Load-Bearing Capacity of Monolithic Zirconia Fixed Dental Prostheses Fabricated with Different Connector Designs and Embrasure Shaping Methods

Effect of placement strategies and connector designs in CAD/CAM technology on fracture resistance of multilayered monolithic zirconia fixed dental prostheses: An in vitro study

This study evaluated fracture resistance of monolithic fixed dental prostheses (FDPs) fabricated using different placement strategies of various connector designs in multilayered zirconia disc. Monolithic FDPs were placed in translucent and dentin layers of multilayered zirconia disc and fabricated with V-shaped and U-shaped connector designs gained by sharp and blunt millings. The FDPs were cemented on abutment models made of polymer material, underwent thermal cycles, and loaded to fracture using the universal testing machine. Fracture loads and modes were analyzed using two-way ANOVA, Tukey's post hoc test, and Fisher exact test (p≤0.05). The chosen placement strategy and connector designs gained by different milling procedures in computer-aided design/computer-aided manufacturing technology affect fracture resistance of monolithic FDPs made of multilayered zirconia materials. Placing the connector in translucent layer rather than dentin layer of multilayered zirconia disc and using sharp milling significantly reduces fracture resistance of monolithic multilayered zirconia FDPs.

Flexural Strength of Translucent Zirconia Materials Produced with Different Multilayer Technologies: An In Vitro Study

Objective

To evaluate the flexural strength of two translucent multilayered zirconia materials produced with different multilayer technologies. Methodology. Eighty bar-shaped zirconia specimens were prepared from two different multilayered zirconia materials (IPS e.max® ZirCAD Prime and KATANA™ Multilayered Zirconia HTML) and divided into eight groups (n = 10) based on the materials used and the individual layers of the disc for each material: Dentin Prime, Transition Prime, Translucent Prime, Multilayered Prime, Dentin HTML, Transition HTML, Translucent HTML, and Multilayered HTML. The bar-shaped zirconia specimens were cut to include all the layers from translucent to dentin In Multilayered Prime and Multilayered HTML groups. All specimens were fully sintered after cutting from multilayered zirconia discs and subjected to three-point flexural strength test using the universal testing machine.

Results

The specimens made of HTML zirconia material showed significantly (P < 0.001) higher flexural strength than those made of IPS e.max® ZirCAD Prime material, with no significant difference (P > 0.05) compared to the specimens in the Dentin Prime group. The Dentin Prime specimens had the highest flexural strength (743 ± 116 MPa) compared to those in the Translucent Prime (514 ± 120 MPa), Transition Prime (575 ± 102 MPa), and Multilayered Prime (531 ± 132 MPa) groups. The flexural strength of the specimens from the individual layers of HTML zirconia material was not significantly different (P > 0.05) among the Dentin HTML (763 ± 56 MPa), Translucent HTML (791 ± 106 MPa), Transition HTML (816 ± 85 MPa), and Multilayered HTML (793 ± 102 MPa) groups.

Conclusion

Multilayered zirconia materials produced with different yttria contents by layer have lower flexural strength than those produced with gradient shade technology and the same yttria content for each layer. Therefore, various factors such as the type of prostheses, nesting strategies of prostheses within the zirconia disc, and the desired aesthetical requirements should be considered when selecting the multilayered zirconia materials.

Performance of high-translucent zirconia CAD/CAM fixed dental prostheses using a digital workflow: A clinical study up to 6 years

Background/purpose

Zirconia has recently become a popular material for fixed restorations. The purpose of this study was to use a digital workflow to fabricate monolithic zirconia fixed dental prostheses (FDPs) and assess the connection between variable connector sizes compared to their clinical performance.

Materials and methods

Clinicians evaluated monolithic zirconia FDPs in 58 patients. After definitive impressions were made, stone casts were obtained. The stone casts were scanned to a standard triangle language (STL) file. A digital wax up was fabricated, and corresponding provisional restorations were milled. Final FDPs were fabricated from a high-translucent zirconia material. During digital fabrication, the connector area of each FDP was recorded while meticulous attention was paid to ensure that the connector cross-sectional area was ≥9 mm² for the 3-unit restorations (pontic to retainer) and ≥12 mm² for the 4-unit restorations (pontic to pontic). Biological an technical outcomes of the FDPs were performed at 1 week, 6 months and then annually for 6 consecutive years.

Results

A total of 23 men and 35 women received a total of 63 full-contour zirconia FDPs in the posterior regions and were observed for a time period ranging between 50 and 70 months. No decementation occurred and no caries were detected during the observation period, however signs of gingivitis were detected in 4 patients. The dimension of the connector areas was 12 mm² in the two broken 4-unit FDPs.

Conclusion

The results of this study suggest that the use of digital scanning and milling to fabricate monolithic zirconia FDPs of posterior regions may be an acceptable alternative restorative approach to traditional metal-ceramic restorations.

Fracture Resistance and Fracture Behaviour of Monolithic Multi-Layered Translucent Zirconia Fixed Dental Prostheses with Different Placing Strategies of Connector: An in vitro Study

Purpose

To evaluate the effect of different placing strategies performed in the connector area on fracture resistance and fracture behaviour of monolithic multi-layered translucent zirconia fixed dental prostheses (FDPs).

Materials and Methods

Thirty 3-unit monolithic FDPs were produced and divided into three groups (n = 10) based on the different strategies for placing the connector area of FDPs in multi-layered zirconia blank with varying contents of yttria ranging from 4 to 5 mol%. The groups were as follows: FDPs with connectors placed in dentin layer with 4 mol% yttria content, FDPs with connectors placed in gradient layer, and FDPs with connectors placed in translucent layer with 5 mol% yttria content. A final group (n = 10) of conventional monolithic zirconia with a monolayer of yttria content (4 mol%) has been used as a control group. The specimens were artificially aged using thermocycling and pre-loading procedures and subsequently loaded to fracture using a universal testing machine. Fracture loads and fracture behaviour were analyzed using one-way ANOVA and Fisher’s exact tests and statistically evaluated (p ≤ 0.05).

Results

There were no significant differences in fracture loads among the groups based on the placing strategies of the connector area of the FDPs in the multi-layered translucent zirconia blank (p > 0.05). There was no significant difference in fracture loads between monolithic multi-layered translucent zirconia and conventional monolithic translucent zirconia materials (p > 0.05). Fracture behaviour of FDPs with connector area placed in translucent layer differed significantly compared to FDPs with connector area placed in dentin layer and FDPs in control group (p = 0.004).

Conclusion

The placing strategies of the connector used in the computer aided design and manufacturing procedures do not considerably affect fracture resistance of monolithic FDPs made of multi-layered translucent zirconia. Monolithic FDPs made of multi-layered translucent zirconia show comparable strength to FDPs made of conventional translucent zirconia, but with different fracture behaviour.

Comparison of porcelain veneer fracture in implant-supported fixed full-arch prostheses with a framework of either titanium, cobalt-chromium, or zirconia: An in vitro study

Objectives

The aim of this study was to compare porcelain veneer strength on screw‐retained implant‐supported fixed full‐arch prostheses with a framework of either milled titanium (Ti), cobalt–chromium (CoCr), and yttria‐stabilized zirconia (Y‐TZP) in an in vitro loading model.

Materials and Methods

Fifteen screw‐retained maxillary implant‐supported full‐arch prostheses (FDP), five each of Ti, CoCr, and Y‐TZP frameworks with porcelain veneers were included. All FDPs were subjected to thermocycling before loading until fracture of the veneer. The load was applied at the distal fossa of the occlusal area of the pontic replacing 24. Fracture loads were analyzed, and the fracture quality was assessed. Statistical analysis on the fracture load was performed using Kruskal–Wallis test. The statistical significance was set at p < .05.

Results

There was no statistical significance found between the groups regarding fracture load. The highest and lowest load was seen within the CoCr FDP, varying between 340 and 1484 N. Different types of fracture appearances were seen. The Y‐TZP FDPs had a higher number of fractures locally in the loaded area while CoCr and Ti more often showed cracks in the anterior region, at a distance from the loaded area.

Conclusions

Within the limitations of this study, the conclusion was that framework material may affect the fracture behavior of maxillary full‐arch bridges; however, there were no differences in veneer fracture strength when frameworks of Ti, CoCr, or Y‐TZP were compared.

Clinical evaluation of monolithic zirconia multiunit posterior fixed dental prostheses

STATEMENT OF PROBLEM

Monolithic zirconia restorations have been evaluated with in vitro studies, but limited clinical evidence of their longevity and reliability is available.

PURPOSE

The purpose of this clinical study was to evaluate the clinical performance of posterior multiunit glazed monolithic zirconia fixed dental prostheses.

MATERIAL AND METHODS

A total of 20 participants received 33 monolithic posterior zirconia fixed dental prostheses (Zolid white; Amann Girrbach AG) with minimally invasive preparations. Bilaterally supported fixed dental prostheses with a connector area of at least 9 mm² were luted with resin-modified glass ionomer cement. The clinical evaluations were performed after 1 week, 6 months, and then annually after completion of the treatment. The biologic outcomes were evaluated by assessing the pocket depth, attachment level, plaque control, bleeding on probing, caries, and tooth vitality. Esthetics and the functional performance of the prostheses (color match, cavosurface marginal discoloration, anatomic form, marginal adaptation) were evaluated as per the rating scales of Cvar and Ryge. An analysis of survival was made by using the Kaplan-Meier method.

RESULTS

After 39.8 ±16.7 months of observation, the overall survival rate of the monolithic zirconia multiunit posterior prostheses was 93.9%. No caries were found on the abutment teeth, signs of gingivitis were noted in 1 participant after 24 months, and increased probing depths of the abutment teeth were detected in 5 prostheses (15.1%). No loss of retention was detected. Two prostheses had to be replaced: 1 because of a biologic complication and 1 because of a technical complication. The remaining 31 prostheses received Alfa scores for marginal adaptation, cavosurface marginal discoloration, and caries. Twenty-seven (87.1%) prostheses were rated as Alfa and 4 (12.9%) as Bravo for anatomic form. The color match was noted as Alfa in 15 (48.3%) prostheses, and 16 (51.6%) were rated as Bravo.

CONCLUSIONS

Monolithic zirconia restorations demonstrated a reliable treatment option after medium-term clinical use for the replacement of missing posterior teeth.

Retrospective Clinical Study of a Freely Removable Implant-Supported Fixed Dental Prosthesis by a Microlocking System

This retrospective clinical study was conducted to evaluate the clinical usefulness of a freely removable microlocking implant prosthesis (MLP) that was developed to overcome the problems with conventional implant prostheses. A total of 54 patients (male: 31, female: 23) and 100 implant prostheses were included. Patients were divided into three groups such as 6-12 months, 12-18 months, and 18-24 months according to the used period after implant prosthesis delivery, and the patients in each group were recalled for examinations of survival rate, marginal bone resorption, peri-implant soft tissue indices, and complications. The prosthetic complications were analysed by combining the recorded chart data during the periodic checks including the last call for this study. During a 2-year observation period, all the implants showed a 100% survival rate without clinical mobility and functional problems. There was no significant difference in marginal bone resorption, plaque index, and bleeding index over the observation period after implant prosthesis delivery. Probing depth of the 18-24 months group (1.5 ± 0.19 mm) was significantly lower than that of the 6-12 months group (p < 0.05). The main complication was abutment loosening (4%), followed by implant prosthesis fracture (2%) and food impaction (2%) which were recorded. Within the limits of the present study, the implant prostheses with MLP are considered to be an applicable and predictable treatment method.