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Mohseni P, Soufi A, Chrcanovic BR. Clinical outcomes of zirconia implants: a systematic review and meta-analysis. Clin Oral Investig 2023; 28:15. [PMID: 38135804 PMCID: PMC10746607 DOI: 10.1007/s00784-023-05401-8] [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: 10/18/2023] [Accepted: 12/04/2023] [Indexed: 12/24/2023]
Abstract
PURPOSE To assess the clinical outcomes of zirconia dental implants based on an updated systematic literature review. METHODS An electronic search was performed in three databases, last updated in June 2023, supplemented by hand searching. The eligibility criteria were clinical studies reporting patients rehabilitated with zirconia implants. The cumulative survival rate (CSR) of implants was calculated. A meta-analysis for marginal bone loss (MBL) under different follow-up times and a meta-regression assessing the relationship between mean MBL and follow-up were done. RESULTS Twenty-five studies were included (4017 implants, 2083 patients). Seven studies had follow-up longer than 60 months. 172 implants failed, after a mean of 12.0 ± 16.1 months (min-max 0.3-86.0), of which 47 early failures, and 26 due to implant fracture, the majority in narrow-diameter implants. The 10-year CSR was 95.1%. Implants with coronal part prepared by drills presented statistically significant lower survival than non-prepared implants (p < 0.001). Two-piece implants presented lower survival than one-piece implants (p = 0.017). Implants discontinued from the market presented lower survival than the commercially available ones (p < 0.001). The difference in survival was not significant between implants in maxilla and mandible (p = 0.637). The mean MBL fluctuated between 0.632 and 2.060 mm over long periods of observation (up until 132 months). There was an estimated MBL increase of 0.005 mm per additional month of follow-up. CONCLUSION Zirconia implants present high 10-year CSR and short-term low MBL. The review was registered in PROSPERO (CRD42022342055). CLINICAL RELEVANCE The clinical outcomes observed for zirconia dental implants are very promising, although these have not yet been extensively studied as titanium alloy implants.
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Affiliation(s)
| | - Ahmad Soufi
- Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Bruno Ramos Chrcanovic
- Department of Oral and Maxillofacial Surgery and Oral Medicine, Faculty of Odontology, Malmö University, Carl Gustafs Väg 34, 214 21, Malmö, Sweden.
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Khaohoen A, Sornsuwan T, Chaijareenont P, Poovarodom P, Rungsiyakull C, Rungsiyakull P. Biomaterials and Clinical Application of Dental Implants in Relation to Bone Density-A Narrative Review. J Clin Med 2023; 12:6924. [PMID: 37959389 PMCID: PMC10649288 DOI: 10.3390/jcm12216924] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 10/29/2023] [Accepted: 11/02/2023] [Indexed: 11/15/2023] Open
Abstract
Titanium has been the material of choice for dental implant fixtures due to its exceptional qualities, such as its excellent balance of rigidity and stiffness. Since zirconia is a soft-tissue-friendly material and caters to esthetic demands, it is an alternative to titanium for use in implants. Nevertheless, bone density plays a vital role in determining the material and design of implants. Compromised bone density leads to both early and late implant failures due to a lack of implant stability. Therefore, this narrative review aims to investigate the influence of implant material/design and surgical technique on bone density from both biomechanical and biological standpoints. Relevant articles were included for analysis. Dental implant materials can be fabricated from titanium, zirconia, and PEEK. In terms of mechanical and biological aspects, titanium is still the gold standard for dental implant materials. Additionally, the macro- and microgeometry of dental implants play a role in determining and planning the appropriate treatment because it can enhance the mechanical stress transmitted to the bone tissue. Under low-density conditions, a conical titanium implant design, longer length, large diameter, reverse buttress with self-tapping, small thread pitch, and deep thread depth are recommended. Implant material, implant design, surgical techniques, and bone density are pivotal factors affecting the success rates of dental implant placement in low-density bone. Further study is required to find the optimal implant material for a clinical setting's bone state.
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Affiliation(s)
- Angkoon Khaohoen
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| | - Tanapon Sornsuwan
- Department of Restorative Dentistry, Faculty of Dentistry, Naresuan University, Phitsanulok 65000, Thailand;
| | - Pisaisit Chaijareenont
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| | - Pongsakorn Poovarodom
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
| | - Chaiy Rungsiyakull
- Department of Mechanical Engineering, Faculty of Engineering, Chiang Mai University, Chiang Mai 50200, Thailand;
| | - Pimduen Rungsiyakull
- Department of Prosthodontics, Faculty of Dentistry, Chiang Mai University, Chiang Mai 50200, Thailand; (A.K.); (P.C.); (P.P.)
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Lévaro NR, Alves MF, Santos C, Sencadas V, Olhero S. Direct Ink Writing of ATZ composites based on inks prepared by colloidal or hydrogel route: linking inks rheology with mechanical properties. Colloids Surf A Physicochem Eng Asp 2023. [DOI: 10.1016/j.colsurfa.2023.131426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
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Ban S. Classification and Properties of Dental Zirconia as Implant Fixtures and Superstructures. MATERIALS 2021; 14:ma14174879. [PMID: 34500970 PMCID: PMC8432657 DOI: 10.3390/ma14174879] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 11/16/2022]
Abstract
Various types of zirconia are widely used for the fabrication of dental implant superstructures and fixtures. Zirconia-alumina composites, such as ATZ and NanoZR, are adequate for implant fixtures because they have excellent mechanical strength in spite of insufficient esthetic properties. On the other hand, yttria-stabilized zirconia has been used for implant superstructures because of sufficient esthetic properties. They are classified to 12 types with yttria content, monochromatic/polychromatic, uniform/hybrid composition, and monolayer/multilayer. Zirconia with a higher yttria content has higher translucency and lower mechanical strength. Fracture strength of superstructures strongly depends on the strength on the occlusal contact region. It suggests that adequate zirconia should be selected as the superstructure crown, depending on whether strength or esthetics is prioritized. Low temperature degradation of zirconia decreases with yttria content, but even 3Y zirconia has a sufficient durability in oral condition. Although zirconia is the hardest dental materials, zirconia restorative rarely subjects the antagonist teeth to occlusal wear when it is mirror polished. Furthermore, zirconia has less bacterial adhesion and better soft tissue adhesion when it is mirror polished. This indicates that zirconia has advantageous for implant superstructures. As implant fixtures, zirconia is required for surface modification to obtain osseointegration to bone. Various surface treatments, such as roughening, surface activation, and coating, has been developed and improved. It is concluded that an adequately selected zirconia is a suitable material as implant superstructures and fixtures because of mechanically, esthetically, and biologically excellent properties.
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Affiliation(s)
- Seiji Ban
- Department of Dental Materials Science, School of Dentistry, Aichi Gakuin University, Nagoya 464-8650, Japan
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Additively Manufactured Zirconia for Dental Applications. MATERIALS 2021; 14:ma14133694. [PMID: 34279264 PMCID: PMC8269801 DOI: 10.3390/ma14133694] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 06/27/2021] [Accepted: 06/28/2021] [Indexed: 11/17/2022]
Abstract
We aimed to assess the crystallography, microstructure and flexural strength of zirconia-based ceramics made by stereolithography (SLA). Two additively manufactured 3 mol% yttria-stabilized tetragonal zirconia polycrystals (3Y-TZP: LithaCon 3Y 230, Lithoz; 3D Mix zirconia, 3DCeram Sinto) and one alumina-toughened zirconia (ATZ: 3D Mix ATZ, 3DCeram Sinto) were compared to subtractively manufactured 3Y-TZP (control: LAVA Plus, 3M Oral Care). Crystallographic analysis was conducted by X-ray diffraction. Top surfaces and cross-sections of the subsurface microstructure were characterized using scanning electron microscopy (SEM). Biaxial flexural strength was statistically compared using Weibull analysis. The additively and subtractively manufactured zirconia grades revealed a similar phase composition. The residual porosity of the SLA 3Y-TZPs and ATZ was comparable to that of subtractively manufactured 3Y-TZP. Weibull analysis revealed that the additively manufactured LithaCon 3Y 230 (Lithoz) had a significantly lower biaxial flexural strength than 3D Mix ATZ (3D Ceram Sinto). The biaxial flexural strength of the subtractively manufactured LAVA Plus (3M Oral Care) was in between those of the additively manufactured 3Y-TZPs, with the additively manufactured ATZ significantly outperforming the subtractively manufactured 3Y-TZP. Additively manufactured 3Y-TZP showed comparable crystallography, microstructure and flexural strength as the subtractively manufactured zirconia, thus potentially being a good option for dental implants.
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Microstructure and Young’s modulus evolution during re-sintering of partially sintered alumina-zirconia composites (ATZ ceramics). Ann Ital Chir 2021. [DOI: 10.1016/j.jeurceramsoc.2021.01.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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A Prospective Clinical Cohort Investigation on Zirconia Implants: 5-Year Results. J Clin Med 2020; 9:jcm9082585. [PMID: 32785031 PMCID: PMC7464596 DOI: 10.3390/jcm9082585] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 07/21/2020] [Accepted: 08/06/2020] [Indexed: 12/17/2022] Open
Abstract
Mid-term data on zirconia oral implants is very rare. Therefore, the aim of this prospective clinical investigation was to evaluate the survival rate and the marginal bone loss of a one-piece zirconia implant after five years. Patient-reported outcomes were also recorded. Zirconia implants to support single crowns (SC) or a 3-unit fixed dental prosthesis (FDP) were placed and subsequently restored. After the insertion of the implants, at prosthetic delivery, and after five years, standardized radiographs were taken to evaluate marginal bone loss (MBL). For bone tissue evaluation, linear mixed models with random intercepts were fitted. Twenty-seven patients received one implant for an SC and 13 patients received two implants for a 3-unit FDP. Three patients each lost one implant for an SC before prosthetic delivery. Thirty-five patients were seen after five years, and no further implant was lost. The cumulative five-year implant survival rate was 94.3%. The MBL from implant installation up to five years was 0.81 mm. The MBL from implant installation to prosthetic delivery was statistically significant (p < 0.001). Patients perceived a significant improvement in function, esthetics, sense, speech, and self-esteem from pretreatment up to the five-year follow-up. The present findings substantiate the clinical applicability of this implant system.
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Bethke A, Pieralli S, Kohal RJ, Burkhardt F, von Stein-Lausnitz M, Vach K, Spies BC. Fracture Resistance of Zirconia Oral Implants In Vitro: A Systematic Review and Meta-Analysis. MATERIALS (BASEL, SWITZERLAND) 2020; 13:E562. [PMID: 31991565 PMCID: PMC7040771 DOI: 10.3390/ma13030562] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 01/15/2020] [Accepted: 01/21/2020] [Indexed: 12/27/2022]
Abstract
Various protocols are available to preclinically assess the fracture resistance of zirconia oral implants. The objective of the present review was to determine the impact of different treatments (dynamic loading, hydrothermal aging) and implant features (e.g., material, design or manufacturing) on the fracture resistance of zirconia implants. An electronic screening of two databases (MEDLINE/Pubmed, Embase) was performed. Investigations including > 5 screw-shaped implants providing information to calculate the bending moment at the time point of static loading to fracture were considered. Data was extracted and meta-analyses were conducted using multilevel mixed-effects generalized linear models (GLMs). The Šidák method was used to correct for multiple testing. The initial search resulted in 1864 articles, and finally 19 investigations loading 731 zirconia implants to fracture were analyzed. In general, fracture resistance was affected by the implant design (1-piece > 2-piece, p = 0.004), material (alumina-toughened zirconia/ATZ > yttria-stabilized tetragonal zirconia polycrystal/Y-TZP, p = 0.002) and abutment preparation (untouched > modified/grinded, p < 0.001). In case of 2-piece implants, the amount of dynamic loading cycles prior to static loading (p < 0.001) or anatomical crown supply (p < 0.001) negatively affected the outcome. No impact was found for hydrothermal aging. Heterogeneous findings of the present review highlight the importance of thoroughly and individually evaluating the fracture resistance of every zirconia implant system prior to market release.
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Affiliation(s)
- Annalena Bethke
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.B.); (S.P.); (F.B.); (M.v.S.-L.)
| | - Stefano Pieralli
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.B.); (S.P.); (F.B.); (M.v.S.-L.)
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany;
| | - Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany;
| | - Felix Burkhardt
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.B.); (S.P.); (F.B.); (M.v.S.-L.)
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany;
| | - Manja von Stein-Lausnitz
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.B.); (S.P.); (F.B.); (M.v.S.-L.)
| | - Kirstin Vach
- Institute of Medical Biometry and Statistics, Faculty of Medicine, Medical Center—University of Freiburg, University of Freiburg, Stefan-Meier-Str. 26, 79104 Freiburg, Germany;
| | - Benedikt Christopher Spies
- Department of Prosthodontics, Geriatric Dentistry and Craniomandibular Disorders, Charité—Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Aßmannshauser Str. 4-6, 14197 Berlin, Germany; (A.B.); (S.P.); (F.B.); (M.v.S.-L.)
- Department of Prosthetic Dentistry, Faculty of Medicine, Center for Dental Medicine, Medical Center—University of Freiburg, Hugstetter Str. 55, 79106 Freiburg, Germany;
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Zhao W, He B, Zhou A, Li Y, Chen X, Yang Q, Chen B, Qiao B, Jiang D. D-RADA16-RGD-Reinforced Nano-Hydroxyapatite/Polyamide 66 Ternary Biomaterial for Bone Formation. Tissue Eng Regen Med 2019; 16:177-189. [PMID: 30989044 DOI: 10.1007/s13770-018-0171-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 11/11/2018] [Accepted: 11/23/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Nano-hydroxyapatite/polyamide 66 (nHA/PA66) is a composite used widely in the repair of bone defects. However, this material is insufficient bioactivity. In contrast, D-RADA16-RGD self-assembling peptide (D-RADA16-RGD sequence containing all D-amino acids is Ac-RADARADARADARADARGDS-CONH2) shows admirable bioactivity for both cell culture and bone regeneration. Here, we describe the fabrication of a favorable biomaterial material (nHA/PA66/D-RADA16-RGD). METHODS Proteinase K and circular dichroism spectroscopy were employed to test the stability and secondary structural properties of peptide D-RADA16-RGD respectively. Scanning electron microscopy (SEM) and transmission electron microscopy (TEM) were used to characterize the surface of these materials. Confocal laser scanning (CLS), cell counting kit-8 tests (CCK-8), alizarin red S staining, cell immunofluorescence analysis and Western blotting were involved in vitro. Also biosafety and bioactivity of them have been evaluated in vivo. RESULTS Proteinase K and circular dichroism spectroscopy demonstrated that D-RADA16-RGD in nHA/PA66 was able to form stable-sheet secondary structure. SEM and TEM showed that the D-RADA16-RGD material was 7-33 nm in width and 130-600 nm in length, and the interwoven pore size ranged from 40 to 200 nm. CLS suggests that cells in nHA/PA66/D-RADA16-RGD group were linked to adjacent cells with more actin filaments. CCK-8 analysis showed that nHA/PA66/D-RADA16-RGD revealed good biocompatibility. The results of Alizarin-red S staining and Western blotting as well as vivo osteogenesis suggest nHA/PA66/D-RADA16-RGD exhibits better bioactivity. CONCLUSION This study demonstrates that our nHA/PA66/D-RADA16-RGD composite exhibits reasonable mechanical properties, biocompatibility and bioactivity with promotion of bone formation.
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Affiliation(s)
- WeiKang Zhao
- 1The First Affiliated Hospital of Chongqing Medical University, No 1 Medicine Road, Yuzhong District, Chongqing, 400016 People's Republic of China.,2The Third Affiliated Hospital of Chongqing Medical University, No 1 Shuanghu Road, Yubei District, Chongqing, 401120 People's Republic of China
| | - Bin He
- 1The First Affiliated Hospital of Chongqing Medical University, No 1 Medicine Road, Yuzhong District, Chongqing, 400016 People's Republic of China
| | - Ao Zhou
- 2The Third Affiliated Hospital of Chongqing Medical University, No 1 Shuanghu Road, Yubei District, Chongqing, 401120 People's Republic of China
| | - Yuling Li
- Affiliated Hospital of Northern, Sichuan Medical University, Cultural Road 63, Nanchong City, 637000 Sichuan Province People's Republic of China
| | - Xiaojun Chen
- 2The Third Affiliated Hospital of Chongqing Medical University, No 1 Shuanghu Road, Yubei District, Chongqing, 401120 People's Republic of China
| | - Qiming Yang
- 2The Third Affiliated Hospital of Chongqing Medical University, No 1 Shuanghu Road, Yubei District, Chongqing, 401120 People's Republic of China
| | - Beike Chen
- 1The First Affiliated Hospital of Chongqing Medical University, No 1 Medicine Road, Yuzhong District, Chongqing, 400016 People's Republic of China.,2The Third Affiliated Hospital of Chongqing Medical University, No 1 Shuanghu Road, Yubei District, Chongqing, 401120 People's Republic of China
| | - Bo Qiao
- 1The First Affiliated Hospital of Chongqing Medical University, No 1 Medicine Road, Yuzhong District, Chongqing, 400016 People's Republic of China
| | - Dianming Jiang
- 1The First Affiliated Hospital of Chongqing Medical University, No 1 Medicine Road, Yuzhong District, Chongqing, 400016 People's Republic of China.,2The Third Affiliated Hospital of Chongqing Medical University, No 1 Shuanghu Road, Yubei District, Chongqing, 401120 People's Republic of China
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Current status of zirconia implants in dentistry: preclinical tests. J Prosthodont Res 2018; 63:1-14. [PMID: 30205949 DOI: 10.1016/j.jpor.2018.07.006] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 07/18/2018] [Accepted: 07/26/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE This systematic review aimed to provide an overview of zirconia implants as well as regarding the outcome of the implant-restorative complex in preclinical studies. STUDY SELECTION An electronic search of the literature prior to July 2017 was performed to identify all articles related to preclinical research on zirconia implants. The search was conducted using MEDLINE (National Library of Medicine) and PubMed without restrictions concerning the date of publication. The search terminology included: zirconia implant, osseointegration, bone-to-implant contact, soft tissue, histology, histomorphometry, surface modification, surface roughness, surface characteristics, and restoration (connecting multiple keywords with AND, OR). RESULTS Fifty-seven studies were finally selected from an initial yield of 654 titles, and the data were extracted. The identified preclinical studies focused on several aspects related to zirconia implants, namely biocompatibility, mechanical properties, implant design, osseointegration capacity, soft tissue response, and restorative options. Due to heterogeneity of the studies, a meta-analysis was not possible. The most frequently used zirconia material for the fabrication of implants is yttria-stabilized tetragonal zirconia polycrystal. The resistance-to-fracture for zirconia implants ranged between 516-2044N. The mostly investigated parameter was osseointegration, which is compared to that of titanium. A lack of evidence was found with other parameters. CONCLUSIONS Due to its good biocompatibility as well as favorable physical and mechanical properties, zirconia implants are a potential alternative to titanium implants. However, knowledge regarding the implant-restorative complex and related aspects is still immature to recommend its application for daily practice.
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Hein AT, Cho YD, Jo YH, Kim DJ, Han JS. Analysis of osteogenic potential on 3mol% yttria-stabilized tetragonal zirconia polycrystals and two different niobium oxide containing zirconia ceramics. J Adv Prosthodont 2018; 10:147-154. [PMID: 29713436 PMCID: PMC5917107 DOI: 10.4047/jap.2018.10.2.147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/13/2017] [Accepted: 10/30/2017] [Indexed: 12/11/2022] Open
Abstract
PURPOSE This study was performed to evaluate the osteogenic potential of 3mol% yttria-stabilized tetragonal zirconia polycrystals (3Y-TZP) and niobium oxide containing Y-TZPs with specific ratios, new (Y,Nb)-TZPs, namely YN4533 and YN4533/Al20 discs. MATERIALS AND METHODS 3Y-TZP, YN4533 and YN4533/Al20 discs (15 mm diameter and 1 mm thickness) were prepared and their average surface roughness (Ra) and surface topography were analyzed using 3-D confocal laser microscope (CLSM) and scanning electron microscope (SEM). Mouse pre-osteoblast MC3T3-E1 cells were seeded onto all zirconia discs and evaluated with regard to cell attachment and morphology by (CLSM), cell proliferation by PicoGreen assay, and cell differentiation by Reverse-Transcription PCR and Quantitative Real-Time PCR, and alkaline phosphatase (Alp) staining. RESULTS The cellular morphology of MC3T3-E1 pre-osteoblasts was more stretched on a smooth surface than on a rough surface, regardless of the material. Cellular proliferation was higher on smooth surfaces, but there were no significant differences between 3Y-TZP, YN4533, and YN4533/Al20. Osteoblast differentiation patterns on YN4533 and YN4533/Al20 were similar to or slightly higher than seen in 3Y-TZP. Although there were no significant differences in bone marker gene expression (alkaline phosphatase and osteocalcin), Alp staining indicated better osteoblast differentiation on YN4533 and YN4533/Al20 compared to 3Y-TZP. CONCLUSION Based on these results, niobium oxide containing Y-TZPs have comparable osteogenic potential to 3Y-TZP and are expected to be suitable alternative ceramics dental implant materials to titanium for aesthetically important areas.
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Affiliation(s)
- Aung Thu Hein
- Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Young-Dan Cho
- Department of Periodontology, School of Dentistry and Dental Research Institute, BK21 Program, Seoul National University, Seoul, Republic of Korea
| | - Ye-Hyeon Jo
- Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea
| | - Dae-Joon Kim
- Department of Advanced Materials Engineering, Sejong University, Seoul, Republic of Korea
| | - Jung-Suk Han
- Department of Prosthodontics, School of Dentistry, Seoul National University, Seoul, Republic of Korea
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Evans ZP, Renne WG, Bacro TR, Mennito AS, Ludlow ME, Lecholop MK. Anatomic Customization of Root-Analog Dental Implants With Cone-Beam CT and CAD/CAM Fabrication: A Cadaver-Based Pilot Evaluation. J ORAL IMPLANTOL 2018; 44:15-26. [DOI: 10.1563/aaid-joi-d-17-00090] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Existing root-analog dental implant systems have no standardized protocols regarding retentive design, surface manipulation, or prosthetic attachment design relative to the site's unique anatomy. Historically, existing systems made those design choices arbitrarily. For this report, strategies were developed that deliberately reference the adjacent anatomy, implant and restorable path of draw, and bone density for implant and retentive design. For proof of concept, dentate arches from human cadavers were scanned using cone-beam computed tomography and then digitally modeled. Teeth of interest were virtually extracted and manipulated via computer-aided design to generate root-analog implants from zirconium. We created a stepwise protocol for analyzing and developing the implant sites, implant design and retention, and prosthetic emergence and connection all from the pre-op cone-beam data. Root-analog implants were placed at the time of extraction and examined radiographically and mechanically concerning ideal fit and stability. This study provides proof of concept that retentive root-analog implants can be produced from cone-beam data while improving fit, retention, safety, esthetics, and restorability when compared to the existing protocols. These advancements may provide the critical steps necessary for clinical relevance and success of immediately placed root-analog implants. Additional studies are necessary to validate the model prior to clinical trial.
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Affiliation(s)
- Zachary P. Evans
- Department of Periodontics, Division of Stomatology, College of Dental Medicine, Medical University of South Carolina, Charleston, SC
| | - Walter G. Renne
- Department of Oral Rehabilitation, College of Dental Medicine, Medical University of South Carolina, Charleston, SC
| | - Thierry R. Bacro
- Center for Anatomical Studies and Education, Department of Regenerative Medicine and Cell Biology, Medical University of South Carolina, Charleston, SC
| | - Anthony S. Mennito
- Department of Oral Rehabilitation, College of Dental Medicine, Medical University of South Carolina, Charleston, SC
| | - Mark E. Ludlow
- Department of Oral Rehabilitation, College of Dental Medicine, Medical University of South Carolina, Charleston, SC
| | - Michael K. Lecholop
- Department of Oral and Maxillofacial Surgery, College of Dental Medicine, Medical University of South Carolina, Charleston, SC
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Sivaraman K, Chopra A, Narayan AI, Balakrishnan D. Is zirconia a viable alternative to titanium for oral implant? A critical review. J Prosthodont Res 2017; 62:121-133. [PMID: 28827030 DOI: 10.1016/j.jpor.2017.07.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 06/22/2017] [Accepted: 07/11/2017] [Indexed: 02/04/2023]
Abstract
PURPOSE Titanium based implant systems, though considered as the gold standard for rehabilitation of edentulous spaces, have been criticized for many inherent flaws. The onset of hypersensitivity reactions, biocompatibility issues, and an unaesthetic gray hue have raised demands for more aesthetic and tissue compatible material for implant fabrication. Zirconia is emerging as a promising alternative to conventional Titanium based implant systems for oral rehabilitation with superior biological, aesthetics, mechanical and optical properties. This review aims to critically analyze and review the credibility of Zirconia implants as an alternative to Titanium for prosthetic rehabilitation. STUDY SELECTION The literature search for articles written in the English language in PubMed and Cochrane Library database from 1990 till December 2016. The following search terms were utilized for data search: "zirconia implants" NOT "abutment", "zirconia implants" AND "titanium implants" AND "osseointegration", "zirconia implants" AND compatibility. RESULTS The number of potential relevant articles selected were 47. All the human in vivo clinical, in vitro, animals' studies were included and discussed under the following subheadings: Chemical composition, structure and phases; Physical and mechanical properties; Aesthetic and optical properties; Osseointegration and biocompatibility; Surface modifications; Peri-implant tissue compatibility, inflammation and soft tissue healing, and long-term prognosis. CONCLUSIONS Zirconia implants are a promising alternative to titanium with a superior soft-tissue response, biocompatibility, and aesthetics with comparable osseointegration. However, further long-term longitudinal and comparative clinical trials are required to validate zirconia as a viable alternative to the titanium implant.
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Affiliation(s)
- Karthik Sivaraman
- Department of Prosthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, 576104, India.
| | - Aditi Chopra
- Department of Periodontology, Manipal College of Dental Sciences, Manipal University, Manipal, India
| | - Aparna I Narayan
- Department of Prosthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, 576104, India
| | - Dhanasekar Balakrishnan
- Department of Prosthodontics, Manipal College of Dental Sciences, Manipal University, Manipal, 576104, India
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Surface-Engineered Blood Adsorption Device for Hyperphosphatemia Treatment. ASAIO J 2017; 64:389-394. [PMID: 28799951 DOI: 10.1097/mat.0000000000000639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Correspondence: Melanie S. Joy, PharmD, PhD, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences, Department of Pharmaceutical Sciences, Mail Stop C238, Room V20-4108, 12850 East Montview Blvd, Aurora, CO 80045. Email: Melanie.Joy@ucdenver.edu The research employed surface engineering methods to develop, optimize, and characterize a novel textile-based hemoadsorption device for hyperphosphatemia in hemodialysis-dependent end-stage kidney disease. Phosphate adsorbent fabrics (PAFs) were prepared by thermopressing alumina powders to polyester filtration fabrics and treatment with trimesic acid (TMA). For static experiments, phosphate adsorption capacity in buffer solution, plasma, and blood were evaluated by submersing the PAFs in 100 ml. For dynamic experiments, PAFs were equipped in a device prototype and incorporated in a pump-driven circuit. Phosphates were determined by a colorimetric assay and an Ortho Clinical Diagnostics Vitros 5600 Integrated analyzer. The maximum loading amount of TMA-alumina on PAFs was approximately 35 g/m under 260°C processing temperature. Phosphate adsorption capacity increased with initial concentration. Adsorption isotherms from buffer demonstrated a maximum phosphate adsorption capacity of approximately 893 mg/m at 37.5°C, pH 7.4, with similar results from plasma and whole blood. Measured phosphate concentrations during simulations demonstrated a 42% reduction, confirming the high capacity of the PAFs for removing phosphate from whole blood. Results from the current study indicated that an alumina-TMA treated PAF can dramatically reduce phosphate concentrations from biological samples. The technology could potentially be used as a tunable adsorbent for managing hyperphosphatemia in kidney disease.
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Cionca N, Hashim D, Mombelli A. Zirconia dental implants: where are we now, and where are we heading? Periodontol 2000 2016; 73:241-258. [DOI: 10.1111/prd.12180] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Kammermeier A, Rosentritt M, Behr M, Schneider-Feyrer S, Preis V. In vitro performance of one- and two-piece zirconia implant systems for anterior application. J Dent 2016; 53:94-101. [PMID: 27528418 DOI: 10.1016/j.jdent.2016.08.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 08/09/2016] [Accepted: 08/11/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To investigate the long-term in vitro performance and fracture resistance of one-piece and bonded two-piece zirconia implant systems for anterior application. METHODS Two groups of bonded two-piece zirconia (ZZB), four groups of one-piece zirconia (Z), and two groups of two-piece titanium (TTS, reference) implant systems were restored with identical monolithic zirconia crowns (n=10/group). Eight specimens per group were mounted at an angle of 135° in the chewing simulator and subjected to thermal cycling (TC:18,000 cycles; 5°/55°) and mechanical loading (ML:3.6×10(6) cycles; 100N) simulating an anterior situation. Fracture resistance and maximum bending stress were determined for specimens that survived aging and for two references per group after 24h water storage. SEM pictures were used for failure analysis. Data were statistically analysed (one-way-ANOVA, post-hoc Bonferroni, Kaplan-Meier-Log-Rank, α=0.05). RESULTS A one-piece zirconia and a two-piece titanium implant system survived TCML without failures. Both bonded two-piece zirconia implant systems and a one-piece zirconia implant system totally failed (fractures of abutment or implant). Failure numbers of the other systems varied between 1× (1 group) and 5× (2 groups). Significantly different survival rates were found (Log-Rank-test: p=0.000). Maximum fracture forces/bending stresses varied significantly ( ANOVA p=0.000) between 188.00±44.80N/381.02±80.15N/mm(2) and 508.67±107.00N/751.45±36.73N/mm(2). Mean fracture values after 24h water storage and TCML were not significantly different. CONCLUSION Zirconia implant systems partly showed material defects or connection insufficiencies. Bonded two-piece systems had higher failure rates and lower fracture resistance than one-piece implants. CLINICAL SIGNIFICANCE Individual zirconia implant systems may be applied in anterior regions with limitations.
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Affiliation(s)
- Armin Kammermeier
- Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg 93042, Germany
| | - Martin Rosentritt
- Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg 93042, Germany
| | - Michael Behr
- Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg 93042, Germany
| | - Sibylle Schneider-Feyrer
- Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg 93042, Germany
| | - Verena Preis
- Department of Prosthetic Dentistry, Regensburg University Medical Center, Regensburg 93042, Germany.
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Preis V, Kammermeier A, Handel G, Rosentritt M. In vitro performance of two-piece zirconia implant systems for anterior application. Dent Mater 2016; 32:765-74. [PMID: 27068740 DOI: 10.1016/j.dental.2016.03.028] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2015] [Revised: 02/03/2016] [Accepted: 03/22/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To investigate the influence of the implant-abutment connection on the long-term in vitro performance and fracture resistance of two-piece zirconia implant systems for anterior application. METHODS Six groups of two-piece zirconia implant systems (n=10/group) with screw-retained (5×) or bonded (1×) connections were restored with full-contour zirconia crowns. A two-piece screw-retained titanium system served as reference. For simulating anterior loading the specimens (n=8/group) were mounted at an angle of 135° in the chewing simulator, and subjected to thermal cycling (TC: 2×9000×5°/55°C) and mechanical loading (ML: 3.6×10(6)×100N). Failed restorations were examined (scanning electron microscopy). Fracture resistance and maximum bending stress of surviving restorations were determined. 2 specimens per group were loaded to fracture after 24h water storage without TCML. Data were statistically analyzed (ANOVA; Bonferroni; Kaplan-Meier-Log-Rank; α=0.05). RESULTS The bonded zirconia system and the titanium reference survived TCML without any failures. Screw-retained zirconia systems showed fractures of abutments and/or implants, partly combined with screw fracture/loosening. Failure frequency (F) varied between the groups (F=8×: 3 groups, F=3×: 1 group, F=1×: 1 group). The Log-Rank-test showed significant (p=0.000) differences. Fracture forces and maximum bending stresses (mean±standard deviation) differed significantly ( ANOVA p=0.000) between 233.4±31.4N/317.1±42.6N/mm(2) and 404.3±15.1N/549.2±20.5N/mm(2). Fracture forces after TCML were similar to 24h fracture forces. SIGNIFICANCE Screw-retained two-piece zirconia implant systems showed higher failure rates and lower fracture resistance than a screw-retained titanium system, and may be appropriate for clinical anterior requirements with limitations. Failures involved the abutment/implant region around the screw, indicating that the connecting design is crucial for clinical success.
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Affiliation(s)
- Verena Preis
- Department of Prosthetic Dentistry, Regensburg University Medical Center, 93042 Regensburg, Germany.
| | - Armin Kammermeier
- Department of Prosthetic Dentistry, Regensburg University Medical Center, 93042 Regensburg, Germany
| | - Gerhard Handel
- Department of Prosthetic Dentistry, Regensburg University Medical Center, 93042 Regensburg, Germany
| | - Martin Rosentritt
- Department of Prosthetic Dentistry, Regensburg University Medical Center, 93042 Regensburg, Germany
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Spies BC, Nold J, Vach K, Kohal RJ. Two-piece zirconia oral implants withstand masticatory loads: An investigation in the artificial mouth. J Mech Behav Biomed Mater 2016; 53:1-10. [DOI: 10.1016/j.jmbbm.2015.07.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 07/09/2015] [Accepted: 07/15/2015] [Indexed: 02/04/2023]
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Li Y, Li H, Zhang J, Zhao W, Shen J, Jiang D. In vitro evaluation of an yttria-stabilized zirconia reinforced nano-hydroxyapatite/polyamide 66 ternary biomaterial: biomechanics, biocompatibility and bioactivity. RSC Adv 2016. [DOI: 10.1039/c6ra24509a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The characterization of a novel ternary biomaterial composed of nano-hydroxyapatite/polyamide 66/yttria-stabilized tetragonal zirconia.
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Affiliation(s)
- Yuling Li
- Department of Orthopedics
- The First Affiliated Hospital of Chongqing Medical University
- Chongqing
- People's Republic of China
| | - Hong Li
- Research Center for Nano-Biomaterials
- Analytical and Testing Center
- Sichuan University
- Chengdu
- People's Republic of China
| | - Jing Zhang
- Department of Gastroenterology
- The Affiliated Hospital of North Sichuan Medical College
- Nanchong
- People's Republic of China
| | - Weikang Zhao
- Department of Orthopedics
- The First Affiliated Hospital of Chongqing Medical University
- Chongqing
- People's Republic of China
| | - Jieliang Shen
- Department of Orthopedics
- The First Affiliated Hospital of Chongqing Medical University
- Chongqing
- People's Republic of China
| | - Dianming Jiang
- Department of Orthopedics
- The First Affiliated Hospital of Chongqing Medical University
- Chongqing
- People's Republic of China
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Kohal RJ, Kilian JB, Stampf S, Spies BC. All-Ceramic Single Crown Restauration of Zirconia Oral Implants and Its Influence on Fracture Resistance: An Investigation in the Artificial Mouth. MATERIALS 2015; 8:1577-1589. [PMID: 28788018 PMCID: PMC5507023 DOI: 10.3390/ma8041577] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 03/20/2015] [Accepted: 03/27/2015] [Indexed: 11/30/2022]
Abstract
The aim of the current investigation was to evaluate the fracture resistance of one-piece zirconia oral implants with and without all-ceramic incisor crowns after long-term thermomechanical cycling. A total of 48 implants were evaluated. The groups with crowns (C, 24 samples) and without crowns (N, 24 samples) were subdivided according to the loading protocol, resulting in three groups of 8 samples each: Group “0” was not exposed to cyclic loading, whereas groups “5” and “10” were loaded with 5 and 10 million chewing cycles, respectively. This resulted in 6 different groups: C0/N0, C5/N5 and C10/N10. Subsequently, all 48 implants were statically loaded to fracture and bending moments were calculated. All implants survived the artificial aging. For the static loading the following average bending moments were calculated: C0: 326 Ncm; C5: 339 Ncm; C10: 369 Ncm; N0: 339 Ncm; N5: 398 Ncm and N10: 355 Ncm. To a certain extent, thermomechanical cycling resulted in an increase of fracture resistance which did not prove to be statistically significant. Regarding its fracture resistance, the evaluated ceramic implant system made of Y-TZP seems to be able to resist physiological chewing forces long-term. Restauration with all-ceramic single crowns showed no negative influence on fracture resistance.
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Affiliation(s)
- Ralf-Joachim Kohal
- Department of Prosthetic Dentistry, Center for Dental Medicine, University Hospital Freiburg, Albert-Ludwigs-University, Freiburg 79106, Germany.
| | | | - Susanne Stampf
- Department for Medical Biometry and Medical Informatics, Institute for Medical Biometry and Statistics, Albert-Ludwigs-University, Freiburg 79104, Germany.
| | - Benedikt Christopher Spies
- Department of Prosthetic Dentistry, Center for Dental Medicine, University Hospital Freiburg, Albert-Ludwigs-University, Freiburg 79106, Germany.
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Spies BC, Sauter C, Wolkewitz M, Kohal RJ. Alumina reinforced zirconia implants: Effects of cyclic loading and abutment modification on fracture resistance. Dent Mater 2015; 31:262-72. [DOI: 10.1016/j.dental.2014.12.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/12/2014] [Accepted: 12/16/2014] [Indexed: 11/28/2022]
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Spies BC, Sperlich M, Fleiner J, Stampf S, Kohal RJ. Alumina reinforced zirconia implants: 1-year results from a prospective cohort investigation. Clin Oral Implants Res 2015; 27:481-90. [DOI: 10.1111/clr.12560] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Benedikt Christopher Spies
- Center for Dental Medicine; Department of Prosthetic Dentistry; Albert-Ludwigs-University; Freiburg Germany
| | | | | | - Susanne Stampf
- Institute for Medical Biometry and Statistics; Department for Medical Biometry and Medical Informatics; Albert-Ludwigs-University; Freiburg Germany
| | - Ralf-Joachim Kohal
- Center for Dental Medicine; Department of Prosthetic Dentistry; Albert-Ludwigs-University; Freiburg Germany
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Abstract
Since Brånemark discovered the favorable effects of titanium in bone healing in 1965, titanium has emerged as the gold standard bulk material for present-time dental implantology. In the course of years researchers aimed for improvement of the implants performance in bone even at compromised implant sites and multiple factors were investigated influencing osseointegration. This review summarizes and clarifies the four factors that are currently recognized being relevant to influence the tissue-implant contact ratio: bulk materials and coatings, topography, surface energy, and biofunctionalization. The macrodesigns of bulk materials (e.g., titanium, zirconium, stainless steel, tantalum, and magnesium) provide the mechanical stability and their influence on bone cells can be additionally improved by surface treatment with various materials (calcium phosphates, strontium, bioglasses, diamond-like carbon, and diamond). Surface topography can be modified via different techniques to increase the bone-implant contact, for example, plasma-spraying, grit-blasting, acid-etching, and microarc oxidation. Surface energy (e.g., wettability and polarity) showed a strong effect on cell behavior and cell adhesion. Functionalization with bioactive molecules (via physisorption, covalent binding, or carrier systems) targets enhanced osseointegration. Despite the satisfying clinical results of presently used dental implant materials, further research on innovative implant surfaces is inevitable to pursuit perfection in soft and hard tissue performance.
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Trends in computer-aided manufacturing in prosthodontics: a review of the available streams. Int J Dent 2014; 2014:783948. [PMID: 24817888 PMCID: PMC4000974 DOI: 10.1155/2014/783948] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 03/10/2014] [Indexed: 11/18/2022] Open
Abstract
In prosthodontics, conventional methods of fabrication of oral and facial prostheses have been considered the gold standard for many years. The development of computer-aided manufacturing and the medical application of this industrial technology have provided an alternative way of fabricating oral and facial prostheses. This narrative review aims to evaluate the different streams of computer-aided manufacturing in prosthodontics. To date, there are two streams: the subtractive and the additive approaches. The differences reside in the processing protocols, materials used, and their respective accuracy. In general, there is a tendency for the subtractive method to provide more homogeneous objects with acceptable accuracy that may be more suitable for the production of intraoral prostheses where high occlusal forces are anticipated. Additive manufacturing methods have the ability to produce large workpieces with significant surface variation and competitive accuracy. Such advantages make them ideal for the fabrication of facial prostheses.
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Rosentritt M, Hagemann A, Hahnel S, Behr M, Preis V. In vitro performance of zirconia and titanium implant/abutment systems for anterior application. J Dent 2014; 42:1019-26. [PMID: 24699071 DOI: 10.1016/j.jdent.2014.03.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 03/05/2014] [Accepted: 03/23/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To investigate the type of failure and fracture resistance behaviour of different zirconia and titanium implant/abutment systems for anterior application. METHODS Eight groups of implant-abutment combinations (n=8/system) were restored with identical full-contour zirconia crowns. The systems represented one-piece and multi-piece zirconia (Z) or titanium (T) implants/abutments with different types of connection (screwed=S, bonded=B). The following combinations (implant-abutment-connection) were investigated: ZZS, ZZB, ZZZB (three-piece), ZTS, TTS, TTS reference, and Z (one-piece, 2×). To simulate clinical anterior loading situations the specimens were mounted into the chewing simulator at an angle of 135° and subjected to thermal cycling (2×3000×5°/55°C) and mechanical loading (1.2×10(6)×50N; 1.6Hz). Fracture resistance and maximum bending stress were determined for all specimens that survived ageing. Data were statistically analyzed with the Kolmogorov-Smirnov-test and one-way ANOVA (α=0.05). Survival performance was calculated with the Kaplan-Meier Log-Rank test. RESULTS Independent of the material combinations screwed systems showed partly failures of the screws during simulation (ZZS: 3×, ZTS: 8×, TTS: 3×). Screw failures were combined with implant/abutment fractures of zirconia systems. Zirconia one-piece implants and the reference system did not show any failures, and only one specimen of the systems with a bonded connection (ZZZB) fractured. Mean (±standard deviation) fracture forces and maximum bending stresses differed significantly (p=0.000) between 187.4±42.0N/250.0±56.0N/mm(2) (ZZZB) and 524.3±43.1N/753.0±61.0N/mm(2) (Z). CONCLUSIONS Both material (zirconia or titanium) and the type of connection influenced failure resistance during fatigue testing, fracture force, and maximum bending stress. CLINICAL SIGNIFICANCE Different material combinations for implants and abutments as well as different types of connection achieved acceptable or even good failure and fracture resistance that may be satisfactory for anterior clinical application.
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Affiliation(s)
- Martin Rosentritt
- Department of Prosthetic Dentistry, University Medical Center Regensburg, 93042 Regensburg, Germany
| | - Anna Hagemann
- Department of Prosthetic Dentistry, University Medical Center Regensburg, 93042 Regensburg, Germany
| | - Sebastian Hahnel
- Department of Prosthetic Dentistry, University Medical Center Regensburg, 93042 Regensburg, Germany
| | - Michael Behr
- Department of Prosthetic Dentistry, University Medical Center Regensburg, 93042 Regensburg, Germany
| | - Verena Preis
- Department of Prosthetic Dentistry, University Medical Center Regensburg, 93042 Regensburg, Germany.
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26
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Osteoblast and bone tissue response to surface modified zirconia and titanium implant materials. Dent Mater 2013; 29:763-76. [DOI: 10.1016/j.dental.2013.04.003] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2012] [Revised: 02/24/2013] [Accepted: 04/11/2013] [Indexed: 12/31/2022]
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Rationale for the use of CAD/CAM technology in implant prosthodontics. Int J Dent 2013; 2013:768121. [PMID: 23690778 PMCID: PMC3652193 DOI: 10.1155/2013/768121] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Accepted: 03/28/2013] [Indexed: 11/18/2022] Open
Abstract
Despite the predictable longevity of implant prosthesis, there is an ongoing interest to continue to improve implant prosthodontic treatment and outcomes. One of the developments is the application of computer-aided design and computer-aided manufacturing (CAD/CAM) to produce implant abutments and frameworks from metal or ceramic materials. The aim of this narrative review is to critically evaluate the rationale of CAD/CAM utilization for implant prosthodontics. To date, CAD/CAM allows simplified production of precise and durable implant components. The precision of fit has been proven in several laboratory experiments and has been attributed to the design of implants. Milling also facilitates component fabrication from durable and aesthetic materials. With further development, it is expected that the CAD/CAM protocol will be further simplified. Although compelling clinical evidence supporting the superiority of CAD/CAM implant restorations is still lacking, it is envisioned that CAD/CAM may become the main stream for implant component fabrication.
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Noro A, Kaneko M, Murata I, Yoshinari M. Influence of surface topography and surface physicochemistry on wettability of zirconia (tetragonal zirconia polycrystal). J Biomed Mater Res B Appl Biomater 2012; 101:355-63. [PMID: 23165774 DOI: 10.1002/jbm.b.32846] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2012] [Revised: 06/30/2012] [Accepted: 09/25/2012] [Indexed: 11/08/2022]
Abstract
Surface modification technologies are available for tetragonal zirconia polycrystal (TZP) to enhance its bioactivity and osseointegration capability. The surface wettability of an implant material is one of the important factors in the process of osseointegration, possibly regulating protein adsorption, and subsequent cell behavior. The aim of this study was to clarify the effect of topographical or physicochemical modification of TZP ceramics on wettability to determine the potential of such treatment in application to implants. Several types of surface topography were produced by alumina blasting and acid etching with hydrofluoric acid; surface physicochemistry was modified with oxygen (O(2)) plasma, ultraviolet (UV) light, or hydrogen peroxide treatment. The obtained specimens were also subjected to storage under various conditions to evaluate their potential to maintain superhydrophilicity. The results showed that surface modification of surface topography or physicochemistry, especially of blast/acid etching as well as O(2) plasma and UV treatment, greatly increased the surface wettability, resulting in superhydrophilicity. X-ray photoelectron spectroscopy revealed that a remarkable decrease in carbon content and the introduction of hydroxyl groups were responsible for the observed superhydrophilicity. Furthermore, superhydrophilicity was maintained, even after immersion in an aqueous solution, an important consideration in the clinical application of this technology.
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Affiliation(s)
- Akio Noro
- Division of Oral Implants Research, Oral Health Science Center, Tokyo Dental College, Mihama-ku, Chiba, Japan
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Ogihara N, Usui Y, Aoki K, Shimizu M, Narita N, Hara K, Nakamura K, Ishigaki N, Takanashi S, Okamoto M, Kato H, Haniu H, Ogiwara N, Nakayama N, Taruta S, Saito N. Biocompatibility and bone tissue compatibility of alumina ceramics reinforced with carbon nanotubes. Nanomedicine (Lond) 2012; 7:981-93. [DOI: 10.2217/nnm.12.1] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Aims: The addition of carbon nanotubes (CNTs) remarkably improves the mechanical characteristics of base materials. CNT/alumina ceramic composites are expected to be highly functional biomaterials useful in a variety of medical fields. Biocompatibility and bone tissue compatibility were studied for the application of CNT/alumina composites as biomaterials. Methods & results: Inflammation reactions in response to the composite were as mild as those of alumina ceramic alone in a subcutaneous implantation study. In bone implantation testing, the composite showed good bone tissue compatibility and connected directly to new bone. An in vitro cell attachment test was performed for osteoblasts, chondrocytes, fibroblasts and smooth muscle cells, and CNT/alumina composite showed cell attachment similar to that of alumina ceramic. Discussion & conclusion: Owing to proven good biocompatibility and bone tissue compatibility, the application of CNT/alumina composites as biomaterials that contact bone, such as prostheses in arthroplasty and devices for bone repair, are expected. Original submitted 23 March 2011; Revised submitted 16 November 2011; Published online 8 March 2012
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Affiliation(s)
- Nobuhide Ogihara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Yuki Usui
- Research Center for Exotic Nanocarbons, Asahi 3-1-1, Matsumoto, 390-8621, Japan and Institute of Carbon Science & Technology, Shinshu University, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Kaoru Aoki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Masayuki Shimizu
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Nobuyo Narita
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Kazuo Hara
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Koichi Nakamura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Norio Ishigaki
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Seiji Takanashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Masanori Okamoto
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Hiroyuki Kato
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Hisao Haniu
- Institute of Carbon Science & Technology, Shinshu University, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Naoko Ogiwara
- Department of Laboratory Medicine, Shinshu University Hospital, Asahi 3-1-1, Matsumoto, 390-8621, Japan
| | - Noboru Nakayama
- Faculty of Engineering, Shinshu University, Wakasato 4-17-1, Nagano, 380–8553, Japan
| | - Seiichi Taruta
- Faculty of Engineering, Shinshu University, Wakasato 4-17-1, Nagano, 380–8553, Japan
| | - Naoto Saito
- Department of Applied Physical Therapy, Shinshu University School of Health Sciences, Asahi 3-1-1, Matsumoto, 390-8621, Japan
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Kohal RJ, Knauf M, Larsson B, Sahlin H, Butz F. One-piece zirconia oral implants: one-year results from a prospective cohort study. 1. Single tooth replacement. J Clin Periodontol 2012; 39:590-7. [PMID: 22519944 DOI: 10.1111/j.1600-051x.2012.01876.x] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2012] [Indexed: 11/26/2022]
Abstract
AIM To investigate the clinical and radiographic outcome of a one-piece zirconia oral implant for single tooth replacement after 1 year. MATERIALS AND METHODS A total of 65 patients received a one-stage implant surgery with immediate temporization. Standardized radiographs were taken at implant insertion and after 1 year to monitor peri-implant bone loss. A univariate analysis of the influence of different baseline parameters on marginal bone loss from implant insertion to 12 months was performed. Soft tissue parameters were evaluated at prosthesis insertion and at the 1-year follow-up. RESULTS After 1 year, three implants were lost, giving a cumulative survival rate of 95.4%. The marginal bone loss after 1 year was 1.31 mm. Thirty-four per cent of the implants lost at least 2 mm bone, and 14% more than 3 mm. The univariate analysis could not depict any parameter influencing marginal bone loss. Probing depth, Clinical Attachment Level, Bleeding and Plaque Index decreased over 1 year. CONCLUSIONS The cumulative survival rate of the presented ceramic implant was comparable to the reported survival rate of titanium implants when immediately restored. However, the frequency of increased radiographic bone loss (>2 mm) after 1 year was considerably higher as compared to conventional two-piece titanium implants. The presented zirconia implant can therefore not be recommended for clinical usage.
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Affiliation(s)
- Ralf-Joachim Kohal
- Department of Prosthodontics, School of Dentistry, Albert-Ludwigs University, Freiburg, Germany.
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OGURI T, TAMAKI Y, HOTTA Y, MIYAZAKI T. Effects of a convenient silica-coating treatment on shear bond strengths of porcelain veneers on zirconia-based ceramics. Dent Mater J 2012; 31:788-96. [DOI: 10.4012/dmj.2012-037] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Att W, Yajima ND, Wolkewitz M, Witkowski S, Strub JR. Influence of preparation and wall thickness on the resistance to fracture of zirconia implant abutments. Clin Implant Dent Relat Res 2011; 14 Suppl 1:e196-203. [PMID: 22222141 DOI: 10.1111/j.1708-8208.2011.00428.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Studies about the effect of grinding procedures as well as material thickness on the resistance of zirconia implant abutments are in short supply. PURPOSE This study evaluated the effect of wall thickness as well as preparation on the resistance of zirconia implant abutments. MATERIALS AND METHOD Sixty-four implants received titanium (group Ti) and zirconia abutments (groups Zr-8, Zr-18, and Zr-1). The abutments of group Zr-8 had a 0.8-mm wall thickness, whereas the wall thickness of group Zr-18 was reduced by preparation from 1 mm to 0.8 mm. The abutments of group Zr-1 had a wall thickness of 1 mm. Standardized maxillary central incisor metal crowns were cemented on all abutments. All specimens were then tested in a universal testing machine for their resistance to fracture before and after masticatory simulation (n = 8). RESULTS The median resistance to fracture values (N) before and after aging were, respectively: group Ti: 500-504; group Zr-8: 487-491; group Zr-18: 490-451; and group Zr-1: 519-480. No significant effects of group, aging, or combinations were found (p > .05). CONCLUSION All tested abutments have the potential to withstand physiologic occlusal forces in the anterior region (> 200 N). The applicability of the results to other implant systems should be verified.
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Affiliation(s)
- Wael Att
- Department of Prosthodontics, Dental School, Albert-Ludwig University, Freiburg, Germany.
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Matsumoto TJ, An SH, Ishimoto T, Nakano T, Matsumoto T, Imazato S. Zirconia-hydroxyapatite composite material with micro porous structure. Dent Mater 2011; 27:e205-12. [PMID: 21816461 DOI: 10.1016/j.dental.2011.07.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 05/17/2011] [Accepted: 07/13/2011] [Indexed: 10/17/2022]
Abstract
OBJECTIVES Titanium plates and apatite blocks are commonly used for restoring large osseous defects in dental and orthopedic surgery. However, several cases of allergies against titanium have been recently reported. Also, sintered apatite block does not possess sufficient mechanical strength. In this study, we attempted to fabricate a composite material that has mechanical properties similar to biocortical bone and high bioaffinity by compounding hydroxyapatite (HAp) with the base material zirconia (ZrO(2)), which possesses high mechanical properties and low toxicity toward living organisms. METHODS After mixing the raw material powders at several different ZrO(2)/HAp mixing ratios, the material was compressed in a metal mold (8 mm in diameter) at 5 MPa. Subsequently, it was sintered for 5 h at 1500°C to obtain the ZrO(2)/HAp composite. The mechanical property and biocompatibility of materials were investigated. Furthermore, osteoconductivity of materials was investigated by animal studies. RESULTS A composite material with a minute porous structure was successfully created using ZrO(2)/HAp powders, having different particle sizes, as the starting material. The material also showed high protein adsorption and a favorable cellular affinity. When the mixing ratio was ZrO(2)/HAp=70/30, the strength was equal to cortical bone. Furthermore, in vivo experiments confirmed its high osteoconductivity. SIGNIFICANCE The composite material had strength similar to biocortical bones with high cell and tissue affinities by compounding ZrO(2) and HAp. The ZrO(2)/HAp composite material having micro porous structure would be a promising bone restorative material.
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Gahlert M, Burtscher D, Grunert I, Kniha H, Steinhauser E. Failure analysis of fractured dental zirconia implants. Clin Oral Implants Res 2011; 23:287-93. [DOI: 10.1111/j.1600-0501.2011.02206.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kohal RJ, Wolkewitz M, Tsakona A. The effects of cyclic loading and preparation on the fracture strength of zirconium-dioxide implants: an in vitro investigation. Clin Oral Implants Res 2011; 22:808-14. [PMID: 21320166 DOI: 10.1111/j.1600-0501.2010.02067.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Zirconia is a potential material for the fabrication of oral implants. The aim of this study was to evaluate the effects of cyclic loading and preparation on the fracture strength of a zirconia implant system. MATERIALS AND METHODS Forty-eight one-piece implants were divided into two groups of 24 implants: group A (without modification) and group B (1 mm chamfer preparation). Groups A and B were divided into three subgroups of eight implants each (1 = no artificial load, 2 = artificial load [98 N; 1.2 million loading cycles], and 3 = artificial load [98 N; 5 million loading cycles]). After completion of the loading, the fracture strength of each implant was determined in a universal testing machine. A two-way analysis of variance was used, the continuous response variable (fracture strength in Newtons) is modeled as a function of preparation, cycles, and the corresponding interaction as explanatory variables. RESULTS The mean fracture strength values obtained for the groups were: A1 (no preparation, no load) = 1928.73 N, A2 (no preparation, 1.2 million cycles) = 2044.84 N, A3 (no preparation, 5 million cycles) = 1364.50 N, B1 (preparation, no load) = 1221.66 N, B2 (preparation, 1.2 million cycles) = 967.11 N, and B3 (preparation, 5 million cycles) = 884.89 N. Fracture values were significantly different between subgroups A1 vs. A3 and B1 vs. B3. There was no significant difference between subgroups A1 vs. A2 and B1 vs. B2. CONCLUSIONS Preparation as well as cyclic loading can decrease the fracture strength resistance of zirconia implants. Nevertheless, even the lowest values of mean fracture strength of the implants used in our study seem to withstand average occlusal forces even after an extended interval of artificial loading.
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Affiliation(s)
- Ralf J Kohal
- Department of Prosthodontics, Dental School, University Clinics of Freiburg, Freiburg, Germany.
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