All-ceramic versus titanium-based implant supported restorations: Preliminary 12-months results from a randomized controlled trial

PURPOSE: The aim of the present randomized controlled study was to compare prefabricated all-ceramic, anatomically shaped healing abutments followed by all-ceramic abutments and all-ceramic crowns and prefabricated standard-shaped (round-diameter) titanium healing abutments followed by final titanium abutments restored with porcelain-fused-to-metal (PFM) implant crowns in the premolar and molar regions. MATERIALS AND METHODS: Forty-two patients received single implants restored either by all-ceramic restorations (test group, healing abutment, final abutment, and crown all made of zirconia) or conventional titanium-based restorations. Immediately after prosthetic incorporation and after 12 months of loading, implant survival, technical complications, bone loss, sulcus fluid flow rate (SFFR) as well as plaque index (PI) and implant stability (Periotest) were analyzed clinically and radiologically. RESULTS: After 12 months of loading, an implant and prosthetic survival rate of 100% was observed. Minor prosthetic complications such as chipping of ceramic veneering occurred in both groups. No statistical significant differences were observed between both groups with only a minimum of bone loss, SFFR, and PI. CONCLUSION: All-ceramic implant prostheses including a prefabricated anatomically shaped healing abutment achieved comparable results to titanium-based restorations in the posterior region. However, observational results indicate a benefit as shaping the peri-implant soft-tissue with successive provisional devices and subsequent compression of the soft tissue can be avoided.

In-vitro performance and fracture strength of thin monolithic zirconia crowns

PURPOSE: All-ceramic restorations required extensive tooth preparation. The purpose of this in vitro study was to investigate a minimally invasive preparation and thickness of monolithic zirconia crowns, which would provide sufficient mechanical endurance and strength. MATERIALS AND METHODS: Crowns with thickness of 0.2 mm (group 0.2, n=32) or of 0.5 mm (group 0.5, n=32) were milled from zirconia and fixed with resin-based adhesives (groups 0.2A, 0.5A) or zinc phosphate cements (groups 0.2C, 0.5C). Half of the samples in each subgroup (n=8) underwent thermal cycling and mechanical loading (TCML)(TC: 5℃ and 55℃, 2×3,000 cycles, 2 min/cycle; ML: 50 N, 1.2×106 cycles), while the other samples were stored in water (37℃/24 h). Survival rates were compared (Kaplan-Maier). The specimens surviving TCML were loaded to fracture and the maximal fracture force was determined (ANOVA; Bonferroni; α=.05). The fracture mode was analyzed. RESULTS: In both 0.5 groups, all crowns survived TCML, and the comparison of fracture strength among crowns with and without TCML showed no significant difference (P=.628). Four crowns in group 0.2A and all of the crowns in group 0.2C failed during TCML. The fracture strength after 24 hours of the cemented 0.2 mm-thick crowns was significantly lower than that of adhesive bonded crowns. All cemented crowns provided fracture in the crown, while about 80% of the adhesively bonded crowns fractured through crown and die. CONCLUSION: 0.5 mm thick monolithic crowns possessed sufficient strength to endure physiologic performance, regardless of the type of cementation. Fracture strength of the 0.2 mm cemented crowns was too low for clinical application.

Surface roughness of zirconia for full-contour crowns after clinically simulated grinding and polishing / 国际口腔科学杂志·英文版

The aim of this study was to evaluate the effect of controlled intraoral grinding and polishing on the roughness of full-contour zirconia compared to classical veneered zirconia. Thirty bar-shaped zirconia specimens were fabricated and divided into two groups (n=15). Fifteen specimens (group 1) were glazed and 15 specimens (group 2) were veneered with feldspathic ceramic and then glazed. Prior to grinding, maximum roughness depth (Rmax) values were measured using a profilometer, 5 times per specimen. Simulated clinical grinding and polishing were performed on the specimens under water coolant for 15 s and 2 N pressure. For grinding, NTI diamonds burs with grain sizes of 20 µm, 10 µm, and 7.5 µm were used sequentially. The ground surfaces were polished using NTI kits with coarse, medium and fine polishers. After each step, Rmax values were determined. Differences between groups were examined using one-way analysis of variance (ANOVA). The roughness of group 1 was significantly lower than that of group 2. The roughness increased significantly after coarse grinding in both groups. The results after glazing were similar to those obtained after fine grinding for non-veneered zirconia. However, fine-ground veneered zirconia had significantly higher roughness than venerred, glazed zirconia. No significant difference was found between fine-polished and glazed zirconia, but after the fine polishing of veneered zirconia, the roughness was significantly higher than after glazing. It can be concluded that for full-contour zirconia, fewer defects and lower roughness values resulted after grinding and polishing compared to veneered zirconia. After polishing zirconia, lower roughness values were achieved compared to glazing; more interesting was that the grinding of glazed zirconia using the NTI three-step system could deliver smooth surfaces comparable to untreated glazed zirconia surfaces.