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Title CAD-CAM Fabricated Zirconia Frameworks Provide Clinically Acceptable Fit at the Implant/Abutment Interface
Clinical Question Does a zirconia framework fit as well as a titanium framework for an all-on-4 implant retained denture?
Clinical Bottom Line CAD-CAM fabricated zirconia frameworks had similar fit to milled titanium frameworks for a 4-implant retained dental prosthesis
Best Evidence (you may view more info by clicking on the PubMed ID link)
PubMed ID Author / Year Patient Group Study type
(level of evidence)
#1) 28720339Al-Mraikhi, H/2017Patient Group In vitro 5 samples from each materialLaboratory study
Key resultsIn vitro study concludes that zirconia frameworks for implant retained dentures had similar fit to titanium frameworks.Three-dimensional microgap measurements of frameworks showed clinically acceptable misfit values. Absolute passive fit was not achieved
#2) 28477917Al-Mraikhi, H/2017Patient Group In vitro 5 samples from each materialLaboratory study
Key resultsIn vitro study determines that both zirconia and titanium frameworks exhibit distortion. However, there was no statistically significant difference between the two materials. The distortion was more pronounced in the horizontal and sagittal plane than in the vertical plane.
#3) 23025489Katsoulis, J/2014In vitro, 6 zirconia and 5 titanium samplesLaboratory study
Key resultsThis lab study concludes that the fit of cast alloy frameworks for implant retained full arch fixed dental prosthesis is unacceptable, while titanium and zirconia provide clinically acceptable fits. Optical and tactile scanners with CAD/CAM technology allow for the fabrication of highly accurate long-span screw-retained ZrO implant-reconstructions. Titanium frameworks showed the most consistent precision
Evidence Search (((((accuracy) or fit) and zirconia) and titanium) and framework
Comments on
The Evidence
Validity: Calibrated computed tomography (CT) , optical, and tactile scanners are a valid method to accurately digitize a three dimensional model. Using the data obtained from these scans, creating and analyzing standard tessellation language (STL) files are widely accepted and used in dentistry. Software used to measure differences between STL file samples is among the most accurate method for measurement at this scale, and is appropriate for these analyses. Statistical analysis and clinical applicability make evident the validity of the findings that the accuracy of titanium and zirconia frameworks are acceptable to use in the fabrication of full arch fixed prostheses. Perspective: Using either titanium or zirconia frameworks for full arch, implant supported fixed prostheses is a relatively new technique made possible due to recent significant advancements in computer aided design, computer aided manufacture (CAD/CAM) technology. Because these capabilities are so new, very little research exists on zirconia utilized in this manner, despite its rapid adoption and widespread use for full arch prostheses. This research demonstrates that, despite the significant 20% volumetric shrinkage from milled pre-sintered zirconia to sintered zirconia, a reliable product can be manufactured and utilized without deleterious effect on supporting implants or peri-implant bone.
Applicability These studies demonstrate that a zirconia framework is appropriate to restore multi-implant, screw retained full arch fixed prostheses when compared to a milled titanium framework in regards to passivity of fit of the prosthesis to multiple implants, while cast metal is an unacceptable material for utilization in this application. Limited studies, however, have yet to be published on the long-term fracture toughness and clinical serviceability of a zirconia full arch framework, so caution is advised in use for high load potential patients. Additionally, this type of in vitro evidence is the only peer reviewed data available at this time related to passivity of fit of full arch implant supported zirconia frameworks, which is rapidly gaining popularity and utilization in the dental field. Additional randomized controlled trials and systematic reviews with meta-analysis are warranted for this subject.
Specialty/Discipline (Public Health) (Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Prosthodontics) (Restorative Dentistry)
Keywords Zirconia framework, titanium framework, all-on-four, implant supported fixed dental prosthesis (FDP), Computer aided design-computer aided manufacture, CAD/CAM, passive fit
ID# 3291
Date of submission: 12/11/2017spacer
E-mail deckert@livemail.uthscsa.edu
Author Dr. Troy Decker, DDS
Co-author(s) Dr. Melissa Thomas, DDS
Co-author(s) e-mail thomasm@livemail.uthscsa.edu
Faculty mentor/Co-author
Faculty mentor/Co-author e-mail
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