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Three- to nine-year survival estimates and fracture mechanisms of zirconia- and alumina-based restorations using standardized criteria to distinguish the severity of ceramic fractures

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Abstract

Objectives

The aims of this study were set as follows:

  1. 1.

    To provide verifiable criteria to categorize the ceramic fractures into non-critical (i.e., amenable to polishing) or critical (i.e., in need of replacement)

  2. 2.

    To establish the corresponding survival rates for alumina and zirconia restorations

  3. 3.

    To establish the mechanism of fracture using fractography

Materials and methods

Fifty-eight patients restored with 115 alumina-/zirconia-based crowns and 26 zirconia-based fixed dental prostheses (FDPs) were included. Ceramic fractures were classified into four types and further subclassified into “critical” or “non-critical.” Kaplan–Meier survival estimates were calculated for “critical fractures only” and “all fractures.” Intra-oral replicas were taken for fractographic analyses.

Results

Kaplan–Meier survival estimates for “critical fractures only” and “all fractures” were respectively: Alumina single crowns: 90.9 and 68.3 % after 9.5 years (mean 5.71 ± 2.6 years). Zirconia single crowns: 89.4 and 80.9 % after 6.3 years (mean 3.88 ± 1.2 years). Zirconia FDPs: 68.6 % (critical fractures) and 24.6 % (all fractures) after 7.2 and 4.6 years respectively (FDP mean observation time 3.02 ± 1.4 years). No core/framework fractures were detected.

Conclusions

Survival estimates varied significantly depending on whether “all” fractures were considered as failures or only those deemed as “critical”. For all restorations, fractographic analyses of failed veneering ceramics systematically demonstrated heavy occlusal wear at the failure origin. Therefore, the relief of local contact pressures on unsupported ceramic is recommended. Occlusal contacts on mesial or distal ridges should systematically be eliminated.

Clinical relevance

A classification standard for ceramic fractures into four categories with subtypes “critical” and “non-critical” provides a differentiated view of the survival of ceramic restorations.

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Acknowledgments

Our gratitude is expressed to Professor Urs C. Belser; to Drs. Brazzola, Crottaz, Grütter, Srinivasan, and Vailati; as well as to the clinical faculty of the Division of Fixed Prosthodontics and Biomaterials for their help during the course of the present study. We are also indebted to Mr. Sylvain Carciofo, MDT, for his contribution to building the laboratory database and to Mrs. Marie-Claude Reymond for assistance with the SEM images. Statistical analyses and figures were provided by the Clinical Research Center, University of Geneva and Geneva University Hospitals (Dr. Angèle Gayet-Agéron).

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The authors declare no conflict of interest.

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Authors and Affiliations

  1. Division of Fixed Prosthodontics and Biomaterials, School of Dental Medicine, University of Geneva, Rue Barthélemy-Menn 19, 1205, Geneva, Switzerland

    Osvaldo D. Moráguez, H. W. Anselm Wiskott & Susanne S. Scherrer

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  1. Osvaldo D. Moráguez
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Correspondence to Osvaldo D. Moráguez.

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Moráguez, O.D., Wiskott, H.W.A. & Scherrer, S.S. Three- to nine-year survival estimates and fracture mechanisms of zirconia- and alumina-based restorations using standardized criteria to distinguish the severity of ceramic fractures. Clin Oral Invest 19, 2295–2307 (2015). https://doi.org/10.1007/s00784-015-1455-y

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  • DOI: https://doi.org/10.1007/s00784-015-1455-y

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