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Kraus RD, Hjerppe J, Naenni N, Balmer M, Jung RE, Thoma DS. A 7.5-year randomized controlled clinical study comparing cemented and screw-retained one-piece zirconia-based implant-supported single crowns. Clin Oral Implants Res 2024. [PMID: 39172056 DOI: 10.1111/clr.14346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 06/26/2024] [Accepted: 07/29/2024] [Indexed: 08/23/2024]
Abstract
OBJECTIVES To compare marginal bone levels, biological, and technical outcomes of screw-retained versus cemented all-ceramic implant-supported zirconia-based single crowns after an observation period of 7.5 years. METHODS Forty-four single implants in the esthetic zone in 44 patients (22 females, 22 males) were randomly assigned to two types of restorations: SR (screw-retained); veneered one-piece zirconia abutment and CR (cement-retained); veneered lithium disilicate crown intraorally cemented on a one-piece zirconia abutment. Patients were recalled annually up to 7.5 years and survival rates, biological, and technical parameters assessed. RESULTS A total of 31 patients attended the 7.5-year follow-up visit (17 SR group, 14 CR group). The survival rate on the restorative level was 77.5% (74.0% CR, 81.0% SR, p = .6399). Median marginal bone loss (MBL) values yielded -0.073 mm (-0.305; 0.238) in the CR and -0.215 mm (-0.500; 0.555) in the SR group (intergroup p = .6194). Mean bleeding on probing (BoP) values were significantly in favor of group SR with 20 ± 17% compared to 40 ± 22% in group CR (p = .011). The overall biological complication rate amounted to 27.5% (42.1% CR, 14.3% SR, p = .0775), whereas the technical complication rate was 32.5% (42.1% CR, 23.8% SR, p = .314). In total, CR restorations showed significantly more complications (84.2% for CR, 38.1% for SR, p = .0041). CONCLUSION One-piece zirconia-based single crowns on two-piece dental implants exhibited a high rate of technical and biological complications at 7.5 years of follow-up. Cemented restorations revealed significant higher rates of bleeding on probing and total complications compared to screw-retained restorations.
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Affiliation(s)
- Riccardo D Kraus
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Jenni Hjerppe
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Nadja Naenni
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Marc Balmer
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center for Dental Medicine, University of Zurich, Zurich, Switzerland
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Strasding M, Marchand L, Merino E, Zarauz C, Pitta J. Material and abutment selection for CAD/CAM implant-supported fixed dental prostheses in partially edentulous patients - A narrative review. Clin Oral Implants Res 2024; 35:984-999. [PMID: 38864592 DOI: 10.1111/clr.14315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 05/15/2024] [Accepted: 05/27/2024] [Indexed: 06/13/2024]
Abstract
Restorative material selection has become increasingly challenging due to the speed of new developments in the field of dental material science. The present narrative review gives an overview of the current indications for implant abutments and restoration materials for provisional and definitive implant-supported fixed dental prostheses in partially edentulous patients. For single implant restorations, titanium base abutments for crowns are suggested as an alternative to the conventional stock- and customized abutments made out of metal or zirconia. They combine the mechanical stability of a metallic connection with the esthetic potential of ceramics. For multiple-unit restorations, conical titanium bases especially designed for bridges are recommended, to compensate for deviating implant insertion axes and angulations. Even though titanium base abutments with different geometries and heights are available, certain clinical scenarios still benefit from customized titanium abutments. Indications for the definitive material in fixed implant restorations depend on the region of tooth replacement. In the posterior (not esthetically critical) zone, ceramics such as zirconia (3-5-Ymol%) and lithium-disilicate are recommended to be used in a monolithic fashion. In the anterior sector, ceramic restorations may be buccally micro-veneered for an optimal esthetic appearance. Lithium-disilicate is only recommended for single-crowns, while zirconia (3-5-Ymol%) is also recommended for multiple-unit and cantilever restorations. Attention must be given to the specific mechanical properties of different types of zirconia, as some feature reduced mechanical strengths and are therefore not indicated for all regions and restoration span lengths. Metal-ceramics remain an option, especially for cantilever restorations.
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Affiliation(s)
- Malin Strasding
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Laurent Marchand
- Department of Prosthodontics, School of Dental Medicine, Tufts University, Boston, Massachusetts, USA
| | - Elizabeth Merino
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Cristina Zarauz
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - João Pitta
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
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Puengpaiboon U, Rattanapan N, Pasam VK, Sukjamsri C. Finite Element Analysis of Anterior Implant-Supported Restorations with Different CAD-CAM Restorative Materials. Eur J Dent 2024. [PMID: 38744334 DOI: 10.1055/s-0044-1785532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES Due to the lack of literature concerning the selection of crown materials for the restoration of anterior teeth, this study aimed to investigate the effects of six distinct computer-aided design and computer-aided manufacturing (CAD-CAM) crown materials on stress and strain distribution within implant-supported maxillary central incisor restorations, employing finite element analysis (FEA). Furthermore, a comparative analysis was conducted between models that incorporated adjacent natural teeth and those that did not, intending to guide the selection of the most suitable modeling approach. MATERIALS AND METHODS Crown materials, including Lava Ultimate, Enamic, Emax CAD, Suprinity, Celtra Duo, and Cercon xt ML, were the subjects of the investigation. FEA models incorporating Coulomb friction were developed. These models were subjected to an oblique load, simulating the average maximum bite force experienced by anterior teeth. The potential for failure in titanium implant components and the prosthesis crown was evaluated through von Mises and principal stress, respectively. Furthermore, the failure of crestal bone was assessed through principal strain values. STATISTICAL ANALYSIS Stress values for each implant component and strain values of the bone were extracted from the models. To assess the impact of the six groups of crown materials, Kruskal-Wallis analysis of variance and post-hoc comparisons were conducted. Additionally, a statistical comparison between the two groups with Lava Ultimate and Cercon xt ML was performed using the Mann-Whitney U test to determine the difference in the two modeling approaches. RESULTS Higher crown material stiffness led to decreased stress in the abutment, fixture, and retaining screw, along with reduced strain in the surrounding bone. However, the decrease in stress and strain values became less significant with increasing crown stiffness. Additionally, the model with adjacent teeth showed significantly lower stress and strain concentrations compared to the model without adjacent teeth. CONCLUSION Crowns with a high elastic modulus were the optimal choice for anterior teeth restoration. Constructing FEA models with adjacent teeth was highly recommended to gain a deeper understanding of the mechanical behavior of dental implant restorations.
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Affiliation(s)
- Usanee Puengpaiboon
- Department of General Dentistry, Faculty of Dentistry, Srinakharinwirot University, Bangkok, Thailand
| | - Nichapat Rattanapan
- Department of Biomedical Engineering, Faculty of Engineering, Srinakharinwirot University, Nakhon Nayok, Thailand
| | - Vamsi Krishna Pasam
- Department of Mechanical Engineering, National Institute of Technology Warangal, Warangal, Telangana, India
| | - Chamaiporn Sukjamsri
- Department of Biomedical Engineering, Faculty of Engineering, Srinakharinwirot University, Nakhon Nayok, Thailand
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4
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Lv X, Pu Y, Zhang X, Jiang X, Zhang X, Shi J, Lai H. One-piece versus two-piece zirconia abutment supported single implant crown in the esthetic region: 3-Year results from a split-mouth randomized controlled clinical trial. Clin Oral Implants Res 2023; 34:1330-1341. [PMID: 37655630 DOI: 10.1111/clr.14173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Revised: 08/06/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVES To compare the clinical, radiographic, and immunological outcomes between one-piece versus two-piece zirconia abutments supported single implant crowns in the esthetic region. MATERIALS AND METHODS The study followed a split-mouth, double-blind, and randomized controlled clinical design for a duration of 3 years. Twenty-two eligible patients with 44 implants were randomly assigned to two groups: Group 1 (one-piece zirconia abutment with zirconia base, n = 22) and Group 2 (two-piece zirconia abutment with titanium base, n = 22). The primary outcome was the technical complication rate. Additionally, survival rates, cytokines concentrations in peri-implant crevicular fluid (PICF), peri-implant conditions, marginal bone loss, and pink/white esthetics score (PES/WES) were assessed as secondary outcomes. RESULTS Twelve of 22 patients attended the 1-year follow-up (due to the COVID pandemic), and 19 patients attended the 3-year examination. Two abutments in Group 1 were fractured after 10 and 12 months in function. Additionally, one screw loosening occurred in Group 1 at 1-year follow-up. The 3-year technical complication rate was significantly higher in Group 1 than that in Group 2 (15.79% vs. 0%, p < .001). The 3-year implant survival rate was 100% in both groups. The concentration of IFN-γ in PICF was significantly upregulated in Group 2 (p = .018). Furthermore, the IL-6 concentration was positively correlated with BOP% (p = .020). CONCLUSIONS Two-piece zirconia abutments exhibited superior technical performance compared to one-piece designs during a 3-year follow-up in the anterior region. However, further long-term research is necessary to verify the immunological stability of two-piece zirconia abutments.
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Affiliation(s)
- Xiaolei Lv
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Yiping Pu
- Department of Oral Surgery, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- National Clinical Research Center for Oral Diseases; Shanghai Key Laboratory of Stomatology & Shanghai Research Institute of Stomatology, Research Unit of Oral and Maxillo-facial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Xiaomeng Zhang
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xue Jiang
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Xiao Zhang
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Junyu Shi
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Hongchang Lai
- Department of Oral and Maxillo-facial Implantology, Shanghai Key Laboratory of Stomatology, National Clinical Research Center for Stomatology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
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5
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Del Castillo R, Gutiérrez-Garrido L, Padial-Molina M, Galindo-Moreno P. Screw-retained internal connection zirconia CAD-CAM abutments in single implant reconstructions: Results of a 1-year prospective case series study. J Prosthodont 2023; 32:679-688. [PMID: 36882991 DOI: 10.1111/jopr.13674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 02/24/2023] [Accepted: 02/24/2023] [Indexed: 03/09/2023] Open
Abstract
PURPOSE To evaluate the clinical and radiographic outcomes of single-tooth implant restorations using one-piece, internally connected, screw-retained, computer-aided design and computer-aided manufactured monolithic zirconia restorations fabricated on regular diameter implants. MATERIAL AND METHODS Following a 2-stage surgical procedure, 22 implants placed in anterior and posterior areas in 21 partially edentulous patients (mean age of 55 years; 9 males/12 females) were evaluated in terms of plaque index, pocket probing depth, bleeding on probing, level of oral hygiene (OH), signs of mucositis/peri-implantitis, esthetic score (ES), gingival zenith position (GZP), papilla index score, the thickness of peri-implant gingiva, radiographic marginal bone loss, and technical complications. Implants and restorations were prospectively followed from the insertion of the restoration (baseline), up to 12-months post-loading. RESULTS A 100% implant survival rate resulted after loading; one implant was lost before loading. Clinically, patients performed an adequate OH, and tissues were kept healthy. Probing depth showed a slightly lower value at baseline compared to any follow-up examination (2.26 [0.94] at baseline vs. 2.53 [0.66] mm at 12 months). ES, GZP, and the thickness of the peri-implant gingiva improved throughout the course of the study. Radiographically, average marginal bone level (MBL) was 0.40 (0.40) mm after 1-year follow-up with no differences in average MBL at all time points. Technically, after 1 year of clinical function, neither abutment fracture nor any other serious complications occurred. Hence, prosthetic reconstruction survival rate was 100%. CONCLUSIONS Clinical outcomes of single-tooth implant restorations using internally connected, screw-retained, computer-aided design and computer-aided manufacturing monolithic zirconia abutments can be considered a reliable treatment alternative after 1-year clinical observation.
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Affiliation(s)
- Rafael Del Castillo
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | | | - Miguel Padial-Molina
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria., IBS, University of Granada., Granada, Spain
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
- Instituto de Investigación Biosanitaria., IBS, University of Granada., Granada, Spain
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6
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Del Castillo R, Ata-Ali J. The clinical use of computer aided designed/computer aided manufactured titanium nitride coated implant abutments: Surgical and prosthetic considerations-A case series. J ESTHET RESTOR DENT 2023; 35:1008-1021. [PMID: 36932837 DOI: 10.1111/jerd.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 02/12/2023] [Accepted: 02/23/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE To describe the clinical use of nitride-coated titanium CAD/CAM implant abutments in the maxillary esthetic zone in two patients with high esthetic and functional demands and, to highlight the advantages of nitride-coated milled titanium abutments when compared to stock/custom titanium, one-piece monolithic zirconia, and hybrid metal-zirconia implant abutments. CLINICAL CONSIDERATIONS Due to the inherent mechanical and esthetic clinical challenges, single implant-supported reconstructions in the maxillary esthetic zone are a complex restorative treatment. While CAD/CAM technology has been suggested to enhance and ease implant abutment design and manufacturing, implant abutment material selection remains as a critical decision affecting restoration's long-term clinical outcomes. To date, considering the esthetic disadvantages of conventional titanium implant abutments, the mechanical limitations of one-piece zirconia abutments and the manufacturing time and costs associated with hybrid metal-zirconia abutments, no abutment material can be considered "ideal" for all clinical scenarios. Due to their biocompatibility, biomechanical characteristics (hardness and wear resistance), optical properties (yellow color), and peri-implant soft tissue esthetic integration, the use of CAD/CAM titanium nitride-coated implant abutments has been suggested as a predictable implant abutment material in mechanically challenging but esthetically demanding clinical situations, as the maxillary esthetic zone. CONCLUSIONS Two patients requiring a combined tooth-implant restorative treatment in the maxillary esthetic zone were treated using CAD/CAM nitride coated titanium implant abutments. The principal advantages of TiN coated abutments include comparable clinical outcomes to stock abutments, optimal biocompatibility, adequate fracture, wear, and corrosion resistance, reduced bacterial adhesion, and excellent esthetic integration with adjacent soft tissues. CLINICAL SIGNIFICANCE Clinical reports and short term mechanical, biological and esthetic clinical outcomes indicate that CAD/CAM nitride coated titanium implant abutments can represent a predictable restorative alternative to stock/custom and metal/zirconia implant abutments and be considered a clinical relevant option in mechanically challenging but esthetically demanding situations, as often found in the maxillary esthetic zone.
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Affiliation(s)
- Rafael Del Castillo
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | - Javier Ata-Ali
- Department of Dentistry, Faculty of Health Sciences, Universidad Europea de Valencia, Public Dental Health Service, Conselleria de Sanitat Universal i Salut Pública, Valencia, Spain
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Zhang Y, Yang T, Li B, Li J. Surface modifications of zirconia with plasma pretreatment and polydopamine coating to enhance the bond strength and durability between zirconia and titanium. Dent Mater J 2023. [PMID: 37032104 DOI: 10.4012/dmj.2022-185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
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.
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Affiliation(s)
- Yuan Zhang
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University
- Stomatological Medical Center, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases
| | - Tao Yang
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University
| | - Beibei Li
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University
| | - Jun Li
- Department of Dental Implant Center, Beijing Stomatological Hospital, School of Stomatology, Capital Medical University
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Takano R, Honda J, Kobayashi T, Kubochi K, Takata H, Komine F. Fracture strength of implant-supported hybrid abutment crowns in premolar region fabricated using different restorative CAD/CAM materials. Dent Mater J 2023; 42:187-192. [PMID: 36476684 DOI: 10.4012/dmj.2022-165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The present study investigated the fracture strength of hybrid abutment crowns (HACs) in the premolar region that were fabricated with different restorative computer-aided design/computer-aided manufacturing (CAD/CAM) materials. The abutment-implant structures were randomly assigned into four groups (n=11 per group): bi-layered zirconia restorations (BL), translucent zirconia (4Y-PSZ) restorations (TZ), lithium disilicate ceramic restorations (LD), and dispersed nanoparticle-filled composite resin restorations (CM). All restorations were adhesively bonded to the titanium abutments. After the restoration-abutment complex was tightened onto the implant, the fracture strength was measured. The TZ (2.06 kN) and LD (1.87 kN) groups had significantly higher median fracture strengths than the BL (1.12 kN) and CM (1.10 kN) groups. In terms of fracture resistance, the 4Y-PSZ and lithium disilicate ceramic monolithic restorations would be superior to bi-layered 3Y-TZP and composite resin monolithic restorations for HACs in the premolar region.
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Affiliation(s)
- Ryoki Takano
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
| | - Junichi Honda
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
| | - Tatsuro Kobayashi
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
| | - Kei Kubochi
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
| | - Hiroki Takata
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
| | - Futoshi Komine
- Department of Fixed Prosthodontics, Nihon University School of Dentistry
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9
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Thakare V, Chaware S, Kakatkar V, Darekar A. An insight performance of zirconia implant abutment: A systematic review and meta-analysis of randomized controlled clinical trial. Indian J Dent Res 2023; 34:80-86. [PMID: 37417063 DOI: 10.4103/ijdr.ijdr_465_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023] Open
Abstract
To determine the clinical performance of zirconia abutment (ZA) by comparing with a titanium abutment (TA) and sub-mucosal-modified zirconia abutment. A systematic search was conducted to retrieve eligible randomised controlled trials (RCTs) from Medline, Cochrane Library, SCOPUS, Embase, Web of Science, and Google Scholar. A search was further divided in two parts. Part I comprises eligible RCTs between zirconia abutment and titanium abutment, and part II included RCTs of zirconia abutment with sub-mucosal modified, pink-veneered glass ceramic versus non-veneered zirconia abutment. Esthetic, biological, and abutment survival was a primary outcome, and technical complications were included as an additional outcome. Fifteen eligible RCTs (Part I: N = 9 and Part II: N = 6) were evaluated, and a total of 362 abutments in 364 subjects were analysed for outcome variables. A sub-group meta-analysis reported no significant difference for Esthetic outcome. However, the overall mean (p =0.03) was higher for zirconia group in those of thin gingival phenotype. Spectrophotometric evaluation of peri-implant mucosal Esthetic does not show any significant difference. Similarly, pink-veneered versus non-veneered group reported no significant difference for thin (<2 mm) and thick (>2 mm) mucosal attachment. Biological outcome does not show any significant difference for comparable groups in both parts. There is marginally lower abutment survival for internally connected zirconia abutment (ZA: 95.4% TA: 100%). Zirconia abutment exhibited excellent Esthetic compared to titanium abutment in those of thin gingival phenotype. Sub-mucosa veneering of zirconia abutment with pink glass ceramic does not show any favourable Esthetic outcome compared to the non-veneered surface.
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Affiliation(s)
- Vrushali Thakare
- Department of Public Health Dentistry, MGV KBH Dental College and Hospital, Nashik, Maharashtra, India
| | - Sachin Chaware
- Department of Prosthodontics, Crown and Bridge, Pacific Dental College and Hospital, Udaipur, Rajasthan, India
| | - Vinay Kakatkar
- Department of Prosthodontics and Crown and Bridge, SMBT IDSR Dental College Dhamangaon, Nashik, Maharashtra, India
| | - Abhishek Darekar
- Department of Prosthodontics and Crown and Bridge, SMBT IDSR Dental College Dhamangaon, Nashik, Maharashtra, India
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10
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Kihara H, Hatakeyama W, Kondo H, Yamamori T, Baba K. Current complications and issues of implant superstructure. J Oral Sci 2022; 64:257-262. [PMID: 35989295 DOI: 10.2334/josnusd.21-0534] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
The purpose of this review is to search for complications of dental implant superstructures and consider the issues involved. This narrative review was performed by searching through PubMed databases and review articles that were published after 1990. Misfitting of the superstructure can result in loosening of screws, reduced preload, and in some cases, significant stress around the implant. External connection modalities and single implant prostheses have been reported to have more loose or broken abutment screws. In addition, when zirconia abutment was used for platform shifting, the rate of fracture of the abutment was considered to be high. Additionally, it was reported that men were significantly at an increased risk of abutment fracture. As for the retention mechanism of implant overdenture, stud attachment (Locator type) should receive more attention to wear and damage of retention parts than other attachments. The causes of the complications of implant superstructures have not been clarified in some cases, and further verification is required. Verification of complications is considered important to obtain a long-term prognosis for superstructures of implants. It will be necessary to further verify complications of implants in the future.
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Affiliation(s)
- Hidemichi Kihara
- Department of Prosthodontics and Oral Implantology, Iwate Medical University School of Dentistry
| | - Wataru Hatakeyama
- Department of Prosthodontics and Oral Implantology, Iwate Medical University School of Dentistry
| | - Hisatomo Kondo
- Department of Prosthodontics and Oral Implantology, Iwate Medical University School of Dentistry
| | - Tetsuo Yamamori
- Department of Prosthetic Dentistry, Ohu University School of Dentistry
| | - Kazuyoshi Baba
- Department of Prosthodontics, Showa University School of Dentistry
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11
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Del Castillo R, Chochlidakis K, Galindo-Moreno P, Ercoli C. Titanium Nitride Coated Implant Abutments: From Technical Aspects And Soft tissue Biocompatibility to Clinical Applications. A Literature Review. J Prosthodont 2022; 31:571-578. [PMID: 34731520 DOI: 10.1111/jopr.13446] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/28/2022] Open
Abstract
PURPOSE To review the most up to date scientific evidence concerning the technical implications, soft tissue biocompatibility, and clinical applications derived from the use of titanium nitride hard thin film coatings on titanium alloy implant abutments. MATERIALS AND METHODS A review was performed to answer the following focused question: "What is the clinical reliability of nitride coated titanium alloy abutments?". A MEDLINE search between 1980 and 2021 was performed for investigations pertaining to the clinical use of nitride coated titanium alloy implant abutments (TiN) in case reports, case series, and short- and long-term non/randomized controlled clinical trials. Literature analysis led to addition evaluation of research related to the technical and biological aspects, as well as the physicochemical characteristics of TiN hard thin film coatings and their impact on titanium abutment biocompatibility, mechanical properties, macroscopic surface topography, and optical properties. Therefore, preclinical data from biomechanical and in vitro investigations were also considered as inclusion criteria. RESULTS The limited number of clinical investigations published made a systematic review and meta-analysis not possible, therefore a narrative review was conducted. TiN coatings have been applied to dental materials and instruments to improve their clinical longevity. Implant abutments are coated with titanium nitride to mask the titanium oxide surface and enhance its surface characteristics providing the TiN abutment surface with a low friction coefficient and a very high chemical inertness. TiN coating is suggested to reduce early bacterial colonization and biofilm formation and enhance fibroblast cell proliferation, attachment and adhesion when compared to Ti controls. Additionally, studies indicate that hard thin film coatings enhance the mechanical properties (hardness and wear resistance) of titanium alloy and appears as a yellow color when deposited on the titanium alloy substrate. To date, clinical investigations show that nitride coated titanium abutments provide promising short-term clinical outcomes. CONCLUSIONS Published research on nitride-coated abutments is still limited, however, the available biomedical research, mechanical engineering tests, in vitro investigations, and short-term clinical trials have, to date, reported promising mechanical, biological, and esthetic outcomes.
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Affiliation(s)
- Rafael Del Castillo
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Konstantinos Chochlidakis
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
| | - Pablo Galindo-Moreno
- Department of Oral Surgery and Implant Dentistry, School of Dentistry, University of Granada, Granada, Spain
| | - Carlo Ercoli
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
- Department of Prosthodontics and Periodontology, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
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12
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Clinical Evaluation of Cement-Retained Implant-Supported CAD/CAM Monolithic Zirconia Single Crowns in Posterior Areas: Results of a 6-Year Prospective Clinical Study. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4030031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Different technologies and materials can be used for implant-supported restorations in posterior areas. Our study aimed to evaluate the clinical performance of CAD/CAM implant-supported monolithic zirconia single crowns (ZrSCs) cemented onto titanium abutments with a dual-curing resin cement after 6 years of use. Methods: Fifty patients in need of one single crown in posterior regions were enrolled. The patients were recalled for a follow-up after 6 months and then yearly for a total observation period of 6 years. The biological and technical complications were examined using criteria set by the United States Public Health Service (USPHS), whereas visual analogue scales (VASs) were used to evaluate the patients’ aesthetic and functional satisfaction. Results: No patient was lost at follow-up; both the survival and success rates were 100%. No fractures, decementation, peri-implantitis, or soft tissue inflammation were recorded. Forty-six restorations were rated Alpha in each evaluated parameter of the USPHS’s criteria. According to the patients’ VASs assessments, the overall function of the ZrSCs was 8.4 (±2.1), whereas the overall aesthetic was 8.7 (±0.7). Conclusions: Monolithic zirconia single crowns cemented with dual-curing resin cements onto titanium abutments can be considered an effective clinical option in posterior regions after 6 years of function.
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Comparing the Fracture Resistance and Modes of Failure in Different Types of CAD/CAM Zirconia Abutments with Internal Hexagonal Implants: An In Vitro Study. MATERIALS 2022; 15:ma15072656. [PMID: 35407988 PMCID: PMC9000730 DOI: 10.3390/ma15072656] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 03/28/2022] [Accepted: 04/01/2022] [Indexed: 02/04/2023]
Abstract
Three groups of zirconia abutments (n = 5) consisting of different connection designs or manufacturers were investigated (All-Zr, ASC-Zr, and AM-Zr groups). All-electric dynamic test instruments were used to place static loading on a specimen with a crosshead speed set at 1 mm/min. A Kruskal-Wallis test and a post hoc Mann-Whitney U test were used for statistical evaluation. The mean fracture resistance was 252.37 ± 82.79 N for the All-Zr group, 384.62 ± 45.24 N for ASC-Zr group, and 361.83 ± 90.31 N for the AM-Zr group. The difference of fracture resistance between the three groups was marginally significant (Kruskal-Wallis test, p = 0.054), with the ASC zirconia abutment tending to have higher fracture resistance than the full zirconia abutment. The modes of failure among the three types of abutments are different. The All-Zr group showed an oblique fracture line starting from the buccal aspect at the region of the implant platform. While the ASC-Zr and AM-Zr groups showed a relatively horizontal fracture line with a greater distance from the implant platform. The titanium inserts cannot significantly improve the fracture resistance of the zirconia abutment. However, they may alter the modes of failure, allowing buccal fracture surfaces of the zirconia abutments to be placed away from the implant platform, thereby protecting the implant-abutment connection.
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Kraus RD, Espuelas C, Hämmerle CHF, Jung RE, Sailer I, Thoma DS. Five-year randomized controlled clinical study comparing cemented and screw-retained zirconia-based implant-supported single crowns. Clin Oral Implants Res 2022; 33:537-547. [PMID: 35224774 PMCID: PMC9313572 DOI: 10.1111/clr.13913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 01/17/2022] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
Objectives To compare screw‐retained and cemented all‐ceramic implant‐supported single crowns regarding biological and technical outcomes over a 5‐year observation period. Materials and methods In 44 patients, 44 two‐piece dental implants were placed in single‐tooth gaps in the esthetic zone. Patients randomly received a screw‐retained (SR) or cemented (CR) all‐ceramic single crown and were then re‐examined annually up to 5 years. Outcome measures included: clinical, biological, technical, and radiographic parameters. Data were statistically analyzed with Wilcoxon–Mann–Whitney, Wilcoxon, and Fisher's exact tests. Results During the observation period, three patients (6.8%) were loss to follow‐up. Eight restorations (18.2%, CI (8.2%, 32.7%)) were lost due to technical (6 patients, 13.6% (CI (5.2%, 27.4%)), 2 CR and 4 SR group, intergroup p = .673; implants still present) or biological complications (2 patients, 4.5% (CI (0.6%, 16.5%)), only CR group, intergroup p = .201, both implants lost). This resulted in a survival rate of 81.2% (CI (65.9%, 90.1%)) on the restorative level (18 SR; 15 CR, 3 lost to follow‐up). At the 5‐year follow‐up, the median marginal bone levels were located slightly apical relative to the implant shoulder with 0.4 mm (0.5; 0.3) (SR) and 0.4 mm (0.8; 0.3) (CR) (intergroup p = .582). Cemented restorations demonstrated a significantly higher biological complication rate (36.8%, SR: 0.0%; intergroup p = .0022), as well as a significantly higher overall complication rate (68.4%, SR: 22.7%, intergroup p = .0049). All other outcomes did not differ significantly between the two groups (p > .05). Conclusions All‐ceramic single‐tooth restorations on two‐piece dental implants resulted in a relatively low survival rate. Cemented restorations were associated with a higher biological and overall complication rate than screw‐retained restorations.
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Affiliation(s)
- Riccardo D Kraus
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Catharina Espuelas
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Christoph H F Hämmerle
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel S Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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15
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Bergamo ETP, Campos TMB, Lopes ACO, Cardoso KB, Gouvea MVR, de Araújo-Júnior ENS, Witek L, Gierthmühlen PC, Coelho PG, Benalcázar Jalkh EB, Zahoui A, de Carvalho LF, Bonfante EA. Hydrothermal aging affects the three-dimensional fit and fatigue lifetime of zirconia abutments. J Mech Behav Biomed Mater 2021; 124:104832. [PMID: 34536801 DOI: 10.1016/j.jmbbm.2021.104832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/05/2021] [Accepted: 09/07/2021] [Indexed: 11/30/2022]
Abstract
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.
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Affiliation(s)
- Edmara T P Bergamo
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of Sao Paulo, 9-75 Octavio Pinheiro Brizolla, 17012-901, Bauru, SP, Brazil.
| | - Tiago M B Campos
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of Sao Paulo, 9-75 Octavio Pinheiro Brizolla, 17012-901, Bauru, SP, Brazil
| | - Adolfo C O Lopes
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of Sao Paulo, 9-75 Octavio Pinheiro Brizolla, 17012-901, Bauru, SP, Brazil
| | - Karina B Cardoso
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of Sao Paulo, 9-75 Octavio Pinheiro Brizolla, 17012-901, Bauru, SP, Brazil
| | - Marcus V R Gouvea
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of Sao Paulo, 9-75 Octavio Pinheiro Brizolla, 17012-901, Bauru, SP, Brazil
| | - Everardo N S de Araújo-Júnior
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of Sao Paulo, 9-75 Octavio Pinheiro Brizolla, 17012-901, Bauru, SP, Brazil
| | - Lukasz Witek
- Department of Biomaterials, New York University College of Dentistry, 433 1st Avenue, New York, NY, USA; Department of Biomedical Engineering, New York University Tandon School of Engineering, 6 MetroTech Center, Brooklyn, NY, USA
| | - Petra C Gierthmühlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Paulo G Coelho
- Department of Biomaterials, New York University College of Dentistry, 433 1st Avenue, New York, NY, USA; Hansjörg Wyss Department of Plastic Surgery, NYU Langone Medical Center, 222 East 41st Street New York, NY, USA; Department of Mechanical Engineering, New York University Tandon School of Engineering, 6 MetroTech Center, Brooklyn, NY, USA
| | - Ernesto B Benalcázar Jalkh
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of Sao Paulo, 9-75 Octavio Pinheiro Brizolla, 17012-901, Bauru, SP, Brazil; Department of Biomaterials, New York University College of Dentistry, 433 1st Avenue, New York, NY, USA
| | - Abbas Zahoui
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of Sao Paulo, 9-75 Octavio Pinheiro Brizolla, 17012-901, Bauru, SP, Brazil
| | - Laura F de Carvalho
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of Sao Paulo, 9-75 Octavio Pinheiro Brizolla, 17012-901, Bauru, SP, Brazil
| | - Estevam A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry - University of Sao Paulo, 9-75 Octavio Pinheiro Brizolla, 17012-901, Bauru, SP, Brazil
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16
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Scaringi R, Nannelli M, Franchina A, Lizio G, Stefanelli LV, Pagliarulo M, De Angelis F, Pellegrino G. Full Zirconia Implant-Born Prosthetic Rehabilitation with CAD/CAM Technology after Accurate Digital Planning. A Case Report. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157998. [PMID: 34360288 PMCID: PMC8345593 DOI: 10.3390/ijerph18157998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Revised: 07/21/2021] [Accepted: 07/24/2021] [Indexed: 11/17/2022]
Abstract
CAD/CAM technology can enhance the dentistry application of ceramic materials that meet the more relevant biocompatibility and aesthetics demands. In implant-borne prosthesis rehabilitation, yttria-stabilized zirconia appeared to be a valid alternative to metal-alloys and titanium, with comparable mechanical properties and even better interaction with bone and soft tissues. The improvement of monolithic CAD/CAM manufacturing allows for a reliable, predictable, and rapid workflow that can correspond to a holistic treatment philosophy associated with zirconia fixtures. This reported clinical case highlights the advantages of this approach in resolving particularly functionally and aesthetically complex situations. A 40-year-old patient with permanent canine impaction and the persistence of a deciduous tooth compromised by caries was successfully rehabilitated with the surgical removal of the enclosed tooth, the seating of a mono-phase zirconia implant after the deciduous extraction and its loading with a zirconia single crown, without any clinical or radiographical alteration up to seven years follow-up.
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Affiliation(s)
| | | | - Alessio Franchina
- Private Practice, Periodontal and Dental Implant Surgery, 36100 Vicenza, Italy;
| | - Giuseppe Lizio
- Oral Surgery Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Vitale 59, 40125 Bologna, Italy
- Correspondence:
| | - Luigi V. Stefanelli
- Private Practice, Periodontal and Dental Implant Surgery, 00145 Roma, Italy;
| | - Michele Pagliarulo
- Faculty of Dental Medicine, University of Plovdiv, 4000 Plovdiv, Bulgaria;
| | - Francesca De Angelis
- Department of Oral and Maxillo-Facial Sciences, Sapienza University of Rome, 00185 Rome, Italy;
| | - Gerardo Pellegrino
- Researcher Oral Surgery Unit, Department of Biomedical and Neuromotor Sciences, University of Bologna, Via San Vitale 59, 40125 Bologna, Italy;
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17
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Freifrau von Maltzahn N, Holstermann J, Stiesch M, Kohorst P. In vitro evaluation of the influence of titanium nitride coating on the retention force between components of two-part abutments. BMC Oral Health 2021; 21:285. [PMID: 34078345 PMCID: PMC8173788 DOI: 10.1186/s12903-021-01636-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 05/17/2021] [Indexed: 11/17/2022] Open
Abstract
Background Two-part abutments are typically made up of a base composed of titanium and a ceramic build-up. The long-term outcomes are affected by the mechanical durability. The purpose of the present investigation was to evaluate and compare the retention force of two-part abutment systems with titanium or titanium nitride bases—as fixed with zirconia components and with various surface treatments. Methods A total of 60 two-part abutments were investigated—with a titanium base (n = 30) or titanium nitride coated bases (n = 30) and bonded with zirconia ceramic build-ups. The bonding surfaces were treated with aluminium oxide blasting, with an average particle size of 110 µm. The titanium bases were then pretreated with Alloy Primer or Clearfil Ceramic Primer. The ceramic build-ups were only treated with Clearfil Ceramic Primer. For twenty test specimens, no chemical pretreatment was performed. Test specimens were classified into six groups in accordance with the pretreatment (A–F; n = 10). A resin-based luting agent was employed to attach the two parts. Specimens were then subjected to artificial thermal aging (104 cycles with 5 °C/55 °C). The retention force between the two parts was then investigated with a pull-off test. The findings were analyzed by ANOVA statistics. Fracture patterns were examined by electron microscopy. Results In the absence of primer, titanium nitride coated bases gave significantly greater retention forces than other samples (p < 0.05). Chemical preconditioning with silane coupling agents did not effect on the retention force of coated bases. Conclusions The results of the current study suggested that modifying metal surfaces by coating the base with titanium nitride not only has esthetic and biological advantages, but also enhances the mechanical properties of the adhesive bond of two-part abutments.
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Affiliation(s)
- Nadine Freifrau von Maltzahn
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | | | - Meike Stiesch
- Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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18
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Alqutaibi AY, Alnazzawi AA, Algabri R, Aboalrejal AN, AbdElaziz MH. Clinical performance of single implant-supported ceramic and metal-ceramic crowns: A systematic review and meta-analysis of randomized clinical trials. J Prosthet Dent 2020; 126:369-376. [PMID: 32891403 DOI: 10.1016/j.prosdent.2020.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 06/04/2020] [Accepted: 06/05/2020] [Indexed: 12/01/2022]
Abstract
STATEMENT OF PROBLEM Evidence relating to the choice of materials for single implant-supported crowns is sparse. PURPOSE The purpose of this systematic review and meta-analysis was to assess articles that compared the clinical performance of ceramic and metal-ceramic (MC) implant-supported single crowns with regard to prosthesis failure, complication rate, and patient satisfaction. MATERIAL AND METHODS A comprehensive search of databases (PubMed/MEDLINE, Scopus, and Cochrane Library) was performed. The last search was conducted in December 2019. Randomized clinical trials comparing ceramic and MC implant-supported single crowns with at least a 12-month follow-up were included, all of which were published in English. The pooled effects were presented as both a risk difference (RD) and mean difference according to the type of data with 95% confidence intervals (CIs). RESULTS Seven randomized clinical trials fulfilled the eligibility criteria and were included in the meta-analysis. The pooled data did not show any statistically significant differences concerning prosthesis failure (RD: 0.000, 95% CI: -0.05 to 0.06), marginal bone loss (mean difference [MD]: -0.02, 95% CI: -0.75 to 0.35), mechanical complications (RD: -0.06, 95% CI: -0.18 to 0.07), biological complications (RD: 0.02, 95% CI: -0.07 to 0.11), or patient satisfaction (MD: 4.86, 95% CI: -2.86 to 12.58). CONCLUSIONS Ceramic and MC crowns had similar outcomes with regard to prosthesis failure, mechanical and biological complication rates, and patient satisfaction. As a result, the selection of single implant crown material depends on the preference of the dentist and patient.
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Affiliation(s)
- Ahmed Yaseen Alqutaibi
- Assistant Professor of Prosthodontics, Substitutive Dental Science Department, College of Dentistry, Taibah University, Al-Madinah, Saudi Arabia; Assistant Professor of Prosthodontics, Prosthodontics Department, College of Dentistry, Ibb University, Ibb, Yemen.
| | - Ahmad Abdulkareem Alnazzawi
- Associate Professor of Prosthodontics, Substitutive Dental Science Department, College of Dentistry, Taibah University, Al-Madinah, Saudi Arabia
| | - Radwan Algabri
- Assistant Professor of Prosthodontics, Prosthodontics Department, College of Dentistry, Ibb University, Ibb, Yemen
| | - Afaf N Aboalrejal
- Lecturer of Oral Biology, Oral Biology Department, College of Dentistry, Ibb University, IBB, Yemen
| | - Mohammed Hosny AbdElaziz
- Associate Professor of Crown and Bridge Department, Faculty of Dental Medicine, AlAzhar University, Cairo, Egypt; Associate Professor of prosthodontics, substitutive dental science Department, College of Dentistry, Taibah University, Al-Madinah, Saudi Arabia
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19
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Abstract
PURPOSE The purpose of this systematic review was to identify and summarize clinical studies related to the fracture of zirconia abutments in implant treatments. MATERIAL AND METHODS Medline, Embase, and Cochrane library searches were performed and complemented by manual searches from database inception to February 11, 2018, for title and abstract analysis. RESULTS Initially, 645 articles were obtained through database searches. Fifty-three articles were selected for full-text analysis, and 15 studies met the inclusion criteria. The selected studies were analyzed regarding fracture rate, abutment-implant connection, time point of fracture, location of critical crack, causes, managements, and preventive measures with respect to zirconia abutment fracture. CONCLUSIONS Lower fracture rates were reported for internal connection with metal component (2-piece) zirconia abutments compared with external and internal full-zirconia connection (one-piece) zirconia abutments. Overpreparation and overload should be avoided in case of zirconia abutments.
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20
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Lin YT, Shen YF, Wei PC, Hsu KW. Clinical evaluation of two-piece zirconia abutments with bonded titanium inserts for implant-supported restorations. J Prosthet Dent 2019; 123:449-454. [PMID: 31307812 DOI: 10.1016/j.prosdent.2019.01.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/14/2018] [Accepted: 01/25/2019] [Indexed: 02/04/2023]
Abstract
STATEMENT OF PROBLEM Information about the long-term evaluation of 2-piece zirconia abutments (TPZAs) with bonded titanium inserts for implant-supported restorations is sparse. PURPOSE The purpose of this clinical study was to evaluate the clinical outcome of TPZAs with bonded titanium inserts for implant-supported restorations. MATERIAL AND METHODS This study retrospectively evaluated the records of patients who received implant restorations supported by TPZAs with bonded titanium inserts. The patients were recalled between January 2017 and December 2017 so that the restorations could be examined clinically and radiographically for technical and biological complications. RESULTS A total of 27 patients with 30 restorations and 42 zirconia abutments (ZAs) were included in the study. The patient records revealed that all implants remained integrated. However, 5 restorations supported by seven ZAs in 4 patients had to be refabricated because of abutment failure before the recall. Six of the failed abutments were in the molar area, with a combination of zirconia and titanium as the connection platform. Additional complications included screw loosening (1 patient), ceramic chipping (1 patient), and peri-implantitis (1 patient). The mean observation period was 6.6 ±1.5 years (range: 3.6 to 9.2 years). CONCLUSIONS After a mean observation period of 6 years after insertion, TPZAs with bonded titanium inserts appear to be a suitable treatment option in the anterior and premolar regions. However, in the molar area, the use of the same type of ZA without a complete metal-to-metal connection platform to support the restoration led to a high incidence of fracture.
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Affiliation(s)
- Yu-Ting Lin
- Attending Doctor, Department of Prosthodontics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan, Republic of China
| | - Yu-Fu Shen
- Assistant Professor, Department of Prosthodontics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan, Republic of China
| | - Pein-Chi Wei
- Assistant Professor, Department of Periodontology, Chang Gung Memorial Hospital, Taoyuan Branch, Taoyuan City, Taiwan, Republic of China
| | - Kuang-Wei Hsu
- Lecturer, Department of Prosthodontics, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan City, Taiwan, Republic of China.
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21
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Zarone F, Di Mauro MI, Ausiello P, Ruggiero G, Sorrentino R. Current status on lithium disilicate and zirconia: a narrative review. BMC Oral Health 2019; 19:134. [PMID: 31272441 PMCID: PMC6610968 DOI: 10.1186/s12903-019-0838-x] [Citation(s) in RCA: 162] [Impact Index Per Article: 32.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 06/27/2019] [Indexed: 01/28/2023] Open
Abstract
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.
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Affiliation(s)
- Fernando Zarone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Viale Pansini, 5 -, 80131, Naples, Italy
| | - Maria Irene Di Mauro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Viale Pansini, 5 -, 80131, Naples, Italy.
| | - Pietro Ausiello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Viale Pansini, 5 -, 80131, Naples, Italy
| | - Gennaro Ruggiero
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Viale Pansini, 5 -, 80131, Naples, Italy
| | - Roberto Sorrentino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Viale Pansini, 5 -, 80131, Naples, Italy
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Hu M, Chen J, Pei X, Han J, Wang J. Network meta-analysis of survival rate and complications in implant-supported single crowns with different abutment materials. J Dent 2019; 88:103115. [PMID: 30986515 DOI: 10.1016/j.jdent.2019.04.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 04/04/2019] [Accepted: 04/11/2019] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES To compare the survival rate of abutments, marginal bone loss and peri-implant soft tissue discoloration among implant-supported single crowns with different abutment materials. DATA Randomized controlled trials (RCTs), controlled clinical trials, and cohort studies of implant-supported single crowns with different dental abutment materials. SOURCES A systematic search was conducted by an electronic search in 6 databases without restrictions on September 16, 2018, complemented by a manual search. "Grey" literatures were also searched. STUDY SELECTION Of 3417 studies initially retrieved, thirteen were eligible for inclusion. After studies selected and data extraction, pair-wise and network meta-analyses were performed to analyze the survival rate of the abutment, the marginal bone loss and the soft tissue discoloration. The risk of bias was assessed based on the Cochrane guidelines, Newcastle-Ottawa scale, and funnel plots. Statistical heterogeneity, inconsistencies, and cumulative ranking were also evaluated. RESULTS Fourteen RCTs and nine non-RCTs were included. No significant differences was detected among titanium (Ti), zirconia (Zr), gold (Au), and alumina (Al) abutments in terms of survival rate (excluding Al < Ti (P < 0.05), marginal bone loss (excluding Zr < Ti (P < 0.05) and Au > Zr (P < 0.05)), or discoloration of peri-implant soft tissue. Additionally, Ti abutment had the highest cumulative ranking of survival rate (97.9%); Al abutment had the lowest marginal bone loss (81.4%) and Zr abutment had the least discoloration of peri-implant soft tissue (84.8%). CONCLUSIONS Ti abutment has a comparable survival rate with Zr, but better than Al. In addition, Zr abutment has a better effect in maintaining the marginal bone level, compared with Au and Ti. However, there was no difference in the discoloration of peri-implant soft tissue among Au, Ti, and Zr abutment. CLINICAL SIGNIFICANCE Based on the results of our network meta-analysis, Zr might be a recommended abutment material considering the clinical efficacy of implant-supported single crowns.
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Affiliation(s)
- Menglong Hu
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, No. 14, Section 3, South Renmin Road, Chengdu, 610041, China; Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, 610041, China
| | - Junyu Chen
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, No. 14, Section 3, South Renmin Road, Chengdu, 610041, China; Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, 610041, China
| | - Xibo Pei
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, No. 14, Section 3, South Renmin Road, Chengdu, 610041, China; Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, 610041, China
| | - Jianmin Han
- Dental Medical Devices Testing Center, Dental Materials Laboratory, Peking University School and Hospital of Stomatology, Beijing, 100081, China
| | - Jian Wang
- State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, No. 14, Section 3, South Renmin Road, Chengdu, 610041, China; Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, No. 14, Section 3, South Renmin Road, Chengdu, 610041, China.
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23
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Kraus RD, Epprecht A, Hämmerle CH, Sailer I, Thoma DS. Cemented vs screw-retained zirconia-based single implant reconstructions: A 3-year prospective randomized controlled clinical trial. Clin Implant Dent Relat Res 2019; 21:578-585. [DOI: 10.1111/cid.12735] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 01/08/2019] [Accepted: 01/11/2019] [Indexed: 12/11/2022]
Affiliation(s)
- Riccardo D. Kraus
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Alyssa Epprecht
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Christoph H.F. Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zurich Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials; University Clinics for Dental Medicine, University of Geneva; Geneva Switzerland
| | - Daniel S. Thoma
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine; University of Zurich; Zurich Switzerland
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Pjetursson BE, Zarauz C, Strasding M, Sailer I, Zwahlen M, Zembic A. A systematic review of the influence of the implant-abutment connection on the clinical outcomes of ceramic and metal implant abutments supporting fixed implant reconstructions. Clin Oral Implants Res 2019; 29 Suppl 18:160-183. [PMID: 30306682 DOI: 10.1111/clr.13362] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES The objective of this systematic review was to assess the influence of implant-abutment connection and abutment material on the outcome of implant-supported single crowns (SCs) and fixed dental prostheses (FDPs). METHODS An electronic Medline search complemented by manual searching was conducted to identify randomized controlled clinical trials, prospective and retrospective studies with a mean follow-up time of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Failure and complication rates were analyzed using robust Poisson regression, and comparisons were made with multivariable Poisson regression models. RESULTS The search provided 1511 titles and 177 abstracts. Full-text analysis was performed for 147 articles resulting in 60 studies meeting the inclusion criteria. Meta-analysis of these studies indicated an estimated 5-year survival rate of 97.6% for SCs and 97.0% for FDPs supported by implants with internal implant-abutment connection and 95.7% for SCs and 95.8% for FDPs supported by implants with external connection. The 5-year abutment failure rate ranged from 0.7% to 2.8% for different connections with no differences between the types of connections. The total number of complications was similar between the two connections, yet, at external connections, abutment or occlusal screw loosening was more predominant. Ceramic abutments, both internally and externally connected, demonstrated a significantly higher incidence of abutment fractures compared with metal abutments. CONCLUSION For implant-supported SCs, both metal and ceramic abutments with internal and external connections exhibited high survival rates. Moreover, implant-supported FDPs with metal abutments with internal and external connections for also showed high survival rates.
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Affiliation(s)
- Bjarni Elvar Pjetursson
- Department of Reconstructive Dentistry, Faculty of Odontology, University of Iceland, Reykjavik, Iceland.,Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Cristina Zarauz
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Malin Strasding
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anja Zembic
- Clinic of Fixed and Removable Prosthodontics and Material Science, University of Zurich, Zurich, Switzerland
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25
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Rabel K, Spies BC, Pieralli S, Vach K, Kohal RJ. The clinical performance of all-ceramic implant-supported single crowns: A systematic review and meta-analysis. Clin Oral Implants Res 2019; 29 Suppl 18:196-223. [PMID: 30306684 DOI: 10.1111/clr.13337] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/30/2018] [Accepted: 06/05/2018] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This review aimed at evaluating the survival and technical complication rates of all-ceramic implant-supported single crowns (SC). MATERIAL AND METHODS Three electronic databases were searched for clinical studies conducted at ≥ 15 patients examining implant-supported all-ceramic SCs over ≥ 12 months. Survival rates of implants and restorations plus technical complication rates of SCs were calculated and tested for statistical correlation with confounding variables. Statistical analysis was performed using a negative binomial distribution model to calculate 5- and 10-year survival and complication estimates. RESULTS Forty-one included studies reported on implant-supported SCs made of veneered and monolithic high-strength oxide ceramics, monolithic, and veneered glass-based ceramics and of a monolithic resin-nano-ceramic (RNC). Survival estimates for SCs of 93% (95% CI: 86.6%-96.4%) after 5 years and 94.4% (95% CI: 91.1%-96.5%) after 10 years were calculated, corresponding values for implant survival were 95.3% (95% CI: 90.6%-97.7%) and 96.2% (95% CI: 95.1%-97.1%). Technical complication rates after 5/10 years were as follows: chipping 9.0% (95% CI: 5.4%-14.8%)/2.7% (95% CI: 2.1%-3.5%), framework fractures 1.9% (95% CI: 0.7%-4.9%)/1.2% (95% CI: 1%-1.5%), screw loosening 3.6% (95% CI: 1.6%-8.4%)/5.2% (95% CI: 3.6%-7.5%), and decementations with 1.1% (95% CI: 0.4%-2.8%) after 5 years. Some confounding variables influenced the above-mentioned estimates significantly. CONCLUSIONS All-ceramic implant-supported SCs showed-with the exception of a RNC material-high survival rates. However, failures and technical complications occurred which have to be considered when informing patients on the treatment with implant-supported all-ceramic SCs.
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Affiliation(s)
- Kerstin Rabel
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Benedikt Christopher Spies
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Campus Benjamin Franklin (CBF), CC 3 Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stefano Pieralli
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Campus Benjamin Franklin (CBF), CC 3 Dental and Craniofacial Sciences, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center - University of Freiburg, Freiburg, Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center - University of Freiburg, Freiburg, Germany
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26
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Accuracy of three digital workflows for implant abutment and crown fabrication using a digital measuring technique. J Prosthet Dent 2019; 121:276-284. [DOI: 10.1016/j.prosdent.2018.04.026] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 04/14/2018] [Accepted: 04/16/2018] [Indexed: 11/20/2022]
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Gehrke P, Spanos E, Fischer C, Storck H, Tebbel F, Duddeck D. Influence of scaling procedures on the integrity of titanium nitride coated CAD/CAM abutments. J Adv Prosthodont 2018; 10:197-204. [PMID: 29930789 PMCID: PMC6004353 DOI: 10.4047/jap.2018.10.3.197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 12/07/2017] [Accepted: 02/27/2018] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To determine the extent of treatment traces, the roughness depth, and the quantity of titanium nitride (TiN) removed from the surface of CAD/CAM abutments after treatment with various instruments. MATERIALS AND METHODS Twelve TiN coated CAD/CAM abutments were investigated for an in vitro study. In the test group (9), each abutment surface was subjected twice (150 g vs. 200 g pressure) to standardized treatment in a simulated prophylaxis measure with the following instruments: acrylic scaler, titanium curette, and ultrasonic scaler with steel tip. Three abutments were used as control group. Average surface roughness (Sa) and developed interfacial area ratio (Sdr) of treated and untreated surfaces were measured with a profilometer. The extent of treatment traces were analyzed by scanning electron microscopy. RESULTS Manipulation with ultrasonic scalers resulted in a significant increase of average surface roughness (Sa, P<.05) and developed interfacial area ratio (Sdr, P<.018). Variable contact pressure did not yield any statistically significant difference on Sa-values for all instruments (P=.8). Ultrasonic treatment resulted in pronounced surface traces and partially detachment of the TiN coating. While titanium curettes caused predominantly moderate treatment traces, no traces or detectable substance removal has been determined after manipulation with acrylic curettes. CONCLUSION Inappropriate instruments during regular plaque control may have an adverse effect on the integrity of the TiN coating of CAD/CAM abutments. To prevent defects and an increased surface roughness at the transmucosal zone of TiN abutments, only acrylic scaling instruments can be recommended for regular maintenance care.
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Affiliation(s)
| | | | - Carsten Fischer
- Dental Laboratory, Sirius Ceramics, Frankfurt am Main, Germany
| | | | | | - Dirk Duddeck
- Medical Materials Research Institute, Berlin, Germany
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Øilo M, Arola D. Fractographic analyses of failed one-piece zirconia implant restorations. Dent Mater 2018; 34:922-931. [PMID: 29673708 DOI: 10.1016/j.dental.2018.03.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Revised: 10/19/2017] [Accepted: 03/23/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Promising results of initial clinical trials with yttria-stabilized zirconia have led to more extensive use of zirconia in dental implant superstructures. The applications have extended to abutments and complex individually designed crown-abutment one-piece structures. Little is known about their clinical success and the primary cause of failures. PURPOSE The aim of this study was to identify the cause of fracture of retrieved implant-retained one-piece prostheses that failed during clinical use. METHODS Nine fractured restorations were analyzed with fractographic methods and their fracture origins were identified. RESULTS All but two of the fractures originated in an area of tight contact between the implant or titanium screw and the abutment base. Results of the evaluation showed that zirconia-based implant restorations with very thin walls in the region connecting the prosthesis to the implant are vulnerable to damage from the screw retaining process and fracture from non-axial loads. Two restorations failed due to veneer fractures. SIGNIFICANCE The findings suggest that large crowns on narrow implants or implants with internal fixation should preferably not be made with zirconia abutments, or that a new design approach should be considered.
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Affiliation(s)
- Marit Øilo
- Department of Clinical Dentistry, Faculty of Medicine and Dentistry, University of Bergen, Norway; Department of Materials Science and Engineering, University of Washington Seattle, WA, USA.
| | - Dwayne Arola
- Department of Materials Science and Engineering, University of Washington Seattle, WA, USA; Departments of Oral Health Sciences, School of Dentistry, University of Washington, Seattle, WA, USA; Departments of Restorative Dentistry, School of Dentistry, University of Washington, Seattle, WA, USA
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29
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Riccitiello F, Amato M, Leone R, Spagnuolo G, Sorrentino R. In vitro Evaluation of the Marginal Fit and Internal Adaptation of Zirconia and Lithium Disilicate Single Crowns: Micro-CT Comparison Between Different Manufacturing Procedures. Open Dent J 2018; 12:160-172. [PMID: 29854014 PMCID: PMC5952349 DOI: 10.2174/1874210601812010160] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2017] [Revised: 01/02/2018] [Accepted: 01/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Prosthetic precision can be affected by several variables, such as restorative materials, manufacturing procedures, framework design, cementation techniques and aging. Marginal adaptation is critical for long-term longevity and clinical success of dental restorations. Marginal misfit may lead to cement exposure to oral fluids, resulting in microleakage and cement dissolution. As a consequence, marginal discrepancies enhance percolation of bacteria, food and oral debris, potentially causing secondary caries, endodontic inflammation and periodontal disease. Objective: The aim of the present in vitro study was to evaluate the marginal and internal adaptation of zirconia and lithium disilicate single crowns, produced with different manufacturing procedures. Methods: Forty-five intact human maxillary premolars were prepared for single crowns by means of standardized preparations. All-ceramic crowns were fabricated with either CAD-CAM or heat-pressing procedures (CAD-CAM zirconia, CAD-CAM lithium disilicate, heat-pressed lithium disilicate) and cemented onto the teeth with a universal resin cement. Non-destructive micro-CT scanning was used to achieve the marginal and internal gaps in the coronal and sagittal planes; then, precision of fit measurements were calculated in a dedicated software and the results were statistically analyzed. Results: The heat-pressed lithium disilicate crowns were significantly less accurate at the prosthetic margins (p<0.05) while they performed better at the occlusal surface (p<0.05). No significant differences were noticed between CAD-CAM zirconia and lithium disilicate crowns (p>0.05); nevertheless CAD-CAM zirconia copings presented the best marginal fit among the experimental groups. As to the thickness of the cement layer, reduced amounts of luting agent were noticed at the finishing line, whereas a thicker layer was reported at the occlusal level. Conclusion: Within the limitations of the present in vitro investigation, the following conclusions can be drawn: the recorded marginal gaps were within the clinical acceptability irrespective of both the restorative material and the manufacturing procedures; the CAD-CAM processing techniques for both zirconia and lithium disilicate produced more consistent marginal gaps than the heat-pressing procedures; the tested universal resin cement can be safely used with both restorative materials.
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Affiliation(s)
- Francesco Riccitiello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Naples, Italy
| | - Massimo Amato
- Department of Medicine, Surgery and Dentistry, University of Salerno, Salerno, Italy
| | - Renato Leone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Naples, Italy
| | - Gianrico Spagnuolo
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Naples, Italy
| | - Roberto Sorrentino
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, University "Federico II" of Naples, Naples, Italy
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Abduo J, Gade L, Gill H, Judge R, Darby I. A comparative study of encode protocol versus conventional protocol for restoring single implants: One-year prospective randomized controlled clinical trial. Clin Implant Dent Relat Res 2017; 19:1061-1067. [DOI: 10.1111/cid.12541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 08/19/2017] [Accepted: 08/30/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Jaafar Abduo
- Melbourne Dental School; Melbourne University, 720 Swanston Street; Melbourne Victoria 3010 Australia
| | - Lakshmi Gade
- Melbourne Dental School; Melbourne University, 720 Swanston Street; Melbourne Victoria 3010 Australia
| | - Harjot Gill
- Melbourne Dental School; Melbourne University, 720 Swanston Street; Melbourne Victoria 3010 Australia
| | - Roy Judge
- Melbourne Dental School; Melbourne University, 720 Swanston Street; Melbourne Victoria 3010 Australia
| | - Ivan Darby
- Melbourne Dental School; Melbourne University, 720 Swanston Street; Melbourne Victoria 3010 Australia
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Nilsson A, Johansson LÅ, Lindh C, Ekfeldt A. One-piece internal zirconia abutments for single-tooth restorations on narrow and regular diameter implants: A 5-year prospective follow-up study. Clin Implant Dent Relat Res 2017; 19:916-925. [DOI: 10.1111/cid.12515] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/26/2017] [Accepted: 06/10/2017] [Indexed: 12/11/2022]
Affiliation(s)
- Andrée Nilsson
- Division of Prosthetic Dentistry; Maxillofacial Unit, Halmstad Hospital; Halmstad Sweden
| | - Lars-Åke Johansson
- Division of Prosthetic Dentistry; Maxillofacial Unit, Halmstad Hospital; Halmstad Sweden
- Department of Periodontology, Faculty of Odontology; Malmö University; Malmö Sweden
| | - Christina Lindh
- Department of Oral Radiology, Faculty of Odontology; Malmö University; Malmö Sweden
| | - Anders Ekfeldt
- Department of Prosthetic Dentistry and Oral Function, Faculty of Dentistry, Institute of Clinical Dentistry; University of Oslo; Oslo Norway
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Eighteen-Month Outcomes of Titanium Frameworks Using Computer-Aided Design and Computer-Aided Manufacturing Method. IMPLANT DENT 2017; 26:480-484. [DOI: 10.1097/id.0000000000000582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
INTRODUCTION The use of zirconia in medicine and dentistry has rapidly expanded over the past decade, driven by its advantageous physical, biological, esthetic, and corrosion properties. Zirconia orthopedic hip replacements have shown superior wear-resistance over other systems; however, risk of catastrophic fracture remains a concern. In dentistry, zirconia has been widely adopted for endosseous implants, implant abutments, and all-ceramic crowns. Because of an increasing demand for esthetically pleasing dental restorations, zirconia-based ceramic restorations have become one of the dominant restorative choices. Areas covered: This review provides an updated overview of the applications of zirconia in medicine and dentistry with a focus on dental applications. The MEDLINE electronic database (via PubMed) was searched, and relevant original and review articles from 2010 to 2016 were included. Expert commentary: Recent data suggest that zirconia performs favorably in both orthopedic and dental applications, but quality long-term clinical data remain scarce. Concerns about the effects of wear, crystalline degradation, crack propagation, and catastrophic fracture are still debated. The future of zirconia in biomedical applications will depend on the generation of these data to resolve concerns.
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Affiliation(s)
- Yen-Wei Chen
- a Department of Restorative Dentistry , University of Washington School of Dentistry , Seattle , WA , USA
| | - Joelle Moussi
- a Department of Restorative Dentistry , University of Washington School of Dentistry , Seattle , WA , USA
| | - Jeanie L Drury
- a Department of Restorative Dentistry , University of Washington School of Dentistry , Seattle , WA , USA
| | - John C Wataha
- a Department of Restorative Dentistry , University of Washington School of Dentistry , Seattle , WA , USA
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