HGF.

Effects of Liner-Bonding of Implant-Supported Glass-Ceramic Crown to Zirconia Abutment on Bond Strength and Fracture Resistance

This study was conducted to test the hypothesis that heat-bonding with a liner positively affects the bond strength and fracture resistance of an implant-supported glass-ceramic crown bonded to a zirconia abutment produced by a computer-aided design/computer-aided milling (CAD/CAM) procedure. Lithium disilicate-reinforced Amber Mill-Q glass ceramic blocks were bonded to 3 mol% yttria stabilized tetragonal zirconia polycrystal (3Y-TZP) blocks by heat-bonding with a liner or cementation with a dual-cure self-adhesive resin cement for a microtensile bond strength test. CAD/CAM implant-supported glass ceramic crowns were produced using Amber Mill-Q blocks and bonded to a milled 3Y-TZP zirconia abutments by heat-bonding or cementation for a fracture test. A statistical analysis was conducted to investigate the significant differences between the experimental results. The mode of failure was analyzed using high-resolution field emission scanning electron microscopy. Chemical bonding was identified at the interface between the zirconia ceramic and liner. The mean tensile bond strength of the liner-bonded group was significantly higher than that of the cement-bonded group. The initial chipping strength of the liner-bonded group was significantly higher than that of the cement-bonded group, although no statistically significant difference was found for the fracture strength. The mode of failure was mixed with cohesive fracture through the liner, whereas the cement-bonded group demonstrated adhesive failure at the interface of bonding.

Effect of Incisal Porcelain Veneering Thickness on the Fracture Resistance of CAD/CAM Zirconia All-Ceramic Anterior Crowns

Statement of Problem. In some clinical situations, the vertical length of either a prepared tooth or an implant abutment is short, while the occlusal clearance to be restored by a porcelain crown is large. Incisal thickness of the veneering porcelain should be considered to prevent mechanical failure of the crown. Purpose. The aim of this study is to evaluate the effect of two different incisal veneering porcelain thickness on the fracture resistance of the anterior all-ceramic CAD/CAM zirconia crown system as compared with the conventionally used metal ceramic crown system. Method. CAD/CAM zirconia all-ceramic and metal ceramic crowns were fabricated on the prepared dies with standardized dimensions and designs using standardized methods according to the manufacturer’s instructions. All crowns were then adhesively luted with resin-based cement (Multilink cement system), subjected to thermal cycling and cyclic loading, and were loaded until fracture using the universal testing machine to indicate the fracture resistance for each crown material in each veneering thickness. Results. Statistical analysis was carried out, and the results showed that the fracture resistance of the nickel-chromium metal ceramic group was significantly higher than that of the CAD/CAM zirconia all-ceramic group. Also, the fracture resistance of crowns with 1.5 mm incisal veneering thickness was significantly higher than those with 3 mm incisal veneering thickness in both groups. Furthermore, there was no significant difference in the fracture mode of the two groups where 50% of the total specimens demonstrated Mode II (veneer chipping), while 35% demonstrated Mode I (visible crack) and only 15% demonstrated Mode III (bulk fracture). Conclusion. High failure load values were demonstrated by the specimens in this study, which suggest sufficient strength of both incisal veneering thickness in both crown systems to withstand clinical applications; however, the fracture patterns still underline the requirement of a core design that support a consistent thickness of the veneering ceramic, and it is recommended to conduct long-term prospective clinical studies to confirm findings reported in the present study.

Fracture resistance and the mode of failure produced in metal-free crowns cemented onto zirconia abutments in dental implants

The purpose of the investigation was to analyze fracture resistance and mode of failure of zirconium oxide (zirconia) abutments placed on dental implants bearing crowns of different esthetic materials: zirconia, lithium disilicate (LDS), and nano-ceramic resin, for replacing single teeth in the anterior sector. Eighty implant-abutment-crown units were divided into four groups: Group T-MC (control): 20 metal-ceramic crowns cemented onto titanium abutments; Group Z-Z: 20 zirconia crowns on zirconia abutments; Group Z-LD: 20 lithium disilicate crowns on zirconia abutments; and Group Z-NCR: 20 nano-ceramic resin crowns on zirconia abutments. Specimens underwent a fatiguing process (dynamic loading and thermocycling), followed by static loading to evaluate mechanical fracture resistance, and the mode of failure produced. Mean fracture resistance values were: Control Group T-MC, 575.85±120.01 N; Group Z-Z 459.64±66.52 N; Group Z-LD, 531.77±34.10 N; and Group Z-NCR, 587.05±59.27 N. In Group T-MC, fracture occurred in the prosthetic fixing screw in 100% of specimens. In Group Z-Z, 80% of fractures occurred in the fixing screw, 15% in the abutment, and 5% in the abutment and crown. In Group Z-LD, 60% of fractures were produced in the fixing screw and 40% in the abutment. In Group Z-NCR, 70% of fractures were produced in the fixing screw and 30% in the abutment. All the abutments and crowns analyzed have the potential to withstand the physiological occlusal forces to which they would be subject in the anterior region. Lithium disilicate and nano-ceramic resin crowns cemented onto zirconia abutments are a good restoration alternative for single implants in the anterior sector.

Fracture of Zirconia Abutments in Implant Treatments: A Systematic Review

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.

Two-part implant abutments with titanium and ceramic components: Surface modification affects retention forces-An in-vitro study

OBJECTIVES

Two-part abutments consist of titanium base and ceramic coping. Their long-term success is largely determined by the mechanical stability. The aim of the present study was to investigate the retention forces of two-part implant abutments. The study included zirconia and lithium disilicate ceramics copings, with different surface treatments and resin-based luting agents.

MATERIAL AND METHODS

The analysis of retention forces was based on a total of 70 test specimens. Seven surface modifications and three resin-based luting agents were employed for the bonding of components in the seven groups (n = 70). All surfaces of titanium bases-except for a control-were pretreated with aluminum oxide blasting, either alone or in combination with surface activating primers. Surfaces of ceramic copings were also treated mechanically by sandblasting, either alone or with acid etching or different primers. All specimens underwent thermal aging (10⁴ cycles, 5°C/55°C). The retention forces between the two parts were measured with a pull-off test. The results were analyzed by two-way ANOVA statistics. Fracture patterns were evaluated by light and scanning electron microscopy.

RESULTS

No mechanical pretreatment of the titanium (group 2) base resulted in the lowest retention. The combination with Monobond plus leads to the highest pull-off forces for both ceramic materials.

CONCLUSIONS

Surface modifications and resin-based agents influence the retention of components of two-part abutments. Lithium disilicate ceramic copings reached comparable results of retention to the typically used zirconia copings.

Fracture resistance of different implant supported ceramic abutment/crown systems

Purpose

The purpose of this study was to investigate the fracture resistance and failure modes of different non-aged and aged abutment/crown systems.

Materials and methods

One hundred dental implants (diameter 4.3 mm and length 11.5 mm) were restored with five abutment/crown systems: G1: a lithium disilicate hybrid abutment crown, G2: a lithium disilicate crown cemented on a lithium disilicate hybrid abutment, G3: a lithium disilicate crown cemented on a zirconia hybrid abutment, G4: a direct veneer porcelain layering on a zirconia hybrid abutment, and G5: a lithium disilicate crown cemented on a prefabricated all-zirconia abutment. Each group was divided into two groups (n=10) as control (non-aged) and thermomechanically aged. The fracture resistance test was performed. Failures during the aging process and after the fracture resistance test were examined.

Results

Both of the factors (restoration type and aging) affected the fracture resistance values and there was not an interaction between the factors (p>0.05). When fracture resistance values were compared regardless of aging, the highest values were observed in G3 and G4, respectively (p<0.05). When comparing the fracture resistance values, regardless of the restoration type, the aged group showed a significant lower fracture resistance value than control group (p<0.05).

Conclusion

A titanium base enhanced the fracture resistance of zirconia abutments. Thermomechanical aging decreased the fracture resistance of the tested ceramic abutment/crown systems. The major failure mode was the abutment fracture.

Current status of zirconia implants in dentistry: preclinical tests

PURPOSE

This systematic review aimed to provide an overview of zirconia implants as well as regarding the outcome of the implant-restorative complex in preclinical studies.

STUDY SELECTION

An electronic search of the literature prior to July 2017 was performed to identify all articles related to preclinical research on zirconia implants. The search was conducted using MEDLINE (National Library of Medicine) and PubMed without restrictions concerning the date of publication. The search terminology included: zirconia implant, osseointegration, bone-to-implant contact, soft tissue, histology, histomorphometry, surface modification, surface roughness, surface characteristics, and restoration (connecting multiple keywords with AND, OR).

RESULTS

Fifty-seven studies were finally selected from an initial yield of 654 titles, and the data were extracted. The identified preclinical studies focused on several aspects related to zirconia implants, namely biocompatibility, mechanical properties, implant design, osseointegration capacity, soft tissue response, and restorative options. Due to heterogeneity of the studies, a meta-analysis was not possible. The most frequently used zirconia material for the fabrication of implants is yttria-stabilized tetragonal zirconia polycrystal. The resistance-to-fracture for zirconia implants ranged between 516-2044N. The mostly investigated parameter was osseointegration, which is compared to that of titanium. A lack of evidence was found with other parameters.

CONCLUSIONS

Due to its good biocompatibility as well as favorable physical and mechanical properties, zirconia implants are a potential alternative to titanium implants. However, knowledge regarding the implant-restorative complex and related aspects is still immature to recommend its application for daily practice.

Sphere-plane methodology to evaluate the wear of titanium of dental implants: a research proposal

Objective

Titanium is the most commonly used material to manufacture dental implants and abutments. Recently, zirconia abutments have been manufactured with better aesthetic properties. However, zirconia abutments are harder than titanium implants; therefore, they could wear the implant surface. Therefore, this article aims to describe a sphere-plane system that can be used to assess the wear that different abutment materials cause in the titanium of dental implants when submitted to cyclic loading. This method can be used to simulate the oral cavity, where the abutment (sphere) applies loads onto the implant (titanium plane). The spheres were made of different materials (titanium and zirconia), and the specimens were loaded for 4,000,000 cycles. The scar size and area on titanium planes were measured with stereoscopic images and analysed through profilometry.

Results

The wear of titanium planes was similar when tested against zirconia or titanium spheres. The sphere-plane system is a method that can be used to evaluate and quantify the wear of the titanium of dental implants, and compared with methods that use real implants, this system is simpler and less expensive. This method could facilitate further research to evaluate the wear of titanium against different materials and under different testing conditions.

Electronic supplementary material

The online version of this article (10.1186/s13104-018-3635-8) contains supplementary material, which is available to authorized users.

Fatigue Failure Load of Lithium Disilicate Restorations Cemented on a Chairside Titanium-Base

PURPOSE

To evaluate the fatigue failure load of distinct lithium disilicate restoration designs cemented on a chairside titanium base for maxillary anterior implant-supported restorations.

MATERIALS AND METHODS

A left-maxillary incisor restoration was virtually designed and sorted into 3 groups: (n = 10/group; CTD: lithium disilicate crowns cemented on custom-milled titanium abutments; VMLD: monolithic full-contour lithium disilicate crowns cemented on a chairside titanium-base; VCLD: lithium disilicate crowns bonded to lithium disilicate customized anatomic structures and then cemented onto a chairside titanium base). The chairside titanium base was air-abraded with aluminum oxide particles. Subsequently, the titanium base was steam-cleaned and air-dried. Then a thin coat of a silane agent was applied. The intaglio surface of the ceramic components was treated with 5% hydrofluoric acid (HF) etching gel, followed by silanization, and bonded with a resin cement. The specimens were fatigued at 20 Hz, starting with a 100 N load (5000× load pulses), followed by stepwise loading from 400 N up to 1400 N (200 N increments) at a maximum of 30,000 cycles each. The failure loads, number of cycles, and fracture analysis were recorded. The data were statistically analyzed using one-way ANOVA, followed by pairwise comparisons (p < 0.05). Kaplan-Meier survival plots and Weibull survival analyses were reported.

RESULTS

For catastrophic fatigue failure load and the total number of cycles for failure, VMLD (1260 N, 175,231 cycles) was significantly higher than VCLD (1080 N, 139,965 cycles) and CDT (1000 N, 133,185 cycles). VMLD had a higher Weibull modulus demonstrating greater structural reliability.

CONCLUSION

VMLD had the best fatigue failure resistance when compared with the other two groups.

Fracture loads and failure modes of customized and non-customized zirconia abutments

OBJECTIVE

This study aimed to evaluate the fracture load and pattern of customized and non-customized zirconia abutments with Morse-taper connection.

METHODS

18 implants were divided into 3 groups according to the abutments used: Zr - with non-customized zirconia abutments; Zrc - with customized zirconia abutments; and Ti - with titanium abutments. To test their load capacity, a universal test machine with a 500-kgf load cell and a 0.5-mm/min speed were used. After, one implant-abutment assembly from each group was analyzed by Scanning Electron Microscopy (SEM). For fractographic analysis, the specimens were transversely sectioned above the threads of the abutment screw in order to examine their fracture surfaces using SEM.

RESULTS

A significant difference was noted between the groups (Zr=573.7±11.66N, Zrc=768.0±8.72N and Ti=659.1±7.70N). Also, the zirconia abutments fractured while the titanium abutments deformed plastically. Zrc presented fracture loads significantly higher than Zr (p=0.009). All the zirconia abutments fractured below the implant platform, starting from the area of contact between the abutment and implant and propagating to the internal surface of the abutment. All the zirconia abutments presented complete cleavage in the mechanical test. Fractography detected differences in the position and pattern of fracture between the two groups with zirconia abutments, probably because of the different diameters in the transmucosal region.

SIGNIFICANCE

Customization of zirconia abutments did not affect their fracture loads, which were comparable to that of titanium and much higher than the maximum physiological limit for the anterior region of the maxilla.

Influence of different restorative materials on the stress distribution in dental implants

Background

To assist clinicians in deciding the most suitable restorative materials to be used in the crowns and abutment in implant rehabilitation.

Material and Methods

For finite element analysis (FEA), a regular morse taper implant was created using a computer aided design software. The implant was inserted at the bone model with 3 mm of exposed threads. An anatomic prosthesis representing a first maxillary molar was modeled and cemented on the solid abutment. Considering the crown material (zirconia, chromium-cobalt, lithium disilicate and hybrid ceramic) and abutment (Titanium and zirconia), the geometries were multiplied, totaling eight groups. In order to perform the static analysis, the contacts were considered bonded and each material was assigned as isotropic. An axial load (200 N) was applied on the crown and fixation occurred on the base of the bone. Results using Von-Mises criteria and micro strain values were obtained. A sample identical to the CAD model was made for the Strain Gauge (SG) analysis; four SGs were bonded around the implant to obtain micro strain results in bone tissue.

Results

FEA results were 3.83% lower than SG. According to the crown material, it is possible to note that the increase of elastic modulus reduces the stress concentration in all system without difference for bone.

Conclusions

Crown materials with high elastic modulus are able to decrease the stress values in the abutments while concentrates the stress in its structure. Zirconia abutments tend to concentrate more stress throughout the prosthetic system and may be more susceptible to mechanical problems than titanium.

Key words:Finite element analysis, dental implants, ceramic.

Compressive Resistances and Failure Modes of Abutments With Different Transgingival Heights and Types on Internal Conical Connected Implants

PURPOSE

This study aimed to research the effect of different transgingival heights (THs) and types of abutments on performances including the compressive resistances and fracture modes of abutments on internal conical connected implants.

MATERIALS AND METHODS

Three groups were established: a 1-piece zirconia abutment group (group A), a 2-piece zirconia abutment group (group B), and a 1-piece titanium abutment group (group C). Three THs (2, 3.5, and 5 mm, n = 6) were set as the subgroups of each group. All groups were subjected to a compressive resistance test at a 30 degree angle. The main failure modes were analyzed using scanning electron microscopy and a stereomicroscope.

RESULTS

The compressive resistances of the abutments on the internal conical connected implants were significantly related to the TH (P = 0.004), the type of abutment (P < 0.0001), and the combined effect (P < 0.0001). All of the subgroups in group C exhibited the greatest compressive loads at the same TH. Different types of abutments had different failure modes.

CONCLUSIONS

Both the TH and the type of abutments influenced compressive resistances of the implant-abutment complexes.