title: Zirconia-implant-supported all-ceramic crowns withstand long-term load: a pilot investigation.
abstract: OBJECTIVE
  The purpose of this pilot investigation was to test whether zirconia implants restored with different all-ceramic crowns would fulfill the biomechanical requirements for clinical use. Therefore, all-ceramic Empress-1 and Procera crowns were cemented on zirconia implants and exposed to the artificial mouth. Afterwards, the fracture strength of the all-ceramic implant-crown systems was evaluated. Conventional titanium implants restored with porcelain-fused-to-metal (PFM) crowns served as controls.
  
  
  METHODS
  Sixteen titanium implants with 16 PFM crowns and 32 zirconia implants with 16 Empress-1 crowns and 16 Procera crowns each--i.e., three implant-crown groups--were used in this investigation. The titanium implants were fabricated using the ReImplant system and the zirconia implants using the Celay system. The upper left central incisor served as a model for the fabrication of the implants and the crowns. Eight samples of each group were submitted to a long-term load test in the artificial mouth (1.2 million chewing cycles). Subsequently, a fracture strength test was performed with seven of the eight crowns. The remaining eight samples of each group were not submitted to the long-term load in the artificial mouth but were fracture-tested immediately. One loaded and one unloaded sample of each group were evaluated regarding the marginal fit of the crowns.
  
  
  RESULTS
  All test samples survived the exposure to the artificial mouth. Three Empress-1 crowns showed cracks in the area of the loading steatite ball. The values for the fracture load in the titanium implant-PFM crown group without artificial loading ranged between 420 and 610 N (mean: 531.4 N), between 460 and 570 N (mean: 512.9 N) in the Empress-1 crown group, and in the Procera crown group the values were between 475 and 700 N (mean: 575.7 N) when not loaded artificially. The results when the specimens were loaded artificially with 1.2 million cycles were as follows: the titanium implant-PFM crowns fractured between 440 and 950 N (mean: 668.6 N), the Empress-1 crowns between 290 and 550 N (mean: 410.7 N), and the Procera crowns between 450 and 725 N (mean: 555.5 N). No statistically significant differences could be found among the groups without artificial load. The fracture values for the PFM and the Procera crowns after artificial loading were statistically significantly higher than that for the loaded Empress-1 crowns. There was no significant difference between the PFM crown group and the Procera group.
  
  
  CONCLUSIONS
  Within the limits of this pilot investigation, it seems that zirconia implants restored with the Procera crowns possibly fulfill the biomechanical requirements for anterior teeth. However, further investigations with larger sample sizes have to confirm these preliminary results. As three Empress-1 crowns showed crack development in the loading area of the steatite balls in the artificial mouth, their clinical use on zirconia implants has to be questioned.
authors.affiliation: Department of Prosthodontics, Albert-Ludwigs-University, University Hospital Freiburg, Hugstetter Strasse 55, 79106 Freiburg, Germany. ralf.kohal@uniklinik-freiburg.de
authors.forename: Ralf-J
authors.initials: RJ
authors.lastname: Kohal
authors.forename: Gerold
authors.initials: G
authors.lastname: Klaus
authors.forename: Jörg R
authors.initials: JR
authors.lastname: Strub
mesh_terms: D000538:Aluminum Silicates / Q000737:chemistry; D001696:Biomechanical Phenomena; D002484:Cementation; D003442:Crowns; D015921:Dental Implants; D003764:Dental Materials / Q000737:chemistry*; D003776:Dental Porcelain / Q000737:chemistry*; D019094:Dental Prosthesis, Implant-Supported; D019232:Dental Restoration Failure; D006801:Humans; D007180:Incisor; D008409:Mastication / Q000502:physiology; D008422:Materials Testing; D016876:Metal Ceramic Alloys / Q000737:chemistry; D010865:Pilot Projects; D013314:Stress, Mechanical; D013499:Surface Properties; D014025:Titanium / Q000737:chemistry; D015040:Zirconium / Q000737:chemistry*
chemical_list: D000538:Aluminum Silicates; D015921:Dental Implants; D003764:Dental Materials; C075815:IPS-Empress ceramic; D016876:Metal Ceramic Alloys; C077451:Procera; D003776:Dental Porcelain; D015040:Zirconium; D014025:Titanium; C028541:zirconium oxide