title: Fracture mode during cyclic loading of implant-supported single-tooth restorations.
abstract: BACKGROUND
  Fracture of veneering ceramics in zirconia-based restorations has frequently been reported. Investigation of the fracture mode of implant-supported ceramic restorations by using clinically relevant laboratory protocols is needed.
  
  
  OBJECTIVE
  This study compared the mode of fracture and number of cyclic loads until veneering fracture when ceramic and metal ceramic restorations with different veneering ceramics were supported by implants.
  
  
  METHODS
  Thirty-two implant-supported single-tooth restorations were fabricated. The test group was composed of 16 ceramic restorations of zirconia abutment-retained crowns with zirconia copings veneered with glass-ceramics (n=8) and feldspathic ceramics (n=8). The control group was composed of 16 metal ceramic restorations of titanium abutment-retained crowns with gold alloy copings veneered with glass (n=8) and feldspathic ceramics (n=8). The palatal surfaces of the crowns were exposed to cyclic loading of 800 N with a frequency of 2 Hz, which continued to 4.2 million cycles or until fracture of the copings, abutments, or implants. The number of cycles and the fracture modes were recorded. The fracture modes were analyzed by descriptive analysis and the Mann-Whitney test (α=.05). The differences in loading cycles until veneering fracture were estimated with the Cox proportional hazards analysis.
  
  
  RESULTS
  Veneering fracture was the most frequently observed fracture mode. The severity of fractures was significantly more in ceramic restorations than in metal ceramic restorations. Significantly more loading cycles until veneering fracture were estimated with metal ceramic restorations veneered with glass-ceramics than with other restorations.
  
  
  CONCLUSIONS
  The metal ceramic restorations demonstrated fewer and less severe fractures and resisted more cyclic loads than the ceramic restorations, particularly when the metal ceramic crowns were veneered with glass-ceramics.
authors.affiliation: Department of Oral Rehabilitation, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Denmark. mandana.hosseini@sund.ku.dk
authors.forename: Mandana
authors.initials: M
authors.lastname: Hosseini
authors.forename: Erik
authors.initials: E
authors.lastname: Kleven
authors.forename: Klaus
authors.initials: K
authors.lastname: Gotfredsen
mesh_terms: D000538:Aluminum Silicates / Q000737:chemistry; D003442:Crowns; D019250:Dental Implants, Single-Tooth; D003776:Dental Porcelain / Q000737:chemistry; D017267:Dental Prosthesis Design; D019232:Dental Restoration Failure; D003799:Dental Stress Analysis; D006801:Humans; D008422:Materials Testing; D016876:Metal Ceramic Alloys / Q000737:chemistry*; D017680:Potassium Compounds / Q000737:chemistry; D014025:Titanium / Q000737:chemistry; D016474:Weight-Bearing; D015040:Zirconium / Q000737:chemistry
chemical_list: D000538:Aluminum Silicates; D016876:Metal Ceramic Alloys; D017680:Potassium Compounds; D003776:Dental Porcelain; C016447:feldspar; D015040:Zirconium; D014025:Titanium; C028541:zirconium oxide