Four-unit Fixed Dental Prostheses Research Articles

Comparative Analysis of the Structural Weights of Fixed Prostheses of Zirconium Dioxide, Metal Ceramic, PMMA and 3DPP Printing Resin-Mechanical Implications.

Four groups were studied with eight samples for each material (n: 32). Each structure was weighed, subjected to compressive tests and analyzed using 3D FEA. PMMA presented the lowest structural weight (1.33 g), followed by 3DPP (1.98 g), ZR O2 (6.34 g) and PFM (6.44 g). In fracture tests, PMMA presented a compressive strength of 2104.73 N and a tension of 351.752 MPa; followed by PFM, with a strength of 1361.48 N and a tension of 227.521 MPa; ZR O2, with a strength of 1107.63 N and a tension of 185.098 MPa; and 3DPP, with a strength of 1000.88 N and a tension of 143.916 MPa. According to 3D FEA, 3DPP presented the lowest degree of deformation (0.001 mm), followed by PFM (0.011 mm), ZR O2 (0.168 mm) and PMMA (1.035 mm). The weights of the materials did not have a direct influence on the mean values obtained for strength, stress or strain. Since the performance was related to the tension and forces supported by the structures in critical zones, the importance of considering design factors is clear. In vitro and 3D FEA assays allowed us to simulate different scenarios for the mechanical properties of certain materials before evaluating them clinically. Thus, they can generate predictions that would allow for the design of a better research methodology in future clinical trials.

Accuracy of additively manufactured zirconia four-unit fixed dental prostheses fabricated by stereolithography, digital light processing and material jetting compared with subtractive manufacturing

ObjectiveTo evaluate the manufacturing accuracy of zirconia four-unit fixed dental prostheses (FDPs) fabricated by three different additive manufacturing technologies compared with subtractive manufacturing. MethodsA total of 79 zirconia FDPs were produced by three different manufacturing technologies, representing additive (one stereolithography [aSLA] and one material jetting [aMJ] device, two digital light processing [aDLP1/aDLP2] devices) and subtractive manufacturing (two devices [s1/s2]), the latter serving as references. After printing, additively manufactured FDPs were debound and finally sintered. Subsequently, samples were circumferentially digitized and acquired surface areas were split in three Regions Of Interest (ROIs: inner/outer shell, margin). Design and acquired data were compared for accuracy using an inspection software. Statistical evaluation was performed using the root mean square error (RMSE) and nonparametric Kruskal-Wallis method with post hoc Wilcoxon-Mann-Whitney U tests. Bonferroni correction was applied in case of multiple testing. ResultsRegardless the ROI, significant differences were observed between manufacturing technologies (P < 0.001). Subtractive manufacturing was the most accurate with no significant difference regarding the material/device (s1/s2, P > 0.054). Likewise, no statistical difference regarding accurary was found when comparing s2 with aMJ and aSLA in most ROIs (P > 0.085). In general, mean surface deviation was< 50 µm for s1/s2 and aMJ and< 100 µm for aSLA and aDLP2. aDLP1 showed surface deviations> 100 µm and was the least accurate compared to the other additive/subtractive technologies. SignificanceAdditive manufacturing represents a promising set of technologies for the manufacturing of zirconia FDPs, but not yet as accurate as subtractive manufacturing. Methodological impact on accuracy within and in between different additive technologies needs to be further investigated.

Reliability and aging behavior of three different zirconia grades used for monolithic four-unit fixed dental prostheses

ObjectiveTo investigate the fracture resistance and phase composition of tooth supported four-unit fixed dental prostheses (FDPs) made from three different zirconia grades after loading and aging. MethodsSeventy-two FDPs were fabricated from 3Y-TZP, 4Y-PSZ and 5Y-PSZ. This resulted in 24 FDPs per grade, subdivided into three groups (n = 8): a control group (C), a hydrothermally aged (H2O, 85 °C, 90 days) group (A) and a group subjected to loading (2.5M cycles, 98N) with simultaneous thermal cycling (H2O, 5–55 °C) subsequent to treatment A (AL). Subsequently, FDPs were statically loaded to fracture. Phase composition was quantified by X-ray diffraction (XRD) and μ-Raman spectroscopy. Focused ion beam (FIB) - Scanning electron microscopy (SEM) was used for visualization in-depth. ResultsCompared to 3Y-C FDPs (1233 ± 165N), reduced fracture load was found for 5Y-C FDPs (889 ± 80 N; p < .001). This did not apply for 4Y-C samples (1065 ± 111N). Treatments (A, AL) did not negatively affect the fracture load for the three grades of zirconia (p > .645). Both A and AL increased monoclinic phase content for 3Y and 4Y FDPs, whereas FIB-SEM suggests no transformability of 5Y-PSZ. 5Y-AL FDPs showed cracks and fractures at the abutment walls and restoration margins after dynamic loading. Reduced fracture load of 5Y samples as compared to 3Y and 4Y was associated with deficient transformability in the fracture zone. SignificanceAging and loading did not negatively affect the fracture resistance of monolithic four-unit FDPs made from three grades of zirconia. Due to cracks after dynamic loading, 5Y-PSZ cannot be recommended for the clinical application of four-unit FDPs.

Fracture resistance of monolithic and veneered all-ceramic four-unit posterior fixed dental prostheses after artificial aging.

This study compared the fracture resistance of monolithic and veneered all-ceramic four-unit posterior fixed dental prostheses (FDPs) generated by computer-aided design/computer-aided manufacturing (CAD/CAM) after aging in a mastication simulator. Four-unit FDPs were designed from six different all-ceramic systems: 1) monolithic lithium disilicate (M-E), 2) monolithic zirconia (M-TZI), 3) veneered zirconia by conventional layering (V-L), 4) veneered zirconia by lithium disilicate pressing (V-P), 5) veneered zirconia by lithium disilicate fusing (CAD-F-E), and 6) veneered zirconia by feldspathic ceramic cementing (CAD-C-CB). The specimens were divided into control and aging groups (n = 10 per group). The aging process included both thermocycling and mechanical loading and was followed by fracture resistance testing. All specimens in the M-E, M-TZI, and V-L groups survived; however, all specimens in the V-P group were fractured during artificial aging. The highest fracture resistance values were observed in the M-TZI group. According to the fracture resistance test, connector fractures were the most frequent type of failure. M-TZI and M-E FDPs revealed no failures during aging and showed higher fracture resistance than the veneered groups. Among the veneered zirconia framework groups, V-L FDPs showed the highest success rate during aging, while the fracture resistance was similar among all the veneered zirconia groups.

Prospective Evaluation of Posterior Fixed Zirconia Dental Prostheses: 10-Year Clinical Results.

To investigate the clinical survival and success rates of conventionally luted three- and four-unit fixed dental prostheses (FDPs) with zirconia frameworks (Cercon Smart Ceramics, DeguDent) after a mean observation period of 119 ± 36 months. A total of 75 patients were treated in the Department of Prosthodontics at the University of Goettingen, Germany, and a total of 99 posterior FDPs were inserted and luted with zinc phosphate cement. Time-dependent survival and success rates were calculated using Kaplan-Meier curves, and their relationships with the type of veneer (ceramic), location (maxilla vs mandible), and span length (three-unit vs four-unit) were analyzed with a Cox regression model (P < .05). Of the 99 inserted FDPs, 24 were lost to follow-up, 51 remained functional and passed the 10-year examination (overall survival rate: 75.0%; 95% confidence interval [CI]: 0.64, 0.85), and 13 were absolute failures caused by technical events (technical survival rate: 84%; 95% CI: 0.64, 0.85). In 50 FDPs, relative failure required a clinical intervention to maintain function (overall success rate: 40%; 95% CI: 0.29, 0.52). For 35 of these FDPs, the relative failure was caused by technical events (technical success rate: 61%; 95% CI: 0.49, 0.73). None of the evaluated factors showed an association with overall or technical survival or success. Zirconia-based posterior FDPs produced with a first-generation computer-assisted manufacturing (CAM) system revealed high rates of absolute and relative failure, mainly due to technical events, after a mean observational period of 10 years. Further clinical studies with updated computer-assisted design (CAD)/CAM systems are needed to determine the long-term performance of zirconia-based FDPs.

Flexural strength of four-unit implant-supported ceramic veneered zircon and full zircon fixed dental prosthesis

Purpose To investigate the flexural strength and the fracture loads of bilayered and monolithic zirconia fixed dental prostheses (FDPs). Materials and methods For flexural strength test, two groups of bar-shaped (25 × 5 × 2 mm3) monolithic zirconia (n = 5) and bilayered zirconia–porcelain (n = 5) specimens were prepared using computer-aided design and manufacture system for zirconia and hand layering for porcelain. Flexural strength test was performed using universal testing machine at cross-head speed of 1 mm/min. For fracture resistance test, 20 master models composed of two implant analogues and their corresponding titanium implant abutments embedded vertically in autopolymerizing acrylic resin blocks to mimic clinical conditions for a four-unit FDPs. Twenty FDPs were fabricated and divided into two groups (n = 10): group A, bilayered zirconia four-unit implant-supported FDPs; group B, monolithic zirconia four-unit implant-supported FDPs. Samples in each group were cemented to their corresponding model and then underwent artificial ageing by thermocycling of 5000/cycle. The fracture resistance test was done using universal testing machine at cross-head speed of 1 mm/min. Statistical analysis of the results and comparison between each two groups were performed using independent t-test (significance: P ≤ 0.05). Results Monolithic zirconia group recorded statistically significant higher flexural strength and fracture resistance compared to bilayered group. Conclusion Strength of monolithic zirconia is significantly higher than bilayered zirconia.

Four-unit fixed dental prostheses replacing the maxillary incisors supported by two narrow-diameter implants - a five-year case series.

(1) To determine the survival rate of 10 four-unit fixed dental prostheses (FDPs) replacing the four maxillary incisors, supported by 20 narrow-diameter implants (NDIs), (2) to assess the incidence of mechanical and biological complications, and (3) to evaluate bone level changes longitudinally after final FDP insertion. Ten patients (six women, four men), mean age 49.4±12.6years, were treated with a four-unit anterior maxillary FDP (six screw-retained; four cemented). Biological parameters, eventual technical complications, radiographic measurements, and study casts were assessed at 1 (baseline), 3, and 5years after implant placement. A multilevel logistic regression test was performed on clinical parameters and bone level changes (significance level P<0.05). The 5-year implant and FDP survival rate was 100%. Mean modified plaque index (mPI) values were 0.03 and 0.02 at 3 and 5years, significantly lower when compared to mPI (0.11±0.31) at 1year. Mean modified sulcus bleeding index (mSBI) was 0.08, 0.08, and 0.15 over time. Probing depth (PD) values were 1.57, 1.64, and 2.03mm. Statistically significant differences were found between 1 vs. 5year (P=0.0003) and 3 vs. 5year (P=0.001). Keratinized mucosa (3.65mm) remained stable during observation period. DIB mean values were 2.01±0.34, 2.13±0.13, and 2.17±0.38mm. Patient satisfaction based on visual analog scale revealed favorable fulfillment of overall treatment and esthetic expectations. Two NDIs supporting a four-unit FDP to replace the four missing maxillary incisors may be considered a predictable treatment modality.

Load-bearing capacity of artificially aged zirconia fixed dental prostheses with heterogeneous abutment supports

Aim of this in vitro study was to investigate the effect of artificial ageing and differential abutment support on the load-bearing capacity of zirconia posterior four-unit fixed dental prostheses (FDPs). Thirty-six FDPs were fabricated using CAD/CAM technology and divided into three groups. Specimens in the first group were cemented onto tooth analogues with simulated periodontal resilience, in the second group onto a dental implant and a tooth analogue, but in the third group only onto implants. Half of the samples in each group underwent artificial ageing. Afterwards, all FDPs were loaded until bulk fracture in a universal testing machine. Load-displacement curves and forces at fracture were recorded and results were statistically analysed using ANOVA. Load-bearing capacities within the different test groups averaged as follows (control/artificially aged): tooth-tooth supported (2,009/1,751 N), tooth-implant supported (2,144/1,935 N) and implant-implant supported (2,689/2,484 N). Artificial ageing as well as differential abutment support did have a significant influence on the fracture strength of the zirconia FDPs. Implant-retained prostheses demonstrated the highest load-bearing capacity, while resilient support was demonstrated to be unfavourable. According to these in vitro results, zirconia four-unit prostheses may be promising for application in posterior areas with all three support scenarios (implant-assisted, tooth-retained, or implant-tooth-interconnected prostheses). However, the restorations' mechanical strength may expected to be significantly influenced in situ by ageing of the material on the long term.