Mechanical Stability of Zirconia Implant Abutments Supporting Cantilevered Fixed Dental Prostheses After Fatigue Loading.

Abstract

To evaluate the mechanical stability and complication rates of titanium (Ti) or zirconia (Zr) abutments restored with cantilevered fixed dental prostheses (cFDPs) when supported by 1 or 2 implants. A total of 32 samples were fabricated. Half of the samples received 1 implant, and the other half received 2 implants (Bone Level Implant, Ø 4.1, 13 mm, Straumann) to simulate the clinical situation of 2 or 3 missing maxillary incisors, respectively. Each group was divided into two subgroups (n = 8). Ti-I and Ti-II groups received Ti abutments (Anatomic Abutment, Straumann) supporting 2- or 3-unit metal cFDPs, respectively, while Zr-I and Zr-II groups received Zr abutments (IPS e.max Anatomic Abutment, Straumann). Following the cementation of cFDPs using resin cement (Multilink Automix, Ivoclar Vivadent), the samples were subjected to thermomechanical fatigue load and were subsequently loaded until fracture in a universal testing machine. Following the static loading test, stereomicroscopic analyses (Carl Zeiss) were done to identify the weakest component of the cFDP, abutment, and implant assembly. Mann-Whitney U test was used to evaluate the effect of the number of supporting implants and abutment material on fracture strength values, and the level of statistical significance was set at 5% (α = .05). All specimens survived the aging, and no screw loosening or fracture was recorded. The mean fracture strength values were 226 N (± 26.45 ), 551.12 N (± 82.19 ), 601 N (± 41.51 ), and 664.5 N (± 37.59 ) for Zr-I, Zr-II, Ti-I, and Ti-II, respectively. The difference between fracture strength values of Ti and Zr groups was significant in favor of Ti abutments (P < .001). The number of supporting implants showed a significantly positive effect on the fracture strength of Zr abutments. Zirconia abutments demonstrated lower fracture strength values than titanium abutments independent from the number of supporting implants when used under cFDPs. Two-implant supported cFDPs with zirconia abutments have the potential to withstand physiologic forces applied in the anterior region.