Comparison of fracture resistance and fit accuracy of customized zirconia abutments with prefabricated zirconia abutments in internal hexagonal implants

Comparing the Fracture Resistance and Modes of Failure in Different Types of CAD/CAM Zirconia Abutments with Internal Hexagonal Implants: An In Vitro Study

Three groups of zirconia abutments (n = 5) consisting of different connection designs or manufacturers were investigated (All-Zr, ASC-Zr, and AM-Zr groups). All-electric dynamic test instruments were used to place static loading on a specimen with a crosshead speed set at 1 mm/min. A Kruskal-Wallis test and a post hoc Mann-Whitney U test were used for statistical evaluation. The mean fracture resistance was 252.37 ± 82.79 N for the All-Zr group, 384.62 ± 45.24 N for ASC-Zr group, and 361.83 ± 90.31 N for the AM-Zr group. The difference of fracture resistance between the three groups was marginally significant (Kruskal-Wallis test, p = 0.054), with the ASC zirconia abutment tending to have higher fracture resistance than the full zirconia abutment. The modes of failure among the three types of abutments are different. The All-Zr group showed an oblique fracture line starting from the buccal aspect at the region of the implant platform. While the ASC-Zr and AM-Zr groups showed a relatively horizontal fracture line with a greater distance from the implant platform. The titanium inserts cannot significantly improve the fracture resistance of the zirconia abutment. However, they may alter the modes of failure, allowing buccal fracture surfaces of the zirconia abutments to be placed away from the implant platform, thereby protecting the implant-abutment connection.

Endosseous Dental Implant Materials and Clinical Outcomes of Different Alloys: A Systematic Review

In recent years, implantology has made significant progress, as it has now become a safe and predictable practice. The development of new geometries, primary and secondary, of new surfaces and alloys, has made this possible. The purpose of this review is to analyze the different alloys present on the market, such as that in zirconia, and evaluate their clinical differences with those most commonly used, such as those in grade IV titanium. The review, conducted on major scientific databases such as Scopus, PubMed, Web of Science and MDPI yielded a startling number of 305 results. After the application of the filters and the evaluation of the results in the review, only 10 Randomized Clinical Trials (RCTs) were included. Multiple outcomes were considered, such as Marginal Bone Level (MBL), Bleeding on Probing (BoP), Survival Rate, Success Rate and parameters related to aesthetic and prosthetic factors. There are currently no statistically significant differences between the use of zirconia implants and titanium implants, neither for fixed prosthetic restorations nor for overdenture restorations. Only the cases reported complain about the rigidity and, therefore, the possibility of fracture of the zirconium. Certainly the continuous improvement in these materials will ensure that they could be used safely while maintaining their high aesthetic performance.

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

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

Fracture resistance of different implant supported ceramic abutment/crown systems

Purpose

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

Materials and methods

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

Results

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

Conclusion

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

A Comparative Study on the Mechanical Properties of a Polymer-Infiltrated Ceramic-Network Material Used for the Fabrication of Hybrid Abutment

Polymer-infiltrated ceramic-network (PICN) material is a new type of material used for the hybrid abutments of dental implants. This study aimed to compare flexural strength, bond strengths, and fracture-resistance values of PICN with lithium disilicate ceramic (LDS) and to evaluate the effect of thermocycling on the tested parameters. Twenty specimens were fabricated using computer-aided design and manufacturing (CAD-CAM) technology for each material according to three-point bending (n = 10), microshear bond strength (µSBS), and a fracture-resistance test (hybrid abutment, n = 10). All specimens of each test group were divided into two subgroups, thermocycled or nonthermocycled. Hybrid abutments were cemented on titanium insert bases and then fixed on implants to compare fracture resistance. Failure loads were recorded for each test and data were statistically analyzed. Thermocycling decreased bond strength to the resin luting agent and the fracture-resistance values of both materials (p < 0.001), whereas flexural-strength values were not affected. LDS ceramic showed significantly higher flexural strength, bond strength, and fracture-resistance values than PICN material (p < 0.001). Within the limitations of this study, LDS may be a preferable hybrid-abutment material to PICN in terms of mechanical and bonding properties.

Comparison of fit accuracy and torque maintenance of zirconia and titanium abutments for internal tri-channel and external-hex implant connections

PURPOSE

This in vitro study aimed to evaluate the effect of implant connection design (external vs. internal) on the fit discrepancy and torque loss of zirconia and titanium abutments.

MATERIALS AND METHODS

Two regular platform dental implants, one with external connection (Brånemark, Nobel Biocare AB) and the other with internal connection (Noble Replace, Nobel Biocare AB), were selected. Seven titanium and seven customized zirconia abutments were used for each connection design. Measurements of geometry, marginal discrepancy, and rotational freedom were done using video measuring machine. To measure the torque loss, each abutment was torqued to 35 Ncm and then opened by means of a digital torque wrench. Data were analyzed with two-way ANOVA and t-test at α=0.05 of significance.

RESULTS

There were significant differences in the geometrical measurements and rotational freedom between abutments of two connection groups (P<.001). Also, the results showed significant differences between titanium abutments of internal and external connection implants in terms of rotational freedom (P<.001). Not only customized internal abutments but also customized external abutments did not have the exact geometry of prefabricated abutments (P<.001). However, neither connection type (P=.15) nor abutment material (P=.38) affected torque loss.

CONCLUSION

Abutments with internal connection showed less rotational freedom. However, better marginal fit was observed in externally connected abutments. Also, customized abutments with either connection could not duplicate the exact geometry of their corresponding prefabricated abutment. However, neither abutment connection nor material affected torque loss values.

Comparative Evaluation of Fracture Resistance and Mode of Failure of Zirconia and Titanium Abutments with Different Diameters

AIM

The purpose of the current study was to compare the fracture resistance and mode of failure of zirconia and titanium abutments with different diameters.

MATERIALS AND METHODS

Fourteen groups of abutments including prefabricated zirconia, copy-milled zirconia and titanium abutments of an implant system (XiVE, Dentsply) were prepared in different diameters. An increasing vertical load was applied to each specimen until failure occurred. Fracture resistance was measured in each group using the universal testing machine. Moreover, the failure modes were studied and categorized as abutment screw fracture, connection area fracture, abutment body fracture, abutment body distortion, screw distortion and connection area distortion. Groups were statistically compared using univariate and post-hoc tests. The level of statistical significance was set at 5%.

RESULTS

Fabrication method (p = 0.03) and diameter (p < 0.001) had significant effect on the fracture resistance of abutments. Fracture resistance of abutments with 5.5 mm diameter was higher than other diameters (p < 0.001). The observed modes of failure were dependent on the abutment material as well. All of the prefabricated titanium abutments fractured within the abutment screw. Abutment screw distortion, connection area fracture, and abutment body fracture were the common failure type in other groups.

CONCLUSION

Diameter had a significant effect on fracture resistance of implant abutments, as abutments with greater diameters were more resistant to static loads. Copy-milled abutments showed lower fracture resistance as compared to other experimental groups.

CLINICAL SIGNIFICANCE

Although zirconia abutments have received great popularity among clinicians and even patients selecting them for narrow implants should be with caution.

Influence of preparation depths on the fracture load of customized zirconia abutments with titanium insert

PURPOSE

This study evaluated the fracture load of customized zirconia abutments with titanium insert according to preparation depths, with or without 5-year artificial aging.

MATERIALS AND METHODS

Thirty-six identical lithium disilicate crowns (IPS e.max press) were fabricated to replace a maxillary right central incisor and cemented to the customized zirconia abutment with titanium insert on a 4.5×10 mm titanium fixture. Abutments were fabricated with 3 preparation depths (0.5 mm, 0.7 mm, and 0.9 mm). Half of the samples were then processed using thermocycling (temperature: 5-55℃, dwelling time: 120s) and chewing simulation (1,200,000 cycles, 49 N load). All specimens were classified into 6 groups depending on the preparation depth and artificial aging (non-artificial aging groups: N5, N7, N9; artificial aging groups: A5, A7, A9). Static load was applied at 135 degrees to the implant axis in a universal testing machine. Statistical analyses of the results were performed using 1-way ANOVA, 2-way ANOVA, independent t-test and multiple linear regression.

RESULTS

The fracture loads were 539.28 ± 63.11 N (N5), 406.56 ± 28.94 N (N7), 366.66 ± 30.19 N (N9), 392.61 ± 50.57 N (A5), 317.94 ± 30.05 N (A7), and 292.74 ± 37.15 N (A9). The fracture load of group N5 was significantly higher than those of group N7 and N9 (P<.017). Consequently, the fracture load of group A5 was also significantly higher than those of group A7 and A9 (P<.05). After artificial aging, the fracture load was significantly decreased in all groups with various preparation depths (P<.05).

CONCLUSION

The fracture load of a single anterior implant restored with lithium disilicate crown on zirconia abutment with titanium insert differed depending on the preparation depths. After 5-year artificial aging, the fracture loads of all preparation groups decreased significantly.

Evaluation of removal forces of implant-supported zirconia copings depending on abutment geometry, luting agent and cleaning method during re-cementation

PURPOSE

To evaluate the effects of different abutment geometries in combination with varying luting agents and the effectiveness of different cleaning methods (prior to re-cementation) regarding the retentiveness of zirconia copings on implants.

MATERIALS AND METHODS

Implants were embedded in resin blocks. Three groups of titanium abutments (pre-fabricated, height: 7.5 mm, taper: 5.7°; customized-long, height: 6.79 mm, taper: 4.8°; customized-short, height: 4.31 mm, taper: 4.8°) were used for luting of CAD/CAM-fabricated zirconia copings with a semi-permanent (Telio CS) and a provisional cement (TempBond NE). Retention forces were evaluated using a universal testing machine. Furthermore, the influence of cleaning methods (manually, manually in combination with ultrasonic bath or sandblasting) prior to re-cementation with a provisional cement (TempBond NE) was investigated with the pre-fabricated titanium abutments (height: 7.5 mm, taper: 5.7°) and SEM-analysis of inner surfaces of the copings was performed. Significant differences were determined via two-way ANOVA.

RESULTS

Significant interactions between abutment geometry and luting agent were observed. TempBond NE showed the highest level of retentiveness on customized-long abutments, but was negatively affected by other abutment geometries. In contrast, luting with Telio CS demonstrated consistent results irrespective of the varying abutment geometries. Manual cleaning in combination with an ultrasonic bath was the only cleaning method tested prior to re-cementation that revealed retentiveness levels not inferior to primary cementation.

CONCLUSION

No superiority for one of the two cements could be demonstrated because their influences on retentive strength are also depending on abutment geometry. Only manual cleaning in combination with an ultrasonic bath offers retentiveness levels after re-cementation comparable to those of primary luting.