Wear of ceramic and titanium ball attachments in subjects with an implant-retained overdenture: a controlled clinical trial.

STATEMENT OF PROBLEM: Loss of retention of implant-retained overdentures due to wear of the patrix or matrix of the attachment system is a common clinical problem. PURPOSE: The purpose of this controlled clinical trial was to compare the wear of ceramic and titanium ball attachments and their corresponding gold matrices after 1 year of clinical function in subjects with implant-retained mandibular overdentures. MATERIAL AND METHODS: Forty subjects who had been treated with a 2-implant-retained overdenture received either 2 ruby ball attachments (20 subjects) or 2 titanium ball attachments (20 subjects). The diameter of the ball attachments and the thickness of the matrix were measured optically before insertion and after 1 year of clinical function. Differences among groups were then compared with the Wilcoxon rank sum test (α=.05). To estimate any correlation between clinical parameters and wear, the Spearman rank test was used. RESULTS: There was no significant difference (P=.73) in the median wear of ball attachments for the titanium group (5.3 µm; median 1.3 µm) and for the ceramic group (1.3 µm; median 1.3 µm). In the ceramic group, a fracture rate of 30% was observed. The mean wear of the matrices in the titanium group was 3.1 µm (median 6.8 µm) and in the ceramic group 2.1 µm (median 3.4 µm), P=.01. No correlation was found between ball attachment wear and matrix insert wear (Spearman rank test). Wear of matrices was weakly correlated with an increase in divergence between implant axes in the sagittal plane (P=-.28 and P=.021). Ball attachment wear was associated with an increase in divergence between matrix axes in the sagittal plane (P=-.34 and P=.047). CONCLUSIONS: Matrices on ceramic ball attachments showed less wear than those placed on titanium ball attachments. However, the use of ruby ball attachments cannot be recommended because of a high fracture rate.

[First clinical experiences with ceramic ball attachments for overdentures]. / Erste klinische Erfahrungen mit Retentionselementen aus Keramik.

In this prospective clinical study on 40 patients with similar clinical conditions (edentulous jaw with 2 interforaminal implants) commercially available ceramic ball attachments (ruby) were compared to commercial titanium ball attachments. The primary aim of the study was to measure the wear of the ball attachments after being 1 year in function. However, in the course of the study already after 7 to 12 months multiple failures with ceramic ball attachments occurred. Twelve (28%) of 43 ceramic ball attachments had to be replaced, mostly because of fractures (8) of the ceramic ball. It seems that ceramic ball attachments of the investigated design are not able to withstand normal intraoral stresses. The short-term susceptibility to fractures didn't allow to examine the ceramic-inherent features such as compressive strength and wear resistance. Furthermore, a secure connection between a titan base and a ceramic ball seems to be challenging. Based on these results, in implant-retained removable prosthesis the use of metal-based retainers is still recommended, although during maintenance a higher wear has to be expected. This wear can be compensated by either activating or changing the matrix or the patrix.

Mechanical and fracture behavior of veneer-framework composites for all-ceramic dental bridges.

OBJECTIVES: High-strength ceramics are required in dental posterior restorations in order to withstand the excessive tensile stresses that occur during mastication. The aim of this study was to investigate the fracture behavior and the fast-fracture mechanical strength of three veneer-framework composites (Empress 2/IPS Eris, TZP/Cercon S and Inceram-Zirconia/Vita VM7) for all-ceramic dental bridges. METHODS: The load bearing capacity of the veneer-framework composites were evaluated using a bending mechanical apparatus. The stress distribution through the rectangular-shaped layered samples was assessed using simple beam calculations and used to estimate the fracture strength of the veneer layer. Optical microscopy of fractured specimens was employed to determine the origin of cracks and the fracture mode. RESULTS: Under fast fracture conditions, cracks were observed to initiate on, or close to, the veneer outer surface and propagate towards the inner framework material. Crack deflection occurred at the veneer-framework interface of composites containing a tough framework material (TZP/Cercon S and Inceram-Zirconia/Vita VM7), as opposed to the straight propagation observed in the case of weaker frameworks (Empress 2/IPS Eris). SIGNIFICANCE: The mechanical strength of dental composites containing a weak framework (K(IC)<3 MPam(1/2)) is ultimately determined by the low fracture strength of the veneer layer, since no crack arresting occurs at the veneer-framework interface. Therefore, high-toughness ceramics (K(IC)>5 MPam(1/2)) should be used as framework materials of posterior all-ceramic bridges, so that cracks propagating from the veneer layer do not lead to a premature failure of the prosthesis.

Cyclic fatigue in water of veneer-framework composites for all-ceramic dental bridges.

OBJECTIVES: Ceramic materials applied in dentistry may exhibit significant subcritical crack growth due to the severe cyclic loading in the aqueous environment encountered in the mouth during mastication. The authors report on the subcritical crack growth behavior of three dental restoration systems (Empress 2/IPS Eris, TZP/Cercon S and Inceram-Zirconia/Vita VM7) under cyclic loading in water, in order to establish guidelines for the use and design of long-lifetime all-ceramic posterior bridges. METHODS: Inert strength and lifetime tests under cyclic loading in an aqueous environment were performed in a mechanical bending apparatus and evaluated with Weibull statistics. RESULTS: Subcritical crack growth occurred predominantly in the outer veneer layer of the veneer-framework composites. The apatite-based veneer (IPS Eris) was more susceptible to subcritical crack propagation compared to the feldspathic glass veneers (Cercon S and Vita VM7). SIGNIFICANCE: Dental restoration systems containing apatite-based veneers and weak frameworks (Empress 2/IPS Eris) are not recommended for the fabrication of all-ceramic bridges in the molar region. Conversely, veneer-framework systems consisting of feldspathic glass veneers and tough zirconia-based frameworks (TZP/Cercon S and Inceram-Zirconia/Vita VM7) may exhibit lifetimes longer than 20 years if the bridge connector is properly designed.

Strength and reliability of four-unit all-ceramic posterior bridges.

OBJECTIVES: The purpose of this study was to determine the in vitro load bearing capacity of four-unit posterior frameworks made of glass ceramic with lithium-disilicate crystals (E2), of zirconia-reinforced glass-infiltrated alumina (ICZ) and of zirconia stabilized with 3 mol% yttria (CEZ). METHODS: All frameworks mimicked a four-unit posterior situation with 7.3 mm2 interdental cross-sections and possessed exactly the same dimensions. The load bearing capacity was measured on a special bridge test setup with 15 specimens for each of the materials. The data were analyzed with Weibull statistics giving the characteristic load bearing capacity F0 at 63% failure probability and the Weibull modulus m as indicator for the reliability and reproducibility. RESULTS: For the E2 frameworks the average load bearing capacity and the SD was 260 (+/-53) N, the characteristic load F0 282 N and the reliability m = 5.7. For the ICZ frameworks the average load bearing capacity was 470 (+/-101) N, F0 518 N and m = 4.5. CEZ frameworks revealed the highest average load bearing capacity of 706 (+/-123) N, the highest characteristic load bearing capacity F0 = 755 N and the best reliability m = 7.0. SIGNIFICANCE: CEZ frameworks showed the best mechanical properties as demonstrated by the high values of average load bearing capacity, reliability and characteristic load bearing capacity with respect to the other ceramics studied. However, for four-unit posterior CEZ frameworks the connector size of 7.3 mm2 is insufficient to withstand occlusal forces reported in the literature. Four-unit posterior frameworks require a connector size larger than 7.3 mm2.