Fits of Implant Zirconia Custom Abutments and Frameworks: A Systematic Review and Meta-Analyses.

PURPOSE: The aim of this systematic review and meta-analyses was to evaluate fits of zirconia custom abutments and frameworks on implants and to identify the factors that influence their fits. MATERIALS AND METHODS: An electronic search was conducted through PubMed (MEDLINE), Google Scholar, and Cochrane Central Registrar of Controlled Trials. The search was completed in August 2017. Series of meta-analyses were conducted to compare fits of zirconia custom abutments and frameworks on implants with metal abutments and frameworks. The interest variables were the interface gap and the rotational misfit of abutments and the vertical fit of frameworks. RESULTS: Initially, a total of 672 articles were identified from the electronic search. After applying the inclusion criteria, 17 suitable articles were selected, including 9 studies on the fit of zirconia custom abutments and 8 studies on the fit of zirconia frameworks. There is a tendency for zirconia abutments to exhibit greater interface gaps and rotational misfits than metal abutments. Abutments produced by manual-aided designs/manual-aided manufacturing (MAD/MAM) exhibited inferior fits compared with those produced by computer-aided design/computer-aided manufacturing (CAD/CAM). Proprietary abutments had superior fits compared with non-proprietary abutments. Milled zirconia frameworks had insignificantly inferior fits compared with milled metal frameworks. CONCLUSION: Within the limitations of this study, custom zirconia abutments and non-proprietary abutments appeared to exhibit slightly inferior fits compared with metal abutments or abutments produced by the same implant company. However, the clinical significance of this difference is yet to be determined. The fit of milled zirconia frameworks is generally comparable to milled metal frameworks.

Comparative In Vitro Study of Implant-Supported Restorations: Implant-Abutment Complex With and Without Prosthetic Finishing Line.

PURPOSE: The aim of this study was to evaluate the mechanical behavior of implant-supported cemented restorations placed on two types of abutment design, with and without a prosthetic finish line, evaluating fracture resistance and the type of fracture produced in the abutment-crown complex. MATERIALS AND METHODS: Eighty zirconia restorations supported by tapered implants were divided into two groups: group I, with 40 zirconia crowns cemented onto individualized zirconia abutments with a chamfered finish line (1 mm deep); and group II, with 40 zirconia crowns cemented onto individualized zirconia abutments without a finish line. All specimens underwent thermocycling and dynamic loading before static load testing to evaluate their fracture resistance. RESULTS: Fracture resistance values (N) and the type of fracture were analyzed. The mean fracture resistance was 462.1 ± 66.3 N in group I and 343 ± 40 N in group II. In group I, fractures were produced in the prosthetic fixation screw; in group II, all mechanical failures were produced in the transepithelial abutment's cervical area. CONCLUSION: Group I specimens showed greater fracture resistance than group II. The fracture type in group I occurred in the prosthetic screw. Group II fractures occurred in the zirconium oxide abutment.

Shear bond strength of a novel porcelain repair system for different computer-aided design/computer-assisted manufacturing ceramic materials.

OBJECTIVES: The purpose of this study was to compare the shear bond strength of a novel repair system, Nova Compo SF with Ceramic Repair, Ivoclar, to computer-aided design/computer-assisted manufacturing (CAD/CAM) restorative materials (IPS e.max CAD and Empress CAD). MATERIALS AND METHODS: The specimens of each CAD/CAM restorative material were randomly divided into two subgroups of nine specimens, using one of two repair systems. All specimens were etched with hydrofluoric acid and rinsed under a water spray for 10 s, then air-dried for 10 s. Next, repair systems were applied according to the manufacturer's instructions. All specimens were stored in distilled water at 37°C for 24 h and then additionally aged for 5000 thermal cycles. A shear bond strength test was performed using a universal testing machine. Each fracture type was examined under a stereomicroscope at ×12.5 magnification. A two-way ANOVA test was used to detect significant differences between the CAD/CAM restorative materials and the composite repair systems. Subgroup analyses were performed using Tukey's honest significant difference. RESULTS: No statistically significant differences were observed between the repair systems (P = 0.9). The bond strength values from Empress CAD were statistically higher than those from e.max CAD (P < 0.05). CONCLUSIONS: Within limitations, SuperFlow may be an alternative to the ceramic repair materials we routinely used in the clinic. Empress CAD can be preferable to e.max CAD in terms of esthetically suitable clinical indications.

Influence of the Prosthetic Index on Fracture Resistance of Morse Taper Dental Implants.

PURPOSE: Manufacturers have inserted a prosthetic index, an internal hexagon to guide prosthetic components inside Morse taper implants. However, it is still unclear if this mechanism could decrease the mechanical strength of Morse taper implants. The aim of this study was to evaluate the influence of the prosthetic index inside Morse taper implants on fracture resistance compared with nonindexed implants. MATERIALS AND METHODS: Fifty-seven Morse taper implants, with 11.5-degree angulation of the internal conical portion, were divided into three groups: implants without the prosthetic index and solid Morse taper universal post (group 1), implants with the prosthetic index and solid Morse taper universal post (group 2), and implants and abutments with the prosthetic index (group 3). All groups were modeled for finite element stress analysis (FEA), simulating force application of a perpendicular load to the abutments. Fracture resistance (n = 10) was determined under the same condition. Dynamic loading (n = 9) was also performed. The statistical analysis was performed using one-way analysis of variance (ANOVA), and the Tukey test was applied (α = .05). The metallographic analysis was used to identify the fracture distribution and the microstructure of the titanium alloy. RESULTS: There was no statistically significant difference between the values of all tested groups. According to the FEA, the prosthetic index region was out of stress. The mean fracture resistances and loading test were 353.7 N and 200 N for group 1, 397.3 N and 170 N for group 2, and 372.0 N and 160 N for group 3, respectively. Metallographic analysis showed a macroscopic failure pattern just as demonstrated by FEA. CONCLUSION: The presence of the prosthetic index on Morse taper implants did not decrease its resistance to fracture for the tested implants.

An In Vitro Evaluation of the Loosening of Different Interchangeable Abutments in Internal-Connection-Type Implants.

PURPOSE: The aim of this study was to compare the loosening of interchangeable one-piece abutments connected to internal-connection-type implants after cyclic loading. MATERIALS AND METHODS: Four implant abutment groups (n = 7 in each group) with Straumann tissue-level implants were assessed: Straumann solid abutment (group S), Southern Implants solid abutment (group SI), Implant Direct straight abutment (group ID), and Blue Sky Bio regular platform abutment (group BSB). The implant was firmly held in a special jig to ensure fixation. Abutment screws were tightened to manufacturers' recommended torque with a digital torque gauge. The hemispherical loading members were fabricated for the load cell of a universal testing machine to evenly distribute the force on the specimens and to fulfill the ISO 14801:2007 standard. A cyclic loading of 25 N at 30 degrees to the implant's long axis was applied for a duty of a half million cycles. Tightening torques were measured prior to the loading. Removal torques were measured after cyclic loading. The data were analyzed with one-way analysis of variance (ANOVA), and the significance level was set at P < .05. RESULTS: The mean removal torques after cyclic loading were 34.0 ± 1.1 Ncm (group S), 25.0 ± 1.5 Ncm (group SI), 23.9 ± 2.1 Ncm (group ID), and 27.9 ± 1.3 Ncm (group BSB). Removal torques of each group were statistically different in the order of group S > group BSB > groups SI and ID (P < .05). The mean reduction rates were -2.9% ± 3.2% (group S), -21.9% ± 4.8% (group SI), -20.2% ± 7.2% (group ID), and -6.9% ± 4.3% (group BSB) after a half million cycles, respectively. Reduction rates of groups S and BSB were statistically lower than those of groups SI and ID (P < .01). The standard deviation of group S was lower than group BSB. CONCLUSION: The removal torque of the original Straumann abutment was significantly higher than those of the copy abutments. The reduction rate of the groups S and BSB abutments was lower than those of the other copy abutments.

Influence of indexed abutments on the fracture resistance of internal conical dental implants.

The aim of this study was to evaluate the influence of abutments with a prosthetic index on the fracture resistance of Morse taper dental implants. Morse taper implants were divided into 2 groups (n = 5 per group): a group with an indexed implant and a nonindexed abutment (solid Morse taper universal post; WIS group), and a group with an indexed implant and an indexed abutment (WIP group). Both groups were subjected to bending tests for fracture strength until 5 mm of displacement or implant fracture occurred. Statistical analysis was performed using the Student t test (α = 0.05). There was no statistically significant difference between the mean fracture values, which were 305.8 N and 318.6 N for the WIS group and WIP group, respectively. The presence of a prosthetic index on Morse taper abutments did not influence the resistance to fracture.

Mechanical Reliability Evaluation of an Oral Implant-Abutment System According to UNI EN ISO 14801 Fatigue Test Protocol.

PURPOSE: The aim of this in vitro study was to evaluate the mechanical reliability of a dental implant system by testing its maximum fracture load and mechanical performance under cyclic fatigue stress. METHODS: An experimental study according to the international standards (UNI EN ISO 14801: 2008) was performed using 13 implants (3.80 mm in diameter and 12 mm in length) with straight titanium abutments tightened to 30 N. Five samples were subjected to compression stress at break. Based on the mean fracture load value obtained in this test, the levels of dynamic loading range were set and were carried on at a frequency of 15 Hz for 5 × 10 cycles. RESULTS: The compression stress at break mean value of the tested implants was 430 N (SD ± 35.66 N). In the mechanical fatigue stress test, the fatigue limit for 5 × 10 load cycles was 172 N. CONCLUSIONS: The evaluated implant system proved to withstand considerable mechanical loads under the "worst-case" loading situation performed according to UNI EN ISO 14801 standard. The reliability of this test protocol makes it suitable to be accomplished for understanding and comparing mechanical properties of implant systems.

Three-Dimensional Nonlinear Finite Element Analysis and Microcomputed Tomography Evaluation of Microgap Formation in a Dental Implant Under Oblique Loading.

PURPOSE: Since bacterial leakage along the implant-abutment interface may be responsible for peri-implant infections, a realistic estimation of the interface gap width during function is important for risk assessment. The purpose of this study was to compare two methods for investigating microgap formation in a loaded dental implant, namely, microcomputed tomography (micro-CT) and three-dimensional (3D) nonlinear finite element analysis (FEA); additionally, stresses to be expected during loading were also evaluated by FEA. MATERIALS AND METHODS: An implant-abutment complex was inspected for microgaps between the abutment and implant in a micro-CT scanner under an oblique load of 200 N. A numerical model of the situation was constructed; boundary conditions and external load were defined according to the experiment. The model was refined stepwise until its load-displacement behavior corresponded sufficiently to data from previous load experiments. FEA of the final, validated model was used to determine microgap widths. These were compared with the widths as measured in micro-CT inspection. Finally, stress distributions were evaluated in selected regions. RESULTS: No microgaps wider than 13 µm could be detected by micro-CT for the loaded implant. FEA revealed gap widths up to 10 µm between the implant and abutment at the side of load application. Furthermore, FEA predicted plastic deformation in a limited area at the implant collar. CONCLUSION: FEA proved to be an adequate method for studying microgap formation in dental implant-abutment complexes. FEA is not limited in gap width resolution as are radiologic techniques and can also provide insight into stress distributions within the loaded complex.

Fatigue Behavior of Computer-Aided Design/Computer-Assisted Manufacture Ceramic Abutments as a Function of Design and Ceramics Processing.

PURPOSE: Zirconia is being widely used, at times apparently by simply copying a metal design into ceramic. Structurally, ceramics are sensitive to both design and processing (fabrication) details. The aim of this work was to examine four computer-aided design/computer-assisted manufacture (CAD/CAM) abutments using a modified International Standards Organization (ISO) implant fatigue protocol to determine performance as a function of design and processing. MATERIALS AND METHODS: Two full zirconia and two hybrid (Ti-based) abutments (n = 12 each) were tested wet at 15 Hz at a variety of loads to failure. Failure probability distributions were examined at each load, and when found to be the same, data from all loads were combined for lifetime analysis from accelerated to clinical conditions. RESULTS: Two distinctly different failure modes were found for both full zirconia and Ti-based abutments. One of these for zirconia has been reported clinically in the literature, and one for the Ti-based abutments has been reported anecdotally. The ISO protocol modification in this study forced failures in the abutments; no implant bodies failed. Extrapolated cycles for 10% failure at 70 N were: full zirconia, Atlantis 2 × 10(7) and Straumann 3 × 10(7); and Ti-based, Glidewell 1 × 10(6) and Nobel 1 × 10(21). Under accelerated conditions (200 N), performance differed significantly: Straumann clearly outperformed Astra (t test, P = .013), and the Glidewell Ti-base abutment also outperformed Atlantis zirconia at 200 N (Nobel ran-out; t test, P = .035). CONCLUSION: The modified ISO protocol in this study produced failures that were seen clinically. The manufacture matters; differences in design and fabrication that influence performance cannot be discerned clinically.

Stiffness, strength, and failure modes of implant-supported monolithic lithium disilicate crowns: influence of titanium and zirconia abutments.

PURPOSE: The objective of this study was to evaluate stiffness, strength, and failure modes of monolithic crowns produced using computer-aided design/computer-assisted manufacture, which are connected to diverse titanium and zirconia abutments on an implant system with tapered, internal connections. MATERIALS AND METHODS: Twenty monolithic lithium disilicate (LS2) crowns were constructed and loaded on bone level-type implants in a universal testing machine under quasistatic conditions according to DIN ISO 14801. Comparative analysis included a 2 × 2 format: prefabricated titanium abutments using proprietary bonding bases (group A) vs nonproprietary bonding bases (group B), and customized zirconia abutments using proprietary Straumann CARES (group C) vs nonproprietary Astra Atlantis (group D) material. Stiffness and strength were assessed and calculated statistically with the Wilcoxon rank sum test. Cross-sections of each tested group were inspected microscopically. RESULTS: Loaded LS2 crowns, implants, and abutment screws in all tested specimens (groups A, B, C, and D) did not show any visible fractures. For an analysis of titanium abutments (groups A and B), stiffness and strength showed equally high stability. In contrast, proprietary and nonproprietary customized zirconia abutments exhibited statistically significant differences with a mean strength of 366 N (Astra) and 541 N (CARES) (P < .05); as well as a mean stiffness of 884 N/mm (Astra) and 1,751 N/mm (CARES) (P < .05), respectively. Microscopic cross-sections revealed cracks in all zirconia abutments (groups C and D) below the implant shoulder. CONCLUSION: Depending on the abutment design, prefabricated titanium abutment and proprietary customized zirconia implant-abutment connections in conjunction with monolithic LS2 crowns had the best results in this laboratory investigation.

The Concept of Platform Switching to Preserve Peri-implant Bone Level: Assessment of Methodologic Quality of Systematic Reviews.

PURPOSE: To assess the methodologic quality of systematic reviews on the effect of platform switching upon peri-implant marginal bone loss. MATERIALS AND METHODS: An electronic literature search of several databases was conducted by two reviewers. Articles were considered for quality assessment if they met the following inclusion criterion: systematic reviews that aimed at investigating the effect of platform switching/mismatch on marginal bone levels around dental implants. Two independent examiners evaluated the review publications using two quality-ranking scales (assessment of multiple systematic reviews [AMSTAR] and Glenny checklist). Descriptive statistics were used to summarize the results, and Cohen's kappa coefficients were calculated to appraise interrater agreement of each checklist. RESULTS: Overall, five systematic reviews (including three of them with meta-analysis) were evaluated. The mean AMSTAR score ± standard deviation was 8.4 ± 2.6 (range, 4 to 11), and the mean Glenny score was 10.8 ± 2.9 (range, 6 to 14), showing high statistical correlation (rs = 0.98, P = .005). Cohen interexaminer test yielded values of κ = 0.88 and κ = 0.86 for the AMSTAR and Glenny checklist, respectively. The AMSTAR items rated positive in 78%, whereas 18% met the criteria for "no" and 4% were "not applicable." Only one review article met all criteria. Items of the Glenny checklist rated positive in 73% and negative in 27%. All but one study with the lowest quality scores (finding no difference) demonstrated a clinical benefit of implant platform switching in preserving the peri-implant marginal bone loss. CONCLUSION: According to the quality-ranking scales appraised, substantial methodologic variability was found in systematic assessment of benefits with the platform switching concept to preserve peri-implant bone level. High-quality systematic reviews, however, generally favored platform switching over platform matching.

Relationship Between Insertion Torque and Resonance Frequency Measurements, Performed by Resonance Frequency Analysis, in Micromobility of Dental Implants: An In Vitro Study.

PURPOSE: To evaluate the micromobility of dental implants under occlusal loading in relation to stability measurements of resonance frequency analysis and insertion torque. MATERIALS AND METHODS: The sample comprised of 24 implants inserted in 12 fresh cow ribs. Insertion torque and Osstell implant stability quotient (ISQ) measurements were recorded. An "ad hoc" acrylic premolar was made on a temporary abutment and screwed to each implant, and a force of 100 N was subsequently applied at an angle of 6 degrees. Implant micromotion was measured using a Questar microscope with a resolution of 2 µm and an image analysis program. RESULTS: Data show a statistically significant inverse correlation between the ISQ values and implant micromotion under a load of 100 N (R = 0.86, P < 0.0001). The same relationship is found between insertion torque and implant micromotion, although the relationship is linear up to 34 N·cm and becomes exponential for higher values (R = 0.78, P < 0.0001). A direct correlation is established between insertion torque and ISQ values. CONCLUSION: There is an inverse relationship between both ISQ and insertion torque values and implant micromotion under a load of 100 N.

30-Year Outcomes of Dental Implants Supporting Mandibular Fixed Dental Prostheses: A Retrospective Review of 4 Cases.

PURPOSE: The aim of this study was to present the 30-year outcomes of 28 implants supporting mandibular screw-retained fixed dental prostheses (FDPs). MATERIALS AND METHODS: Dental charts of the 4 patients were carefully reviewed, and it was noticed that they received 28 implants and 5 screw-retained FDPs in 1983 and 1984. The chief concerns raised by these patients were poor retention of their complete dentures and decreased masticatory function at the time of treatment planning. Each dental care they received was recorded in the last 30 years. Implant survival, radiographic, and prosthodontic examinations were performed. RESULTS: No implants were lost after 30 years, giving the implant a survival rate of 100%. The average marginal bone level was 2.6 ± 0.5 mm at the last recall appointment. Of the 5 FDPs delivered, 1 needed replacement, indicating a prosthesis survival rate of 80%. The patients needed 21 repairs such as replacement of denture teeth/gold screws and hard relining, and 19 adjustments such as occlusal adjustments and acrylic resin contouring, over 30 years. CONCLUSION: This clinical report shows that machined-surface dental implants can successfully support screw-retained fixed dental prostheses for over 30 years, making dental implants an important dental treatment alternative compared to the traditional prosthetic treatment methods.

Fracture resistance of computer-aided design and computer-aided manufacturing ceramic crowns cemented on solid abutments.

BACKGROUND: Because no information was found in the dental literature regarding the fracture resistance of all-ceramic crowns using CEREC (Sirona) computer-aided design and computer-aided manufacturing (CAD-CAM) system on solid abutments, the authors conducted a study. METHODS: Sixty synOcta (Straumann) implant replicas and regular neck solid abutments were embedded in acrylic resin and randomly assigned (n = 20 per group). Three types of ceramics were used: feldspathic, CEREC VITABLOCS Mark II (VITA); leucite, IPS Empress CAD (Ivoclar Vivadent); and lithium disilicate, IPS e.max CAD (Ivoclar Vivadent). The crowns were fabricated by the CEREC CAD-CAM system. After receiving glaze, the crowns were cemented with RelyX U200 (3M ESPE) resin cement under load of 1 kilogram. For each ceramic, one-half of the specimens were subjected to the fracture resistance testing in a universal testing machine with a crosshead speed of 1 millimeter per minute, and the other half were subjected to the fractured resistance testing after 1,000,000 cyclic fatigue loading at 100 newtons. RESULTS: According to a 2-way analysis of variance, the interaction between the material and mechanical cycling was significant (P = .0001). According to a Tukey test (α = .05), the fracture resistance findings with or without cyclic fatigue loading were as follows, respectively: CEREC VITABLOCKS Mark II (405 N/454 N) was statistically lower than IPS Empress CAD (1169 N/1240 N) and IPS e.max CAD (1378 N/1025 N) (P < .05). The IPS Empress CAD and IPS e.max CAD did not differ statistically (P > .05). According to a t test, there was no statistical difference in the fracture resistance with and without cyclic fatigue loading for CEREC VITABLOCS Mark II and IPS Empress CAD (P > .05). For IPS e.max CAD, the fracture resistance without cyclic fatigue loading was statistically superior to that obtained with cyclic fatigue loading (P < .05). CONCLUSIONS: The IPS Empress CAD and IPS e.max CAD showed higher fracture resistance compared with CEREC VITABLOCS Mark II. The cyclic fatigue loading negatively influenced only IPS e.max CAD. PRACTICAL IMPLICATIONS: The CEREC VITABLOCS Mark II, IPS Empress CAD, and IPS e.max CAD ceramic crowns cemented on solid abutments showed sufficient resistance to withstand normal chewing forces.

Tolerance measurements on internal- and external-hexagon implants.

PURPOSE: To measure the horizontal machining tolerances of the interface between internal- and external-hexagon implants and analogs with corresponding components after delivery from the manufacturer. These values may be a valuable tool for evaluating increasing misfit caused by fabrication, processing, and wear. MATERIALS AND METHODS: Seven implants and seven analogs with external- and internal-hexagon connections (Biomet 3i) with corresponding prefabricated gold cylinders and gold screws, prefabricated cylindric plastic cylinders, and laboratory screws were studied. One set of components from the external and internal groups was measured manually and digitally. Measurements from the test subjects were compared with identical measurements from the virtual model to obtain threshold values. The virtual model was then used to obtain optimally oriented cuts. RESULTS: The horizontal machining tolerances for castable plastic abutments on external implants were 12 ± 89 µm, and for internal implants they were 86 ± 47 µm. Tolerance measurements on prefabricated gold abutments for external implants were 44 ± 9 µm, and for internal implants they were 58 ± 28 µm. CONCLUSION: The groups with metallic components showed the smallest tolerance at < 50 µm for the external group and < 90 µm for the internal group. The prefabricated plastic cylinder groups ranged from < 100 µm for external and < 130 µm for internal connection.

The effect of implant connection length on the dimensional impression accuracy of inclined implants.

PURPOSE: Accurate recording of implant locations is essential for precise passively fitting prostheses with proper support. This in vitro study evaluated the accuracy of impressions made of parallel and nonparallel implants with different lengths of impression coping connections. MATERIALS AND METHODS: A reference model containing four internal-connection implant analogs (two at 0 degrees and two at 30 degrees in relation to the perpendicular line) was fabricated. Thirty medium-consistency silicon impressions of this model were made using the open-tray impression technique. Three groups of 10 specimens each were made with different impression coping connection lengths (2, 1.5, or 1 mm). Impressions were poured with type IV stone. The positional accuracy of the implant replica heads in the x-, y-, and z-axes was evaluated using a coordinate measuring machine, and measurements were compared with the obtained dimensions from the reference model. Data were analyzed with two-way analysis of variance (α = .05). RESULTS: There was no significant difference in impression accuracy, regardless of the lengths of the impression connections. Additionally, there was no significant difference between the impression accuracy of inclined and straight implants, except in the y-axis (P = .006). CONCLUSIONS: Within the limitations of this study, the accuracy of implant impressions did not differ for different lengths of transfer coping connections of inclined and straight implants.

An in vitro comparison of the accuracy of implant impressions with coded healing abutments and different implant angulations.

STATEMENT OF PROBLEM: Fabricating implant definitive casts with CAD/CAM technology (Robocasts) from coded healing abutment impressions represents a simpler and innovative alternative to conventional implant impression techniques. However, information about the accuracy of the impressions and the resultant definitive casts is limited. PURPOSE: The purpose of the study was to evaluate the accuracy of the Robocasts and compare them to those definitive casts fabricated with conventional implant impression techniques (open tray with splinted impression copings technique). MATERIAL AND METHODS: A reference epoxy resin cast was fabricated and shaped to simulate a dental arch. Two regular platform implant replicas (Biomet 3i Certain, 4.1 mm diameter and 15 mm length) with internal connections were placed 10 mm apart with a 10-degree convergence for one side of the reference resin cast and a 30-degree convergence for the other. Coded healing abutments (Encode) were placed at 3 different heights above the level of the soft tissue replication material (approximately 1, 2, and 4 mm) and served as test groups (E1, E2, and E4), and open trays with splinted impression copings (OTSC) served as a control group. The control group was compared to the impressions of the coded healing abutments by using a standardized measurement protocol. Impressions were made for each group (n=18) and poured with vacuum mixed (100 g powder/20 mL water) Type IV dental stone. The vertical discrepancy (Z axis) between 2 prefabricated passively fitting titanium reference frameworks and the platforms of the implant replicas was measured with an optical comparator applying the 1 screw test. Data were analyzed with Kruskal-Wallis and post-hoc Mann-Whitney U tests, as well as the Wilcoxon signed-rank tests. The Bonferroni correction was used to account for multiple comparisons. The significance level (α) used in a given set of tests was equal to .05 divided by the number of tests performed in that set. RESULTS: The median vertical discrepancy of each coded healing abutment impression group was higher than the corresponding median of the control group (OTSC) for every combination of angulation and position. Kruskal-Wallis tests indicated a statistically significant difference (P<.001) between groups for each angulation/position combination. All post hoc Mann-Whitney U tests indicated statistically significant differences (all P≤.002) between OTSC and the other groups. Differences between the angulations and positions were not statistically significant when accounting for multiple comparisons. CONCLUSIONS: The implant definitive casts fabricated from the coded healing abutment impressions were found to be less accurate than those fabricated from the open tray with splinted impression copings technique for restoring 2 paired (10 or 30 degrees) convergent internal connection implants with nonengaging screw-retained splinted 2-unit implant restorations. Accuracy of fit was not influenced by the implant angulation or position for either impression technique or by the Encode healing abutment height for the Encode impression technique.

Improving the fit of implant prosthetics: an in vitro study.

PURPOSE: Accurate and passive fit between a prosthesis and its supporting implants has been considered a prerequisite for successful long-term osseointegration. The objective of this in vitro study was to evaluate the strain development during tightening of a five-unit screw-retained superstructure constructed using five different methods. MATERIALS AND METHODS: Five-unit screw-retained fixed partial prostheses (n = 25) were fabricated on three implants embedded in an epoxy resin block using five different methods: (1) cobalt-chromium (Co-Cr), plastic cylinders, one-piece cast; (2) Co-Cr, plastic cylinders, framework sectioned, preceramic laser-welding soldering; (3) gold-platinum (Au-Pt), gold cylinders, one-piece cast; (4) Au-Pt, gold cylinders, framework sectioned, preceramic laser-welding soldering; (5) Co-Cr, one-piece cast, and cementation to "passive abutments" (Southern Implants) after final finishing and polishing. Strain gauges (SG) were attached to the fixed partial prosthesis (FPP) and to the resin block to measure the stress created during screw tightening. RESULTS: The combination of Co-Cr alloy and plastic cylinders in a one-piece cast showed such an inadequate fit among the fabricated methods that this group was excluded from the remainder of the experiment. Specimens of Au-Pt cast on gold cylinders in one piece showed higher strain development than the other groups used in this study, with strains ranging from 223.1 to 2,198.1 Μm/m. Sectioning and soldering significantly improved the overall fit. FPPs of Co-Cr in a one-piece cast cemented to "passive abutments" produced the best level of fit, with the least strain development in the prosthesis and the resin block (59 to 204.6 Μm/m). CONCLUSION: Absolute fit of superstructures on implants is not possible using conventional laboratory procedures. Cementing FPPs onto prefabricated cylinders directly onto the implants significantly reduces strain development compared to the other fabrication methods.

Fracture resistance of crowns cemented on titanium and zirconia implant abutments: a comparison of monolithic versus manually veneered all-ceramic systems.

PURPOSE: To evaluate the fracture resistance of all-ceramic crowns cemented on titanium and zirconia implant abutments. MATERIAL AND METHODS: Customized implant abutments for maxillary right central incisors made of titanium (Ti) and zirconia (Zr) (n=60, n=30 per group) were fabricated for an internal connection implant system. All-ceramic crowns were fabricated for their corresponding implant abutments using the following systems (n=10 per group): (1) monolithic computer-aided design/computer-assisted manufacture (CAD/CAM) lithium disilicate (MLD); (2) pressed lithium disilicate (PLD); (3) yttrium stabilized tetragonal zirconia polycrystal (YTZP). The frameworks of both PLD and YTZP systems were manually veneered with a fluorapatite-based ceramic. The crowns were adhesively cemented to their implant abutments and loaded to fracture in a universal testing machine (0.5 mm/minute). Data were analyzed using two-way analysis of variance (ANOVA) and Tukey's test (α=0.05). RESULTS: Both the abutment material (P=.0001) and the ceramic crown system (P=.028) significantly affected the results. Interaction terms were not significant (P=.598). Ti-MLD (558.5±35 N) showed the highest mean fracture resistance among all abutment-crown combinations (340.3±62-495.9±53 N) (P<.05). Both MLD and veneered ceramic systems in combination with Ti abutments (558.5±35-495.9±53 N) presented significantly higher values than with Zr abutments (392.9±55-340.3±62 N) (P<.05). MLD crown system showed significantly higher mean fracture resistance compared to manually veneered ones on both Ti and Zr abutments (P<.05). While Ti-MLD and Ti-PLD abutment-crown combinations failed only in the crowns without abutment fractures, Zr-YTZP combination failed exclusively in the abutment without crown fracture. Zr-MLD and Zr-PLD failed predominantly in both the abutment and the crown. Ti-YTZP showed only implant neck distortion. CONCLUSIONS: The highest fracture resistance was obtained with titanium abutments restored with MLD crowns, but the failure type was more favorable with Ti-YTZP combination.