Effect of screw access hole on the fracture load of implant-supported monolithic translucent zirconia crowns after mechanical cycling

To evaluate the effect of screw access hole (SAH) presence and location on the marginal and intaglio fit and fracture resistance of zirconia crowns. Implants were placed in a maxillary first molar dentiform at 0, 15 and 30 degrees- angulations. Based on implant angulation, custom titanium abutments and zirconia crowns were fabricated. Crowns were divided into 4 groups: 0/NSAH (no SAH), 0/SAH (SAH at 0 degrees), 15/SAH (SAH at 15 degrees) and 30/SAH (SAH at 30 degrees), with 13 specimens er group. Marginal and intaglio gaps were measured using the silicone replica technique. Crowns were cemented with resin cement after sandblasting. All specimens underwent thermocycling and dynamic loading. Fracture load was measured using a universal testing machine. Fracture surfaces were analyzed with SEM and fracture patterns were classified. The 0/NSAH group exhibited significantly greater marginal and intaglio gaps and higher fracture load than the SAH groups (P <.05). No significant differences were observed among the SAH groups. The occlusal area gap was the largest across all groups. SAH location affected fracture patterns: fractures in the 0/SAH and 15/SAH groups commonly involved the SAH, while those in the 30/SAH group did not. The presence of an SAH improved fit but reduced fracture resistance. SAH location did not influence fit or strength but affected fracture pattern depending on proximity to the loading point.

This study aimed to assess the influence of translucent monolithic versus bilayered crowns and whether the use of a CoCr base abutments affects the fatigue and fracture resistance of screwed implant-supported single crowns with external connections under mechanical cycling. Fifty specimens were divided into groups: (1) metal-ceramic (MC) crown, (2) veneered zirconia crown (Zr), (3) veneered zirconia crown with a CoCr base abutment (ZrB), (4) monolithic translucent zirconia crown (MZr), and (5) monolithic translucent zirconia crown with a CoCr base abutment (MZrB). Specimens underwent mechanical cycling (5 × 106 cycles; 150 N) evaluating fatigue resistance (number of failures) and those that failed were subsequently subjected to fractographic analyses (stereomicroscope and scanning electron microscope) to evaluate failure location and area, and maximum fracture load was also measured. The failure-related survival rate (100%) and maximum fracture resistance of the MZrB were significantly higher than those of MC and Zr (50%; p < 0.05). There were no significant differences in the failure rate and fracture resistance when a CoCr base abutment was used or not in the translucent monolithic Zr groups (p > 0.05;MZrB vs. MZr). Failure location, with MC crowns' fractures, noted at the screw area (p = 0.043), while all-ceramic crowns were mostly in the cuspid and to failure area, the Zr group had the largest mean (15.55 ± 9.17 mm2) among the groups, significant difference only when compared with MC (1.62 ± 0.81 mm2) (p = 0.025). Translucent monolithic zirconia crowns exhibited significantly higher fatigue and fracture resistance compared with conventional MC and bilayered crowns. The appropriate choice of material and manufacturing technique is crucial for predicting the higher clinical performance of single crowns. Enhanced mechanical resistance in terms of fatigue and fracture resistance can be achieved by replacing MC and bilayered restorations with computer-aided design and computer-aided manufacturing monolithic zirconia.

This study investigated the impact of different veneering design on the fracture resistance and failure mode of layered translucent zirconia crowns, compared to the full monolithic zirconia crowns. Ninety crowns with different designs were divided into six groups (n=15); one fully contoured monolithic crown (FMC), one fully veneered with porcelain (FVC), or four partially veneered designs. All crowns were thermo-cycled, and then loaded to failure in a universal testing machine. The fracture resistance (N) and fracture modes were assessed. One-way ANOVA was performed followed by Tukey's multiple comparison (α<0.05). Results demonstrated that all the tested partially veneered designs exhibited enhanced fracture resistances and were comparable to that of the full-contour monolithic translucent zirconia crowns.

Long-term results of a randomized clinical trial of 2 types of ceramic crowns in participants with extensive tooth wear

To evaluate the effect of screw access hole design on the fracture resistance of cement-retained implant-supported zirconia-based restorations with screw access holes. Thirty cement-retained implant-supported zirconia-based molar crown specimens were fabricated. The specimens were divided into 3 groups of 10: without access holes (C), with screw access holes (S), and with screw access holes accompanied with a surrounding zirconia wall (W). The veneering ceramic thickness was 0.8 mm in all groups. Implants were vertically mounted in a metal block. Abutments were screwed on the implants and the specimens were cemented to the abutments. A universal testing machine applied compressive forces to the specimens until fracture. Fracture resistance values of the specimens were measured. One-way analysis of variance (ANOVA) and Tukey HSD tests were used to analyze data (P < .05). The mean fracture resistance values were 5794.85 N for C, 2691.48 N for S, and 3878.06 N for W. The screw access hole design significantly affected the fracture resistance (P < .0001). Significant differences were found between C and S (P < .001), C and W (P < .001), and S and W (P = .026). The screw access hole decreased the fracture resistance. A surrounding zirconia wall for the screw access hole increased the fracture resistance. Screw access hole design may affect the fracture resistance of cement-retained implant-supported zirconia-based restorations with screw access holes. This study introduced a screw access hole design to improve the fracture resistance of these restorations.

Purpose: To evaluate the effect of endodontic access hole preparation and choice of luting cement on the fracture resistance of translucent zirconia (5Y) crowns. Materials and Methods: Polymethylmethacrylate (PMMA) dies, representing a prepared maxillary molar tooth, were milled. Translucent zirconia crowns were milled from 5Y (Cercon XTML) zirconia discs and sintered. Forty crowns were divided into four groups (n = 10 per group) based on access hole preparation (accessed, non-accessed) and type of luting cement (resin cement, resin modified glass ionomer (RMGI) cement). Crowns were cemented on the PMMA dies with either resin cement (Panavia SA Cement Universal, Kuraray Noritake Dental Inc.) or RMGI cement (RelyX Luting Plus, 3M, US) under constant weight (500 g) and incubated (37°C) for twenty-four hours. In half of the samples, a uniform endodontic access hole was created using a diamond bur under water irrigation and restored immediately using resin composite (Filtek Supreme Ultra, 3M ESPE). The fracture resistance of the specimens was tested on an Instron 5566 universal testing machine with a stainless-steel ball indenter and the maximum load before failure was recorded as fracture load (N). Two-way ANOVA testing examined the effect of access hole preparation and luting cement on fracture load of the crowns. Statistical tests were two-sided and significance level was set at 95% (α = 0.05). Results: Fracture load was significantly affected by access hole preparation and choice of luting cement (p &lt; 0.001). Pairwise comparisons revealed that access hole preparation significantly reduced the fracture load of all specimens, regardless of the type of cement used. When resin cement was used, the fracture load was increased in the accessed and non-accessed specimens. Conclusion: Access hole preparation and type of luting cement had significant effects on the fracture load of translucent zirconia crowns

Implant-supported cement–screw-retained crowns combine the advantages of screw-retained and cement-retained crowns. However, the occlusal screw access hole interrupts porcelain integrity, which may result in porcelain cracks or fractures. There is insufficient scientific evidence to prove that screw access holes affect the fracture load of implant-supported monolithic zirconia crowns. In this study, we investigated the effects of the screw access hole and its preparation technique on the fracture load of implant-supported monolithic zirconia single crown. The crowns were designed for the maxillary right first premolar. Three techniques analysed for screw access hole preparations included computer-aided designed/computer-aided manufactured (CAD/CAM) before sintering, manually prepared after sintering, and then resintering. Our findings show that the screw access holes and preparation techniques have no significant effects on the fracture load of implant-supported monolithic zirconia single crown. On the other hand, the screw access hole preparation techniques affect failure initiation in implant-supported monolithic zirconia single crown.

Effect of screw-access hole and mechanical cycling on fracture load of 3-unit implant-supported fixed dental prostheses

BackgroundRetrieval of cement-retained implant-supported restorations is intriguing in cases of screw loosening. Detecting the estimated size of the screw access hole (SAH) could decrease destruction to the prosthesis and preserve the crown.ObjectivesTo precisely localize loose implant screws through cemented crowns to reduce crown damage after screw loosening.Materials and methodsIn this in vitro study, 60 cement-retained implants supported 30 zirconia-based, and 30 ceramics fused to metal (CFM) lower molar crowns were invented, and each was subdivided into three subgroups (10 each). In group I (AI/BI) (control), SAH was created with the aid of orthopantomography (OPG). In contrast, in group II (zirconia-crown), SAH was created with the aid of CBCT + 3D printed surgical guide with a 2 mm metal sleeve in subgroups IIA/IIIA and CBCT + MAR was used to develop SAH in subgroups IIB/IIIB. SEM and Micro-CT scanned the SAH openings to determine the diameter of the hole, cracking, chipping, and chipping volume.ResultsRegarding the effect of plane CBCT and CBCT + MAR on prepared crowns, a highly significant association between group I with group II (p = 0.001) and group III (p = 0.002) was detected. Regarding the cracking of SAH, significant differences between the zirconium crown and CFM restoration (p = 0.009) were found, while for the chipping, no significant association was seen between groups (p = 0.19).ConclusionsCBCT, either as a plane CBCT or with MAR, significantly improved the accuracy of drilling the screw channel and decreased injury to the existing restoration and abutment, aiding in better localization of SAH in loosened implant abutment screws.

The purpose of this study was to assess the influence of sealing of the screw access hole (SAH) on the fracture resistance of metal-ceramic implant-supported restorations. UCLA abutments were used to make 30 implant-retained mandibular molar restorations and divide equally into three groups: Group SRS: screw-retained restorations with SAH sealed; Group SRNS: screw-retained restorations with SAH not sealed; Group CR: cement-retained restorations. The following protocol was adopted to restore the SAH: the ceramic surface of the SAH was air-abraded with aluminum oxide; etched with 10% hydrofluoric acid; a silane coupling agent and a bonding agent were applied; cotton pellets were used as filling material and P-60 resin composite as restoring material. The cement-retained restorations were cemented with Rely-X U100. A metal rod with a spherical tip of 6.0 mm diameter was used to apply a vertical static load, simultaneously on the buccal and lingual incline cusps, at a crosshead speed of 0.5 mm/min until the fracture of the specimens. Data were analyzed using one-way ANOVA and Dunnet test (p<0.05) for multiples comparisons. The mode of failure was evaluated by a scanning electron microscopy (SEM). No significant difference between screw-retained restorations was found. The highest mean fracture resistance values were observed with CR group. Therefore, it was shown that SAH sealing did not influence the fracture resistance of the screw-retained restorations.

To compare four different types of monolithic zirconia crowns in terms of survival rate and fracture resistance after thermocycling and/or thermo-mechanical loading in a chewing simulator. Partially stabilized zirconia (PSZ) crowns with fiber-reinforced resin die assemblies (n=80) were fabricated using: multi-yttria-layered 5Y-PSZ/3Y-PSZ, multi-yttria-layered 5Y-PSZ/4Y-PSZ, monolithic 4Y-PSZ, and monolithic 3Y-PSZ as control (n=20). Half of the samples in each group were subjected to thermo-mechanical loading under 110N, 1.4Hz, 1.2 million cycles with simultaneous thermocycling (10,000cycles, 5-55°C). The other half were subjected to thermocycling alone. The samples were loaded to failure to measure their fracture resistance. The data were analyzed using by two-way ANOVA and Tukey's HSD post-hoc test (α=0.05). All specimens survived the aging protocols. The yttria content significantly affected the fracture resistance of the crowns (p<0.0001). The mean fracture resistance, from highest to lowest: 3Y-PSZ, 4Y-PSZ, followed by the two multi-yttria-layered systems. The mean difference between the two multi-yttria-layered systems were not statistically significant (p=0.98). The mechanical loading protocol did not affect the mean fracture resistance within each group (p=0.18). Within each group, there was no difference in fracture resistance after thermocycling alone and thermo-mechanical loading. However, increasing the yttria concentration at the occlusal third of the crown decreased its fracture resistance. The term "monolithic zirconia" alone without specifying the actual yttria content is misleading. This term represents different materials with different mechanical properties. The yttria content has an inverse relationship with the fracture resistance of zirconia crowns. The fracture resistance of multi-layer zirconia crowns is determined by the amount of the weaker zirconia phase at the occlusal part of the restoration rather than enforced by the stronger zirconia at the cervical part of the crown.

To test the push-out force and marginal leakage of different screw hole-sealing methods in monolithic zirconia implant crowns. Ninety monolithic zirconia (Prettau, Zirkonzahn) specimens were milled with two different screw access hole designs: conventional smooth hole or threaded screw hole (for group PMMA-SC), and divided into five groups (n = 18) according to filling method: unbonded composite (UBC); bonded composite (BC); airborne-particle abrasion of screw hole and unbonded composite (ABR-UBC); airborne-particle abrasion of screw hole and bonded composite (ABR-BC); and PMMA screw plugs (PMMA-SC). Twelve specimens per group were subjected to static push-out force with a universal testing machine. Before testing, 6 specimens per group were stored in dry conditions, and 6 were kept in water storage (+37°C) for 7 days. For the remaining specimens (n = 6), cotton pellets were placed under the screw access hole fillings, and the specimens were immersed in 0.5% basic fuchsin solution for 2 weeks. Dye in cotton pellets was dissolved in 2 mL of water, and absorbances of the solutions were measured with a spectrophotometer at 465 nm. Data are reported as mean and SD. Statistical analysis was made using a generalized linear model with logarithmic transformation. PMMA-SC specimens showed the highest push-out forces (P < .0001) and lowest fuchsin penetration (P = .009). Airborne-particle abrasion increased the push-out force and decreased the microleakage in composite groups. The storage conditions affected the results of both unbonded groups. The design and sealing method of the screw access hole affect push-out force and microleakage.

Introduction Screw-retained restorations have a screw access hole (SAH) sealed with resin composite aiming at safe-guarding the aesthetic features of the ceramic veneer. The loss or wear of the resin composite applied in sealing the SAH is among the most common complications in implant prosthodontics, as the fracture of ceramic veneer. Objective Evaluate the influence of sealant materials on the fracture resistance of resin composite applied in sealing screw access hole in screwed (SAH) implants. Material and method The samples were produced from UCLA abutments in metallic NiCr alloy with subsequent application of ceramic. After asperisation and conditioning ceramic surface, was applied silane and dentin adhesive, before sealing the conduits with resin composites Z100 and P60. Nine groups (n=10) were evaluated: sealing with Z-100 (ZNC) and P-60 (PNC) without obturation of SAH; sealing with Z100 (ZCP) and P-60 (PCP) with absorbent cotton; Z100 (ZPT) and P60 (PPT) with polytetrafluoroethylene; Z100 (ZGP) and P60 (PGP) with gutta-percha and a cemented ceramic crown (ICS). After the fracture resistance test, the data were analyzed using two-way ANOVA and Tukey HSD tests (p&lt;.05). Result The fracture mode was evaluated by scanning electron microscope. Irrespective of the filling material, the highest mean values of fracture resistance were observed in the sealing with P60 (p=.002). When combined with resins composed of a sealing material, the results obtained were: ZGP: 805.5N/ PGP: 929.5N&lt;ZPT: 1079.1N/ PPT: 1149.5N=ZNC 1183.1N/ PNC: 1350.6N&lt;ZCP: 1403.6N/ PCP: 1641.3N&lt;ICS: 2645.0N. Conclusion The use of P60 with cotton wool exhibited the highest fracture resistance.

To assess the influence of a screw access hole (SAH) and mechanical cycling on the fracture load of implant-supported crowns (ISCs) manufactured with screw-retained (s) or cement-retained (c) abutments with either metal (M) or zirconia (Z) infrastructure. Six groups of restorations were made based on type of infrastructure (M or Z), fixation (s or c), and whether they underwent aging (a) with mechanical cycling: Zc, Zs, Zsa, Mc, Ms, and Msa. All ISCs were porcelain veneered and tested for compression to failure in distilled water (37°C) using a universal testing machine. ISCs from groups Zsa and Msa were mechanically cycled (106 cycles; 2 Hz, 100 N) in distilled water before compressive testing. Fractographic principles were followed to assess the fracture surfaces. The fracture load data were statistically analyzed using one-way analysis of variance and Tukey test (α = .05). The relationships between experimental group and failure mode were analyzed using chi-square test (α = .05). Regardless of the infrastructure material, cement-retained ISCs (Zc and Mc) showed higher fracture load values than screw-retained ISCs (Zs, Zsa, Ms, and Msa) (P < .001), which were statistically similar to each other (P > .05). Aging had no effect on the fracture load of ISCs. There was a significant relationship between failure mode and experimental group (P < .001). Catastrophic fractures were found only in Zc and Zs. All metal-based ISCs failed from chipping reaching the metal infrastructure. Cement-retained ISCs showed higher fracture resistance than screw-retained prostheses. No catastrophic failures were found for metal-based ISCs. Aging did not affect the fracture load, but did affect the failure mode of ISCs.

The effect of post type and length on the fracture resistance of endodontically treated teeth