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Volume 27 , Issue 6
November/December 2012

Pages 1448–1455

Fracture Resistance of Crowns Cemented on Titanium and Zirconia Implant Abutments: A Comparison of Monolithic Versus Manually Veneered All-Ceramic Systems

Francisco Martínez-Rus, DDS, PhD/Alberto Ferreiroa, DDS/Mutlu Özcan, DDS, Dr Med Dent, PhD/José F. Bartolomé, PhD/Guillermo Pradíes, DDS, PhD

PMID: 23189296

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 fluorapatitebased 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. Int J Oral Maxillofac Implants 2012;27:1448–1455

Key words: CAD/CAM, lithium disilicate, monolithic crowns, pressed ceramics, titanium, YTZP

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