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Sales PHDH, Barros AWP, Oliveira-Neto OBD, de Lima FJC, Carvalho ADAT, Leão JC. Do zirconia dental implants present better clinical results than titanium dental implants? A systematic review and meta-analysis. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2023; 124:101324. [PMID: 36330865 DOI: 10.1016/j.jormas.2022.10.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 10/26/2022] [Accepted: 10/28/2022] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The purpose of this systematic review is to determine if the zirconia implants present better clinical results when compared to titanium implants. METHODS Searches were conducted in 5 databases including, until March 2022, by 2 independent reviewers, according to the inclusion and exclusion criteria established in the study and according whit this question: Do zirconia dental implants present better clinical results than titanium dental implants? RESULTS 3235 studies were initially found in the researched databases. 03 randomized clinical trials were included in this systematic review and meta-analysis. A total of 71 patients with 192 implants (87 titanium and 105 zirconia) were evaluated, showing an effectiveness of 87,4% and 78,1% respectively and there was no statistically significant difference in terms of survival rate in the meta-analysis (P = 0.70; I2 = 0%). Still in the meta-analysis, there was no statistically significant difference between titanium and zirconia implants in relation to the pink esthetich score or bleeding on probing, however, a favorable difference was observed for titanium in relation to marginal bone loss (P = 0.001; I2 = 0%). None of the studies evaluated had a low risk of bias. CONCLUSION Oral rehabilitation with zirconia implants showed no advantages over titanium in this systematic review. However, the small number of studies included and the uncertain risk of bias may raise doubts in this interpretation and the results should be analyzed with caution. New studies with greater methodological rigor, follow-up time and number of interventions should be performed in order to safely determine the indication for the use of zirconia implants.
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Affiliation(s)
- Pedro Henrique da Hora Sales
- Post-Graduated Program in Dentistry, Department of Prothesis and Oral and Maxillofacial Surgery, Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego 1235 - Cidade Universitária, Recife, PE 50670-901, Brazil.
| | - Ana Waleska Pessoa Barros
- Post-Graduated Program in Dentistry, Department of Prothesis and Oral and Maxillofacial Surgery, Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego 1235 - Cidade Universitária, Recife, PE 50670-901, Brazil
| | | | | | | | - Jair Carneiro Leão
- Department of Clinical and Preventive Dentistry, Federal University of Pernambuco (UFPE), Recife, PE, Brazil
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Pjetursson BE, Sailer I, Latyshev A, Rabel K, Kohal RJ, Karasan D. A systematic review and meta-analysis evaluating the survival, the failure, and the complication rates of veneered and monolithic all-ceramic implant-supported single crowns. Clin Oral Implants Res 2021; 32 Suppl 21:254-288. [PMID: 34642991 PMCID: PMC9293296 DOI: 10.1111/clr.13863] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/04/2021] [Indexed: 12/28/2022]
Abstract
Objective To assess the survival, failure, and complication rates of veneered and monolithic all‐ceramic implant‐supported single crowns (SCs). Methods Literature search was conducted in Medline (PubMed), Embase, and Cochrane Central Register of Controlled Trials until September 2020 for randomized, prospective, and retrospective clinical trials with follow‐up time of at least 1 year, evaluating the outcome of veneered and/or monolithic all‐ceramic SCs supported by titanium dental implants. Survival and complication rates were analyzed using robust Poisson's regression models. Results Forty‐nine RCTs and prospective studies reporting on 57 material cohorts were included. Meta‐analysis of the included studies indicated an estimated 3‐year survival rate of veneered‐reinforced glass‐ceramic implant‐supported SCs of 97.6% (95% CI: 87.0%–99.6%). The estimated 3‐year survival rates were 97.0% (95% CI: 94.0%–98.5%) for monolithic‐reinforced glass‐ceramic implant SCs, 96.9% (95% CI: 93.4%–98.6%) for veneered densely sintered alumina SCs, 96.3% (95% CI: 93.9%–97.7%) for veneered zirconia SCs, 96.1% (95% CI: 93.4%–97.8%) for monolithic zirconia SCs and only 36.3% (95% CI: 0.04%–87.7%) for resin‐matrix‐ceramic (RMC) SCs. With the exception of RMC SCs (p < 0.0001), the differences in survival rates between the materials did not reach statistical significance. Veneered SCs showed significantly (p = 0.017) higher annual ceramic chipping rates (1.65%) compared with monolithic SCs (0.39%). The location of the SCs, anterior vs. posterior, did not influence survival and chipping rates. Conclusions With the exception of RMC SCs, veneered and monolithic implant‐supported ceramic SCs showed favorable short‐term survival and complication rates. Significantly higher rates for ceramic chipping, however, were reported for veneered compared with monolithic ceramic SCs.
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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
| | - Irena Sailer
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Andrey Latyshev
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.,Department of Maxillofacial, Oral and Plastic Surgery, Faculty of Dentistry, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Kerstin Rabel
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental 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
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
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In Vitro Investigations in a Biomimetic Approach to Restore One-Piece Zirconia Implants. MATERIALS 2021; 14:ma14164361. [PMID: 34442883 PMCID: PMC8400740 DOI: 10.3390/ma14164361] [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: 06/30/2021] [Revised: 07/27/2021] [Accepted: 07/31/2021] [Indexed: 11/21/2022]
Abstract
The objective of this study was to evaluate the fracture load and retention force of different bonding systems while restoring one-piece zirconia implants with a novel cementation approach using a mesostructure. Polymer-infiltrated ceramic mesostructures (n = 112) were therefore designed as caps on the implant abutment, and a molar feldspathic ceramic crown was constructed on top of it as a suprastructure. For cementation, different bonding systems were used. Fracture load and retention force were measured immediately after storage in water at 37 °C for 24 h (n = 8) as well as after artificial aging in a chewing simulator and subsequent thermal cycling (n = 8). Combined restorations showed higher fracture load compared to monolithic restorations of polymer-infiltrated ceramic (n = 8) or feldspathic ceramic (n = 8) identical in shape. However, the fracture load of the combined restorations was significantly affected by aging, independent of the primers and cements used. Restorations cemented with primers containing methyl methacrylate and 10-methacryloyloxydecyl dihydrogen phosphate exhibited the highest retention force values. Aging did not affect the retention force significantly. Similar fracture load values can be expected from combination restorations when compared with monolithic crowns.
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Laumbacher H, Strasser T, Knüttel H, Rosentritt M. Long-term clinical performance and complications of zirconia-based tooth- and implant-supported fixed prosthodontic restorations: A summary of systematic reviews. J Dent 2021; 111:103723. [PMID: 34119611 DOI: 10.1016/j.jdent.2021.103723] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Revised: 05/21/2021] [Accepted: 06/02/2021] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To present an overview on systematic reviews on prosthodontic zirconia restorations and to discuss long-term complications as well as information on anatomical and functional changes to the masticatory system. DATA/SOURCES MEDLINE, EMBASE, Trip medical, and Cochrane Library databases were searched for systematic reviews up to February 2021. Bias was assessed and clinical survival and complications were analyzed. STUDY SELECTION 38 eligible articles published between 2006 and 2021 were included. The reviews were based on 128 in vivo studies on approximately 10,000 zirconia restorations. 5-year cumulative survival rates varied between 91.2% and 95.9% for tooth-supported (TS) single crowns (SC), 89.4% and 100% for TS multi-unit fixed dental prostheses (FDP), 97.1% and 97.6% for implant-supported (IS) SCs and 93.0% and 100% for IS FDPs. Chipping was the most often technical complication, followed by framework fracture, loss of retention, marginal discrepancies/discoloration, occlusal roughness and abutment/screw loosening. Color mismatch was the only esthetic complication. Biological complications were caries, endodontic complications, tooth fracture, periodontal disease, abrasion/attrition, persisting pain, high sensitivity, peri‑implantitis and soft tissue issues. Patients with bruxism were only examined sporadically. CONCLUSIONS 5-year results for zirconia restorations were satisfactory. The predominant technical problem of veneering fractures could be overcome with adapted design or fabrication and application of monolithic restorations, but reviews of clinical studies on this subject are rare. The impact of zirconia restorations on the masticatory system remains unclear. CLINICAL SIGNIFICANCE Zirconia restorations are experiencing a rapidly increasing use in dental practice. Being highly wear-resistant, hard and durable, it can be assumed that they do not follow natural abrasion and changes in the masticatory system. Possible long-term effects on the stomatognathic system as a whole should therefore be considered.
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Affiliation(s)
- Harald Laumbacher
- Department of Prosthetic Dentistry, UKR University Hospital Regensburg, 93042 Regensburg, Germany
| | - Thomas Strasser
- Department of Prosthetic Dentistry, UKR University Hospital Regensburg, 93042 Regensburg, Germany
| | - Helge Knüttel
- University Library, University of Regensburg, 93042 Regensburg, Germany
| | - Martin Rosentritt
- Department of Prosthetic Dentistry, UKR University Hospital Regensburg, 93042 Regensburg, Germany.
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Rohr N, Märtin S, Fischer J. Fracture load of zirconia implant supported CAD/CAM resin crowns and mechanical properties of restorative material and cement. J Prosthodont Res 2021; 65:502-508. [PMID: 33840705 DOI: 10.2186/jpr.jpr_d_20_00051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
PURPOSE To test if resin CAD/CAM materials should be considered for zirconia implants and how their mechanical properties affect the fracture load. METHODS Fracture load of molar crowns of CAD/CAM materials (VITA CAD-Temp [CT], Cerasmart [CS], Lava Ultimate [LU], Pekkton Ivory [PK]) on zirconia implants (ceramic.implant, 4.0 mm) fixed either with no cement, temporary cement (Harvard Implant semi-permanent [HIS]), self-adhesive (VITA Adiva S-Cem [VAS]) or either one of two adhesive cements (Multilink Automix [MLA], VITA Adiva F-Cem [VAF]) was analyzed. The restorative materials were characterized by their flexural strength, fracture toughness, elemental composition and organic/inorganic ratio while compressive strength of the cements was measured. RESULTS For the fracture load significantly highest mean values were fo und overall for PK (2921 ±300 N) > LU (2017 ±499 N) > CS (1463 ±367 N) = CT (1451 ±327 N) (p > 0.05). When analyzing the effect of the cement on the fracture load the overall ranking was VAF (2245 ±650 N) ≥ MLA (2188 ±708 N) ≥ VAS (2017 ±563 N) > HIS (1757 ±668 N) = no cement (1595 ±757 N) (p <0.05), meaning fracture load increased with the compressive strength of the cements. Additionally, a linear trend was found between the fracture load and the fracture toughness of the restorative materials. CONCLUSIONS All restorative materials exhibited fracture load values similar or higher than lithium disilicate tested previously. Fracture load of CT, CS and LU can be significantly increased when an adhesive cement with a high compressive strength is used.
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Affiliation(s)
- Nadja Rohr
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine, University of Basel, Basel
| | - Sabrina Märtin
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine, University of Basel, Basel
| | - Jens Fischer
- Biomaterials and Technology, Department of Reconstructive Dentistry, University Center for Dental Medicine, University of Basel, Basel
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Fretwurst T, Müller J, Larsson L, Bronsert P, Hazard D, Castilho RM, Kohal R, Nelson K, Iglhaut G. Immunohistological composition of peri-implantitis affected tissue around ceramic implants-A pilot study. J Periodontol 2020; 92:571-579. [PMID: 32839977 DOI: 10.1002/jper.20-0169] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/30/2020] [Accepted: 07/10/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Aim of the pilot study was the histologic classification of the inflamed peri-implant soft tissue around ceramic implants (CI) in comparison with titanium implants (TI). METHODS Peri-implant tissue were retrieved from 15 patients (aged 34 to 88 years, seven males/eight females) with severe peri-implantitis (eight CI, seven TI). The peri-implant soft tissue samples were retrieved from the sites during scheduled removal of the implant and prepared for immunohistochemical analysis. Monoclonal antibodies (targeting CD3, CD20, CD138, and CD68) were used to identify T- and B-cells, plasma cells and macrophages. Quantitative assessment was performed by one histologically trained investigator. Linear mixed regression models were used. RESULTS A similar numerical distribution of the cell population was found in peri-implantitis around CI compared with TI. CD3 (TI, 17% to 85% versus CI, 20% to 70% of total cell number) and CD138 (TI, 1% to 73% versus CI, 12% to 69% of total cell number) were predominantly expressed. Notably, patient-individual differences of numerical cell distribution were detected. Co-localization of B- and T-lymphocytes was observed. CONCLUSIONS Peri-implantitis around CI in comparison with TI seems to have a similar histological appearance. Differences in cellular composition of peri-implantitis lesions might also depend on the patient's specific immune status and not only on the material used.
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Affiliation(s)
- Tobias Fretwurst
- Department of Oral and Craniomaxillofacial Surgery, Translational Implantology, Center for Dental Medicine, University Medical Center, Freiburg, Baden-Württemberg, Germany
| | - Janina Müller
- Department of Oral and Craniomaxillofacial Surgery, Translational Implantology, Center for Dental Medicine, University Medical Center, Freiburg, Baden-Württemberg, Germany
| | - Lena Larsson
- Department of Periodontology, Institute of Odontology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Bronsert
- Institute of Surgical Pathology, University Medical Center, Freiburg, Germany, Tumorbank Comprehensive Cancer Center Freiburg, Medical Center- University of Freiburg, Freiburg, Germany, Faculty of Medicine, University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Derek Hazard
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Rogerio M Castilho
- Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, Ann Arbor, Michigan, USA.,Laboratory of Epithelial Biology, Department of Periodontics and Oral Medicine, University of Michigan School, Ann Arbor, Michigan, USA
| | - Ralf Kohal
- Department of Prosthetic Dentistry, Center for Dental Medicine, University Medical Center Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Katja Nelson
- Department of Oral and Craniomaxillofacial Surgery, Translational Implantology, Center for Dental Medicine, University Medical Center, Freiburg, Baden-Württemberg, Germany
| | - Gerhard Iglhaut
- Department of Oral and Craniomaxillofacial Surgery, Translational Implantology, Center for Dental Medicine, University Medical Center, Freiburg, Baden-Württemberg, Germany
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Clinical Outcomes of Root-Analogue Implants Restored with Single Crowns or Fixed Dental Prostheses: A Retrospective Case Series. J Clin Med 2020; 9:jcm9082346. [PMID: 32717843 PMCID: PMC7465378 DOI: 10.3390/jcm9082346] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 01/08/2023] Open
Abstract
The objective was to investigate clinical and radiological outcomes of rehabilitations with root-analogue implants (RAIs). Patients restored with RAIs, supporting single crowns or fixed dental prostheses, were recruited for follow-up examinations. Besides clinical and esthetical evaluations, X-rays were taken and compared with the records. Patients were asked to evaluate the treatment using Visual Analogue Scales (VAS). For statistical analyses, mixed linear models were used. A total of 107 RAIs were installed in one dental office. Of these, 31 were available for follow-up examinations. For those remaining, survival has been verified via phone. RAIs were loaded after a mean healing time of 6.6 ± 2.5 months. 12.1 ± 6.9 months after loading, a mean marginal bone loss (MBL) of 1.20 ± 0.73 mm was measured. Progression of MBL significantly decreased after loading (p = 0.013). The mean pink and white esthetic score (PES/WES) was 15.35 ± 2.33 at follow-up. A survival rate of 94.4% was calculated after a mean follow-up of 18.9 ± 2.4 months after surgery. Immediate installation of RAIs does not seem to reduce MBL, as known from the literature regarding screw-type implants, and might not be recommended for daily routine. Nevertheless, they deliver esthetically satisfying results.
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Digitization of One-Piece Oral Implants: A Feasibility Study. MATERIALS 2020; 13:ma13081990. [PMID: 32344639 PMCID: PMC7215390 DOI: 10.3390/ma13081990] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/13/2020] [Accepted: 04/23/2020] [Indexed: 11/16/2022]
Abstract
For digital impression-making of two-piece oral implants, scan bodies are used to transfer the exact intraoral implant position to the dental laboratory. In this in vitro investigation, the accuracy of digitizing a one-piece ceramic oral implant without a scan body (OC) was compared to that of a standard two-piece titanium implant with a scan body (TT) and a preparation of a natural single tooth (ST). Furthermore, incomplete scans of OC simulating clinical compromising situations (OC1–4) were redesigned using a virtual reconstruction tool (RT) and superimposed to OC. OC and TT oral implants and one ST were inserted into a mandible typodont model and digitized (N = 13) using two different intraoral scanners. The resulting virtual datasets were superimposed onto a three-dimensional (3D) laser scanner-based reference. Test and reference groups were aligned using an inspection software according to a best-fit algorithm, and circumferential as well as marginal discrepancies were measured. For the statistical evaluation, multivariate analyses of variance with post-hoc Tukey tests and students t-tests to compare both scanners were performed. A total of 182 datasets were analyzed. For circumferential deviations, no significant differences were found between ST, TT, and OC (p > 0.964), but increased deviations for OC1–4 (p < 0.001) were observed. The measurements of the marginal deviations revealed that ST had the smallest deviations, and that there were no significant differences between TT, OC, and OC1–4 (p > 0.979). Except for marginal deviation of OC (p < 0.001), the outcome was not affected by the scanner. Within the limitations of this study, digitization of OC is as accurate as that of TT, but less than that of ST. In the case of known geometries, post-processing of compromised scans with a virtual reconstruction results in accurate data.
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Balmer M, Spies BC, Kohal RJ, Hämmerle CHF, Vach K, Jung RE. Zirconia implants restored with single crowns or fixed dental prostheses: 5-year results of a prospective cohort investigation. Clin Oral Implants Res 2020; 31:452-462. [PMID: 31981374 DOI: 10.1111/clr.13581] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 12/15/2019] [Accepted: 01/08/2020] [Indexed: 02/06/2023]
Abstract
AIM To evaluate the clinical and radiological outcomes of one-piece zirconia implants restored with single crowns (SCs) or fixed dental prostheses (FDPs) over an observation period of 5 years in function. MATERIALS AND METHODS In a prospective cohort investigation with two investigational centers, one-piece zirconia implants were placed in anterior and posterior sites. After a healing period of at least 2 months in the mandible and 4 months in the maxilla with immediate provisional reconstructions, the final all-ceramic SCs or three-unit FDPs were cemented. Patients were followed for 5 years. Clinical parameters and radiological measurements of the implants and the neighboring teeth were assessed. For the statistical analysis, linear mixed models were applied. RESULTS A total of 71 implants were placed in 60 patients. Sixty-three implants in 53 patients could be evaluated at the 5-year follow-up. Six patients with a total of seven implants were counted as dropouts. One implant did not achieve adequate osseointegration and had to be removed 5 weeks after implantation. The 5-year survival rate was calculated as 98.4% (95% CI 91.6, 99.9). The mean overall marginal bone loss from implant placement to the 5-year follow-up was 0.7 ± 0.6 mm. After an initial mean marginal loss before loading the implants (0.7 mm), no further statistically significant change in marginal bone level (p = .458) could be observed. CONCLUSION The investigated one-piece zirconia implant showed a high survival rate, very stable marginal bone, and mucosal margin levels after 5 years in function. Therefore, it can be considered safe and reliable for the reconstruction of implant-supported SCs or FDPs over a mid-term period.
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Affiliation(s)
- Marc Balmer
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Benedikt C Spies
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany.,Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Humboldt-Universität zu Berlin and Berlin Institute of Health, corporate member of Freie Universität Berlin, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Medical Center - University of Freiburg, Center for Dental Medicine, University of Freiburg, Freiburg, Germany
| | | | - Kirstin Vach
- Faculty of Medicine, Medical Center - University of Freiburg, Center for Medical Biometry and Medical Informatics, Institute for Medical Biometry and Statistics, University of Freiburg, Freiburg, Germany
| | - Ronald E Jung
- Clinic of Reconstructive Dentistry, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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AlTarawneh S, Abu-Awwad M, Riyal S, Samara R, Hattar S. A multi-center retrospective assessment of monolithic zirconia restorations on posterior teeth and implants. JOURNAL OF ORAL RESEARCH 2019. [DOI: 10.17126/joralres.2019.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Objective: the purpose of this multicenter retrospective study was to report on survival, success, and complication rates in monolithic zirconia restorations on teeth and implants. Materials and Methods: data on 671 monolithic zirconia restorations was collected by five prosthodontists from three different specialty practice centers, including a dental school and two private practice centers. Restorations included single crowns and multiple-unit fixed dental prostheses on teeth and implants in the posterior area (premolar and molars). Follow-up time was up to 62 months. Results: mean follow-up time was 28.1±12.9 months. A total of 671 units, 534 single crowns, and 137 multi-unit restorations. Cumulative survival and success rates at 5 years were 97.4%, and 93.8% respectively. Complications presented in 11 restorations out of 671 and included: decementation, abutment screw loosening, restoration crack, restoration fracture, and tooth fracture. No significant differences were observed between tooth-supported and implant-supported restoration (p=0.42), single crowns and multiple-unit restorations (p=0.07), bruxers and non-bruxers (p=0.57). Patients with group function occlusal scheme had significantly less survival rates (p=0.001). Conclusion: the use of monolithic zirconia for restorations on the posterior teeth and implants seems to be promising as it provides a durable solution with a low rate of complications.
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Rohr N, Balmer M, Müller JA, Märtin S, Fischer J. Chewing simulation of zirconia implant supported restorations. J Prosthodont Res 2019; 63:361-367. [DOI: 10.1016/j.jpor.2019.02.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 02/01/2019] [Accepted: 02/13/2019] [Indexed: 11/28/2022]
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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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13
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Biofilm formation on restorative materials and resin composite cements. Dent Mater 2018; 34:1702-1709. [DOI: 10.1016/j.dental.2018.08.300] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/16/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
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14
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Roehling S, Schlegel KA, Woelfler H, Gahlert M. Performance and outcome of zirconia dental implants in clinical studies: A meta‐analysis. Clin Oral Implants Res 2018; 29 Suppl 16:135-153. [DOI: 10.1111/clr.13352] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Revised: 02/28/2018] [Accepted: 07/04/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Stefan Roehling
- Clinic for Oral and Cranio‐Maxillofacial SurgeryHightech Research CenterUniversity Hospital BaselUniversity of Basel Basel Switzerland
- Clinic for Oral and Cranio‐Maxillofacial SurgeryKantonsspital Aarau Aarau Switzerland
- Unit for Oral & Maxillofacial SurgeryMedical Healthcare Center Lörrach Lörrach Germany
| | - Karl A. Schlegel
- Private Clinic for Oral and Maxillofacial Surgery Prof. Schlegel Munich Germany
- Maxillofacial Surgery DepartmentUniversity Hospital ErlangenUniversity of Erlangen Erlangen Germany
| | | | - Michael Gahlert
- Clinic for Oral and Cranio‐Maxillofacial SurgeryHightech Research CenterUniversity Hospital BaselUniversity of Basel Basel Switzerland
- Private Dental Clinic PD Dr. Gahlert Munich Germany
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15
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Cheng CW, Chien CH, Chen CJ, Papaspyridakos P. Randomized Controlled Clinical Trial to Compare Posterior Implant-Supported Modified Monolithic Zirconia and Metal-Ceramic Single Crowns: One-Year Results. J Prosthodont 2018. [PMID: 29528175 DOI: 10.1111/jopr.12767] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
PURPOSE The purpose of this randomized controlled clinical trial was to investigate the prosthetic outcomes of posterior implant-supported single crowns (SCs) with a modified monolithic zirconia or metal-ceramic design at 1 year of loading. MATERIALS AND METHODS Forty participants with 73 dental implants in need of at least 1 maxillary or mandibular posterior implant-supported SC were consecutively selected for this study. The included participants were randomly divided into modified monolithic zirconia (MMZ) and metal-ceramic (MC) groups. The implant-supported SCs were examined after 1 year for survival and technical complications. Descriptive statistics were used to illustrate the data, and the association associated risks of complications were estimated using the logistic regression model with Firth's approach for rare outcome (α = 0.05). RESULTS During the observation period, 2 participants in the MC group were lost to follow-up. A total of 38 participants with 70 posterior implant-supported SCs (36 and 34 SCs in the MMZ and MC groups respectively) completed the 1-year follow-up examination. One implant failed in the MMZ group. The 1-year survival rates for implants and crowns were both 97.2% in the MMZ group. The survival rates for implants and crowns were both 100% in the MC group. One screw loosening event was observed in one screw-retained SC in the MMZ group; however, 8 complication events occurred in 7 SCs in the MC group. Therefore, the complication-free rates were 97.1% and 79.4% in the MMZ and MC SCs respectively. The most common complication in the MC group was screw loosening (14.7%), followed by loss of retention (5.9%), and ceramic fracture (2.9%). Significantly more technical complications were observed in the MC SCs than MMZ SCs (p = 0.0432). CONCLUSION The modified monolithic zirconia design applied to the posterior implant-supported SCs had a significantly lower technical complication rate than did the metal-ceramic one.
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Affiliation(s)
- Chih-Wen Cheng
- Division of Prosthodontics, Department of Dentistry, Chi Mei Medical Center, Tainan, Taiwan
| | - Chia-Hui Chien
- Division of Prosthodontics, Department of Dentistry, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Chun-Jung Chen
- Division of Periodontics, Department of Dentistry, Chi Mei Medical Center, Tainan, Taiwan
| | - Panos Papaspyridakos
- Division of Postgraduate Prosthodontics, Tufts University School of Dental Medicine, Boston, MA.,Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, NY
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16
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Balmer M, Spies BC, Vach K, Kohal RJ, Hämmerle CHF, Jung RE. Three-year analysis of zirconia implants used for single-tooth replacement and three-unit fixed dental prostheses: A prospective multicenter study. Clin Oral Implants Res 2018; 29:290-299. [PMID: 29330869 DOI: 10.1111/clr.13115] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2017] [Indexed: 12/24/2022]
Abstract
AIM The aim of the present investigation was to evaluate clinically and radiographically the outcome of zirconia oral implants after 3 years in function. MATERIALS AND METHODS In 60 patients in need of either a single-tooth replacement or a three-unit fixed dental prosthesis (FDP), a total of 71 one-piece zirconia implants were placed and immediately restored with temporary fixed prostheses. After a period of at least 2 months in the mandible and at least 4 months in the maxilla, zirconia-based reconstructions were cemented. The implants were clinically and radiologically examined at implant insertion, prosthetic delivery, at 6 months and then yearly up to 3 years. A linear mixed model was used to analyze statistically the influence of prognostic factors on changes in the marginal bone level. RESULTS Seventy-one implants (48 in the mandible, 23 in the maxilla) inserted in 60 patients were restored with 49 crowns and 11 FDP. One patient lost his implant after 5 weeks. Five patients with one implant each could not be evaluated after 3 years. Based on 55 patients with a total of 66 implants, the mean survival rate was 98.5% after 3 years in function. A statistically significant mean marginal bone loss (0.70 mm ± 0.72 mm) has been detected from implant insertion to the 3-year follow-up. The largest marginal bone loss occurred between implantation and prosthetic delivery (0.67 mm ± 0.56 mm). After delivery, no statistically significant bone level change was observed (0.02 mm ± 0.59 mm). None of the investigated prognostic factors had a significant influence on changes in the marginal bone level. CONCLUSIONS After 3 years in function, the investigated one-piece zirconia implant showed a high survival rate and a low marginal bone loss. The implant system was successful for single-tooth replacement and three-unit FDPs. Further investigations with long-term data are needed to confirm these findings.
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Affiliation(s)
- Marc Balmer
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Benedikt C Spies
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center, University of Freiburg, Freiburg, Germany.,Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin (CBF), CC 3 Dental and Craniofacial Sciences, Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Berlin, Germany
| | - Kirstin Vach
- Center for Medical Biometry and Medical Informatics, Institute for Medical Biometry and Statistics, University Medical Center Freiburg, Freiburg, Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center, University of Freiburg, Freiburg, Germany
| | - Christoph H F Hämmerle
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
| | - Ronald E Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland
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17
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All-ceramic, bi-layered crowns supported by zirconia implants: Three-year results of a prospective multicenter study. J Dent 2017; 67:58-65. [DOI: 10.1016/j.jdent.2017.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 09/16/2017] [Accepted: 09/18/2017] [Indexed: 11/18/2022] Open
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18
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Rohr N, Märtin S, Fischer J. Correlations between fracture load of zirconia implant supported single crowns and mechanical properties of restorative material and cement. Dent Mater J 2017; 37:222-228. [PMID: 29176305 DOI: 10.4012/dmj.2017-111] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Zirconia implants that were restored with veneered zirconia displayed severe chipping rates of the restorations in clinical studies. Purpose of this study was to evaluate the fracture load of different zirconia implant supported monolithic crown materials (zirconia, alumina, lithium disilicate, feldspar ceramic and polymer-infiltrated ceramic) cemented with various cements (Harvard LuteCem SE, Harvard Implant Semi-permanent, Multilink Automix, VITA Adiva F-Cem). Flexural strength and fracture toughness of crown materials and compressive strength of the cements were measured. Fracture load values of crowns fabricated from lithium disilicate, feldspar ceramic and polymer-infiltrated ceramic were increased when cement with high compressive strength was used. Fracture loads for zirconia and alumina crowns were not influenced by the cement. Flexural strength and fracture toughness of the ceramics correlated linearly with the respective fracture load when using adhesive cement with high compressive strength. To achieve sufficient fracture load values, cementation with adhesive cement is essential for feldspar and polymer-infiltrated ceramic.
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Affiliation(s)
- Nadja Rohr
- Division of Dental Materials and Engineering, Department of Reconstructive Dentistry and Temporomandibular Disorders, University Center for Dental Medicine, University of Basel
| | | | - Jens Fischer
- Division of Dental Materials and Engineering, Department of Reconstructive Dentistry and Temporomandibular Disorders, University Center for Dental Medicine, University of Basel
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Spies BC, Pieralli S, Vach K, Kohal RJ. CAD/CAM-fabricated ceramic implant-supported single crowns made from lithium disilicate: Final results of a 5-year prospective cohort study. Clin Implant Dent Relat Res 2017; 19:876-883. [DOI: 10.1111/cid.12508] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 04/05/2017] [Accepted: 05/17/2017] [Indexed: 11/27/2022]
Affiliation(s)
- Benedikt Christopher Spies
- Department of Prosthetic Dentistry; Center for Dental Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; Germany
| | - Stefano Pieralli
- Department of Prosthetic Dentistry; Center for Dental Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; Germany
| | - Kirstin Vach
- Medical Center-University of Freiburg; Center for Medical Biometry and Medical Informatics, Institute for Medical Biometry and Statistics; Freiburg Germany
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry; Center for Dental Medicine, Medical Center-University of Freiburg, Faculty of Medicine, University of Freiburg; Germany
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20
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Influence of cement type and ceramic primer on retention of polymer-infiltrated ceramic crowns to a one-piece zirconia implant. J Prosthet Dent 2017; 119:138-145. [PMID: 28461047 DOI: 10.1016/j.prosdent.2017.02.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/06/2017] [Accepted: 02/06/2017] [Indexed: 11/24/2022]
Abstract
STATEMENT OF PROBLEM The best procedure for cementing a restoration to zirconia implants has not yet been established. PURPOSE The purpose of this in vitro study was to measure the retention of polymer-infiltrated ceramic crowns to zirconia 1-piece implants using a wide range of cements. The effect of ceramic primer treatment on the retention force was also recorded. The retention results were correlated with the shear bond strength of the cement to zirconia and the indirect tensile strength of the cements to better understand the retention mechanism. MATERIAL AND METHODS The retention test was performed using 100 polymer-infiltrated ceramic crowns (Vita Enamic) and zirconia implants (ceramic.implant CI) The crowns were cemented with either interim cement (Harvard Implant semipermanent, Temp Bond), glass-ionomer cement (Ketac Cem), self-adhesive cement (Perma Cem 2.0, RelyX Unicem Automix 2, Panavia SA), or adhesive cement (Multilink Implant, Multilink Automix, Vita Adiva F-Cem, RelyX Ultimate, Panavia F 2.0, Panavia V5 or Panavia 21) (n=5). Additionally ceramic primer was applied on the intaglio crown surface and implant abutment before cementation for all adhesive cements (Multilink Implant, Multilink Automix: Monobond plus; RelyX Ultimate Scotchbond Universal; Vita Adiva F-Cem: Vita Adiva Zr-Prime; Panavia F2.0, Panavia V5: Clearfil Ceramic Primer) and 1 self-adhesive cement containing 10-methacryloyloxydecyl dihydrogen phosphate (MDP) (Panavia SA: Clearfil Ceramic Primer). Crown debond fracture patterns were recorded. Shear bond strength was determined for the respective cement groups to polished zirconia (n=6). The diametral tensile strength of the cements was measured (n=10). Statistical analysis was performed using 1-way or 2-way analysis of variance followed by the Fisher LSD test (α=.05) within each test parameter. RESULTS Adhesive and self-adhesive resin cements had shear bond strength values of 0.0 to 5.3 MPa and revealed similar retention forces. Cements containing MDP demonstrated shear bond strength values above 5.3 MPa and displayed increased retention. The highest retention values were recorded for Panavia F 2.0 (318 ±28 N) and Panavia 21 (605 ±82 N). All other adhesive and self-adhesive resin cements attained retention values between 222 ±16 N (Multilink Automix) and 270 ±26 N (Panavia SA), which were significantly higher (P<.05) than glass-ionomer (Ketac Cem: 196 ±34 N) or interim cement (Harvard Implant semipermanent: 43 ±6 N, Temp Bond: 127 ±13 N). Application of manufacturer-specific ceramic primer increased crown retention significantly only for Panavia SA. CONCLUSIONS Products containing MDP provided a high chemical bond to zirconia. Self-adhesive and adhesive resin cements with low chemical bonding capabilities to zirconia provided retention force values within a small range (220 to 290 N).
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