title: The effect of load cycling on metal ceramic screw-retained implant restorations with unrestored and restored screw access holes.
abstract: BACKGROUND
  It has been shown that under cyclic loading, more chipping fractures of the veneer ceramic occur on the occlusal surface of screw-retained implant-supported fixed partial dentures (FPDs) with unrestored screw access holes (SAHs) than in cemented restorations. This lack of stability may result in esthetic and functional problems.
  
  
  OBJECTIVE
  The purpose of this study was to investigate whether, under dynamic loading, fewer chipping fractures occur on the occlusal surface of screw-retained ceramic veneered implant FPDs with restored SAHs than in those with unrestored SAHs.
  
  
  METHODS
  Twenty screw-retained ceramic veneered 5-unit FPDs were manufactured for a 3-implant situation and divided into 2 groups of 10 unrestored and 10 SAHs restored with adhesive composite resin restorations (Tetric Evo Ceram). A masticatory simulator was used to load the FPDs occlusal to the implant positions for 20,000 cycles with a force of 100 N applied for 1 second, followed by 1 second of no loading. Three prosthodontists evaluated the FPDs using a light microscope and a dental probe. The number of chipping fractures found were analyzed using a generalized linear model with Poisson response and log link function (alpha =.05).
  
  
  RESULTS
  Investigators found significantly more chipping fractures in the group of screw-retained FPDs with unrestored SAHs. The rate ratio of unrestored versus restored prostheses was 3.29 (P=.006).
  
  
  CONCLUSIONS
  Adhesive composite resin restorations can significantly reduce the number of chipping fractures occurring around the SAHs of screw-retained implant-supported restorations.
authors.affiliation: Department of Prosthodontics, University of Erlangen-Nuremberg, Erlangen, Germany. karl_matthias@web.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Karl
authors.forename: Friedrich
authors.initials: F
authors.lastname: Graef
authors.forename: Manfred G
authors.initials: MG
authors.lastname: Wichmann
authors.forename: Siegfried M
authors.initials: SM
authors.lastname: Heckmann
mesh_terms: D015921:Dental Implants; D017268:Dental Prosthesis Retention / Q000295:instrumentation / Q000379:methods*; D019094:Dental Prosthesis, Implant-Supported / Q000379:methods*; D019232:Dental Restoration Failure; D003799:Dental Stress Analysis / Q000379:methods*; D003830:Denture, Partial, Fixed; D006801:Humans; D016474:Weight-Bearing
chemical_list: D015921:Dental Implants