In vitro performance and fracture resistance of interim conventional or CAD-CAM implant-supported screw- or cement-retained anterior fixed partial dentures.

STATEMENT OF PROBLEM

Interim restorations represent an essential clinical treatment step; however, limited information is available concerning the performance of computer-aided design and computer-aided manufacturing (CAD-CAM) interim materials.

PURPOSE

The purpose of this in vitro study was to evaluate the performance and fracture load of resin anterior implant-supported interim fixed partial dentures (IFPDs).

MATERIAL AND METHODS

Identical anterior resin IFPDs (maxillary central incisor to canine; n=16 per material) were milled from polymethylmethacrylate (PMMA) or di-methacrylate (DMA) systems with different filler content. The IFPD groups were split to simulate a chairside (cemented implant-supported prosthesis) or laboratory procedure (screw-retained implant-supported prosthesis). A cartridge DMA material served as a control. After interim cementation, combined thermocycling and mechanical loading (TCML) was performed on all restorations to approximate a maximum of 2.5 years of clinical function. Behavior during TCML and fracture force was determined, and failures were analyzed. The data were statistically investigated (Kolmogorov-Smirnov test, 1-way-ANOVA; post hoc Bonferroni, Kaplan-Meier survival, α=.05).

RESULTS

Drop out during TCML varied between no failures and complete failure during loading. For most systems, failure occurred between 120 000 and 600 000 mechanical loading cycles. For IFPDs without a screw channel fracture, values varied between 644 ±263 N and 987 ±101 N. Those with a screw channel fracture failed between 493 ±89 N and 951 ±248 N. Individual IFPDs had significantly higher mean fracture loads (P<.002), but the mean fracture values between IFPDs with and without a screw channel were not significantly different (P>.137). Failures were characterized by fracture of the connector (n=53) followed by mixed failures (n=22) or fractures at the abutment (n=21).

CONCLUSIONS

These interim materials are sufficiently fracture resistant for the fabrication of implant-supported anterior IFPDs and are expected to survive between 6 months and 2 years before failure. The stability of IFPDs depended on the type of material but not on the restoration design (with or without a screw channel).