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Huang B, Chen M, Wang J, Zhang X. Advances in zirconia-based dental materials: Properties, classification, applications, and future prospects. J Dent 2024; 147:105111. [PMID: 38866229 DOI: 10.1016/j.jdent.2024.105111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 06/14/2024] Open
Abstract
OBJECTIVES Zirconia (ZrO2) ceramics are widely used in dental restorations due to their superior mechanical properties, durability, and ever-improving translucency. This review aims to explore the properties, classification, applications, and recent advancements of zirconia-based dental materials, highlighting their potential to revolutionize dental restoration techniques. STUDY SELECTION, DATA AND SOURCES The most recent literature available in scientific databases (PubMed and Web of Science) reporting advances of zirconia-based materials within the dental field is thoroughly examined and summarized, covering the major keywords "dental zirconia, classification, aesthetic, LTD, applications, manufacturing, surface treatments". CONCLUSIONS An exhaustive overview of the properties, classifications, and applications of dental zirconia was presented, alongside an exploration of future prospects and potential advances. This review highlighted the importance of addressing challenges such as low-temperature degradation resistance and optimizing the balance between mechanical strength and translucency. Also, innovative approaches to improve the performances of zirconia as dental material was discussed. CLINICAL SIGNIFICANCE This review provides a better understanding of zirconia-based dental biomaterials for dentists, helping them to make better choice when choosing a specific material to fabricate the restorations or to place the implant. Moreover, new generations of zirconia are still expected to make progress on key issues such as the long-term applications in dental materials while maintaining both damage resistance and aesthetic appeal, defining the directions for future research.
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Affiliation(s)
- Bo Huang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Mengbing Chen
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China
| | - Jian Wang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
| | - Xin Zhang
- State Key Laboratory of Oral Diseases & National Center for Stomatology & National Clinical Research Center for Oral Diseases & Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu 610041, Sichuan, China.
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Zaninovich M, Petrucci C, Drago C. Classification system for maxillary fixed dental prostheses. J Prosthodont 2024. [PMID: 39023038 DOI: 10.1111/jopr.13905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2024] [Accepted: 06/06/2024] [Indexed: 07/20/2024] Open
Abstract
PURPOSE To present an addendum to existing fixed dental prostheses (FDPs) classification system for maxillary prostheses. The new classification identifies the relationships between FP-1 (fixed prostheses) designs and newly developed clinical interdental gingival contours. MATERIALS AND METHODS Clinical and laboratory descriptions of the various types of full-arch fixed prostheses are described with photographic illustrations. Benefits and limitations of the various prosthetic designs are explained. Surgical differences in the amount of alveolectomy are illustrated. One clinical case is demonstrated. RESULTS A new classification system for maxillary implant fixed complete dentures is presented. The new system will serve as an improved communication aid for clinicians, patients, and laboratory technicians. Treatment of patients with edentulous maxillae and/or terminal dentitions and implant fixed complete dentures include several options relative to design and materials. Restorative space can have a major impact on prosthesis design and longevity. Early on in dental implant therapy, prostheses were generally made with cast metal frameworks, denture bases and denture teeth. Prosthetic complications were widely reported. With increased clinical experience and improved materials, computer-aided design and computer-aided manufacturing (CAD-CAM) protocols were developed that allowed stronger prostheses to be constructed in reduced or small restorative volumes. FP-1 ceramic implant-supported fixed prostheses (CISFPs) are designed to replace only the dental hard tissues and to promote preservation and rehabilitation of gingival soft tissues. The physical properties and minimum thickness requirements in full arch prostheses are influenced by several factors including distances between implants and rigid connector sizes. CONCLUSION FP-1 CISFPs may be the closest prostheses the profession can offer edentulous patients that mimic the look, feel, and function of missing dentitions. Aesthetic outcomes of FP-1 CISFPs are variable and depend on a multitude of factors. This article presented a classification system that builds on existing classification by identifying the level of papilla heights achieved with FP-1 CISFPs.
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Affiliation(s)
- Michael Zaninovich
- Aria Dental Specialist Implant Centre, Perth, Western Australia, Australia
| | | | - Carl Drago
- Greenbrook Dental Group, Brookfield, Wisconsin, US
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Bömicke W, Boisserée P, Rammelsberg P, Rues S. Initial damage and failure load of zirconia-ceramic and metal-ceramic posterior cantilever fixed partial dentures. Clin Oral Investig 2024; 28:94. [PMID: 38221600 PMCID: PMC10788321 DOI: 10.1007/s00784-024-05501-z] [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: 10/16/2023] [Accepted: 01/07/2024] [Indexed: 01/16/2024]
Abstract
OBJECTIVES The aim of this study was to compare failure load and initial damage in monolithic, partially veneered, and completely veneered (translucent) zirconia cantilevered fixed partial dentures (CFPDs), as well as completely veneered metal-ceramic CFPDs under different support and loading configurations. MATERIALS AND METHODS Eight test groups with anatomically congruent CFPDs (n = 8/group) were fabricated, differing in CFPD material/support structure/loading direction (load applied via steel ball (Ø 6 mm) 3 mm from the distal end of the pontic for axial loading with a 2-point contact on the inner cusp ridges of the buccal and oral cusps and 1.3 mm below the oral cusp tip for 30° oblique loading): (1) monolithic zirconia/CoCr abutment teeth/axial, (2) monolithic zirconia/CoCr abutment teeth/oblique, (3) partially veneered zirconia/CoCr abutment teeth/axial, (4) partially veneered zirconia/CoCr abutment teeth/oblique, (5) completely veneered zirconia/CoCr abutment teeth/axial, (6) completely veneered CoCr/CoCr abutment teeth/axial (control group), (7) partially veneered zirconia/implants/axial, and (8) partially veneered zirconia/natural teeth/axial. Restorations were artificially aged before failure testing. Statistical analysis was conducted using one-way ANOVA and Tukey post hoc tests. RESULTS Mean failure loads ranged from 392 N (group 8) to 1181 N (group 1). Axially loaded monolithic zirconia CFPDs (group 1) and controls (group 6) showed significantly higher failure loads. Oblique loading significantly reduced failure loads for monolithic zirconia CFPDs (group 2). Initial damage was observed in all groups except monolithic zirconia groups, and fractography revealed design flaws (sharp edges at the occlusal boundary of the veneering window) in partially veneered zirconia CFPDs. CONCLUSIONS Monolithic zirconia CFPDs might be a viable alternative to completely veneered CoCr CFPDs in terms of fracture load. However, oblique loading of monolithic zirconia CFPDs should be avoided in clinical scenarios. Design improvements are required for partially veneered zirconia CFPDs to enhance their load-bearing capacity. CLINICAL RELEVANCE Monolithic zirconia may represent a viable all-ceramic alternative to the established metal-ceramic option for CFPD fabrication. However, in daily clinical practice, careful occlusal adjustment and regular monitoring should ensure that oblique loading of the cantilever is avoided.
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Affiliation(s)
- Wolfgang Bömicke
- Department of Prosthetic Dentistry, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany.
| | | | - Peter Rammelsberg
- Department of Prosthetic Dentistry, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Stefan Rues
- Department of Prosthetic Dentistry, University Hospital Heidelberg, University of Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
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Papaspyridakos P, Bedrossian EA, Ntovas P, Kudara Y, Bokhary A, Chochlidakis K. Reverse scan body: The scan pattern affects the fit of complete-arch prototype prostheses. J Prosthodont 2023; 32:186-191. [PMID: 37721306 DOI: 10.1111/jopr.13772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 08/23/2023] [Accepted: 09/11/2023] [Indexed: 09/19/2023] Open
Abstract
PURPOSE To assess the effect of different scan patterns on the fit of implant-supported complete-arch prototype prostheses fabricated via a complete digital extraoral protocol with a reverse scan body. MATERIALS AND METHODS A mandibular cast with four multi-unit abutment (MUA) implant analogs with adequate antero-posterior spread served as the reference cast, simulating a common clinical patient situation, and a polymethylmethacrylate interim screw-retained prosthesis was fabricated on it. Novel reverse scan bodies were connected to the interim prosthesis on the intaglio of the MUA abutments and extraoral scanning was performed with a white light intraoral scanner (TRIOS 4; 3 shape) and three different scan patterns: starting from the occlusal surface of the interim prosthesis (O-group), starting from the intaglio (I-group), and helix pattern (H-group). The resulting STL files from the three groups were then imported to computer-aided design (CAD) software and after the digital design, the STL files were exported to a computer-aided manufacturing (CAM) milling machine which generated a total of 15 CAD-CAM milled prototype prostheses per group. Two clinicians assessed the fit of each digitally fabricated prototype prosthesis on the reference cast, utilizing the screw-resistance test and radiographic evaluation. Fisher's exact test was used to test the difference between the three groups, and Cohen's k-score was used to assess the inter-examiner agreement. RESULTS Out of the three different groups, the O-group scan pattern led to 100% prosthesis fit, while the prototype prostheses generated from I- and H-groups had 80% and 53% fit, respectively. The results were statistically significant (p = 0.008). CONCLUSIONS Occlusal scan pattern leads to fitting milled prototype prostheses after extraoral scanning with reverse scan bodies without intraoral implant data acquisition.
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Affiliation(s)
- Panos Papaspyridakos
- Department of Prosthodontics, Tufts School of Dental Medicine, Boston, Massachusetts, USA
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
| | - E Armand Bedrossian
- Department of Prosthodontics, University of Washington, Seattle, Washington, USA
| | - Panagiotis Ntovas
- Department of Prosthodontics, Tufts School of Dental Medicine, Boston, Massachusetts, USA
| | - Yukio Kudara
- Department of Prosthodontics, Tufts School of Dental Medicine, Boston, Massachusetts, USA
| | - Abdullah Bokhary
- Department of Dental Public Health, King Abdulaziz University Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Konstantinos Chochlidakis
- Department of Prosthodontics, Eastman Institute for Oral Health, University of Rochester, Rochester, New York, USA
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Martakoush-Saleh S, Salgado-Peralvo AO, Peña-Cardelles JF, Kewalramani N, Gallucci GO. Evaluating the clinical behavior of veneered zirconia in comparison with monolithic zirconia complete arch implant-supported prostheses: A systematic review and meta-analysis. J Prosthet Dent 2023:S0022-3913(23)00497-3. [PMID: 37696747 DOI: 10.1016/j.prosdent.2023.07.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 09/13/2023]
Abstract
STATEMENT OF PROBLEM Because the use of zirconia in dentistry is relatively new, the number of published studies on the subject is scarce, even though material selection is an important factor in clinical performance. Therefore, a systematic assessment of the impact of the prosthetic material, framework design, veneering material, and manufacturing process is required. PURPOSE The purpose of this systematic review and meta-analysis was to investigate the survival and success rates of feldspathic porcelain veneered zirconia (VZir) in comparison with monolithic zirconia (MZir) complete arch implant-supported prostheses (CAISPs). A secondary objective was to assess the influence of the type of loading, the presence or absence of a cantilever, the type of zirconia used, the location, and the opposing arch on complications rates and patient satisfaction. MATERIAL AND METHODS An electronic search of the MEDLINE database (via PubMed), Scopus, Science Direct, Cochrane Library, and OpenGrey was carried out. The criteria described in the preferred reporting items for systematic reviews and meta-analyses statement were used. The search was restricted from January 2000 to January 2022. RESULTS The systematic search resulted in 20 articles that met the established criteria. In total, 751 patients (VZir=302; MZir=449) with 3038 CAISPs (VZir=368; MZir=2670) were analyzed. Higher prosthetic survival and success rates were found in MZir compared with VZir CAISPs (100% and 95.45%, respectively). The meta-analysis found significantly fewer complications related to MZir (9.4% [4.8%-14.1%]) compared with VZir (33.7% [17.5%-49.9%]). CONCLUSIONS Based on the findings of this systematic review, MZir CAISPs had higher survival and success rates than VZir CAISPs, with significantly fewer prosthetic complications. The influence of factors such as the type of functional loading, the presence of a cantilever, the material used in the prosthodontic workflow, the location of the CAISP, and the type of antagonist arch on the performance of Zir CAISPs remains unclear.
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Affiliation(s)
- Sara Martakoush-Saleh
- Postgraduate student, Department of Dental Clinical Specialties, Complutense University of Madrid, Spain
| | - Angel-Orión Salgado-Peralvo
- Professor, Department of Dental Clinical Specialties, Faculty of Odontology, Complutense University of Madrid, Spain.
| | - Juan-Francisco Peña-Cardelles
- Professor, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass
| | - Naresh Kewalramani
- Professor, Department of Nursery and Stomatology, Faculty of Dentistry, Rey Juan Carlos University, Madrid, Spain
| | - German O Gallucci
- Professor and Department Chair, Department of Restorative Dentistry and Biomaterials Sciences, Harvard School of Dental Medicine, Boston, Mass
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Silvestri F, Maille G, Mansuy C, Graillon N, Mense C. Prosthetic rehabilitation of a completely edentulous maxilla with a sectioned implant-supported screw-retained prosthesis in a multiamputee patient with microstomia: A clinical report. J Prosthet Dent 2023:S0022-3913(23)00411-0. [PMID: 37442751 DOI: 10.1016/j.prosdent.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 05/26/2023] [Accepted: 05/26/2023] [Indexed: 07/15/2023]
Abstract
Providing fixed implant-supported prostheses for edentulous patients with microstomia or limited mouth opening is challenging. The clinical treatment of a patient who was a multiple amputee with microstomia and a complete loss of lips elasticity is described. A custom half-sectioned prosthesis was fabricated to resolve numerous difficulties. A screw-retained complete implant-supported prosthesis was developed from a monolithic zirconia framework supported by 4 implants and with digital scanning and computer-aided design and computer-aided manufacturing of the prosthesis. The protocol achieved a complete screw-retained implant-supported prosthesis and offered a solution for a patient with microstomia and limited mouth opening, leading to improved quality of life.
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Affiliation(s)
- Frédéric Silvestri
- Assistant Professor, Department of Prosthesis and Implantology, School of Dental Medicine, ADES, CNRS, Aix-Marseille University, Marseille, France.
| | - Gérald Maille
- Assistant Professor, Department of Prosthesis and Implantology, School of Dental Medicine, ADES, CNRS, Aix-Marseille University, Marseille, France
| | - Charlotte Mansuy
- Assistant Professor, Department of Prosthesis and Implantology, School of Dental Medicine, ADES, CNRS, Aix-Marseille University, Marseille, France
| | - Nicolas Graillon
- Assistant Professor, School of Medicine, Aix-Marseille University, Marseille, France; and Assistant Professor, Department of Maxillofacial and Oral Surgery, Conception Hospital, Marseille, France
| | - Chloë Mense
- Assistant Professor, Department of Prosthesis and Implantology, School of Dental Medicine, ADES, CNRS, Aix-Marseille University, Marseille, France
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Thompson J, Schoenbaum TR, Pannu D, Knoernschild K. Survival analysis of zirconia implant-supported, fixed complete dentures: A 5-year retrospective cohort study. J Prosthet Dent 2023:S0022-3913(23)00288-3. [PMID: 37286415 DOI: 10.1016/j.prosdent.2023.04.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 06/09/2023]
Abstract
STATEMENT OF PROBLEM Existing data on the mid-term to long-term survival rates of zirconia implant-supported, fixed complete dentures (Zir-IFCDs) are lacking. PURPOSE The purpose of this retrospective clinical study was to assess the prosthetic survival rate in patients treated with Zir-IFCDs. MATERIAL AND METHODS The patient record system at the Dental College of Georgia (DCG), Augusta University was searched to identify all patients treated with Zir-IFCDs from 2015 through 2022 by the DCG graduate prosthodontic, general practice residency, and Advanced Education in General Dentistry (AEGD) programs. Reasons for replacement were grouped as failure of veneering porcelain, framework fracture, implant loss, patient-driven concerns, excessive occlusal wear, and other. RESULTS A total of 67 arches were found that met the inclusion criteria, 46 maxillary and 21 mandibular. The median follow-up time was 8.5 months (interquartile range, 2.7 to 30.9 months). A total of 9 of the 67 arches were identified as having failed (4 maxillary, 5 mandibular), requiring replacement. Reasons for failure were as follows: 3 framework fractures, 2 implant losses, 2 patient-related concerns, 1 fracture of veneering porcelain, and 1 unknown. The combined survival rate (Kaplan-Meier, log-normal modeling) for Zir-IFCDs was 88.8% at 1 year and 72.5% at 5 years CONCLUSIONS: Based on the findings, the Zir-IFCDs investigated had a survival rate lower than that reported in similar studies, though higher than published results for metal-acrylic resin-IFCDs. The most common source of failure was fracture of the zirconia framework. Thickness of the zirconia framework, interocclusal space, cantilever length, occlusal force, and status of the opposing dentition may have been associated with framework failures and should be investigated further.
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Affiliation(s)
- James Thompson
- Resident, Department of Restorative Sciences, Advanced Education in Prosthodontics, The Dental College of Georgia at Augusta University, Augusta, GA
| | - Todd R Schoenbaum
- Professor, Department of Restorative Sciences, The Dental College of Georgia at Augusta University, Augusta, GA.
| | - Darshanjit Pannu
- Program Director, Department of Prosthodontics, The Dental College of Georgia at Augusta University, Augusta, GA
| | - Kent Knoernschild
- Department Chair, Department of Restorative Sciences, The Dental College of Georgia at Augusta University, Augusta, GA
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Cinquini C, Alfonsi F, Marchio V, Gallo F, Zingari F, Bolzoni AR, Romeggio S, Barone A. The Use of Zirconia for Implant-Supported Fixed Complete Dental Prostheses: A Narrative Review. Dent J (Basel) 2023; 11:144. [PMID: 37366667 DOI: 10.3390/dj11060144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/24/2023] [Accepted: 05/26/2023] [Indexed: 06/28/2023] Open
Abstract
The success of implant-supported fixed complete dental prostheses (ISFCDPs) depends on multiple factors: some are related to the fixtures, such as fixture material, surface characteristics, positioning, and type of connection to prosthetic components; others are related to the prostheses, such as design and materials used. Zirconia is a material widely used in fixed prosthodontics, whether on natural teeth or on implants, with excellent results over time. Regarding the use of zirconia for ISFCDPs, the 2018 ITI Consensus Report stated that "implant-supported monolithic zirconia prostheses may be a future option with more supporting evidence". Since CAD/CAM technology and zirconia are being continuously innovated to achieve better results and performances over time, a narrative review of the literature seems necessary to focus research efforts towards effective and durable solutions for implant-supported, full-arch rehabilitations. The objective of the present narrative review was to search the literature for studies regarding the clinical performance of zirconia-based ISFCDPs. According to the results of this review, the use of zirconia for ISFCDPs showed good clinical outcomes, with high survival rates ranging from 88% to 100% and prosthetic complications that were restorable by the clinicians in most cases.
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Affiliation(s)
- Chiara Cinquini
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Fortunato Alfonsi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Vincenzo Marchio
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Francesco Gallo
- Department of Maxillofacial Surgery, Istituto Stomatologico Italiano, 20122 Milan, Italy
| | - Francesco Zingari
- Department of Maxillofacial Surgery, Galeazzi Hospital, 20157 Milan, Italy
| | - Alessandro Remigio Bolzoni
- Maxillo-Facial Surgery and Dental Unit, Department of Biomedical, Surgical and Dental Sciences, University of Milano, 20122 Milan, Italy
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, University of Milano, 20122 Milan, Italy
| | | | - Antonio Barone
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
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Saponaro PC, Karasan D, Donmez MB, Johnston WM, Yilmaz B. Prosthetic complications with monolithic or micro-veneered implant-supported zirconia single-unit, multiple-unit, and complete-arch prostheses on titanium base abutments: A single center retrospective study with mean follow-up period of 72.35 months. Clin Implant Dent Relat Res 2023; 25:99-106. [PMID: 36321480 DOI: 10.1111/cid.13149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/13/2022] [Accepted: 10/14/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND The influence of prosthetic design on prosthetic complications when monolithic or micro-veneered zirconia prostheses are supported with titanium base (ti-base) abutments is not well-known. PURPOSE The purpose of this single center, retrospective study was to assess the prevalence of prosthetic complications with monolithic or micro-veneered single-unit, multi-unit, and complete-arch zirconia prostheses supported with ti-base abutments (implant level or multi-unit abutment level). MATERIAL AND METHODS This study retrospectively evaluated the electronic health record (EHR) of participants who received either monolithic or micro-veneered implant-supported single-unit, multi-unit, and/or complete-arch prostheses supported by ti-base or zirconia-ti-base hybrid abutments delivered between the years 2010 and 2021. Data were analyzed by using logistic regression and Exact Mantel-Haenszel chi-square test (α = 0.05) to assess the clinical performance of prostheses and complications including crown decementation, feldspathic porcelain chipping, prosthesis fracture, zirconia-ti-base hybrid abutment decementation, abutment screw loosening, screw fracture, abutment fracture, implant loss, and prosthesis remake. RESULTS The study included 94 participants (50 female, 44 male) with a mean age of 59.5 years (range: 24-101 years of age). The retrospective EHR evaluation yielded 82 single-unit, 51 multi-unit, and 20 complete-arch prostheses on 325 implants. Among 153 prostheses delivered, 108 were micro-veneered (47 single-unit, 41 multi-unit, and 20 complete-arch prostheses) and 45 were monolithic. The average duration was 72.35 months (6.02 years) with a follow-up period of 5-132 months. From the time of insertion to the time of EHR review, of 153 prostheses, 78.43% did not exhibit any prosthetic complication. However, 33 prostheses (21.57%) from 29 participants (30.85%) had at least one prosthetic complication. Only four patients (4.25%) experienced two or more prosthetic complications. Prosthetic design affected the probability of having a complication (p = 0.005); complete-arch prostheses had higher probability (p ≤ 0.028). Single-unit prostheses had lower probability of complication than multi-unit prostheses (p = 0.005). The most commonly observed complication was fracture of veneering material (5.88%) followed by prosthetic screw loosening (4.57%) and decementation between the zirconia and the ti-base abutment (2.61%). Micro-veneered complete-arch prostheses had higher probability of having chipping than that of not having (p < 0.001), and other micro-veneered prosthetic designs had similar probability of chipping with that of complete-arch prostheses (p ≥ 0.082). Frequency of chipping was affected by veneering (p < 0.001). Monolithic prostheses had lower probability of chipping than micro-veneered prostheses, regardless of the prosthetic design (p < 0.001). CONCLUSIONS The frequency of prosthetic complications varied depending on prosthetic design. Complete-arch prostheses had the highest probability of complications while the single-unit prostheses had the lowest. Micro-veneered prostheses had higher probability for chipping than monolithic prostheses. Probability of chipping was similar for micro-veneered single-unit, multi-unit, and complete-arch zirconia prostheses.
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Affiliation(s)
- Paola C Saponaro
- Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA
| | - Duygu Karasan
- Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
| | - Mustafa Borga Donmez
- Department of Prosthodontics, Faculty of Dentistry, Istinye University, Istanbul, Turkey.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - William Michael Johnston
- Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA
| | - Burak Yilmaz
- Division of Restorative and Prosthetic Dentistry, The Ohio State University College of Dentistry, Columbus, Ohio, USA.,Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland.,Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland
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10
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Papaspyridakos P, Vazouras K, Gotsis S, Bokhary A, Sicilia E, Kudara Y, Bedrossian A, Chochlidakis K. Complete digital workflow for prosthesis prototype fabrication with double digital scanning: A retrospective study with 45 edentulous jaws. J Prosthodont 2022. [PMID: 36527731 DOI: 10.1111/jopr.13630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 11/02/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
PURPOSE To assess the accuracy of fit of complete-arch printed prosthesis prototypes generated with a digital workflow protocol for completely edentulous jaws. MATERIALS AND METHODS Forty-five edentulous jaws (35 patients) underwent intraoral complete-arch digital scans with the double digital scanning (DDS) technique and the generated standard tessellation language (STL) files were superimposed and imported into computer-aided design software. After STL merging, each master STL file was used for printing a prosthesis prototype. The primary outcome was the accuracy of fit assessment of the printed prototypes on verified master stone casts. Two experienced clinicians tested the accuracy of fit with radiographs and screw-resistance tests. Secondary outcomes were the effect of the scan body shape and implant number on the accuracy of fit. RESULTS Out of the 45 DDS-generated prosthesis prototypes, 39 presented with accurate fit on verified master stone casts, yielding an 86.70% accuracy of fit. Cylindrical scan bodies led to 100% accuracy of fit (25/25), whereas polygonal scan bodies presented with 70% accuracy of fit (14/20). Four implant-supported prostheses yielded 100% accuracy of fit (12/12), compared with 25/29 (86.30%) accuracy of fit for the six-implant-supported ones. Fisher's exact test was used to assess the effect of different scan body shapes (p = 0.005) and implant number on accuracy of fit. Chi-squared test was used to assess the association between the number of implants per arch and the accuracy of fit (p = 0.039). CONCLUSIONS Thirty-nine out of 45 complete-arch prosthesis prototypes generated with a completely digital workflow presented with clinically acceptable fit. The effect of the scan body design and implant number was statistically significant, favoring cylindrical scan bodies and four-implant-supported prostheses.
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Affiliation(s)
- Panos Papaspyridakos
- Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts, USA.,Department of Prosthodontics, University of Rochester Eastman Institute for Oral Health, Rochester, New York, USA
| | - Konstantinos Vazouras
- Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Sotirios Gotsis
- Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Abdullah Bokhary
- Department of Dental Public Health, Faculty of Dentistry, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Elena Sicilia
- Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Yukio Kudara
- Department of Prosthodontics, Tufts University School of Dental Medicine, Boston, Massachusetts, USA
| | - Armand Bedrossian
- Department of Prosthodontics, University of Washington, Seattle, Washington, USA
| | - Konstantinos Chochlidakis
- Department of Prosthodontics, University of Rochester Eastman Institute for Oral Health, Rochester, New York, USA
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Novais M, Silva AS, Mendes J, Barreiros P, Aroso C, Mendes JM. Fracture Resistance of CAD/CAM Implant-Supported 3Y-TZP-Zirconia Cantilevers: An In Vitro Study. MATERIALS (BASEL, SWITZERLAND) 2022; 15:6638. [PMID: 36233980 PMCID: PMC9571496 DOI: 10.3390/ma15196638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/17/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
(1) Introduction: Implant-supported fixed complete dentures are mostly composed of cantilevers. The purpose of this work was to evaluate the fracture resistance of zirconia (Prettau®, second generation, or Ice Zirkon Translucent, first generation) with cantilever lengths of 6 and 10 mm, and zirconia’s fracture resistance in relation to an average bite force of 250 N. (2) Materials and methods: Forty structures were created in CAD/CAM and divided into four groups: group A (6 mm cantilever in IZT), group B (10 mm cantilever in IZT), group C (6 mm cantilever in Pz), and group D (10 mm cantilever in pz). The study consisted of a traditional “load-to-failure” test. (3) Results: A statistically significant result was found for the effect of cantilever length, t(38) = 16.23 (p < 0.001), with this having a large effect size, d = 4.68. The 6 mm cantilever length (M = 442.30, sd = 47.49) was associated with a higher mean force at break than the 10 mm length (M = 215.18, sd = 40.74). No significant effect was found for the type of zirconia: t(38) = 0.31 (p = 0.757), and d = 0.10. (4) Conclusions: All the components with cantilever lengths of 6 mm broke under forces higher than 250 N. Cantilevers larger than 10 mm should be avoided.
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