ARTICLE
Evaluation of Zirconia-Based All-Ceramic Single Crowns and Fixed Dental Prosthesis on Zirconia Implants: 5-Year Results of a Prospective Cohort Study
Benedikt Christopher Spies DMD, Dr Med Dent,
Susanne Stampf Dr Rer Nat,
Ralf-Joachim Kohal DMD, Dr Med Dent, PhD,
Corresponding Author
Benedikt Christopher Spies DMD, Dr Med Dent
Assistant professor
Clinic of Prosthodontics, School of Dentistry, Albert-Ludwigs-University, Freiburg, Germany
Corresponding Author: Dr. Benedikt Christopher Spies, Clinic of Prosthodontics, School of Dentistry, University Hospital Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; e-mail: [email protected]Search for more papers by this authorSusanne Stampf Dr Rer Nat
Center for Medical Biometry and Medical Informatics, Medical Center – University of Freiburg, Freiburg, Germany
Search for more papers by this authorRalf-Joachim Kohal DMD, Dr Med Dent, PhD
Associate professor
Clinic of Prosthodontics, School of Dentistry, Albert-Ludwigs-University, Freiburg, Germany
Search for more papers by this authorBenedikt Christopher Spies DMD, Dr Med Dent,
Susanne Stampf Dr Rer Nat,
Ralf-Joachim Kohal DMD, Dr Med Dent, PhD,
Corresponding Author
Benedikt Christopher Spies DMD, Dr Med Dent
Assistant professor
Clinic of Prosthodontics, School of Dentistry, Albert-Ludwigs-University, Freiburg, Germany
Corresponding Author: Dr. Benedikt Christopher Spies, Clinic of Prosthodontics, School of Dentistry, University Hospital Freiburg, Hugstetter Straße 55, 79106 Freiburg, Germany; e-mail: [email protected]Search for more papers by this authorSusanne Stampf Dr Rer Nat
Center for Medical Biometry and Medical Informatics, Medical Center – University of Freiburg, Freiburg, Germany
Search for more papers by this authorRalf-Joachim Kohal DMD, Dr Med Dent, PhD
Associate professor
Clinic of Prosthodontics, School of Dentistry, Albert-Ludwigs-University, Freiburg, Germany
Search for more papers by this authorAbstract
Objective
The objective of this 5-year cohort investigation was to determine the survival and success rate of all-ceramic reconstructions on zirconia oral implants.
Material and Methods
Ninety-three patients received 122 one-piece zirconia implants. One hundred seventeen implants were restored with 63 single crowns (SCs) and 27 three-unit bridges (fixed dental prostheses, FDPs) fabricated using zirconia frameworks (Procera® Zirconia, Nobel Biocare®, Göteborg, Sweden) hand-layered with a silicate ceramic (NobelRondo™ Zirconia, Nobel Biocare®). With any occurrence of chipping regarded as an event, Kaplan-Meier success curves were plotted. Covariates (gender, location, manufacturing date) were estimated by the use of log-rank tests.
Results
Eighty-nine patients received prosthetic reconstructions. Sixty-three of them were seen at the 5-year follow-up, with a mean observation time of 58.2 months (47 patients with SCs, 16 patients with FDPs). Reasons for the decreasing number of patients at the follow-up sessions included dropouts due to implant loss (n = 21), moving (n = 3), missed appointments (n = 1), and severe illness (n = 1). Over half of the SCs (57.2%) and 38% of the FDPs were successful after an observation time of 5 years (overall success rate of 51.7%). The performed log-rank tests revealed no statistically significant differences for the success curves regarding the above-mentioned covariates. Among the 63 restorations that completed the study, 11 of 47 SCs and one of 16 FDPs had to be replaced due to the severity of the observed chipping. This results in survival rates of 76.6% for the SCs and 93.8% for the FDPs. No framework fractures or decementations were observed in any group.
Conclusion
Hand-layering of zirconia-based SCs and FDPs with NobelRondo™ Zirconia restoring one-piece zirconia implants did not show acceptable survival and success rates. Meanwhile, the material has been recalled from the market. It is advised that new materials should undergo adequate preclinical evaluation before coming to the market.
References
- 1 Geller W. Dunkel- und Schattenzonen – einer der wichtigen Aspekte der kreativen Farbtechnik nach W. Geller. Quintessenz Zahntech 1982; 8: 467–473.
- 2 Anusavice KJ. Recent developments in restorative dental ceramics. J Am Dent Assoc 1993; 124: 72–74, 76–78, 80–74.
- 3 Denry I, Holloway J. Ceramics for dental applications: a review. Materials 2010; 3: 351–368.
- 4 Guess PC, Schultheis S, Bonfante EA, Coelho PG, Ferencz JL, Silva NR. All-ceramic systems: laboratory and clinical performance. Dent Clin North Am 2011; 55: 333–352, ix.
- 5 Land CH. Porcelain dental art. Dent Cosmos 1903; 45: 437–615.
- 6 Conrad HJ, Seong WJ, Pesun IJ. Current ceramic materials and systems with clinical recommendations: a systematic review. J Prosthet Dent 2007; 98: 389–404.
- 7 Garvie RC, Hannink RH, Pascoe RT. Ceramic steel? Nature 1975; 258: 703–704.
- 8 Seghi RR, Denry IL, Rosenstiel SF. Relative fracture toughness and hardness of new dental ceramics. J Prosthet Dent 1995; 74: 145–150.
- 9 Tinschert J, Zwez D, Marx R, Anusavice KJ. Structural reliability of alumina-, feldspar-, leucite-, mica- and zirconia-based ceramics. J Dent 2000; 28: 529–535.
- 10 Manicone PF, Rossi Iommetti P, Raffaelli L. An overview of zirconia ceramics: basic properties and clinical applications. J Dent 2007; 35: 819–826.
- 11 Christel P, Meunier A, Heller M, Torre JP, Peille CN. Mechanical properties and short-term in-vivo evaluation of yttrium-oxide-partially-stabilized zirconia. J Biomed Mater Res 1989; 23: 45–61.
- 12 Bona AD, Kelly JR. The clinical success of all-ceramic restorations. J Am Dent Assoc 2008; 139: 8S–13S.
- 13 Kohal RJ, Att W, Bächle M, Butz F. Ceramic abutments and ceramic oral implants. An update. Periodontol 2000 2008; 47: 224–243.
- 14 Denry I, Kelly JR. State of the art of zirconia for dental applications. Dent Mater 2008; 24: 299–307.
- 15 Al-Amleh B, Lyons K, Swain M. Clinical trials in zirconia: a systematic review. J Oral Rehabil 2010; 37: 641–652.
- 16 Guess PC, Att W, Strub JR. Zirconia in fixed implant prosthodontics. Clin Implant Dent Relat Res 2012; 14: 633–645.
- 17 Koutayas SO, Vagkopoulou T, Pelekanos S, Koidis P, Strub JR. Zirconia in dentistry: part 2. Evidence-based clinical breakthrough. Eur J Esthet Dent 2009; 4: 348–380.
- 18 Pjetursson BE, Sailer I, Zwahlen M, Hämmerle CH. A systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of at least 3 years. Part I: single crowns. Clin Oral Implants Res 2007; 18(Suppl 3): 73–85.
- 19 Monaco C, Caldari M, Scotti R. Clinical evaluation of 1132 zirconia-based single crowns: a retrospective cohort study from the AIOP clinical research group. Int J Prosthodont 2013; 26: 435–442.
- 20 Groten M, Hüttig F. The performance of zirconium dioxide crowns: a clinical follow-up. Int J Prosthodont 2010; 23: 429–431.
- 21 Örtorp A, Kihl ML, Carlsson GE. A 5-year retrospective study of survival of zirconia single crowns fitted in a private clinical setting. J Dent 2012; 40: 527–530.
- 22 Schmitt J, Wichmann M, Holst S, Reich S. Restoring severely compromised anterior teeth with zirconia crowns and feather-edged margin preparations: a 3-year follow-up of a prospective clinical trial. Int J Prosthodont 2010; 23: 107–109.
- 23 Vigolo P, Mutinelli S. Evaluation of zirconium-oxide-based ceramic single-unit posterior fixed dental prostheses (FDPs) generated with two CAD/CAM systems compared to porcelain-fused-to-metal single-unit posterior FDPs: a 5-year clinical prospective study. J Prosthodont 2012; 21: 265–269.
- 24 Sailer I, Pjetursson BE, Zwahlen M, Hämmerle CH. A systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of at least 3 years. Part II: fixed dental prostheses. Clin Oral Implants Res 2007; 18(Suppl 3): 86–96.
- 25 Tinschert J, Natt G, Latzke P, Heussen N, Spiekermann H. Vollkeramische Bruecken aus DC-Zirkon – ein klinisches Konzept mit Erfolg? Deutsch Zahnaerztl Z 2005; 10: 435–445.
- 26 Sailer I, Feher A, Filser F, Gauckler LJ, Luthy H, Hämmerle CH. Five-year clinical results of zirconia frameworks for posterior fixed partial dentures. Int J Prosthodont 2007; 20: 383–388.
- 27 Raigrodski AJ, Chiche GJ, Potiket N, et al. The efficacy of posterior three-unit zirconium-oxide-based ceramic fixed partial dental prostheses: a prospective clinical pilot study. J Prosthet Dent 2006; 96: 237–244.
- 28 Raigrodski AJ, Yu A, Chiche GJ, Hochstedler JL, Mancl LA, Mohamed SE. Clinical efficacy of veneered zirconium dioxide-based posterior partial fixed dental prostheses: five-year results. J Prosthet Dent 2012; 108: 214–222.
- 29 Tinschert J, Schulze KA, Natt G, Latzke P, Heussen N, Spiekermann H. Clinical behavior of zirconia-based fixed partial dentures made of DC-Zirkon: 3-year results. Int J Prosthodont 2008; 21: 217–222.
- 30 Sailer I, Gottnerb J, Kanelb S, Hämmerle CH. Randomized controlled clinical trial of zirconia-ceramic and metal-ceramic posterior fixed dental prostheses: a 3-year follow-up. Int J Prosthodont 2009; 22: 553–560.
- 31 Beuer F, Edelhoff D, Gernet W, Sorensen JA. Three-year clinical prospective evaluation of zirconia-based posterior fixed dental prostheses (FDPs). Clin Oral Investig 2009; 13: 445–451.
- 32 Schmitter M, Mussotter K, Rammelsberg P, Gabbert O, Ohlmann B. Clinical performance of long-span zirconia frameworks for fixed dental prostheses: 5-year results. J Oral Rehabil 2012; 39: 552–557.
- 33 Rinke S, Gersdorff N, Lange K, Roediger M. Prospective evaluation of zirconia posterior fixed partial dentures: 7-year clinical results. Int J Prosthodont 2013; 26: 164–171.
- 34 Wolfart S, Harder S, Eschbach S, Lehmann F, Kern M. Four-year clinical results of fixed dental prostheses with zirconia substructures (Cercon): end abutments versus cantilever design. Eur J Oral Sci 2009; 117: 741–749.
- 35 Sax C, Hämmerle CH, Sailer I. 10-year clinical outcomes of fixed dental prostheses with zirconia frameworks. Int J Comput Dent 2011; 14: 183–202.
- 36 Schmitt J, Holst S, Wichmann M, Reich S, Göllner M, Hamel J. Zirconia posterior fixed partial dentures: a prospective clinical 3-year follow-up. Int J Prosthodont 2009; 22: 597–603.
- 37 Molin MK, Karlsson SL. Five-year clinical prospective evaluation of zirconia-based Denzir 3-unit FPDs. Int J Prosthodont 2008; 21: 223–227.
- 38 Edelhoff D, Florian B, Florian W, Johnen C. HIP zirconia fixed partial dentures – clinical results after 3 years of clinical service. Quintessence Int 2008; 39: 459–471.
- 39 Schley JS, Heussen N, Reich S, Fischer J, Haselhuhn K, Wolfart S. Survival probability of zirconia-based fixed dental prostheses up to 5 yr: a systematic review of the literature. Eur J Oral Sci 2010; 118: 443–450.
- 40 Raigrodski AJ, Hillstead MB, Meng GK, Chung KH. Survival and complications of zirconia-based fixed dental prostheses: a systematic review. J Prosthet Dent 2012; 107: 170–177.
- 41 Komine F, Blatz MB, Matsumura H. Current status of zirconia-based fixed restorations. J Oral Sci 2010; 52: 531–539.
- 42 Heintze SD, Rousson V. Survival of zirconia- and metal-supported fixed dental prostheses: a systematic review. Int J Prosthodont 2010; 23: 493–502.
- 43 Swain MV. Unstable cracking (chipping) of veneering porcelain on all-ceramic dental crowns and fixed partial dentures. Acta Biomater 2009; 5: 1668–1677.
- 44 Esposito M, Murray-Curtis L, Grusovin MG, Coulthard P, Worthington HV. Interventions for replacing missing teeth: different types of dental implants. Cochrane Database Syst Rev 2007; 17:CD003815.
- 45 Jung RE, Zembic A, Pjetursson BE, Zwahlen M, Thoma DS. Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years. Clin Oral Implants Res 2012; 23(Suppl 6): 2–21.
- 46 Andersson B, Ödman P, Lindvall AM, Brånemark PI. Five-year prospective study of prosthodontic and surgical single-tooth implant treatment in general practices and at a specialist clinic. Int J Prosthodont 1998; 11: 351–355.
- 47 Bonde MJ, Stokholm R, Isidor F, Schou S. Outcome of implant-supported single-tooth replacements performed by dental students. A 10-year clinical and radiographic retrospective study. Eur J Oral Implantol 2010; 3: 37–46.
- 48 Pjetursson BE, Thoma D, Jung R, Zwahlen M, Zembic A. A systematic review of the survival and complication rates of implant-supported fixed dental prostheses (FDPs) after a mean observation period of at least 5 years. Clin Oral Implants Res 2012; 23(Suppl 6): 22–38.
- 49 Larsson C, Vult von Steyern P. Five-year follow-up of implant-supported Y-TZP and ZTA fixed dental prostheses. A randomized, prospective clinical trial comparing two different material systems. Int J Prosthodont 2010; 23: 555–561.
- 50 Schwarz S, Schröder C, Hassel A, Bömicke W, Rammelsberg P. Survival and chipping of zirconia-based and metal-ceramic implant-supported single crowns. Clin Implant Dent Relat Res 2012; 14(Suppl 1): e119–e125.
- 51 Hosseini M, Worsaae N, Schiødt M, Gotfredsen K. A 3-year prospective study of implant-supported, single-tooth restorations of all-ceramic and metal-ceramic materials in patients with tooth agenesis. Clin Oral Implants Res 2013; 24: 1078–1087.
- 52 Nothdurft FP, Pospiech PR. Zirconium dioxide implant abutments for posterior single-tooth replacement: first results. J Periodontol 2009; 80: 2065–2072.
- 53 Larsson C, Vult Von Steyern P. Implant-supported full-arch zirconia-based mandibular fixed dental prostheses. Eight-year results from a clinical pilot study. Acta Odontol Scand 2013; 71: 1118–1122.
- 54 Andreiotelli M, Wenz HJ, Kohal RJ. Are ceramic implants a viable alternative to titanium implants? A systematic literature review. Clin Oral Implants Res 2009; 20(Suppl 4): 32–47.
- 55 Silva NRFA, Sailer I, Zhang Y, et al. Performance of zirconia for dental healthcare. Materials 2010; 3: 863–896.
- 56 Wenz HJ, Bartsch J, Wolfart S, Kern M. Osseointegration and clinical success of zirconia dental implants: a systematic review. Int J Prosthodont 2008; 21: 27–36.
- 57 Cannizzaro G, Torchio C, Felice P, Leone M, Esposito M. Immediate occlusal versus non-occlusal loading of single zirconia implants. A multicentre pragmatic randomised clinical trial. Eur J Oral Implantol 2010; 3: 111–120.
- 58 Payer M, Arnetzl V, Kirmeier R, Koller M, Arnetzl G, Jakse N. Immediate provisional restoration of single-piece zirconia implants: a prospective case series – results after 24 months of clinical function. Clin Oral Implants Res 2013; 24: 569–575.
- 59 Oliva J, Oliva X, Oliva JD. One-year follow-up of first consecutive 100 zirconia dental implants in humans: a comparison of 2 different rough surfaces. Int J Oral Maxillofac Implants 2007; 22: 430–435.
- 60 Kohal RJ, Knauf M, Larsson B, Sahlin H, Butz F. One-piece zirconia oral implants: one-year results from a prospective cohort study. 1. Single tooth replacement. J Clin Periodontol 2012; 39: 590–597.
- 61 Kohal RJ, Patzelt SB, Butz F, Sahlin H. One-piece zirconia oral implants: one-year results from a prospective case series. 2. Three-unit fixed dental prosthesis (FDP) reconstruction. J Clin Periodontol 2013; 40: 553–562.
- 62 Kaplan EL, Meier P. Nonparametric estimation from incomplete observations. J Am Stat Assoc 1958; 53: 457–481.
- 63 Hämmerle CH, Wagner D, Brägger U, et al. Threshold of tactile sensitivity perceived with dental endosseous implants and natural teeth. Clin Oral Implants Res 1995; 6: 83–90.
- 64 Herrero AA, Sierraalta M, Razzoog ME. Flexural strength of several porcelain systems for zirconium ceramics. J Dent Res 2006; 85: abstract # 1355.
- 65 Sierraalta M, Odén A, Razzoog ME. Material strength of zirconia produced with two methods. J Dent Res 2003; 82: abstract # 0450.
- 66 Fischer J, Stawarczyk B, Hämmerle CHF. Flexural strength of veneering ceramics for zirconia. J Dent 2008; 36: 316–321.
- 67 Choi JE, Waddell JN, Torr B, Swain MV. Pressed ceramics onto zirconia. Part 1: comparison of crystalline phases present, adhesion to a zirconia system and flexural strength. Dent Mater 2011; 27: 1204–1212.
- 68 Choi JE, Waddell JN, Swain MV. Pressed ceramics onto zirconia. Part 2: indentation fracture and influence of cooling rate on residual stresses. Dent Mater 2011; 27: 1111–1118.
- 69 Peutzfeldt A, Sahafi A, Flury S. Bonding of restorative materials to dentin with various luting agents. Oper Dent 2011; 36: 266–273.
- 70 Aboushelib MN, Kleverlaan CJ, Feilzer AJ. Microtensile bond strength of different components of core veneered all-ceramic restorations. Part 3: double veneer technique. J Prosthodont 2008; 17: 9–13.
- 71 Fischer J, Stawarczyk B, Tomic M, Strub JR, Hämmerle CH. Effect of thermal misfit between different veneering ceramics and zirconia frameworks on in vitro fracture load of single crowns. Dent Mater J 2007; 26: 766–772.
- 72 Saito A, Komine F, Blatz MB, Matsumura H. A comparison of bond strength of layered veneering porcelains to zirconia and metal. J Prosthet Dent 2010; 104: 247–257.
- 73 Bonfante EA, Rafferty BT, Silva NRFA, et al. Residual thermal stress simulation in three-dimensional molar crown systems: a finite element analysis. J Prosthodont 2012; 21: 529–534.
- 74 Bonfante EA, Coelho PG, Navarro JM Jr, et al. Reliability and failure modes of implant-supported Y-TZP and MCR three-unit bridges. Clin Implant Dent Relat Res 2010; 12: 235–243.
- 75 Guess PC, Kulis A, Witkowski S, Wolkewitz M, Zhang Y, Strub JR. Shear bond strengths between different zirconia cores and veneering ceramics and their susceptibility to thermocycling. Dent Mater 2008; 24: 1556–1567.
- 76 Ashkanani HM, Raigrodski AJ, Flinn BD, Heindl H, Mancl LA. Flexural and shear strengths of ZrO2 and a high-noble alloy bonded to their corresponding porcelains. J Prosthet Dent 2008; 100: 274–284.
- 77 Aboushelib MN, Feilzer AJ, de Jager N, Kleverlaan CJ. Prestresses in bilayered all-ceramic restorations. J Biomed Mater Res B Appl Biomater 2008; 87: 139–145.
- 78 Belli R, Frankenberger R, Appelt A, et al. Thermal-induced residual stresses affect the lifetime of zirconia-veneer crowns. Dent Mater 2013; 29: 181–190.
- 79
Komine F, Strub JR, Matsumura H. Bonding between layering materials and zirconia frameworks. Jpn Dent Sci Rev 2012; 48: 153–161.
10.1016/j.jdsr.2012.06.001 Google Scholar
- 80 Fischer J, Stawarzcyk B, Trottmann A, Hämmerle CH. Impact of thermal misfit on shear strength of veneering ceramic/zirconia composites. Dent Mater 2009; 25: 419–423.
- 81 Al-Dohan HM, Yaman P, Dennison JB, Razzoog ME, Lang BR. Shear strength of core-veneer interface in bi-layered ceramics. J Prosthet Dent 2004; 91: 349–355.
- 82 Fischer J, Grohmann P, Stawarczyk B. Effect of zirconia surface treatments on the shear strength of zirconia/veneering ceramic composites. Dent Mater J 2008; 27: 448–454.
- 83 Tholey MJ, Swain MV, Thiel N. Thermal gradients and residual stresses in veneered Y-TZP frameworks. Dent Mater 2011; 27: 1102–1110.
- 84 Asaoka K, Tesk JA. Transient and residual stresses in dental porcelains as affected by cooling rates. Dent Mater J 1989; 8: 9–25.
- 85 Dehoff PH, Anusavice KJ. Tempering stresses in feldspathic porcelain. J Dent Res 1989; 68: 134–138.
- 86 Rues S, Kröger E, Müller D, Schmitter M. Effect of firing protocols on cohesive failure of all-ceramic crowns. J Dent 2010; 38: 987–994.
- 87 Marchack BW, Futatsuki Y, Marchack CB, White SN. Customization of milled zirconia copings for all-ceramic crowns: a clinical report. J Prosthet Dent 2008; 99: 169–173.
- 88 Tsumita M, Kokubo Y, Vult von Steyern P, Fukushima S. Effect of framework shape on the fracture strength of implant-supported all-ceramic fixed partial dentures in the molar region. J Prosthodont 2008; 17: 274–285.
- 89 Rosentritt M, Steiger D, Behr M, Handel G, Kolbeck C. Influence of substructure design and spacer settings on the in vitro performance of molar zirconia crowns. J Dent 2009; 37: 978–983.
- 90 Lorenzoni FC, Martins LM, Silva NR, et al. Fatigue life and failure modes of crowns systems with a modified framework design. J Dent 2010; 38: 626–634.
- 91 Preis V, Letsch C, Handel G, Behr M, Schneider-Feyrer S, Rosentritt M. Influence of substructure design, veneer application technique, and firing regime on the in vitro performance of molar zirconia crowns. Dent Mater 2013; 29: e113–e121.
- 92 Guess PC, Bonfante EA, Silva NR, Coelho PG, Thompson VP. Effect of core design and veneering technique on damage and reliability of Y-TZP-supported crowns. Dent Mater 2013; 29: 307–316.
- 93 Bonfante EA, Rafferty B, Zavanelli RA, et al. Thermal/mechanical simulation and laboratory fatigue testing of an alternative yttria tetragonal zirconia polycrystal core-veneer all-ceramic layered crown design. Eur J Oral Sci 2010; 118: 202–209.
- 94 Aboushelib MN, Kleverlaan CJ, Feilzer AJ. Microtensile bond strength of different components of core veneered all-ceramic restorations. Part II: zirconia veneering ceramics. Dent Mater 2006; 22: 857–863.
- 95 Baldassarri M, Zhang Y, Thompson VP, Rekow ED, Stappert CF. Reliability and failure modes of implant-supported zirconium-oxide fixed dental prostheses related to veneering techniques. J Dent 2011; 39: 489–498.
- 96 Ishibe M, Raigrodski AJ, Flinn BD, Chung KH, Spiekerman C, Winter RR. Shear bond strengths of pressed and layered veneering ceramics to high-noble alloy and zirconia cores. J Prosthet Dent 2011; 106: 29–37.
- 97 Tsalouchou E, Cattell MJ, Knowles JC, Pittayachawan P, McDonald A. Fatigue and fracture properties of yttria partially stabilized zirconia crown systems. Dent Mater 2008; 24: 308–318.
- 98 Aboushelib MN, de Kler M, van der Zel JM, Feilzer AJ. Effect of veneering method on the fracture and bond strength of bilayered zirconia restorations. Int J Prosthodont 2008; 21: 237–240.
- 99 Kosmač T, Oblak Č, Jevnikar P, Funduk N, Marion L. The effect of surface grinding and sandblasting on flexural strength and reliability of Y-TZP zirconia ceramic. Dent Mater 1999; 15: 426–433.
- 100 Kosmač T, Oblak Č, Jevnikar P, Funduk N, Marion L. Strength and reliability of surface treated Y-TZP dental ceramics. J Biomed Mater Res 2000; 53: 304–313.
- 101 Wang H, Aboushelib MN, Feilzer AJ. Strength influencing variables on CAD/CAM zirconia frameworks. Dent Mater 2008; 24: 633–638.
- 102 Hobkirk JA, Wiskott HW. Ceramics in implant dentistry (Working Group 1). Clin Oral Implants Res 2009; 20(Suppl 4): 55–57.
- 103 Tysowsky GW. The science behind lithium disilicate: a metal-free alternative. Dent Today 2009; 28: 112–113.
- 104 Etman MK, Woolford MJ. Three-year clinical evaluation of two ceramic crown systems: a preliminary study. J Prosthet Dent 2010; 103: 80–90.
- 105 Fasbinder DJ, Dennison JB, Heys D, Neiva G. A clinical evaluation of chairside lithium disilicate CAD/CAM crowns: a two-year report. J Am Dent Assoc 2010; 141(Suppl 2): 10S–14S.
- 106 Wolfart S, Eschbach S, Scherrer S, Kern M. Clinical outcome of three-unit lithium-disilicate glass-ceramic fixed dental prostheses: up to 8 years results. Dent Mater 2009; 25: e63–e71.
- 107 Kern M, Sasse M, Wolfart S. Ten-year outcome of three-unit fixed dental prostheses made from monolithic lithium disilicate ceramic. J Am Dent Assoc 2012; 143: 234–240.
- 108 Kim JH, Lee SJ, Park JS, Ryu JJ. Fracture load of monolithic CAD/CAM lithium disilicate ceramic crowns and veneered zirconia crowns as a posterior implant restoration. Implant Dent 2013; 22: 66–70.
- 109 Martínez-Rus F, Ferreiroa A, Özcan M, Pradíes G. Marginal discrepancy of monolithic and veneered all-ceramic crowns on titanium and zirconia implant abutments before and after adhesive cementation: a scanning electron microscopy analysis. Int J Oral Maxillofac Implants 2013; 28: 480–487.
Citing Literature
