In Vitro Investigations in a Biomimetic Approach to Restore One-Piece Zirconia Implants.

Reto Nueesch,Jens Fischer,Nadja Rohr,Sabrina Märtin

doi:10.3390/ma14164361

Abstract

The objective of this study was to evaluate the fracture load and retention force of different bonding systems while restoring one-piece zirconia implants with a novel cementation approach using a mesostructure. Polymer-infiltrated ceramic mesostructures (n = 112) were therefore designed as caps on the implant abutment, and a molar feldspathic ceramic crown was constructed on top of it as a suprastructure. For cementation, different bonding systems were used. Fracture load and retention force were measured immediately after storage in water at 37 °C for 24 h (n = 8) as well as after artificial aging in a chewing simulator and subsequent thermal cycling (n = 8). Combined restorations showed higher fracture load compared to monolithic restorations of polymer-infiltrated ceramic (n = 8) or feldspathic ceramic (n = 8) identical in shape. However, the fracture load of the combined restorations was significantly affected by aging, independent of the primers and cements used. Restorations cemented with primers containing methyl methacrylate and 10-methacryloyloxydecyl dihydrogen phosphate exhibited the highest retention force values. Aging did not affect the retention force significantly. Similar fracture load values can be expected from combination restorations when compared with monolithic crowns.

Highlights

IntroductionDue to successful osseointegration as well as clinical reliability and based on welldocumented scientific data, commercially pure titanium or its alloys with a moderately rough surface are the gold standard for dental implants [1].With a survival rate of 94.3–98.4% after 3–5 years of functional loading and a mean peri-implant bone loss of 0.7–1.0 mm [2,3,4], implants made from zirconia (ZrO2) have been introduced as a possible alternative to titanium implants [5,6,7,8,9,10].Today, cement-retained ceramic crowns are the common restorations used on one-piece zirconia implants
Laboratory results testing monolithic solutions for the restoration of one-piece zirconia implants with zirconia, lithium disilicate, and even more elastic materials such as polymer, composite, or polymer-infiltrated ceramic suggest that all tested monolithic materials can be recommended for use on zirconia implants from a mechanical point of view [15,16,17,18,19,20], provided that a resin composite cement with high compressive strength is used for cementing the restoration on the abutment [16,17,20]
No cement residues could be detected on the implant abutment for these groups; in Group 4, fragments of the restoration adhered to the abutment

Summary

Introduction

Due to successful osseointegration as well as clinical reliability and based on welldocumented scientific data, commercially pure titanium or its alloys with a moderately rough surface are the gold standard for dental implants [1].With a survival rate of 94.3–98.4% after 3–5 years of functional loading and a mean peri-implant bone loss of 0.7–1.0 mm [2,3,4], implants made from zirconia (ZrO2) have been introduced as a possible alternative to titanium implants [5,6,7,8,9,10].Today, cement-retained ceramic crowns are the common restorations used on one-piece zirconia implants. Clinical studies have reported unacceptable rates of veneer chipping of up to 47% after up to five years for one-piece zirconia implant-supported veneered zirconia crowns [8,11,12,13]. Clinical results for zirconia implant-supported monolithic lithium disilicate restorations showed a survival rate of 100% after five years. Laboratory results testing monolithic solutions for the restoration of one-piece zirconia implants with zirconia, lithium disilicate, and even more elastic materials such as polymer, composite, or polymer-infiltrated ceramic suggest that all tested monolithic materials can be recommended for use on zirconia implants from a mechanical point of view [15,16,17,18,19,20], provided that a resin composite cement with high compressive strength is used for cementing the restoration on the abutment [16,17,20]

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Discussion

Conclusion