title: Bending moments of zirconia and titanium implant abutments supporting all-ceramic crowns after aging.
abstract: OBJECTIVE
  To test the fracture load and fracture patterns of zirconia abutments restored with all-ceramic crowns after fatigue loading, exhibiting internal and external implant-abutment connections as compared to restored and internally fixed titanium abutments.
  
  
  METHODS
  A master abutment was used for the customization of 5 groups of zirconia abutments to a similar shape (test). The groups differed according to their implant-abutment connections: one-piece internal connection (BL; Straumann Bonelevel), two-piece internal connection (RS; Nobel Biocare ReplaceSelect), external connection (B; Branemark MkIII), two-piece internal connection (SP, Straumann StandardPlus) and one-piece internal connection (A; Astra Tech AB OsseoSpeed). Titanium abutments with internal implant-abutment connection (T; Straumann Bonelevel) served as control group. In each group, 12 abutments were fabricated, mounted to the respective implants and restored with glass-ceramic crowns. All samples were embedded in acrylic holders (ISO-Norm 14801). After aging by means of thermocycling in a chewing simulator, static load was applied until failure (ISO-Norm 14801). Fracture load was analyzed by calculating the bending moments. Values of all groups were compared with one-way ANOVA followed by Scheffé post hoc test (P-value<0.05). Failure mode was analyzed descriptively.
  
  
  RESULTS
  The mean bending moments were 464.9 ± 106.6 N cm (BL), 581.8 ± 172.8 N cm (RS), 556.7 ± 128.4 N cm (B), 605.4 ± 54.7 N cm (SP), 216.4 ± 90.0 N cm (A) and 1042.0 ± 86.8 N cm (T). No difference of mean bending moments was found between groups BL, RS, B and SP. Test group A exhibited significantly lower mean bending moment than the other test groups. Control group T had significantly higher bending moments than all test groups. Failure due to fracture of the abutment and/or crown occurred in the test groups. In groups BL and A, fractures were located in the internal part of the connection, whereas in groups RS and SP, a partial deformation of the implant components occurred and cracks and fractures of the zirconia abutment were detected.
  
  
  CONCLUSIONS
  The differently connected zirconia abutments exhibited similar bending moments with the exception of one group. Hence, the type of connection only had a minor effect on the stability of restored zirconia abutments. In general, restored titanium abutments exhibited the highest bending moments.
authors.affiliation: Clinic of Fixed and Removable Prosthodontics and Dental Material Science, Center of Dental Medicine, University of Zurich, Zurich, Switzerland.
authors.forename: Sven
authors.initials: S
authors.lastname: Mühlemann
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Truninger
authors.forename: Bogna
authors.initials: B
authors.lastname: Stawarczyk
authors.forename: Christoph H F
authors.initials: CH
authors.lastname: Hämmerle
authors.forename: Irena
authors.initials: I
authors.lastname: Sailer
mesh_terms: D002516:Ceramics / Q000737:chemistry; D003442:Crowns; D000044:Dental Abutments; D059605:Dental Implant-Abutment Design; D019250:Dental Implants, Single-Tooth; D019232:Dental Restoration Failure; D003799:Dental Stress Analysis; D066298:In Vitro Techniques; D008409:Mastication; D008422:Materials Testing; D014025:Titanium / Q000737:chemistry*; D015040:Zirconium / Q000737:chemistry*
chemical_list: C023506:Glass ceramics; D015040:Zirconium; D014025:Titanium; C028541:zirconium oxide
keywords: aging; all-ceramic restoration; bending moment; chewing simulation; implant abutments; implant-abutment connection; thermocycling; zirconia abutments