Esquivel-Upshaw Josephine F, Clark Arthur E, Shuster Jonathan J, Anusavice Kenneth J
Department of Restorative Dental Sciences, University of Florida College of Dentistry, Gainesville, FL; Center for Dental Biomaterials, University of Florida College of Dentistry, Gainesville, FL.
J Prosthodont. 2014 Feb;23(2):73-82. doi: 10.1111/jopr.12066. Epub 2013 Jun 12.
The aim of this study was to determine the survival rates over time of implant-supported ceramic-ceramic and metal-ceramic prostheses as a function of core-veneer thickness ratio, gingival connector embrasure design, and connector height.
An IRB-approved, randomized, controlled clinical trial was conducted as a single-blind pilot study involving 55 patients missing three teeth in either one or two posterior areas. These patients (34 women; 21 men; age range 52-75 years) were recruited for the study to receive a three-unit implant-supported fixed dental prosthesis (FDP). Two implants were placed for each of the 72 FDPs in the study. The implants (Osseospeed, Astra Tech), which were made of titanium, were grit blasted. A gold-shaded, custom-milled titanium abutment (Atlantis, Astra Tech), was secured to each implant body. Each of the 72 FDPs in 55 patients were randomly assigned based on one of the following options: (1) A.
ceramic-ceramic (Yttria-stabilized zirconia core, pressable fluorapatite glass-ceramic, IPS e.max ZirCAD, and ZirPress, Ivoclar Vivadent) B. metal-ceramic (palladium-based noble alloy, Capricorn, Ivoclar Vivadent, with press-on leucite-reinforced glass-ceramic veneer, IPS InLine POM, Ivoclar Vivadent); (2) occlusal veneer thickness (0.5, 1.0, and 1.5 mm); (3) curvature of gingival embrasure (0.25, 0.5, and 0.75 mm diameter); and (4) connector height (3, 4, and 5 mm). FDPs were fabricated and cemented with dual-cure resin cement (RelyX, Universal Cement, 3M ESPE). Patients were recalled at 6 months, 1 year, and 2 years. FDPs were examined for cracks, fracture, and general surface quality.
Recall exams of 72 prostheses revealed 10 chipping fractures. No fractures occurred within the connector or embrasure areas. Two-sided Fisher's exact tests showed no significant correlation between fractures and type of material system (p = 0.51), veneer thickness (p = 0.75), radius of curvature of gingival embrasure (p = 0.68), and connector height (p = 0.91).
Although there were no significant associations between connector height, curvature of gingival embrasure, core/veneer thickness ratio, and material system and the survival probability of implant-supported FDPs with zirconia as a core material, the small number of fractures precludes a definitive conclusion on the dominant controlling factor.
本研究的目的是确定种植体支持的陶瓷-陶瓷和金属-陶瓷修复体随时间的生存率，作为核-贴面厚度比、牙龈连接体间隙设计和连接体高度的函数。
一项经机构审查委员会批准的随机对照临床试验作为单盲试点研究进行，涉及55例在一个或两个后牙区域缺失三颗牙齿的患者。这些患者（34名女性；21名男性；年龄范围52 - 75岁）被招募参加该研究，以接受一个三单位种植体支持的固定义齿（FDP）。研究中的72个FDP每个都植入两颗种植体。种植体（Osseospeed，Astra Tech）由钛制成，进行了喷砂处理。一个金色阴影的定制铣削钛基台（Atlantis，Astra Tech）被固定到每个种植体主体上。55例患者中的72个FDP根据以下选项之一随机分配：（1）材料：A. 陶瓷-陶瓷（氧化钇稳定氧化锆核，可压注氟磷灰石玻璃陶瓷，IPS e.max ZirCAD，以及ZirPress，义获嘉伟瓦登特）B. 金属-陶瓷（钯基贵金属合金，Capricorn，义获嘉伟瓦登特，带有压接的白榴石增强玻璃陶瓷贴面，IPS InLine POM，义获嘉伟瓦登特）；（2）咬合贴面厚度（0.5、1.0和1.5毫米）；（3）牙龈间隙曲率（直径0.25、0.5和0.75毫米）；（4）连接体高度（3、4和5毫米）。FDP制作完成后用双固化树脂水门汀（RelyX，通用水门汀，3M ESPE）粘结。患者在6个月、1年和2年时进行复诊。检查FDP是否有裂纹、骨折和一般表面质量。
对72个修复体的复诊检查发现10例崩瓷骨折。连接体或间隙区域未发生骨折。双侧Fisher精确检验显示骨折与材料系统类型（p = 0.51）、贴面厚度（p = 0.75）、牙龈间隙曲率半径（p = 0.68）和连接体高度（p = 0.91）之间无显著相关性。
尽管连接体高度、牙龈间隙曲率、核/贴面厚度比和材料系统与以氧化锆为核心材料的种植体支持的FDP的生存概率之间没有显著关联，但骨折数量较少，无法就主要控制因素得出明确结论。
