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Humm VL, Sailer I, Thoma DS, Hämmerle CHF, Jung RE, Zembic A. 13-year follow-up of a randomized controlled study on zirconia and titanium abutments. Clin Oral Implants Res 2023; 34:911-919. [PMID: 37340530 DOI: 10.1111/clr.14117] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/22/2023] [Accepted: 06/04/2023] [Indexed: 06/22/2023]
Abstract
OBJECTIVES To assess survival rates and compare technical, biological, and esthetic outcomes of customized zirconia and titanium abutments at 13 years post loading. MATERIALS AND METHODS Initially, 22 patients with 40 implants in posterior regions were included. The sites were randomly assigned to 20 customized zirconia abutments with cemented all ceramic crowns (ACC) and 20 customized titanium abutments with cemented metal ceramic crowns (MCC). At a mean follow-up of 13.4 years, patients were examined and implants/restorations assessed for survival and technical complications, as well as biological and esthetic outcomes (pocket probing depth [PPD], bleeding on probing [BOP], plaque control record [PCR], bone level [BL], papilla index [PAP], mucosal thickness, and recession (distance of the margo mucosae [MM]/margo gingivae MG)). Descriptive analyses were performed for all outcome measures. RESULTS Fifteen patients with 21 abutments (13 zirconia, 8 titanium) were examined at 13 years. The drop-out rate was 25% (patient level). The technical survival rate of the abutments was 100%. The survival rate on the restorative level (crowns) was 100%. The assessed biological outcomes (PPD, PCR, BOP, BL) and esthetic outcomes (MG, PAP) were similar. CONCLUSIONS Zirconia and titanium abutments supporting single implant-borne restorations rendered a high survival rate and minimal differences in terms of technical, biological, and esthetic outcomes at 13 years of follow-up.
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Affiliation(s)
- Viviane Laura Humm
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zürich, Zürich, Switzerland
- Private practice, Winterthur, Switzerland
| | - Irena Sailer
- Division of Fixed Prosthodontics and Occlusion, University clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel Stefan Thoma
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zürich, Zürich, Switzerland
| | | | - Ronald Ernst Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zürich, Zürich, Switzerland
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Rafikova G, Piatnitskaia S, Shapovalova E, Chugunov S, Kireev V, Ialiukhova D, Bilyalov A, Pavlov V, Kzhyshkowska J. Interaction of Ceramic Implant Materials with Immune System. Int J Mol Sci 2023; 24:4200. [PMID: 36835610 PMCID: PMC9959507 DOI: 10.3390/ijms24044200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/30/2023] [Accepted: 02/07/2023] [Indexed: 02/22/2023] Open
Abstract
The immuno-compatibility of implant materials is a key issue for both initial and long-term implant integration. Ceramic implants have several advantages that make them highly promising for long-term medical solutions. These beneficial characteristics include such things as the material availability, possibility to manufacture various shapes and surface structures, osteo-inductivity and osteo-conductivity, low level of corrosion and general biocompatibility. The immuno-compatibility of an implant essentially depends on the interaction with local resident immune cells and, first of all, macrophages. However, in the case of ceramics, these interactions are insufficiently understood and require intensive experimental examinations. Our review summarizes the state of the art in variants of ceramic implants: mechanical properties, different chemical modifications of the basic material, surface structures and modifications, implant shapes and porosity. We collected the available information about the interaction of ceramics with the immune system and highlighted the studies that reported ceramic-specific local or systemic effects on the immune system. We disclosed the gaps in knowledge and outlined the perspectives for the identification to ceramic-specific interactions with the immune system using advanced quantitative technologies. We discussed the approaches for ceramic implant modification and pointed out the need for data integration using mathematic modelling of the multiple ceramic implant characteristics and their contribution for long-term implant bio- and immuno-compatibility.
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Affiliation(s)
- Guzel Rafikova
- Laboratory of Immunology, Institute of Urology and Clinical Oncology, Bashkir State Medical University, 450008 Ufa, Russia
| | - Svetlana Piatnitskaia
- Institute of Fundamental Medicine, Bashkir State Medical University, 450008 Ufa, Russia
| | - Elena Shapovalova
- Department of Chemistry, Tomsk State University, 634050 Tomsk, Russia
| | | | - Victor Kireev
- Institute of Fundamental Medicine, Bashkir State Medical University, 450008 Ufa, Russia
- Department of Applied Physics, Ufa University of Science and Technology, 450076 Ufa, Russia
| | - Daria Ialiukhova
- Institute of Fundamental Medicine, Bashkir State Medical University, 450008 Ufa, Russia
| | - Azat Bilyalov
- Institute of Fundamental Medicine, Bashkir State Medical University, 450008 Ufa, Russia
| | | | - Julia Kzhyshkowska
- Institute of Fundamental Medicine, Bashkir State Medical University, 450008 Ufa, Russia
- Department of Chemistry, Tomsk State University, 634050 Tomsk, Russia
- Institute of Transfusion Medicine and Immunology, Mannheim Institute of Innate Immunosciecnes (MI3), Medical Faculty Mannheim, Heidelberg University, 69117 Mannheim, Germany
- German Red Cross Blood Service Baden-Württemberg, 68167 Mannheim, Germany
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Enkling N, Marder M, Bayer S, Götz W, Stoilov M, Kraus D. Soft tissue response to different abutment materials: A controlled and randomized human study using an experimental model. Clin Oral Implants Res 2022; 33:667-679. [PMID: 35467040 DOI: 10.1111/clr.13932] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 02/01/2022] [Accepted: 04/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Aim of this study was to compare the soft-tissue response to implant abutments made of titanium, zirconia, zirconia veneered with feldspar ceramics and PEEK by various clinical, histological, microbiological and molecular biological markers in an experimental model. MATERIALS AND METHODS 40 experimental one-piece healing abutments of four different materials were mounted on bone-level implants in 20 volunteering patients (split-mouth design). After a three months period of open healing, clinical parameters at the abutments were assessed and adjacent mucosa was sampled for inflammatory cytokine mRNA-concentrations and histological analysis by a novel method. In addition, PISF-samples were obtained for the analysis of periodonto-pathogenic bacteria counts and active MMP-8 levels. Marginal bone level change was measured by intra oral radiographs. RESULTS Abutments of the different materials did not exhibit significant differences regarding clinical parameters, pathogenic bacteria counts or pro-inflammatory cytokine concentrations. Likewise, no significant differences were detected regarding soft tissue morphology or bone level change. Compared to titanium abutments, significantly less mononuclear inflammatory cells were detected in the mucosa at abutments made of zirconia veneered with feldspar ceramics. CONCLUSIONS All examined abutment materials exhibited a similar soft tissue response compared to titanium and histological data did not reveal early signs of elevated inflammation caused by PEEK- and feldspar-veneered zirconia abutments. Due to the short observation period and the small sample size, a final conclusion on the long term suitability of those abutment materials cannot be drawn. However, based on the presented data, we consider further studies on that subject as appropriate.
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Affiliation(s)
- Norbert Enkling
- Department of Prosthodontics, Preclinical Education and Material Sciences, University of Bonn.,Department of Reconstructive Dentistry and Gerodontology, University of Bern
| | - Michael Marder
- Department of Prosthodontics, Preclinical Education and Material Sciences, University of Bonn
| | - Stefan Bayer
- Department of Prosthodontics, Preclinical Education and Material Sciences, University of Bonn
| | - Werner Götz
- Department of Orthodontics, University of Bonn
| | - Milan Stoilov
- Department of Prosthodontics, Preclinical Education and Material Sciences, University of Bonn
| | - Dominik Kraus
- Department of Prosthodontics, Preclinical Education and Material Sciences, University of Bonn
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Mechanical Stability of Screw-Retained Monolithic and Bi-layer Posterior Hybrid Abutment Crowns after Thermomechanical Loading: An In Vitro Study. MATERIALS 2021; 14:ma14247539. [PMID: 34947134 PMCID: PMC8706390 DOI: 10.3390/ma14247539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 11/29/2021] [Accepted: 12/03/2021] [Indexed: 11/17/2022]
Abstract
To evaluate the failure-load and survival-rate of screw-retained monolithic and bi-layered crowns bonded to titanium-bases before and after mouth-motion fatigue, 72 titanium-implants (SICvantage-max, SIC-invent-AG) were restored with three groups (n = 24) of screw-retained CAD/CAM implant-supported-single-crowns (ISSC) bonded to titanium-bases: porcelain-fused-to-metal (PFM-control), porcelain-fused-to-zirconia (PFZ-test) and monolithic LDS (LDS-test). Half of the specimens (n = 12/group) were subjected to fatigue in a chewing-simulator (1.2 million cycles, 198 N, 1.67 Hz, thermocycling 5–55 °C). All samples were exposed to single-load-to-failure without (PFM0, PFZ0, LDS0) or with fatigue (PFM1, PFZ1, LDS1). Comparisons were statistically analyzed with t-tests and regression-models and corrected for multiple-testing using the Student–Neuman–Keuls method. All PFM and LDS crowns survived fatigue exposure, whereas 16.7% of PFZ showed chipping failures. The mean failure-loads (±SD) were: PFM0: 2633 ± 389 N, PFM1: 2349 ± 578 N, PFZ0: 2152 ± 572 N, PFZ1: 1686 ± 691 N, LDS0: 2981 ± 798 N, LDS1: 2722 ± 497 N. Fatigue did not influence load to failure of any group. PFZ ISSC showed significantly lower failure-loads than monolithic-LDS regardless of artificial aging (p < 0.05). PFM ISSC showed significantly higher failure loads after fatigue than PFZ (p = 0.032). All ISSC failed in a range above physiological chewing forces. Premature chipping fractures might occur in PFZ ISSC. Monolithic-LDS ISSC showed high reliability as an all-ceramic material for screw-retained posterior hybrid-abutment-crowns.
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Totou D, Naka O, Mehta SB, Banerji S. Esthetic, mechanical, and biological outcomes of various implant abutments for single-tooth replacement in the anterior region: a systematic review of the literature. Int J Implant Dent 2021; 7:85. [PMID: 34494174 PMCID: PMC8423965 DOI: 10.1186/s40729-021-00370-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/16/2021] [Indexed: 11/17/2022] Open
Abstract
Background The choice of the appropriate implant abutment is a critical step for a successful outcome. Titanium abutments have demonstrated high survival rates, due to their excellent biocompatibility and high mechanical strength, although they often result in a grayish discoloration of the peri-implant mucosa. This esthetic concern culminated in the introduction of ceramic abutments. The aim of this review was to assess the esthetic, mechanical, and biological outcomes as well as the survival of the different types of abutments used for single-implant restorations in the anterior area. Material and methods An electronic search was conducted in Medline, Embase, and Cochrane Central databases using the appropriate Mesh terms and predetermined eligibility criteria. The quality of the studies was assessed using the ROB 2 tool. The last search was conducted on 18th of March 2020. Results From the 2074 records initially identified, 23 randomized controlled trials (32 publications) were included for qualitative analysis. Data were classified based on study information, specific characteristics of the intervention and comparator, and information related to the outcome measures. Seven studies exhibited an overall low risk of bias, while twelve studies raised some concerns. Conclusions The rate of abutment failure was low and was associated with the ceramic abutments, especially those with internal connection. Limited correlation was noted between soft tissue thickness and color difference. Titanium abutments caused significantly more discoloration to the soft tissues than ceramic abutments, while hueing (gold or pink) slightly improved their color performance. Zirconia allowed a better color match than titanium or gold abutments, still discolored slightly the soft tissues. The submucosally modified zirconia abutments exhibited encouraging results. No significant difference was reported between materials or different types of retention on recession, papillary fill, and biological outcomes.
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Affiliation(s)
- Dimitra Totou
- Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, UK
| | - Olga Naka
- Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, UK. .,School of Dentistry, Aristotle University of Thessaloniki, 54124, Thessaloniki, Greece.
| | - Shamir B Mehta
- Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, UK
| | - Subir Banerji
- Faculty of Dentistry Oral and Craniofacial Sciences, King's College London, London, UK
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Dini C, Borges GA, Costa RC, Magno MB, Maia LC, Barão VAR. Peri-implant and esthetic outcomes of cemented and screw-retained crowns using zirconia abutments in single implant-supported restorations-A systematic review and meta-analysis. Clin Oral Implants Res 2021; 32:1143-1158. [PMID: 34352144 DOI: 10.1111/clr.13824] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/23/2021] [Accepted: 07/07/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To evaluate the peri-implant tissue changes and esthetic outcomes of cemented and screw-retained crowns of single-tooth implants in the esthetic zone using zirconia abutments. MATERIAL AND METHODS An electronic search was performed on nine databases. The risk-of-bias was assessed by the revised Cochrane risk-of-bias tool for randomized (RoB 2) and non-randomized (ROBINS-I) clinical trials. Marginal bone level change, soft tissue thickness, bleeding on probing, probing depth, survival rates of implants and crowns, complications, plaque and papilla indexes, and pink esthetic score data were extracted and analyzed. The certainty of evidence was accessed through the GRADE approach. RESULTS Nine records were included and 7 were used in the meta-analyses. Screw-retained crowns presented greater marginal bone level change (MD -0.04 [-0.08, -0.00] p = 0.04, I2 = 0%) compared to cemented crowns up to 1-year. At 3 and 4 years no significant differences (p > 0.05) were observed. Soft tissue thickness did not differ between groups (p > 0.05). The bleeding on probing was higher in cemented group than in screw-retained crowns at 1-year (MD 0.17 [0.08, 0.27] p = 0.0005, I2 = 0%), at medium-term periods (3 and 4 years) no statistically significant differences (p > 0.05) were observed for this outcome. Probing depth, survival rates of implants and crowns, complications, and plaque index, as well as esthetic analysis using the papilla index and pink esthetic score did not differ statistically (p > 0.05) between both retention systems at short and medium-term periods. CONCLUSION The connection system considering zirconia abutments presented no influence on peri-implant parameters and esthetics evaluation for medium-term periods (3 and 4 years).
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Affiliation(s)
- Caroline Dini
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP, Piracicaba, Brazil
| | - Guilherme Almeida Borges
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP, Piracicaba, Brazil
| | - Raphael Cavalcante Costa
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP, Piracicaba, Brazil
| | - Marcela Baraúna Magno
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rua Rodolpho Paulo Rocco - Cidade Universitária, Rio de Janeiro, Brazil
| | - Lucianne Cople Maia
- Department of Pediatric Dentistry and Orthodontics, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Rua Rodolpho Paulo Rocco - Cidade Universitária, Rio de Janeiro, Brazil
| | - Valentim Adelino Ricardo Barão
- Department of Prosthodontics and Periodontology, Piracicaba Dental School, University of Campinas (UNICAMP, Piracicaba, Brazil
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Spitznagel FA, Bonfante EA, Vollmer F, Gierthmuehlen PC. Failure Load of Monolithic Lithium Disilicate Implant-Supported Single Crowns Bonded to Ti-base Abutments versus to Customized Ceramic Abutments after Fatigue. J Prosthodont 2021; 31:136-146. [PMID: 33870577 DOI: 10.1111/jopr.13369] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This laboratory study analyzed the influence of retention mode (screw- vs cement retained) and fatigue application on the failure load of monolithic lithium-disilicate (LDS) implant-supported single crowns (ISSC). MATERIAL AND METHODS A total of 72 samples of monolithic LDS (*Ivoclar Vivadent) ISSC were divided into three groups (n = 24) according to their type of retention mode: Group Ti-CAD: Titanium base (SICvantage CAD/CAM Abutment red (SIC invent AG), screw-retained milled monolithic LDS (IPS e.max CAD*); Group Ti-P: Titanium base (SICvantage CAD/CAM Abutment red), screw-retained pressed monolithic LDS (IPS e.max Press*) and Group Ti-Cust: Titanium base with cemented press LDS (IPS e.max Press*) crown on a LDS (IPS e.max Press*) custom abutment. A mandibular first molar implant-supported single crown model was investigated (Titanium implant: SICvantage-max, SIC invent AG, diameter: 4.2 mm, length: 11.5 mm). Half of each group (n = 12) were exposed to fatigue with cyclic mechanical loading (F = 198 N, 1.2 million cycles) and simultaneous thermocycling (5-55°C). Single load to failure testing was performed, before (Subgroups Ti-CAD, Ti-P, and Ti-Cust) and after (Subgroups Ti-CAD-F, Ti-P-F, and Ti-Cust-F) fatigue. Weibull distribution was used to determine the characteristic strength and Weibull modulus differences between groups. Probability of survival at 900N load was calculated. RESULTS No samples failed during fatigue. Characteristic strength values were as follow: Ti-CAD: 3259.5N, Ti-CAD-F: 2926N, Ti-P: 2763N, Ti-P-F: 2841N, Ti-Cust: 2789N, Ti-Cust-F: 2194N. Whereas no difference was observed between pressed or milled monolithic crowns cemented to Ti-base, regardless of loading condition, fatigue decreased the characteristic strength of crowns cemented to custom abutments. Probability of survival at 900 N was not significantly different between groups. CONCLUSIONS Screw-retained pressed or milled monolithic LDS ISSC, cemented directly to Ti-base abutments or LDS crowns cemented to custom ceramic abutments resist physiological chewing forces after simulated 5-year aging in the artificial mouth and presented equally high probability of survival. However, a significant decrease in load to failure was observed in LDS crowns cemented to custom ceramic abutments after fatigue. Prospective clinical trials are needed to confirm the results of this laboratory investigation.
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Affiliation(s)
- F A Spitznagel
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
| | - E A Bonfante
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of Sao Paulo, Bauru, SP, Brazil
| | - F Vollmer
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany.,Private Practice, Tettnang, Germany
| | - P C Gierthmuehlen
- Department of Prosthodontics, Medical Faculty and University Hospital Düsseldorf, Heinrich-Heine-University, Düsseldorf, Germany
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