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      Fracture resistance and the mode of failure produced in metal-free crowns cemented onto zirconia abutments in dental implants

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          Abstract

          The purpose of the investigation was to analyze fracture resistance and mode of failure of zirconium oxide (zirconia) abutments placed on dental implants bearing crowns of different esthetic materials: zirconia, lithium disilicate (LDS), and nano-ceramic resin, for replacing single teeth in the anterior sector. Eighty implant-abutment-crown units were divided into four groups: Group T-MC (control): 20 metal-ceramic crowns cemented onto titanium abutments; Group Z-Z: 20 zirconia crowns on zirconia abutments; Group Z-LD: 20 lithium disilicate crowns on zirconia abutments; and Group Z-NCR: 20 nano-ceramic resin crowns on zirconia abutments. Specimens underwent a fatiguing process (dynamic loading and thermocycling), followed by static loading to evaluate mechanical fracture resistance, and the mode of failure produced. Mean fracture resistance values were: Control Group T-MC, 575.85±120.01 N; Group Z-Z 459.64±66.52 N; Group Z-LD, 531.77±34.10 N; and Group Z-NCR, 587.05±59.27 N. In Group T-MC, fracture occurred in the prosthetic fixing screw in 100% of specimens. In Group Z-Z, 80% of fractures occurred in the fixing screw, 15% in the abutment, and 5% in the abutment and crown. In Group Z-LD, 60% of fractures were produced in the fixing screw and 40% in the abutment. In Group Z-NCR, 70% of fractures were produced in the fixing screw and 30% in the abutment. All the abutments and crowns analyzed have the potential to withstand the physiological occlusal forces to which they would be subject in the anterior region. Lithium disilicate and nano-ceramic resin crowns cemented onto zirconia abutments are a good restoration alternative for single implants in the anterior sector.

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          Most cited references27

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          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.

          Ronald Jung, Anja Zembic, Bjarni E Pjetursson … (2012)
          To assess the 5-year survival of implant-supported single crowns (SCs) and to describe the incidence of biological, technical, and aesthetic complications. The focused question was: What is the survival rate of implants supporting single crowns and implant-supported crowns with a mean follow-up of 5 years and to which extent do biological, technical, and aesthetic complications occur?
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            Single tooth bite forces in healthy young adults.

            G Serrao, C Dellavia, G Serrao … (2004)
            The assessment of bite forces on healthy single tooth appears essential for a correct quantification of the actual impact of single implant oral rehabilitations. In the present study, a new single tooth strain-gauge bite transducer was used in 52 healthy young adults (36 men, 16 women) with a complete permanent dentition. The influences of tooth position along the dental arch, of side, and of sex, on maximum bite force were assessed by an ANOVA. No significant left-right differences were found. On average, in both sexes the lowest bite force was recorded on the incisors (40-48% of maximum single tooth bite force), the largest force was recorded on the first molar. Bite forces were larger in men than in women (P < 0.002), and increased monotonically along the arch until the first or second permanent molar (P < 0.0001). The present data can be used as reference values for the comparison of dental forces in patients.
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              A systematic review of the performance of ceramic and metal implant abutments supporting fixed implant reconstructions.

              Bjarni E Pjetursson, Anja Zembic, Irena Sailer … (2009)
              The objective of this systematic review was to assess the 5-year survival rates and incidences of complications associated with ceramic abutments and to compare them with those of metal abutments. An electronic Medline search complemented by manual searching was conducted to identify randomized-controlled clinical trials, and prospective and retrospective studies providing information on ceramic and metal abutments with a mean follow-up time of at least 3 years. Patients had to have been examined clinically at the follow-up visit. Assessment of the identified studies and data abstraction was performed independently by three reviewers. Failure rates were analyzed using standard and random-effects Poisson regression models to obtain summary estimates of 5-year survival proportions. Twenty-nine clinical and 22 laboratory studies were selected from an initial yield of 7136 titles and data were extracted. The estimated 5-year survival rate of ceramic abutments was 99.1% [95% confidence interval (CI): 93.8-99.9%] and 97.4% (95% CI: 96-98.3%) for metal abutments. The estimated cumulative incidence of technical complications after 5 years was 6.9% (95% CI: 3.5-13.4%) for ceramic abutments and 15.9% (95% CI: 11.6-21.5%) for metal abutments. Abutment screw loosening was the most frequent technical problem, occurring at an estimated cumulative incidence after 5 years of 5.1% (95% CI: 3.3-7.7%). All-ceramic crowns supported by ceramic abutments exhibited similar annual fracture rates as metal-ceramic crowns supported by metal abutments. The cumulative incidence of biological complications after 5 years was estimated at 5.2% (95% CI: 0.4-52%) for ceramic and 7.7% (95% CI: 4.7-12.5%) for metal abutments. Esthetic complications tended to be more frequent at metal abutments. A meta-analysis of the laboratory data was impossible due to the non-standardized test methods of the studies included. The 5-year survival rates estimated from annual failure rates appeared to be similar for ceramic and metal abutments. The information included in this review did not provide evidence for differences of the technical and biological outcomes of ceramic and metal abutments. However, the information for ceramic abutments was limited in the number of studies and abutments analyzed as well as the accrued follow-up time. Standardized methods for the analysis of abutment strength are needed.
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                Author and article information

                Contributors
                Rubén Agustín-Panadero: Role: Formal analysis
                Blanca Serra-Pastor: Role: InvestigationRole: SupervisionRole: Writing – original draft
                Ana Roig-Vanaclocha: Role: Data curationRole: Formal analysis
                Antonio Fons-Font: Role: MethodologyRole: Project administrationRole: Resources
                María Fernanda Solá-Ruiz:
                ORCID: http://orcid.org/0000-0002-7946-6932
                Role: ConceptualizationRole: Writing – review & editing
                Rafael Sarkis-Onofre: Role: Editor
                Journal
                Journal ID (nlm-ta): PLoS One
                Journal ID (iso-abbrev): PLoS ONE
                Journal ID (publisher-id): plos
                Journal ID (pmc): plosone
                Title: PLoS ONE
                Publisher: Public Library of Science (San Francisco, CA USA )
                ISSN (Electronic): 1932-6203
                Publication date (Electronic): 8 August 2019
                Publication date Collection: 2019
                Volume: 14
                Issue: 8
                Electronic Location Identifier: e0220551
                Affiliations
                [001]Department of Dental Medicine, Faculty of Medicine and Dentistry, Valencia University, Valencia, Spain
                Meridional Faculty IMED, BRAZIL
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0002-7946-6932
                Article
                Publisher ID: PONE-D-18-28489
                DOI: 10.1371/journal.pone.0220551
                PMC ID: 6687178
                PubMed ID: 31393888
                SO-VID: 2741e3ba-8b57-494e-a8ba-14658937d910
                Copyright © © 2019 Agustín-Panadero et al
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 16 October 2018
                Date accepted : 18 July 2019
                Page count
                Figures: 7, Tables: 2, Pages: 11
                Funding
                The authors received no specific funding for this work.
                Categories
                Subject: Research Article
                Subject: Biology and Life Sciences
                Subject: Bioengineering
                Subject: Biotechnology
                Subject: Medical Devices and Equipment
                Subject: Medical Implants
                Subject: Biomaterial Implants
                Subject: Engineering and Technology
                Subject: Bioengineering
                Subject: Biotechnology
                Subject: Medical Devices and Equipment
                Subject: Medical Implants
                Subject: Biomaterial Implants
                Subject: Medicine and Health Sciences
                Subject: Medical Devices and Equipment
                Subject: Medical Implants
                Subject: Biomaterial Implants
                Subject: Biology and Life Sciences
                Subject: Bioengineering
                Subject: Biotechnology
                Subject: Medical Devices and Equipment
                Subject: Medical Implants
                Subject: Titanium Implants
                Subject: Engineering and Technology
                Subject: Bioengineering
                Subject: Biotechnology
                Subject: Medical Devices and Equipment
                Subject: Medical Implants
                Subject: Titanium Implants
                Subject: Medicine and Health Sciences
                Subject: Medical Devices and Equipment
                Subject: Medical Implants
                Subject: Titanium Implants
                Subject: Physical Sciences
                Subject: Chemistry
                Subject: Chemical Elements
                Subject: Titanium
                Subject: Physical Sciences
                Subject: Chemistry
                Subject: Chemical Elements
                Subject: Lithium
                Subject: Biology and Life Sciences
                Subject: Bioengineering
                Subject: Biotechnology
                Subject: Medical Devices and Equipment
                Subject: Assistive Technologies
                Subject: Prosthetics
                Subject: Engineering and Technology
                Subject: Bioengineering
                Subject: Biotechnology
                Subject: Medical Devices and Equipment
                Subject: Assistive Technologies
                Subject: Prosthetics
                Subject: Medicine and Health Sciences
                Subject: Medical Devices and Equipment
                Subject: Assistive Technologies
                Subject: Prosthetics
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Digestive System
                Subject: Teeth
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Digestive System
                Subject: Teeth
                Subject: Biology and Life Sciences
                Subject: Anatomy
                Subject: Head
                Subject: Jaw
                Subject: Teeth
                Subject: Medicine and Health Sciences
                Subject: Anatomy
                Subject: Head
                Subject: Jaw
                Subject: Teeth
                Subject: Physical Sciences
                Subject: Materials Science
                Subject: Materials
                Subject: Ceramics
                Subject: Physical Sciences
                Subject: Physics
                Subject: Classical Mechanics
                Subject: Damage Mechanics
                Subject: Material Fatigue
                Subject: Physical Sciences
                Subject: Materials Science
                Subject: Materials Physics
                Subject: Material Fatigue
                Subject: Physical Sciences
                Subject: Physics
                Subject: Materials Physics
                Subject: Material Fatigue
                Custom metadata
                Data Availability All relevant data are within the paper.

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