Division of Fixed Prosthodontics and Biomaterials, University Clinics for Dental Medicine, University of Geneva, Geneva, Switzerland.
Departments of Oral and Maxillofacial Diseases, Helsinki University Hospital (HUH), Helsinki, Finland.
Clin Oral Implants Res. 2021 Feb;32(2):222-232. doi: 10.1111/clr.13693. Epub 2020 Dec 17.
To evaluate mechanical stability (survival and complication rates) and bending moments of different all-ceramic monolithic restorations bonded to titanium bases (hybrid abutment-crowns) or to customized titanium abutments compared to porcelain-fused-to-metal crowns (PFM) after thermo-mechanical aging.
Sixty conical connection implants (4.3 mm-diameter) were divided in five groups (n = 12): PFM using gold abutment (GAbut-PFM), lithium disilicate crown bonded to customized titanium abutment (TAbut+LDS), lithium disilicate abutment-crown bonded to titanium base (TiBase+LDS), zirconia abutment-crown bonded to titanium base (TiBase+ZR), polymer-infiltrated ceramic-network (PICN) abutment-crown bonded to titanium base (TiBase+PICN). Simultaneous thermocycling (5°-55°C) and chewing simulation (1,200,000-cycles, 49 N, 1.67 Hz) were applied. Catastrophic and non-catastrophic events were evaluated under light microscope, and survival and complication rates were calculated. Specimens that survived aging were loaded until failure and bending moments were calculated.
Survival rates after aging were 100% (TAbut+LDS, TiBase+LDS), 91.7% (GA-PFM), 66.7% (TiBase+ZR) and 58.3% (TiBase+PICN) and differed among the groups (p = .006). Non-catastrophic events as screw loosening (GA-PFM) and loss of retention or micro-/macro-movement (TiBase groups) were observed. Complication rates varied among the groups (p < .001). TiBase+PICN had lower bending moment than all the other groups (p < .001).
Hybrid abutment-crowns made of lithium disilicate can be an alternative to PFM-based restorations, although concerns regarding the bonded interface between the titanium base and abutment-crown can be raised. PICN and zirconia may not be recommended due to its inferior mechanical and bonding outcomes, respectively. Titanium customized abutment with bonded lithium disilicate crown appears to be the most stable combination.
评估不同全陶瓷整体修复体与钛基底（混合基台-冠）或定制钛基台粘结后的机械稳定性（存活率和并发症发生率）以及弯曲力矩，与金属烤瓷冠（PFM）相比，这些修复体在热机械老化后是否存在差异。
将 60 个锥形连接种植体（直径 4.3mm）分为五组（n=12）：金基台的 PFM（GAbut-PFM）、粘结于定制钛基台的锂硅玻璃陶瓷冠（TAbut+LDS）、粘结于钛基底的锂硅玻璃陶瓷基台-冠（TiBase+LDS）、粘结于钛基底的氧化锆基台-冠（TiBase+ZR）、粘结于钛基底的聚合体渗透陶瓷网络基台-冠（TiBase+PICN）。同时进行热循环（5°-55°C）和咀嚼模拟（1,200,000 次循环，49N，1.67Hz）。在光显微镜下评估灾难性和非灾难性事件，并计算存活率和并发症发生率。对经过老化的试件进行加载直至失效，并计算弯曲力矩。
老化后存活率为 100%（TAbut+LDS、TiBase+LDS）、91.7%（GA-PFM）、66.7%（TiBase+ZR）和 58.3%（TiBase+PICN），组间差异有统计学意义（p=0.006）。观察到非灾难性事件，如螺丝松动（GA-PFM）和固位力丧失或微/宏观移动（TiBase 组）。并发症发生率在各组之间存在差异（p<0.001）。TiBase+PICN 的弯曲力矩低于其他所有组（p<0.001）。
尽管对钛基底与基台-冠粘结界面可能存在担忧，但由锂硅玻璃陶瓷制成的混合基台-冠可作为 PFM 修复体的替代物。鉴于其机械性能和粘结效果较差，不建议使用 PICN 和氧化锆。粘结于钛基底的锂硅玻璃陶瓷冠的定制钛基台似乎是最稳定的组合。
