Mechanical stability and technical outcomes of monolithic CAD/CAM fabricated abutment-crowns supported by titanium bases: An in vitro study
Corresponding Author
João Pitta
Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
Correspondence
João Pitta, Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, 1 Rue Michel-Servet, 1211 Genève 4. Switzerland.
Email: [email protected]
Contribution: Conceptualization (equal), Formal analysis (equal), Funding acquisition (lead), Investigation (lead), Methodology (lead), Writing - original draft (lead)
Search for more papers by this authorJenni Hjerppe
Departments of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUH), Helsinki, Finland
Department of Prosthodontics and Stomatognathic physiology, University of Turku, Turku, Finland
Contribution: Formal analysis (equal), Writing - original draft (lead)
Search for more papers by this authorFelix Burkhardt
Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
Contribution: Data curation (equal), Investigation (equal), Methodology (equal), Writing - review & editing (supporting)
Search for more papers by this authorVincent Fehmer
Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
Contribution: Conceptualization (equal), Methodology (equal), Writing - review & editing (supporting)
Search for more papers by this authorPhilippe Mojon
Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
Contribution: Formal analysis (lead), Writing - review & editing (supporting)
Search for more papers by this authorIrena Sailer
Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
Contribution: Conceptualization (lead), Funding acquisition (supporting), Supervision (lead), Writing - review & editing (lead)
Search for more papers by this authorCorresponding Author
João Pitta
Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
Correspondence
João Pitta, Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, 1 Rue Michel-Servet, 1211 Genève 4. Switzerland.
Email: [email protected]
Contribution: Conceptualization (equal), Formal analysis (equal), Funding acquisition (lead), Investigation (lead), Methodology (lead), Writing - original draft (lead)
Search for more papers by this authorJenni Hjerppe
Departments of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUH), Helsinki, Finland
Department of Prosthodontics and Stomatognathic physiology, University of Turku, Turku, Finland
Contribution: Formal analysis (equal), Writing - original draft (lead)
Search for more papers by this authorFelix Burkhardt
Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
Contribution: Data curation (equal), Investigation (equal), Methodology (equal), Writing - review & editing (supporting)
Search for more papers by this authorVincent Fehmer
Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
Contribution: Conceptualization (equal), Methodology (equal), Writing - review & editing (supporting)
Search for more papers by this authorPhilippe Mojon
Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
Contribution: Formal analysis (lead), Writing - review & editing (supporting)
Search for more papers by this authorIrena Sailer
Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland
Contribution: Conceptualization (lead), Funding acquisition (supporting), Supervision (lead), Writing - review & editing (lead)
Search for more papers by this authorAbstract
Objectives
To evaluate mechanical stability (survival and complication rates) and bending moments of different all-ceramic monolithic restorations bonded to titanium bases (hybrid abutment-crowns) or to customized titanium abutments compared to porcelain-fused-to-metal crowns (PFM) after thermo-mechanical aging.
Material and Methods
Sixty conical connection implants (4.3 mm-diameter) were divided in five groups (n = 12): PFM using gold abutment (GAbut-PFM), lithium disilicate crown bonded to customized titanium abutment (TAbut+LDS), lithium disilicate abutment-crown bonded to titanium base (TiBase+LDS), zirconia abutment-crown bonded to titanium base (TiBase+ZR), polymer-infiltrated ceramic-network (PICN) abutment-crown bonded to titanium base (TiBase+PICN). Simultaneous thermocycling (5°–55°C) and chewing simulation (1,200,000-cycles, 49 N, 1.67 Hz) were applied. Catastrophic and non-catastrophic events were evaluated under light microscope, and survival and complication rates were calculated. Specimens that survived aging were loaded until failure and bending moments were calculated.
Results
Survival rates after aging were 100% (TAbut+LDS, TiBase+LDS), 91.7% (GA-PFM), 66.7% (TiBase+ZR) and 58.3% (TiBase+PICN) and differed among the groups (p = .006). Non-catastrophic events as screw loosening (GA-PFM) and loss of retention or micro-/macro-movement (TiBase groups) were observed. Complication rates varied among the groups (p < .001). TiBase+PICN had lower bending moment than all the other groups (p < .001).
Conclusions
Hybrid abutment-crowns made of lithium disilicate can be an alternative to PFM-based restorations, although concerns regarding the bonded interface between the titanium base and abutment-crown can be raised. PICN and zirconia may not be recommended due to its inferior mechanical and bonding outcomes, respectively. Titanium customized abutment with bonded lithium disilicate crown appears to be the most stable combination.
REFERENCES
- Attia, A., & Kern, M. (2004). Influence of cyclic loading and luting agents on the fracture load of two all-ceramic crown systems. Journal of Prosthetic Dentistry, 92, 551–556. https://doi.org/10.1016/j.prosdent.2004.09.002
- Bankoğlu Güngör, M., & Karakoca Nemli, S. (2018). The effect of resin cement type and thermomechanical aging on the retentive strength of custom zirconia abutments bonded to titanium inserts. International Journal of Oral & Maxillofacial Implants, 33, 523–529. https://doi.org/10.11607/jomi.5920
- Carrabba, M., Keeling, A. J., Aziz, A., Vichi, A., Fabian Fonzar, R., Wood, D., & Ferrari, M. (2017). Translucent zirconia in the ceramic scenario for monolithic restorations: A flexural strength and translucency comparison test. Journal of Dentistry, 60, 70–76. https://doi.org/10.1016/j.jdent.2017.03.002
- De Angelis, P., Passarelli, P. C., Gasparini, G., Boniello, R., D'Amato, G., & De Angelis, S. (2020). Monolithic CAD-CAM lithium disilicate versus monolithic CAD-CAM zirconia for single implant-supported posterior crowns using a digital workflow: A 3-year cross-sectional retrospective study. Journal of Prosthetic Dentistry, 123, 252–256. https://doi.org/10.1016/j.prosdent.2018.11.016
- Elsayed, A., Wille, S., Al-Akhali, M., & Kern, M. (2018). Effect of fatigue loading on the fracture strength and failure mode of lithium disilicate and zirconia implant abutments. Clinical Oral Implants Research, 29, 20–27. https://doi.org/10.1111/clr.13034
- Fabbri, G., Fradeani, M., Dellificorelli, G., De Lorenzi, M., Zarone, F., & Sorrentino, R. (2017). Clinical evaluation of the influence of connection type and restoration height on the reliability of zirconia abutments: A retrospective study on 965 abutments with a mean 6-year follow-up. International Journal of Periodontics and Restorative Dentistry, 37, 19–31. https://doi.org/10.11607/prd.2974
- Gehrke, S. A., Poncio da Silva, P. M., Calvo Guirado, J. L., Delgado-Ruiz, R. A., Dedavid, B. A., Aline Nagasawa, M., & Shibli, J. A. (2016). Mechanical behavior of zirconia and titanium abutments before and after cyclic load application. Journal of Prosthetic Dentistry, 116, 529–535. https://doi.org/10.1016/j.prosdent.2016.02.015
- Gierthmuehlen, P., Rübel, A., Stampf, S., & Spitznagel, F. (2019). Effect of reduced material thickness on fatigue behavior and failure load of monolithic CAD/CAM PICN molar crowns. The International Journal Prosthodontics, 32, 71–74. https://doi.org/10.11607/ijp.5946
- Guess, P. C., Zavanelli, R. A., Silva, N. R., Bonfante, E. A., Coelho, P. G., & Thompson, V. P. (2010). Monolithic CAD/CAM lithium disilicate versus veneered Y-TZP crowns: Comparison of failure modes and reliability after fatigue. The International Journal Prosthodontics, 23, 434–442.
- Hebel, K. S., & Gajjar, R. C. (1997). Cement-retained versus screw-retained implant restorations: Achieving optimal occlusion and esthetics in implant dentistry. Journal of Prosthetic Dentistry, 77, 28–35. https://doi.org/10.1016/s0022-3913(97)70203-8
- Helkimo, E., Carlsson, G. E., & Helkimo, M. (1977). Bite force and state of dentition. Acta Odontologica Scandinavica, 35, 297–303. https://doi.org/10.3109/00016357709064128
- Joda, T., & Brägger, U. (2016). Time-efficiency analysis of the treatment with monolithic implant crowns in a digital workflow: A randomized controlled trial. Clinical Oral Implants Research, 27, 1401–1406. https://doi.org/10.1111/clr.12753
- Joda, T., Ferrari, M., & Brägger, U. (2017). Monolithic implant-supported lithium disilicate (LS2) crowns in a complete digital workflow: A prospective clinical trial with a 2-year follow-up. Clinical Implant Dentistry Related Research, 19, 505–511. https://doi.org/10.1111/cid.12472
- Kern, M., Strub, J. R., & Lü, X. Y. (1999). Wear of composite resin veneering materials in a dual-axis chewing simulator. Journal of Oral Rehabilitation, 26, 372–378. https://doi.org/10.1046/j.1365-2842.1999.00416.x
- Kim, J. S., Raigrodski, A. J., Flinn, B. D., Rubenstein, J. E., Chung, K. H., & Mancl, L. A. (2013). In vitro assessment of three types of zirconia implant abutments under static load. Journal of Prosthetic Dentistry, 109, 255–263. https://doi.org/10.1016/S0022-3913(13)60054-2
- Koenig, V., Vanheusden, A. J., Le Goff, S. O., & Mainjot, A. K. (2013). Clinical risk factors related to failures with zirconia-based restorations: An up to 9-year retrospective study. Journal of Dentistry, 41, 1164–1174. https://doi.org/10.1016/j.jdent.2013.10.009
- Kwon, S. J., Lawson, N. C., McLaren, E. E., Nejat, A. H., & Burgess, J. O. (2018). Comparison of the mechanical properties of translucent zirconia and lithium disilicate. J Prosthetic Dentistry, 120, 132–137. https://doi.org/10.1016/j.prosdent.2017.08.004
- Lien, W., Roberts, H. W., Platt, J. A., Vandewalle, K. S., Hill, T. J., & Chu, T. M. (2015). Microstructural evolution and physical behavior of a lithium disilicate glass-ceramic. Dental Materials, 31, 928-940. https://doi.org/10.1016/j.dental.2015.05.003
- Linkevicius, T., Vindasiute, E., Puisys, A., Linkeviciene, L., Maslova, N., & Puriene, A. (2013). The influence of the cementation margin position on the amount of undetected cement. A prospective clinical study. Clinical Oral Implants Research, 24, 71–76. https://doi.org/10.1111/j.1600-0501.2012.02453.x
- Lujan-Climent, M., Martinez-Gomis, J., Palau, S., Ayuso-Monter, R., Salsenhc, J., & Peraire, M. (2008). Influence of static and dynamic occlusal characteristics and muscle force on masticatory performance in dentate adults. European Journal of Oral Sciences, 116, 229–236. https://doi.org/10.1111/j.1600-0722.2008.00530.x
- Magne, P., Gallucci, G. O., & Belser, U. C. (2003). Anatomic crown width/length ratios of unworn and worn maxillary teeth in white subjects. Journal of Prosthetic Dentistry, 89, 453–461. https://doi.org/10.1016/S0022-3913(03)00125-2
- Marocho, S. M., Ozcan, M., Amaral, R., Bottino, M. A., & Valandro, L. F. (2013). Effect of resin cement type on the microtensile bond strength to lithium disilicate ceramic and dentin using different test assemblies. The Journal of Adhesive Dentistry, 15, 361–368. https://doi.org/10.3290/j.jad.a28624
- Moilanen, P., Hjerppe, J., Lassila, L. V. J., & Närhi, T. O. (2018). Fracture strength and precision of fit of implant-retained monolithic zirconia crowns. Journal of Oral Implantology, 44, 330–334. https://doi.org/10.1563/aaid-joi-D-17-00249
- Mühlemann, S., Truninger, T. C., Stawarczyk, B., Hämmerle, C. H., & Sailer, I. (2014). Bending moments of zirconia and titanium implant abutments supporting all-ceramic crowns after aging. Clinical Oral Implants Research, 25, 74–81. https://doi.org/10.1111/clr.12192
- Nordahl, N., Vult von Steyern, P., & Larsson, C. (2015). Fracture strength of ceramic monolithic crown systems of different thickness. Journal of Oral Science, 57, 255–261. https://doi.org/10.2334/josnusd.57.255
- Nothdurft, F. P. (2019). All-ceramic zirconium dioxide implant abutments for single-tooth replacement in the posterior region: A 5-year outcome report. The International Journal Prosthodontics, 32, 177–181. https://doi.org/10.11607/ijp.6115
- Nouh, I., Kern, M., Sabet, A. E., Aboelfadl, A. K., Hamdy, A. M., & Chaar, M. S. (2019). Mechanical behavior of posterior all-ceramic hybrid-abutment-crowns versus hybrid-abutments with separate crowns - A laboratory study. Clinical Oral Implants Research, 30, 90–98. https://doi.org/10.1111/clr.13395
- Özcan, M., & Bernasconi, M. (2015). Adhesion to zirconia used for dental restorations: A systematic review and meta-analysis. The Journal of Adhesive Dentistry, 17, 7–26. https://doi.org/10.3290/j.jad.a33525
- Peumans, M., Valjakova, E. B., De Munck, J., Mishevska, C. B., & Van Meerbeek, B. (2016). Bonding effectiveness of luting composites to different CAD/CAM materials. The Journal of Adhesive Dentistry, 18, 289–302. https://doi.org/10.3290/j.jad.a36155
- Piconi, C., & Maccauro, G. (1999). Zirconia as a ceramic biomaterial. Biomaterials, 20, 1–25. https://doi.org/10.1016/S0142-9612(98)00010-6
- Pitta, J., Burkhardt, F., Mekki, M., Fehmer, V., Mojon, P., & Sailer, I. (2020). Effect of airborne-particle abrasion of a titanium base abutment on the stability of the bonded interface and retention forces of crowns after artificial aging. Journal of Prosthetic Dentistry, https://doi.org/10.1016/j.prosdent.2020.06.013
10.1016/j.prosdent.2020.06.013 Google Scholar
- Pitta, J., Fehmer, V., Sailer, I., & Hicklin, S. P. (2018). Monolithic zirconia multiple-unit implant reconstructions on titanium bonding bases. International Journal of Computerized Dentistry, 21, 163–171.
- Pitta, J., Hicklin, S. P., Fehmer, V., Boldt, J., Gierthmuehlen, P. C., & Sailer, I. (2019). Mechanical stability of zirconia meso-abutments bonded to titanium bases restored with different monolithic all-ceramic crowns. International Journal of Oral & Maxillofacial Implants, 34, 1091–1097. https://doi.org/10.11607/jomi.7431
- Pjetursson, B. E., Valente, N. A., Strasding, M., Zwahlen, M., Liu, S., & Sailer, I. (2018). A systematic review of the survival and complication rates of zirconia-ceramic and metal-ceramic single crowns. Clinical Oral Implants Research, 29(Suppl 16), 199–214. https://doi.org/10.1111/clr.13306
- Preis, V., Behr, M., & Rosentritt, M. (2018). In vitro fatigue and fracture testing of implant-supported anterior ceramic crowns. The International Journal Prosthodontics, 31, 264–266. https://doi.org/10.11607/ijp.5656
- Rabel, K., Spies, B. C., Pieralli, S., Vach, K., & Kohal, R. J. (2018). The clinical performance of all-ceramic implant-supported single crowns: A systematic review and meta-analysis. Clinical Oral Implants Research, 29(Suppl 18), 196–223. https://doi.org/10.1111/clr.13337
- Rauscher, O. (2014). Impressionless implant-supported restorations with Cerec 4.2. International Journal of Computerized Dentistry, 17, 159–168.
- Reich, S. (2015). Tooth-colored CAD/CAM monolithic restorations. International Journal of Computerized Dentistry, 18, 131–146.
- Robinson, D., Aguilar, L., Gatti, A., Abduo, J., Lee, P. V. S., & Ackland, D. (2019). Load response of the natural tooth and dental implant: A comparative biomechanics study. The Journal of Advanced Prosthodontics, 11, 169–178. https://doi.org/10.4047/jap.2019.11.3.169
- Rosentritt, M., Hahnel, S., Engelhardt, F., Behr, M., & Preis, V. (2017). In vitro performance and fracture resistance of CAD/CAM fabricated implant supported molarcrowns. Clinical Oral Investigations, 21, 1213–1219. https://doi.org/10.1007/s00784-016-1898-9
- Sailer, I., Asgeirsson, A. G., Thoma, D. S., Fehmer, V., Aspelund, T., Özcan, M., & Pjetursson, B. E. (2018). Fracture strength of zirconia implant abutments on narrow diameter implants with internal and external connections: A study on the titanium resin base concept. Clinical Oral Implants Research, 29, 411–423. https://doi.org/10.1111/clr.13139
- Sailer, I., Makarov, N. A., Thoma, D. S., Zwahlen, M., & Pjetursson, B. E. (2015). All-ceramic or metal-ceramic tooth-supported fixed dental prostheses (FDPs)? A systematic review of the survival and complication rates. Part I: Single crowns (SCs). Dental Materials, 31, 603–623. https://doi.org/10.1016/j.dental.2015.02.011
- Sailer, I., Mühlemann, S., Zwahlen, M., Hämmerle, C. H., & Schneider, D. (2012). Cemented and screw-retained implant reconstructions: A systematic review of the survival and complication rates. Clinical Oral Implants Research, 23(Suppl 6), 163–201. https://doi.org/10.1111/j.1600-0501.2012.02538.x
- Sancho-Puchades, M., Crameri, D., Özcan, M., Sailer, I., Jung, R. E., Hämmerle, C. H. F., & Thoma, D. S. (2017). The influence of the emergence profile on the amount of undetected cement excess after delivery of cement-retained implant reconstructions. Clinical Oral Implants Research, 28, 1515–1522. https://doi.org/10.1111/clr.13020
- Sax, C., Hämmerle, C. H. F., & Sailer, I. (2011). 10-year clinical outcomes of fixed dental prostheses with zirconia frameworks. International Journal of Computerized Dentistry, 14, 183–202.
- Sieper, K., Wille, S., & Kern, M. (2017). Fracture strength of lithium disilicate crowns compared to polymer-infiltrated ceramic-network and zirconia reinforced lithium silicate crowns. Journal of the Mechanical Behavior of Biomedical Materials, 74, 342–348. https://doi.org/10.1016/j.jmbbm.2017.06.025
- Stimmelmayr, M., Edelhoff, D., Güth, J. F., Erdelt, K., Happe, A., & Beuer, F. (2012). Wear at the titanium-titanium and the titanium-zirconia implant-abutment interface: A comparative in vitro study. Dental Materials, 28, 1215–1220. https://doi.org/10.1016/j.dental.2012.08.008
- Sulaiman, T. A., Abdulmajeed, A. A., Donovan, T. E., Vallittu, P. K., Närhi, T. O., & Lassila, L. V. (2015). The effect of staining and vacuum sintering on optical and mechanical properties of partially and fully stabilized monolithic zirconia. Dental Material Journal, 34, 605–610. https://doi.org/10.4012/dmj.2015-054
- Swain, M. V., Coldea, A., Bilkhair, A., & Guess, P. C. (2016). Interpenetrating network ceramic-resin composite dental restorative materials. Dental Materials, 32, 34–42. https://doi.org/10.1016/j.dental.2015.09.009
- Taylor, T. D., Klotz, M. W., & Lawton, R. A. (2014). Titanium tattooing associated with zirconia implant abutments: A clinical report of two cases. International Journal of Oral & Maxillofacial Implants, 29, 958–960. https://doi.org/10.11607/jomi.3700
- Teichmann, M., Wienert, A. L., Rückbeil, M., Wolker, W., Wolfart, S., & Edelhoff, D. (2018). Ten-year survival and chipping rates and clinical quality grading of zirconia-based fixed dental prostheses. Clinical Oral Investigations, 22, 2905–2915. https://doi.org/10.1007/s00784-018-2378-1
- Testori, T., Weinstein, T., Scutellà, F., Wang, H. L., & Zucchelli, G. (2018). Implant placement in the esthetic area: Criteria for positioning single and multiple implants. Periodontology 2000, 77, 176–196. https://doi.org/10.1111/prd.12211
- Truninger, T. C., Stawarczyk, B., Leutert, C. R., Sailer, T. R., Hammerle, C. H., & Sailer, I. (2012). Bending moments of zirconia and titanium abutments with internal and external implant abutment connections after aging and chewing simulation. Clinical Oral Implants Research, 23, 12–18. https://doi.org/10.1111/j.1600-0501.2010.02141.x
- Wittneben, J. G., Millen, C., & Brägger, U. (2014). Clinical performance of screw- versus cement-retained fixed implant-supported reconstructions – a systematic review. International Journal of Oral & Maxillofacial Implants, 29, 84–98. https://doi.org/10.11607/jomi.2014suppl.g2.1
- Yan, J., Kaizer, M. R., & Zhang, Y. (2018). Load-bearing capacity of lithium disilicate and ultra-translucent zirconias. Journal of the Mechanical Behavior of Biomedical Materials, 88, 170–175. https://doi.org/10.1016/j.jmbbm.2018.08.023
- Zembic, A., Philipp, A. O., Hämmerle, C. H., Wohlwend, A., & Sailer, I. (2015). Eleven-year follow-up of a prospective study of zirconia implant abutments supporting single all-ceramic crowns in anterior and premolar regions. Clinical Implant Dentistry Related Research, 17, e417–e426. https://doi.org/10.1111/cid.12263
- Zenthöfer, A., Rues, S., Krisam, J., Rustemeyer, R., Rammelsberg, P., & Schmitter, M. (2018). Debonding forces for two-Piece zirconia abutments with implant platforms of different diameter and use of different luting strategies. International Journal of Oral & Maxillofacial Implants, 33, 1041–1046. https://doi.org/10.11607/jomi.6300
- Zimmermann, M., Egli, G., Zaruba, M., & Mehl, A. (2017). Influence of material thickness on fractural strength of CAD/CAM fabricated ceramic crowns. Dental Materials Journal, 36, 778–783. https://doi.org/10.4012/dmj.2016-296
Citing Literature
