All-ceramic Fixed Partial Dentures Research Articles

Fracture behavior of inlay and onlay fixed partial dentures – An in-vitro experimental and XFEM modeling study

ObjectivesThis study aimed to explore the “sensitivity” of the fracture load and initiation site to loading position on the central occlusal surface of a pontic tooth for both all-ceramic inlay retained and onlay supported partial denture systems. Materials and methodsThree dimensional (3D) finite element (FE) inlay retained and onlay supported partial denture models were established for simulating crack initiation and propagation by using the eXtended Finite Element Method (XFEM). The models were subjected to a mastication force up to 500N on the central fossa of the pontic. The loading position was varied to investigate its influence on fracture load and crack path. ResultsSmall perturbation of the loading position caused the fracture load and crack pattern to vary considerably. For the inlay fixed partial dentures (FPDs), the fracture origins changed from the bucco-gingival aspect of the molar embrasure to the premolar embrasure when the indenter force location is slightly shifted from the mesial to distal side. In contrast, for onlay FPDs, cracking initiated from bucco-gingival aspect of the premolar embrasure when the indenter is slightly shifted to the buccal side and from molar embrasure when the indenter is shifted to the lingual side. ConclusionsThe fracture load and cracking path were found to be very sensitive to loading position in the all-ceramic inlay and onlay FPDs. The study provides a basis for improved understanding on the role of localized contact loading of the cusp surface in all-ceramic FPDs.

Effect of Framework Design on Fracture Resistance in Zirconia 4-unit All-ceramic Fixed Partial Dentures

The purpose of this study was to conduct static load-bearing tests on 4-unit Y-TZP all-ceramic fixed partial denture (FPD) frameworks with different cross-sectional areas and forms to evaluate the influence of connector design on fracture load. Each of the central, mesial and distal connectors was prepared with one of 2 different cross-sectional areas and one of 3 different forms (one circular and two oval forms) to give a total of 18 designs. Five frameworks were then prepared for each design, making a total of 90. Each framework was cemented to the test model with glass ionomer cement. Fracture load was measured with a universal testing machine at a cross-head speed of 1.0 mm/min. A three-way ANOVA revealed significant differences in fracture load depending on cross-sectional area, central connector cross-sectional form, or mesial/distal connector cross-sectional form (p<0.01). No interaction was observed, however, between any two connector design elements. The results of a Tukey analysis revealed a significant difference between the two connector cross-sectional areas investigated, with an increase in connector cross-sectional area resulting in an increase in fracture load. Fracture load decreased as the height of the mesial or distal connector decreased. Fracture load was significantly higher in frameworks in which the height of the central connector was greater than that of the distal or mesial connector. In conclusion, these results suggest that sufficient height needs to be maintained in the mesial/distal connector to secure a high fracture load in zirconia 4-unit all-ceramic FPDs. Moreover, even when this is not possible, a high fracture load may still be obtained by making the height of the central connector as great as possible. Furthermore, extending the connector cross-sectional area is effective in increasing fracture load.

Clinical evaluation of posterior all-ceramic FPDs (Cercon): A prospective clinical pilot study

This study prospectively evaluated the clinical performance of posterior zirconium-oxide-based all-ceramic fixed partial dentures (FPDs). Forty-two abutments of 21 Cercon FPDs were fitted in 20 patients at the Tsurumi University Dental Hospital from August 2005 to August 2006. The performance of these FPDs was evaluated using the California Dental Association (CDA) quality assessment system at baseline and at all follow-up examinations. All FPDs were examined after a mean observation period of 28.1 (+/-3.4) months. During the observation period, no fracturing of FPDs was seen. All of the FPDs examined were rated as satisfactory with regard to all factors at the follow-up examinations based on the CDA quality assessment criteria. Within the limitations of this short-term clinical study, no core framework fractures were seen. According to the CDA criteria, 100% of the FPDs were rated as satisfactory during this observation period.

The Influence of the Loading Mode on the Stress Distribution on the Connector Region of Metal‐ceramic and All‐ceramic Fixed Partial Denture

Studies pertaining to the mechanical behavior of fixed partial dentures (FPDs) frequently found the highest tensile stress values at the connector region when load is applied at the pontic central region. The connector region is considered the weakest point of the prosthesis with the greatest potential of fractures, regardless of the material used. This 2D finite element study compared the stress distribution on three-element all-ceramic and metal-ceramic FPDs with different loading conditions. Three FPD models were designed: (i) metal-ceramic FPD; (ii) all-ceramic FPD with the veneering porcelain only on the occlusal face; and (iii) all-ceramic FPD with the veneering porcelain on the occlusal and cervical face of the pontic. Loads of 100 N were applied following these simulations: (i) distributed on all working cusps; (ii) only on the abutment teeth; and (iii) only on the pontic. There is a significant change on the stress distribution and on the tensile stress values when the load configuration is changed. The stress distribution from the load applied on the abutments was significantly better compared with the other two load simulations. When the loads were applied on the pontic and distributed on all working cusps, the highest tensile stress values appeared on the cervical region of the connectors between the abutments and the pontic. However, when the load was applied on the abutment teeth, the maximum tensile stress value significantly decreased and was located on the occlusal region of the connectors. In fact, the load applied on the pontic region does not simulate the clinical situation. Studies using this load configuration have overestimated the connector regions as having the highest probability of failures.

Effect of Framework Shape on the Fracture Strength of Implant‐Supported All‐Ceramic Fixed Partial Dentures in the Molar Region

The aim of the present study was to clarify the effects of the shape of the zirconium framework of implant-supported, all-ceramic fixed partial dentures (FPDs) on the fracture strength and fracture mode. This study consisted of mechanical strength testing and 3D finite element analysis (FEA). The three framework shapes used in this study were: (1) conventional shape (control); (2) convex shape: 1.0-mm curve in the direction of the occlusal surface; and (3) concave shape: 1.0-mm curve in the direction of the gingival surface. Five frameworks were made for each condition (total: 15). A load (N) was applied until the FPD fractured. For FEA, a 3D model consisting of cortical bone, cancellous bone, implant bodies, and superstructure was constructed. The results of the mechanical strength test showed that fracture load was 916.0 +/- 150.1 N for the conventional shape, 1690.5 +/- 205.3 N for the convex shape, and 1515.5 +/- 137.0 N for the concave shape. The mean final fracture load for the FPDs with frameworks was the highest for the convex shape; however, a critical crack in the veneer porcelain (736.5 +/- 145.2 N) was confirmed during loading for the convex shape. Stress distribution maps for all conditions showed that tensile stress was generated at the veneer porcelain on the gingival side of the mesial and distal connectors of the pontic; however, there were differences in the maximum value and stress distribution within the framework. The shape of the framework, particularly the shape of the pontic-connector interface, affects the stress distribution, fracture strength, and fracture mode of all-ceramic FPDs, and stress concentration inside a framework may induce cracking of layering porcelain.

Intraoral Repair of All Ceramic Fixed Partial Denture Utilizing Preimpregnated Fiber Reinforced Composite

All ceramic fixed partial dentures (FPD)s exhibit enhanced biocompatibility and esthetics as compared to metal-ceramic restorations. However, framework fractures are frequently reported especially when the connector dimensions are inadequate to withstand the high tensile stresses. The repair of the failed connector would be desirable rather than the complete removal and renewal since the latter is an expensive and time consuming procedure. Furthermore, the replacement or removal of the restoration for extra-oral repair purposes might increase the risk of destroying the entire restoration or damaging the abutment teeth during the removal. This article presents a direct intra-oral method that may be used to repair the connector fractures of all-ceramic FPDs which are otherwise clinically satisfactory. In the present technique, the connector is reconstructed intraorally utilizing composite resin restorative material reinforced with E-glass-fiber.

All-ceramic and porcelain-fused-to-metal fixed partial dentures: a comparative study by 2D finite element analyses

All-ceramic fixed partial dentures (FPDs) have an esthetic approach for oral rehabilitation. However, metal-ceramic FPDs are best indicated in the posterior area where the follow-up studies found a lower failure rate. This 2D finite element study compared the stress distribution on 3-unit all-ceramic and metal-ceramic FPDs and identified the areas of major risk of failure. Three FPD models were designed: (1) metal-ceramic FPD; (2) All-ceramic FPD with the veneering porcelain on the occlusal and cervical surface of the abutment tooth; (3) All-ceramic FPD with the veneering porcelain only on the occlusal surface. A 100 N load was applied in an area of 0.5 mm2 on the working cusps, following these simulations: (1) on the abutment teeth and the pontic; (2) only on the abutment teeth; and (3) only on the pontic. Relative to the maximum stress values found for the physiological load, all-ceramic FPD with only occlusal veneering porcelain produced the lowest stress value (220 MPa), followed by all-ceramic FPD with cervical veneering porcelain (322 MPa) and metal-ceramic FPD (387 MPa). The stress distribution of the load applied on the abutments was significantly better compared to the other two load simulations. The highest principal stress values were low and limited in a small area for the three types of models under this load. When the load was applied on the pontic, the highest stress values appeared on the connector areas between the abutments and pontic. In conclusion, the best stress values and distribution were found for the all-ceramic FPD with the veneering porcelain only on the occlusal surface. However, in under clinical conditions, fatigue conditions and restoration defects must be considered.

Fracture strength of four‐unit Y‐TZP FPD cores designed with varying connector diameter. An in‐vitro study

Reported clinical success rates of all-ceramic fixed partial dentures (FPDs) made of high-strength oxide ceramics range between 82.5% and 100%. The main cause of all-ceramic FPD failure is fracture in the connector area. There is, however, no consensus on what connector dimensions are adequate. The aim of this in-vitro study was, therefore, to compare the fracture strength of four-unit Y-TZP FPD cores designed with different connector diameters. A total of 40 four-unit FPD cores supported by end abutments and having two pontics were manufactured in Procera Zirconia. Five groups of FPD cores with connector dimensions of 2.0, 2.5, 3.0, 3.5 and 4.0 mm were produced. All FPD cores underwent a firing programme according to the manufacturer's recommendations for the veneering porcelain, a cyclic preload, thermocycling and finally, load until fracture. Fracture strength was significantly higher for each increase in connector diameter except for the 2.0-mm and 2.5-mm diameters where all fractures occurred during preload. All FPD cores fractured in the connector area. Within the limitations of this in-vitro study, a minimum diameter of 4.0 mm is recommended for all-ceramic zirconia-based FPDs with long spans or replacing molars. Clinical studies are, however, needed to determine adequate connector dimensions.

Two-year clinical evaluation of lithia-disilicate-based all-ceramic crowns and fixed partial dentures

Objectives The aim of this study was to evaluate the clinical performance of crowns and fixed partial dentures (FPDs) made with the Empress 2 system over a 2-year period. Methods Twenty anterior or posterior all-ceramic (Empress 2) crowns and 20 anterior or posterior, three-unit fixed partial dentures were fabricated for 15 patients. Evaluations of the restorations were performed at baseline and once a year during the 2-year follow-up period. U.S. Public Health Service criteria were used to examine the marginal adaptation, color match, secondary caries and visible fractures in the restorations. Survival rate of the restorations were determined using Kaplan–Meier statistical analysis. Results U.S. Public Health Service criteria showed 100% Alpha scores concerning recurrent caries for both crowns and FPDs. No crown fractures were observed during the 2-year follow-up, however, 10 (50%) catastrophic failures of FPDs occurred. Five (25%) failures occurred within the 1-year clinical period and the others (25%) within the second year. Significance Single unit Empress 2 all-ceramic crowns exhibited a satisfactory clinical performance over 2-year period. Furthermore, the high fracture rate of Empress 2 FPDs limits the usage of Empress 2 for the fabrication of all-ceramic FPD.

Influence of stress simulation parameters on the fracture strength of all-ceramic fixed-partial dentures

This in vitro study tested the influence of diverse stress simulation parameters on the fracture strength of all-ceramic three-unit fixed partial dentures (FPDs). All-ceramic FPDs made of Empress 2 (Ivoclar-Vivadent, FL) were exposed to thermal cycling and mechanical loading (TCML) with varying loading parameters such as chewing force (amount, frequency), thermal loading, lateral jaw motion, abutment material, artificial periodontium or antagonistic denture. To investigate the influence of the abutment material, human teeth, polymer abutments and alloy abutments were used. Two different TCML devices with pneumatic or weight loading were compared. FPDs without aging were used as a control. Combined thermal and mechanical loading significantly reduced the FPD fracture resistance from 1832N to 410N. Duplication of chewing frequency, phase load increase or additional lateral movement did not effect the results. Increasing chewing force, artificial periodontium, and antagonist or abutment material reduced the fracture resistance of the tested FPDs. Different devices with weight or pneumatic loading had no significant influence on the loading capacity of the FPDs. Artificial aging should be performed combining thermal cycling with mechanical loading. Simulation of the artificial periodontium, human antagonists and abutments should be included to achieve a significant aging.

Clinical fit of all‐ceramic three‐unit fixed partial dentures, generated with three different CAD/CAM systems

In this study, the hypothesis was tested that the marginal and internal fit of CAD/CAM fabricated all-ceramic three-unit fixed partial dentures (FPDs) can be as good as in metal-ceramic FPDs. Twenty-four all-ceramic FPDs were fabricated and randomly subdivided into three equally sized groups. Eight frameworks were fabricated using the Digident CAD/CAM system (DIGI), another eight frameworks using the Cerec Inlab system (INLA). Vita Inceram Zirkonia blanks were used for both groups. In a third group frameworks were milled from yttrium-stabilized Zirconium blanks using the Lava system (LAVA). All frameworks were layered with ceramic veneering material. In addition, six three-unit metal-ceramic FPDs served as control group. All FPDs were evaluated using a replica technique with a light body silicone stabilized with a heavy body material. The replica samples were examined under microscope. The medians of marginal gaps were 75 microm for DIGI, 65 microm for LAVA and INLA and 54 microm for the conventional FPDs. Only the DIGI data differed significantly from those of the conventional FPDs. Within the limits of this study, the results suggest that the accuracy of CAD/CAM generated three-unit FPDs is satisfactory for clinical use.

Effects of cantilever design and material on stress distribution in fixed partial dentures – a finite element analysis

The purpose of this study was to examine the stress distribution in distal cantilevered fixed partial dentures (FPDs) that are designed with different cantilever morphology and made from different restorative materials. The finite element (FE) method was used to create models of two restoration types; metal-ceramic and an all-ceramic FPDs. Both models were designed with distal cantilevers involving the first and second premolars as abutments and cantilever extension involving at the premolar or molar. The width of connector between the cantilever and the primary abutment restoration was 2.25 mm. The load applied during the FE analysis was positioned at the cusp tips of all teeth. The FE analysis of the models revealed that Von Mises stress values with maximum stress concentrations were observed on connectors of distal cantilevers. Stress concentration sites were also observed at the distal cervical area of the second premolar tooth. Models with premolar cantilever extensions restored with all-ceramic induced lower Von Mises stress values than metal-ceramic restorations, however models with molar cantilever extensions restored with all-ceramic restorations induced higher Von Misses stress values than metal-ceramic restorations. If the distal cantilever length and restorative material is appropriately chosen, the failure frequency may be reduced. All ceramic can be used as restorative material, when the cantilevers length is not more than the mesiodistal dimension of a premolar tooth and metal-ceramic restorations can be used in longer situations.

Viscoelastic finite element analysis of an all-ceramic fixed partial denture

In recent years metal-free ceramic systems have become increasingly popular in dental practice because of their superior aesthetics, chemical durability and biocompatibility. Recently, manufacturers have proposed new dental ceramic systems that are advertized as being suitable for posterior fixed partial dentures (FPDs). Reports indicate that some of these systems have exhibited poor clinical performance. The objective of this study was to use the viscoelastic option of the ANSYS finite element program to calculate residual stresses in an all-ceramic FPD for four ceramic–ceramic combinations. A three-dimensional finite element model of the FPD was constructed from digitized scanning data and calculations were performed for four systems: (1) IPS Empress ® 2, a glass-veneering material, and Empress ® 2 core ceramic; (2) IPS Eris™ a low fusing fluorapatite-containing glass-veneering ceramic, and Empress ® 2 core ceramic; (3) IPS Empress ® 2 veneer and an experimental lithium–disilicate-based core ceramic; and (4) IPS Eris TM and an experimental lithium–disilicate-based core ceramic. The maximum residual tensile stresses in the veneer layer for these combinations are as follows: (1) 77 MPa, (2) 108 MPa, (3) 79 MPa, and (4) 100 MPa. These stresses are relatively high compared to the flexural strengths of these materials. In all cases, the maximum residual tensile stresses in the core frameworks were well below the flexural strengths of these materials. We conclude that the high residual tensile stresses in all-ceramic FPDs with a layering ceramic may place these systems in jeopardy of failure under occlusal loading in the oral cavity.

Residual stresses in bilayer dental ceramics

It is clinically observed that lithia-disilicate-based all-ceramic fixed partial dentures (FPD) can fail because of the fragmentation of the veneering material. The hypothesis of this study is that the global residual stresses within the surface of those veneered FPDs may be responsible for partial fragmentation of the veneering ceramic. Bilayer and monolithic ceramic composites were prepared using a lithia disilicate based (Li 2O⋅SiO 2) glass–ceramic core and a glass veneer. A four-step fracture mechanics approach was used to analyze residual stress in bilayered all-ceramic FPDs. We found a statistically significant increase in the mean flexural strengths of bilayer specimens compared with monolithic glass specimens ( p ⩽ 0.05 ). There was a statistically significant difference between the mean longitudinal and transverse indentation-induced crack sizes in bilayer specimens ( p ⩽ 0.05 ), which indicates the existence of residual stress. Global residual stresses in the veneer layer, calculated using a fracture mechanics equation, were determined to be responsible for the increased strength and observed chipping, i.e., spallation in bilayer ceramic composites.

All-ceramic resin-bonded bridges. A 3-dimensional finite-element analysis study.

Resin-bonded fixed partial dentures (FPD) with a metal framework have some disadvantages: a grey shimmer of the metal wings through the abutment teeth, a higher corrosion rate, and an allergenic potential of the non-precious alloys used. The Al2O3 ceramic In-Ceram seems to be strong enough to serve as a framework for resinbonded all-ceramic FPDs. Because of the fact that ceramic wings often don't have enough inter-occlusal space, a new preparation design was developed. The objective of this study was to determine the influence of load orientation (45 degrees and 60 degrees) and the design of the interproximal connector on the stress distribution in the bridges. A 3-dimensional finite-element model was developed to simulate the anatomical situation. The biting force was assumed as 250 N and oriented in oro-buccal direction. The loading-point was palatal 1.5 mm beneath the incisal edge. It was found that stress generally increased with an angle of the biting force of 60 degrees. A small interdental connector (3 mm height) and/or strong interdental separation resulted in stresses of up to 455 MPa (45 degrees) or 534 MPa (60 degrees). Less separation with rounded edges and a higher connector (4 mm) reduced the stress to 122 MPa (45 degrees) and 143 MPa (60 degrees). Due to an average tensile strength of In-Ceram at 340-400 MPa, an all-ceramic resin-bonded FPD may only be recommended if the height of the connector could be minimum 4 mm. Rounded edges and little interdental separation are significant for stress reduction.

Failure of All-ceramic Fixed Partial Dentures in vitro and in vivo: Analysis and Modeling

Hertzian cone cracks visible at the loading site of 20 all-ceramic fixed partial dentures (FPDs), tested in vitro, led to the hypotheses that failure was due to the propagation of localized contact damage crack systems (Hertzian stress state) and that such damage was an unlikely clinical failure mode. Fractographic analysis of the 20 laboratory-failed and nine clinically-failed all-ceramic FPDs allowed for definitive testing of these hypotheses and a comparison between in vitro and in vivo failure behavior. In all cases, failure occurred in the FPD connectors (none from contact damage), with approximately 70 to 78% originating from the interface between the core and veneer ceramics. The coincidence between failure origins provides strong evidence that the in vitro test modeled aspects of structural behavior having clinical importance. The fractographic observations, coupled with the in vitro failure load data, furnished very specific boundary conditions which were applied to constrain mathematical models of FPD connector failure. Finite element analysis (FEA) of the laboratory FPDs found that maximum principal tensile stresses would occur at locations consistent with the fractographic observations only if: (1) there were appropriate elastic moduli differences between the ceramics; and (2) a small amount of abutment rotation was allowed. Weibull failure probability (Pf) calculations, incorporating FEA stress profiles, very closely replicated the laboratory failure distribution only when: (1) the veneer ceramic was much weaker than the core ceramic; and (2) the Weibull modulus of the core-veneer interface was much lower than that for the free veneer surface (i.e., the interface is of lower quality with regard to defects).(ABSTRACT TRUNCATED AT 250 WORDS)