Influence of preparation and wall thickness on the resistance to fracture of zirconia implant abutments

Resistance to Fracture of Zirconia Abutments with Different Angulations: Impact of Implant Platform Diameter

Objective  The aim of this study was to assess the impact of implant platform diameters on ultimate force to failure of zirconia abutments with different angulation.

Materials and Methods  Forty-two zirconia abutments with either 0 degree (ST) or 15-degree (AN) angulation were assembled on tapered internal connection titanium implants (Direct's Legacy; 13 mm Implant Direct, LLC, Las Vegas, United States) with a platform diameter of Ø3.0, Ø3.5, and Ø4.5 mm (14 per group). Zirconia crowns (Ceramill Zolid; Amann Girrbach GmbH) were fabricated and cemented using self-adhesive resin cement (MaxCem Elite, Kerr). The specimens were thermomechanically loaded (TCML= 6,000 cycles of 5 to 50°C for 2 minutes/cycle followed by cyclic loading 600,000 cycles) followed by static loading until fracture. The data of load (N) at which fracture occurred were statistically analyzed by using Kruskal–Wallis analysis of variance and Mann–Whitney U tests at 5% significance level.

Results  Higher load to fracture was reported for zirconia crowns in straight abutments groups and a platform of 4.5, 3.5, and 3 mm diameter was 438.2± 85.4, 345.5± 71.3, and 331.1± 59.1 N, respectively. However, the groups restored with zirconia crowns in angulated abutments groups and a platform of 4.5, 3.5, or 3 mm diameter showed a fracture load of 411.4 ± 49.8, 354.2 ± 52.5, and 302.8 ± 52.5 N, respectively.

Conclusion  Straight and angulated zirconia abutments presented similar load to fracture on 3 and 3.5 mm platform diameters yet being significantly less for 4.5 mm diameter.

Fracture resistance and the mode of failure produced in metal-free crowns cemented onto zirconia abutments in dental implants

The purpose of the investigation was to analyze fracture resistance and mode of failure of zirconium oxide (zirconia) abutments placed on dental implants bearing crowns of different esthetic materials: zirconia, lithium disilicate (LDS), and nano-ceramic resin, for replacing single teeth in the anterior sector. Eighty implant-abutment-crown units were divided into four groups: Group T-MC (control): 20 metal-ceramic crowns cemented onto titanium abutments; Group Z-Z: 20 zirconia crowns on zirconia abutments; Group Z-LD: 20 lithium disilicate crowns on zirconia abutments; and Group Z-NCR: 20 nano-ceramic resin crowns on zirconia abutments. Specimens underwent a fatiguing process (dynamic loading and thermocycling), followed by static loading to evaluate mechanical fracture resistance, and the mode of failure produced. Mean fracture resistance values were: Control Group T-MC, 575.85±120.01 N; Group Z-Z 459.64±66.52 N; Group Z-LD, 531.77±34.10 N; and Group Z-NCR, 587.05±59.27 N. In Group T-MC, fracture occurred in the prosthetic fixing screw in 100% of specimens. In Group Z-Z, 80% of fractures occurred in the fixing screw, 15% in the abutment, and 5% in the abutment and crown. In Group Z-LD, 60% of fractures were produced in the fixing screw and 40% in the abutment. In Group Z-NCR, 70% of fractures were produced in the fixing screw and 30% in the abutment. All the abutments and crowns analyzed have the potential to withstand the physiological occlusal forces to which they would be subject in the anterior region. Lithium disilicate and nano-ceramic resin crowns cemented onto zirconia abutments are a good restoration alternative for single implants in the anterior sector.

Fracture of Zirconia Abutments in Implant Treatments: A Systematic Review

PURPOSE

The purpose of this systematic review was to identify and summarize clinical studies related to the fracture of zirconia abutments in implant treatments.

MATERIAL AND METHODS

Medline, Embase, and Cochrane library searches were performed and complemented by manual searches from database inception to February 11, 2018, for title and abstract analysis.

RESULTS

Initially, 645 articles were obtained through database searches. Fifty-three articles were selected for full-text analysis, and 15 studies met the inclusion criteria. The selected studies were analyzed regarding fracture rate, abutment-implant connection, time point of fracture, location of critical crack, causes, managements, and preventive measures with respect to zirconia abutment fracture.

CONCLUSIONS

Lower fracture rates were reported for internal connection with metal component (2-piece) zirconia abutments compared with external and internal full-zirconia connection (one-piece) zirconia abutments. Overpreparation and overload should be avoided in case of zirconia abutments.

Fatigue Failure Load of Lithium Disilicate Restorations Cemented on a Chairside Titanium-Base

PURPOSE

To evaluate the fatigue failure load of distinct lithium disilicate restoration designs cemented on a chairside titanium base for maxillary anterior implant-supported restorations.

MATERIALS AND METHODS

A left-maxillary incisor restoration was virtually designed and sorted into 3 groups: (n = 10/group; CTD: lithium disilicate crowns cemented on custom-milled titanium abutments; VMLD: monolithic full-contour lithium disilicate crowns cemented on a chairside titanium-base; VCLD: lithium disilicate crowns bonded to lithium disilicate customized anatomic structures and then cemented onto a chairside titanium base). The chairside titanium base was air-abraded with aluminum oxide particles. Subsequently, the titanium base was steam-cleaned and air-dried. Then a thin coat of a silane agent was applied. The intaglio surface of the ceramic components was treated with 5% hydrofluoric acid (HF) etching gel, followed by silanization, and bonded with a resin cement. The specimens were fatigued at 20 Hz, starting with a 100 N load (5000× load pulses), followed by stepwise loading from 400 N up to 1400 N (200 N increments) at a maximum of 30,000 cycles each. The failure loads, number of cycles, and fracture analysis were recorded. The data were statistically analyzed using one-way ANOVA, followed by pairwise comparisons (p < 0.05). Kaplan-Meier survival plots and Weibull survival analyses were reported.

RESULTS

For catastrophic fatigue failure load and the total number of cycles for failure, VMLD (1260 N, 175,231 cycles) was significantly higher than VCLD (1080 N, 139,965 cycles) and CDT (1000 N, 133,185 cycles). VMLD had a higher Weibull modulus demonstrating greater structural reliability.

CONCLUSION

VMLD had the best fatigue failure resistance when compared with the other two groups.

Fracture loads and failure modes of customized and non-customized zirconia abutments

OBJECTIVE

This study aimed to evaluate the fracture load and pattern of customized and non-customized zirconia abutments with Morse-taper connection.

METHODS

18 implants were divided into 3 groups according to the abutments used: Zr - with non-customized zirconia abutments; Zrc - with customized zirconia abutments; and Ti - with titanium abutments. To test their load capacity, a universal test machine with a 500-kgf load cell and a 0.5-mm/min speed were used. After, one implant-abutment assembly from each group was analyzed by Scanning Electron Microscopy (SEM). For fractographic analysis, the specimens were transversely sectioned above the threads of the abutment screw in order to examine their fracture surfaces using SEM.

RESULTS

A significant difference was noted between the groups (Zr=573.7±11.66N, Zrc=768.0±8.72N and Ti=659.1±7.70N). Also, the zirconia abutments fractured while the titanium abutments deformed plastically. Zrc presented fracture loads significantly higher than Zr (p=0.009). All the zirconia abutments fractured below the implant platform, starting from the area of contact between the abutment and implant and propagating to the internal surface of the abutment. All the zirconia abutments presented complete cleavage in the mechanical test. Fractography detected differences in the position and pattern of fracture between the two groups with zirconia abutments, probably because of the different diameters in the transmucosal region.

SIGNIFICANCE

Customization of zirconia abutments did not affect their fracture loads, which were comparable to that of titanium and much higher than the maximum physiological limit for the anterior region of the maxilla.

Fracture Resistance of Implant Abutments Following Abutment Alterations by Milling the Margins: An In Vitro Study

This in vitro study evaluated the effect of different levels of preparation of an implant abutment on its fracture resistance. The study evaluated abutments that incorporated a platform switch (Myriad Plus Abutments, Morse Taper Connection) and Standard abutments (BioHorizons Standard Abutment, BioHorizons Inc). Each abutment was connected to an appropriate implant and mounted in a self-cured resin base. Based on the abutment preparation depths, 3 groups were created for each abutment type: as manufactured, abutment prepared 1 mm apical to the original margin, and abutment prepared 1.5 mm to the original margin. All the abutments were prepared in a standardized manner to incorporate a 0.5 mm chamfer margin uniformly. All the abutments were torqued to 30 Ncm on their respective implants. They were then subjected to loading until failure in a universal testing machine. Abutments with no preparation showed the maximum resistance to fracture for both groups. As the preparation depth increased, the fracture resistance decreased. The fracture resistance of implant abutment junction decreases as the preparation depth increases.

Influence of the veneer-framework interface on the mechanical behavior of ceramic veneers: a nonlinear finite element analysis

STATEMENT OF PROBLEM

The chipping of ceramic veneers is a common problem for zirconia-based restorations and is due to the weak interface between both structures.

PURPOSE

The purpose of this study was to evaluate the mechanical behavior of ceramic veneers on zirconia and metal frameworks under 2 different bond-integrity conditions.

MATERIAL AND METHODS

The groups were created to simulate framework-veneer bond integrity with the crowns partially debonded (frictional coefficient, 0.3) or completely bonded as follows: crown with a silver-palladium framework cemented onto a natural tooth, ceramic crown with a zirconia framework cemented onto a natural tooth, crown with a silver-palladium framework cemented onto a Morse taper implant, and ceramic crown with a zirconia framework cemented onto a Morse taper implant. The test loads were 49 N applied to the palatal surface at 45 degrees to the long axis of the crown and 25.5 N applied perpendicular to the incisal edge of the crown. The maximum principal stress, shear stress, and deformation values were calculated for the ceramic veneer; and the von Mises stress was determined for the framework.

RESULTS

Veneers with partial debonding to the framework (frictional coefficient, 0.3) had greater stress concentrations in all structures compared with the completely bonded veneers. The metal ceramic crowns experienced lower stress values than ceramic crowns in models that simulate a perfect bond between the ceramic and the framework. Frameworks cemented to a tooth exhibited greater stress values than frameworks cemented to implants, regardless of the material used.

CONCLUSION

Incomplete bonding between the ceramic veneer and the prosthetic framework affects the mechanical performance of the ceramic veneer, which makes it susceptible to failure, independent of the framework material or complete crown support.

Trends in computer-aided manufacturing in prosthodontics: a review of the available streams

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.

Prosthodontic considerations in the implant-supported all-ceramic restoration of congenitally missing maxillary lateral incisor: a clinical report

The congenitally missing maxillary lateral incisor is the most common agenesis in the anterior region. There are several treatment options for this anomaly, which causes severe deficiencies: orthodontic space closure, tooth-supported restoration, or single-tooth implant. Each of these solutions has a high degree of success if used in the correct situation. An implant-supported restoration with an interdisciplinary approach provides a predictable outcome. This article describes the treatment of a patient with agenesis of the maxillary left lateral incisor. After orthodontic space management, it was decided to restore the tooth with an all-ceramic crown cemented on a zirconia custom abutment, which fractured after only 6 weeks of service. Fractographic analysis revealed that the failure was due to over-reduction of the buccal wall to correct the labial emergence of the implant. Zirconia abutments should be designed with even wall thicknesses of at least 0.8 mm to avoid areas that may compromise functional success.

Rationale for the use of CAD/CAM technology in implant prosthodontics

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.