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: 1.68).
05/2006; 33(5):380-6. DOI: 10.1111/j.1365-2842.2005.01571.x
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.
Available from: Valentim Barao
- "According to the manufacturer and a previous study , the resin has a modulus of elasticity of approximately 12 GPa, which approximates that of human bone. Maxillary central incisors crowns (11.0 mm in height, 8.0 mm proximally)  were fabricated with the nanofluorapatite ceramic IPS e.max Ceram (Ivoclar Vivadent, Liechtenstein, Swiss) layered on the prefabricated zirconia abutments according to the manufacturer's instructions for firing temperature (750 • C) and cycles (furnace Programat EP500, Ivoclar Vivadent). The crowns dimensions were checked in a silicone matrix during layering process to standardize the final shape of all replicas. "
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Evaluate the effect of implant connection designs on reliability and failure modes of screw-retained all-ceramic crowns.
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.
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.
Although group EH presented higher reliability and characteristic strength followed by IH and MT, all groups withstood reported mean anterior loads.
Available from: Irena Sailer
- "Finally, the presence or absence of a reconstruction on a zirconia abutment may play a decisive role. In vitro studies showed that implant-borne reconstructions with allceramic crowns on zirconia abutments demonstrated sufficient stability to withstand physiological occlusal forces in the anterior region (Att et al. 2006a,b). Furthermore, a systematic review on the survival of implant-supported single crowns confirmed that all-ceramic crowns on ceramic abutments performed similarly to metal-ceramic crowns (Jung et al. 2012). "
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To test the fracture load and fracture patterns of zirconia abutments restored with all-ceramic crowns after fatigue loading, exhibiting internal and external implant-abutment connections as compared to restored and internally fixed titanium abutments.
Materials and methods:
A master abutment was used for the customization of 5 groups of zirconia abutments to a similar shape (test). The groups differed according to their implant-abutment connections: one-piece internal connection (BL; Straumann Bonelevel), two-piece internal connection (RS; Nobel Biocare ReplaceSelect), external connection (B; Branemark MkIII), two-piece internal connection (SP, Straumann StandardPlus) and one-piece internal connection (A; Astra Tech AB OsseoSpeed). Titanium abutments with internal implant-abutment connection (T; Straumann Bonelevel) served as control group. In each group, 12 abutments were fabricated, mounted to the respective implants and restored with glass-ceramic crowns. All samples were embedded in acrylic holders (ISO-Norm 14801). After aging by means of thermocycling in a chewing simulator, static load was applied until failure (ISO-Norm 14801). Fracture load was analyzed by calculating the bending moments. Values of all groups were compared with one-way ANOVA followed by Scheffé post hoc test (P-value<0.05). Failure mode was analyzed descriptively.
The mean bending moments were 464.9 ± 106.6 N cm (BL), 581.8 ± 172.8 N cm (RS), 556.7 ± 128.4 N cm (B), 605.4 ± 54.7 N cm (SP), 216.4 ± 90.0 N cm (A) and 1042.0 ± 86.8 N cm (T). No difference of mean bending moments was found between groups BL, RS, B and SP. Test group A exhibited significantly lower mean bending moment than the other test groups. Control group T had significantly higher bending moments than all test groups. Failure due to fracture of the abutment and/or crown occurred in the test groups. In groups BL and A, fractures were located in the internal part of the connection, whereas in groups RS and SP, a partial deformation of the implant components occurred and cracks and fractures of the zirconia abutment were detected.
The differently connected zirconia abutments exhibited similar bending moments with the exception of one group. Hence, the type of connection only had a minor effect on the stability of restored zirconia abutments. In general, restored titanium abutments exhibited the highest bending moments.
Available from: Spiridon Oumvertos Koutayas
- "The aim of our study was to test the com- plete crown-abutment-implant complex under the simulation of clinical loading conditions as it has been performed by many others (see references Butz et al. 2005; Att et al. 2006b; Kohal et al. 2006; Steinebrunner et al. 2008). Therefore, the standardized ISO normed protocol (ISO 14801) that does not consider the final restoration and dynamic chewing simulation could not be followed which limits the comparison of our results with the results of the ISO norm test. "
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The use of all-ceramic crowns over zirconia abutments is a well-established esthetic treatment option in implant dentistry; however, the effect of the mechanical processing due to abutment preparation has not been investigated under functional loading. The purpose of the study was to evaluate the influence of the zirconia abutment preparation depth and preparation mode on the fracture strength and fracture mode of lithium disilicate crowns after chewing simulation.
Material and methods:
Seventy single implant-supported lithium disilicate glass-ceramic crowns (IPS e.max Press, Ivoclar Vivadent) were adhesively cemented (Multilink Automix, Ivoclar Vivadent) onto zirconia abutments (ZirDesign, Astra Tech) using implants with a diameter of 4.5 mm and a length of 15.0 mm (Osseospeed, Astra Tech). Study design concerned the replacement of a maxillary central incisor (11.0 mm in height and 8.0 mm in width). Subgroups (n = 7) were subjected to dynamic loading (C) up to 1.2 × 10(6) loading cycles at 135° with 98N in a thermomechanical chewing simulator (Kausimulator, Willytech); followed by quasi-static loading at a cross-head speed of 0.5 mm/min until fracture in a universal testing machine (Z010/TN2S, Zwick). Additional subgroups were also subjected to quasi-static loading (S) at 135°. Lithium disilicate implant crowns were divided into five study groups (n = 14) according to the abutment preparation depth [A (control): 0.5 mm, B: 0.7 mm, C: 0.9 mm, and preparation mode [(No label): milling by the manufacturer, (P): copy-milling by the Celay System (Mikrona)].
All specimens survived dynamic loading and mean fracture strengths (N) after quasi-static loading were as follows: Group SA: 384 ± 84; Group CA: 403 ± 67; Group SB: 294 ± 95; Group CB: 374 ± 75; Group SC: 332 ± 52; Group CC: 373 ± 105; Group SPB: 332 ± 80; Group CPB: 499 ± 91; Group SPC: 380 ± 101; and Group CPC: 358 ± 54.
Statistical analysis using multiple linear regression showed that both the preparation depth and mode had no influence on the fracture strength of the implant crowns (P > 0.05); however, fracture strength increased statistically significantly after 5 years chewing simulation (P = 0.01).
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