Fracture resistance of single-tooth implant-supported all-ceramic restorations after exposure to the artificial mouth.

Department of Prosthodontics, University of Freiburg, Freiburg, Germany.
Journal of Oral Rehabilitation (Impact Factor: 1.93). 05/2006; 33(5):380-6. DOI: 10.1111/j.1365-2842.2005.01571.x
Source: PubMed

ABSTRACT The purpose of this in vitro study was to evaluate the fracture resistance of single-tooth implant-supported all-ceramic restorations, composed of zirconium dioxide all ceramic restorations on different implant abutments, and to identify the weakest component of the restorative system. Forty-eight standardized maxillary central incisor zirconia crowns (Procera) were fabricated for two test groups and one control group (group Al: alumina abutments; group Zr: zirconia abutments; control group Ti: titanium abutments). All abutments were placed on the implants (Replace) using titanium screws. The crowns were adhesively luted using a resin luting agent (Panavia 21) and artificially aged through dynamic loading and thermal cycling. Afterwards, all specimens were tested for fracture resistance using compressive load on the palatal surfaces of the crowns. Pair-wise Wilcoxon rank tests were performed to test for differences in fracture resistance values with a global significance level of 0.05. All test specimens survived aging in the artificial mouth. No screw loosening was recorded. The median fracture resistance was 1251, 241 and 457 N for groups Ti, Al and Zr respectively. Statistically significant differences were found for the comparisons of group Ti with groups Al and Zr (P < 0.00001), and for the comparison of group Al with Zr (P < 0.00001). Results of this study showed that all tested implant-supported restorations have the potential to withstand physiological occlusal forces applied in the anterior region. Because of the low fracture resistance values of group Al, the combination of zirconia crowns and alumina abutments should carefully be considered before clinical application.

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    ABSTRACT: Objectives To investigate the type of failure and fracture resistance behavior of different zirconia and titanium implant/abutment systems for anterior application. Methods Eight groups of implant-abutment combinations (n = 8/system) were restored with identical full-contour zirconia crowns. The systems represented one-piece and multi-piece zirconia (Z) or titanium (T) implants/abutments with different types of connection (screwed = S, bonded = B). The following combinations (implant-abutment-connection) were investigated: ZZS, ZZB, ZZZB (three-piece), ZTS, TTS, TTS reference, and Z (one-piece, 2x). To simulate clinical anterior loading situations the specimens were mounted into the chewing simulator at an angle of 135° and subjected to thermal cycling (2 × 3000 × 5°/55 °C) and mechanical loading (1.2 × 106 × 50 N; 1.6 Hz). Fracture resistance and maximum bending stress were determined for all specimens that survived aging. Data were statistically analyzed with the Kolmogorov-Smirnov-test and one-way ANOVA (α=0.05). Survival performance was calculated with the Kaplan-Meier Log-Rank test. Results Independent of the material combinations screwed systems showed partly failures of the screws during simulation (ZZS: 3x, ZTS: 8x, TTS: 3x). Screw failures were combined with implant/abutment fractures of zirconia systems. Zirconia one-piece implants and the reference system did not show any failures, and only one specimen of the systems with a bonded connection (ZZZB) fractured. Mean (±standard deviation) fracture forces and maximum bending stresses differed significantly (p = 0.000) between 187.4 ± 42.0 N/250.0 ± 56.0 N/mm2 (ZZZB) and 524.3 ± 43.1 N/753.0± 61.0 N/mm2 (Z). Conclusions Both material (zirconia or titanium) and the type of connection influenced failure resistance during fatigue testing, fracture force, and maximum bending stress. Clinical significance: Different material combinations for implants and abutments as well as different types of connection achieved acceptable or even good failure and fracture resistance that may be satisfactory for anterior clinical application.
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    ABSTRACT: Objective Evaluate the effect of implant connection designs on reliability and failure modes of screw-retained all-ceramic crowns. Methods Central incisor ceramic crowns in zirconia abutments were screwed and torqued down to external hexagon (EH), internal hexagon (IH) and Morse taper (MT) implant systems. Single-load-to-fracture (SLF) test (n = 4 per group) determined three step-stress fatigue profiles with specimens assigned in the ratio of 3:2:1. Fatigue test was performed under water at 10 Hz. Use level probability Weibull curves and reliability for missions of 50,000 cycles at 400 N and 200 N were calculated (90% confidence bounds-CB). Weibull probability distribution (90% CB) was plotted (Weibull modulus vs characteristic strength) for comparison between the groups. Fractographic analyses were conducted under polarized-light microscopy and SEM. Results Use level Weibull probability calculation indicated that failure was not associated with fatigue in groups EH (β = 0.63), IH (β = 0.97) and MT (β = 0.19). Reliability data for a mission of 50,000 cycles at 400 N revealed significant reliability differences between groups EH (97%), IH (46%) and MT (0.5%) but no significant difference at 200 N between EH (100%) and IH (98%), and IH and MT (89%). Weibull strength distribution (figure) revealed β = 13.1/η = 561.8 for EH, β = 5.8/η = 513.4 for IH and β = 5.3/η = 333.2 for MT. Groups EH and IH exhibited veneer cohesive and adhesive failures. Group IH also presented adhesive failure at zirconia/titanium abutment insert while MT showed fracture at abutment neck. Significance Although group EH presented higher reliability and characteristic strength followed by IH and MT, all groups withstood reported mean anterior loads.
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