Maxillary Single-tooth Replacement Utilizing a Novel Ceramic Restorative System: Results to 30 Months

A systematic review and meta-analysis evaluating the survival, the failure, and the complication rates of veneered and monolithic all-ceramic implant-supported single crowns

Objective

To assess the survival, failure, and complication rates of veneered and monolithic all‐ceramic implant‐supported single crowns (SCs).

Methods

Literature search was conducted in Medline (PubMed), Embase, and Cochrane Central Register of Controlled Trials until September 2020 for randomized, prospective, and retrospective clinical trials with follow‐up time of at least 1 year, evaluating the outcome of veneered and/or monolithic all‐ceramic SCs supported by titanium dental implants. Survival and complication rates were analyzed using robust Poisson's regression models.

Results

Forty‐nine RCTs and prospective studies reporting on 57 material cohorts were included. Meta‐analysis of the included studies indicated an estimated 3‐year survival rate of veneered‐reinforced glass‐ceramic implant‐supported SCs of 97.6% (95% CI: 87.0%–99.6%). The estimated 3‐year survival rates were 97.0% (95% CI: 94.0%–98.5%) for monolithic‐reinforced glass‐ceramic implant SCs, 96.9% (95% CI: 93.4%–98.6%) for veneered densely sintered alumina SCs, 96.3% (95% CI: 93.9%–97.7%) for veneered zirconia SCs, 96.1% (95% CI: 93.4%–97.8%) for monolithic zirconia SCs and only 36.3% (95% CI: 0.04%–87.7%) for resin‐matrix‐ceramic (RMC) SCs. With the exception of RMC SCs (p < 0.0001), the differences in survival rates between the materials did not reach statistical significance. Veneered SCs showed significantly (p = 0.017) higher annual ceramic chipping rates (1.65%) compared with monolithic SCs (0.39%). The location of the SCs, anterior vs. posterior, did not influence survival and chipping rates.

Conclusions

With the exception of RMC SCs, veneered and monolithic implant‐supported ceramic SCs showed favorable short‐term survival and complication rates. Significantly higher rates for ceramic chipping, however, were reported for veneered compared with monolithic ceramic SCs.

Zirconia implant abutments supporting single all-ceramic crowns in anterior and premolar regions: A six-year retrospective study

BACKGROUND

Clinical studies regarding zirconia implant abutments reported good survival rates in the short-term observation period. The purpose of this study was to assess the six-year clinical performance of zirconia abutments supporting all-ceramic crowns in anterior and premolar regions.

METHODS

The patients received zirconia implant abutments to support all-ceramic crowns in Chang-Gung Medical Center during the period August 2010 to August 2011 were enrolled. In the following six years of observation period after the implant-crown had finished, the clinical parameters of all of the included patients were registered on a special form. The records regarding the following variables: age, gender, implant location, the condition of edentulous site before implant placement, esthetic performance at baseline, presence or absence of technical complications, and biological outcomes were registered and scrutinized for evaluation.

RESULTS

Out of the 32 zirconia implant abutments and 32 all-ceramic crowns that were followed for six years. Neither abutments nor crowns were lost, yielding 100% survival rates for both zirconia abutments and crowns. The esthetic outcomes were excellent except that a score of 2 was given to two restorations. With regard to technical complications, there was one instance of abutment screw loosening, two cases of veneering ceramic chipping, one restoration with occlusal roughness, and three instances of crowns loosening. Overall, the success rates were 96.8% and 81.2% for abutments and crowns respectively. In biological performance, only 1 implant was classified in group II (satisfactory survival) in the Misch classification, while all the others were classified in group I (excellent).

CONCLUSIONS

Zirconia abutments supporting all-ceramic crowns demonstrated high survival rate, good biological and esthetic results. While some technical complications were frequently observed, the complication-free rates were 96.8% for abutments and 81.2% for crowns in the medium-term observation period.

The clinical performance of all-ceramic implant-supported single crowns: A systematic review and meta-analysis

OBJECTIVE

This review aimed at evaluating the survival and technical complication rates of all-ceramic implant-supported single crowns (SC).

MATERIAL AND METHODS

Three electronic databases were searched for clinical studies conducted at ≥ 15 patients examining implant-supported all-ceramic SCs over ≥ 12 months. Survival rates of implants and restorations plus technical complication rates of SCs were calculated and tested for statistical correlation with confounding variables. Statistical analysis was performed using a negative binomial distribution model to calculate 5- and 10-year survival and complication estimates.

RESULTS

Forty-one included studies reported on implant-supported SCs made of veneered and monolithic high-strength oxide ceramics, monolithic, and veneered glass-based ceramics and of a monolithic resin-nano-ceramic (RNC). Survival estimates for SCs of 93% (95% CI: 86.6%-96.4%) after 5 years and 94.4% (95% CI: 91.1%-96.5%) after 10 years were calculated, corresponding values for implant survival were 95.3% (95% CI: 90.6%-97.7%) and 96.2% (95% CI: 95.1%-97.1%). Technical complication rates after 5/10 years were as follows: chipping 9.0% (95% CI: 5.4%-14.8%)/2.7% (95% CI: 2.1%-3.5%), framework fractures 1.9% (95% CI: 0.7%-4.9%)/1.2% (95% CI: 1%-1.5%), screw loosening 3.6% (95% CI: 1.6%-8.4%)/5.2% (95% CI: 3.6%-7.5%), and decementations with 1.1% (95% CI: 0.4%-2.8%) after 5 years. Some confounding variables influenced the above-mentioned estimates significantly.

CONCLUSIONS

All-ceramic implant-supported SCs showed-with the exception of a RNC material-high survival rates. However, failures and technical complications occurred which have to be considered when informing patients on the treatment with implant-supported all-ceramic SCs.

Dislodgement Resistance of Zirconia Copings Cemented onto Zirconia and Titanium Abutments

PURPOSE

To determine the effect of the cement type and abutment material on the tensile strength required to dislodge zirconia copings.

MATERIALS AND METHODS

Two experimental groups of abutments were prepared: (1) titanium abutments (n = 30) and (2) zirconia abutments (n = 30). Sixty zirconia copings (custom designed) were fabricated using 3-dimensional computer-assisted design to have a 6-mm projection above the abutment to accommodate a hole, through which a wire was inserted to attach the zirconia coping to a universal testing machine. Each abutment was placed onto an implant analog embedded in acrylic resin blocks to fit onto the universal testing machine. The zirconia copings were cemented onto the abutments with a provisional luting agent, zinc phosphate (ZP) cement, and adhesive resin cement, and after 5500 thermocycles, a tensile force was applied at a crosshead speed of 0.5 mm/min. The removal force was recorded for each specimen. Two-way analysis of variance (ANOVA) and 1-way ANOVA were used for the statistical analysis (P < 0.05).

RESULTS

The mean forces necessary to remove the zirconia copings from titanium abutments were 6.52, 83.09, and 251.18 N for temporary cement, ZP cement, and resin cement, respectively. For zirconia abutments, the required forces were 17.82, 116.41, and 248.72 N.

CONCLUSIONS

The abutment material had no effect on retention, but the cement type affected the retention of the zirconia copings.

Fatigue Failure of External Hexagon Connections on Cemented Implant-Supported Crowns

PURPOSE

To evaluate the probability of survival and failure modes of different external hexagon connection systems restored with anterior cement-retained single-unit crowns. The postulated null hypothesis was that there would be no differences under accelerated life testing.

MATERIALS AND METHODS

Fifty-four external hexagon dental implants (∼4 mm diameter) were used for single cement-retained crown replacement and divided into 3 groups: (3i) Full OSSEOTITE, Biomet 3i (n = 18); (OL) OEX P4, Osseolife Implants (n = 18); and (IL) Unihex, Intra-Lock International (n = 18). Abutments were torqued to the implants, and maxillary central incisor crowns were cemented and subjected to step-stress-accelerated life testing in water. Use-level probability Weibull curves and probability of survival for a mission of 100,000 cycles at 200 N (95% 2-sided confidence intervals) were calculated. Stereo and scanning electron microscopes were used for failure inspection.

RESULTS

The beta values for 3i, OL, and IL (1.60, 1.69, and 1.23, respectively) indicated that fatigue accelerated the failure of the 3 groups. Reliability for the 3i and OL (41% and 68%, respectively) was not different between each other, but both were significantly lower than IL group (98%). Abutment screw fracture was the failure mode consistently observed in all groups.

CONCLUSION

Because the reliability was significantly different between the 3 groups, our postulated null hypothesis was rejected.

Eleven-Year Follow-Up of a Prospective Study of Zirconia Implant Abutments Supporting Single All-Ceramic Crowns in Anterior and Premolar Regions

BACKGROUND

Clinical studies on zirconia abutments report very good survival rates and biological and technical results, but few have an observation period of more than 5 years.

PURPOSE

The aim of this study was to assess the long-term performance of customized zirconia implant abutments supporting all-ceramic crowns.

MATERIALS AND METHODS

Twenty-seven patients receiving 54 single implants were included (25 incisors, 14 canines, 15 premolars in both jaws). Yttria-stabilized zirconia abutments were screwed to the implants with a defined torque. All-ceramic crowns were adhesively cemented onto the abutments. The implants, abutments, and crowns were clinically and radiographically examined after 11 years of use. Modified United States Public Health Service (USPHS) criteria were used to assess technical outcomes: fracture of abutment/crown framework/veneering ceramic, loosening of abutment screw/crown, marginal adaptation, anatomical form, occlusal wear, and abutment fit. The biological parameters were pocket probing depth, plaque control record, bleeding on probing, papilla index, and gingival/mucosal recession at implants and neighboring natural teeth. The cumulative success rate of abutments and crowns was calculated by the Kaplan-Meier method. The results of the USPHS criteria were analyzed descriptively.

RESULTS

Sixteen patients with 31 zirconia abutments were examined at 11.3 (±0.9) years after implantation. No abutment or crown was lost. The cumulative success rate was 96.3% for abutments and 90.7% for crowns. Two abutment screws loosened, and three crowns exhibited minor chipping. There were no biological complications.

CONCLUSIONS

Customized zirconia single implant abutments exhibited excellent long-term outcomes in anterior and premolar regions.

Fracture Resistance and Analysis of Stress Distribution of Implant-Supported Single Zirconium Ceramic Coping Combination with Abutments Made of Different Materials

The purpose of this study was to compare the fracture resistance and fracture mode of single implant-zirconium coping combinations using zirconium and titanium abutments and to analyze the stress distribution pattern using three-dimensional finite elements analysis. Twenty implants with titanium and zirconium abutments were randomly divided into two groups (n = 10) and into resin blocks. Zirconium copings were cemented onto the abutments. The specimens were loaded with 135° angles to the long axis and the load values at the moment of failure were recorded using a universal test machine. Stress levels were calculated according to the maximum Von Mises criteria. The fracture resistances for titanium and zirconium abutment groups were 525.65 N and 514.05 N, respectively. No significant differences were observed between two groups regarding the fracture resistance levels. The maximum Von Mises equivalent stress concentrated on zirconium copings in both of the groups. Implant-abutment-ZrO2 coping combination has the potential to withstand physiological occlusal forces in the anterior region. Three-dimensional finite elements analysis results of the implant-abutment-ZrO2 coping combination is compatible with the results of fracture resistance.

Immediate Load and Esthetic Zone Considerations to Replace Maxillary Incisor Teeth Using a New Zirconia Implant Abutment in the Bone Grafted Anterior Maxilla

The goal of this prospective clinical study is to evaluate a new all-ceramic implant abutment made from zirconium oxide during the immediate load of dental implants placed in the block grafted anterior maxilla. This new zirconia abutment gives the clinician the opportunity to provide the patient with an all-ceramic restorative system (abutment and crown) for an optimum esthetic result and a high level of patient satisfaction. A total of 9 hydroxyapatite-coated dental implants were surgically placed in 9 patients and were immediately loaded 5 to 7 days later with a custom composite provisional restoration that was placed out of functional occlusion. Each prefabricated, natural colored zirconia abutment was shaped and connected to the implant with a titanium screw. Provisional restorations were cemented to the zirconia abutment with the use of temporary cement. Twelve weeks later, the provisional restoration was replaced with an all-ceramic restoration. Over a 52-week observation period, no abutment fractures occurred, and no abutment screw loosening was observed. No implants failed. All 9 patients reported total satisfaction regarding esthetic quality of the all-ceramic restorative system (abutment and implant). Preliminary results of this clinical study indicate that this new zirconia abutment offers the clinician and the patient exceptional strength, optimal esthetics, and simplicity. It is of important clinical significance that use of this all-ceramic abutment eliminates the well-known disadvantages of metal abutments.