A comparison of the porcelain fracture resistance of screw-retained and cement-retained implant-supported metal-ceramic crowns

Abstract

Statement of problem The presence of a screw opening on the occlusal surface of implant-supported metal-ceramic crowns may decrease the porcelain fracture resistance and shorten the longevity of the crown. Purpose The purpose of this study was to compare the porcelain fracture resistance between screw-retained and cement-retained implant-supported metal-ceramic crowns and to assess whether narrowing the occlusal table or offsetting the screw-access opening affects fracture resistance. Material and methods Forty standardized maxillary premolar metal copings were fabricated with a Pd-Ga alloy (Protocol) on an implant abutment. Copings were divided into 4 groups (n=10): Group 1 (Screw-retained; occlusal surface buccolingual width=5 mm), screw access opening placed in the center of the occlusal surface; Group 2 (Screw-retained; occlusal surface buccolingual width = 5 mm), screw access opening positioned 1 mm offset from the center of the occlusal surface toward the buccal cusp; Group 3 (Cement-retained; occlusal surface buccolingual width = 5 mm), copings were not altered; and Group 4 (Cement-retained; occlusal surface buccolingual width = 4 mm), copings designed to have a reduced occlusal surface width. All castings were finished with aluminum oxide stones and airborne-particle abraded. Two layers of opaque and dentin porcelain were applied, respectively, on all specimens, which were then glazed. The crown specimens were positioned in a custom testing apparatus and vertically loaded on the middle of the occlusal surface with a universal testing machine at a crosshead speed of 0.5 mm/min until fracture. Mean values of load at fracture (Kgf) were calculated in each group and compared with a 1-way analysis of variance and Tukey's Studentized test (α=.05). Results Mean values of loads required to fracture the crowns were as follow: Group 1: 95.01±46.6 Kgf; Group 2: 108.61±57.9 Kgf; Group 3: 390.94±151.3 Kgf; Group 4: 380.04±211.8 Kgf. Groups 1 and 2 required a significantly lower force to fracture the crowns compared with Groups 3 and 4 ( P=.0001). Comparing Group 1 with 2 ( P=.9) and Groups 3 with 4 ( P=.6), no significant differences were noted. Conclusions Screw-retained implant-supported metal-ceramic crowns demonstrated a significantly lower porcelain fracture resistance than cement-retained crowns. Placing the screw access opening 1 mm offset from the center of the occlusal surface did not result in lower fracture resistance. Cement-retained crowns with 4- or 5-mm buccolingual width of the occlusal surface showed similar porcelain fracture resistance.