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Retrospective clinical study of 1472-unit monolithic zirconia restorations with feather-edge margins realized with digital workflow

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Abstract

Objectives

To evaluate the clinical performance of monolithic zirconia restorations with feather-edge margins fabricated by digital impressions.

Materials and methods

All participants that present monolithic zirconia restorations with feather-edge margins realized with digital workflow were evaluated during scheduled periodontal maintenance between February and September 2022 according to predetermined inclusion criteria. Clinical performance was assessed using the modified USPHS and periodontal parameters. Overall survival was calculated for monolithic zirconia restorations. Technical and biologic complications were reported. Descriptive statistical analysis and life-table analyses were performed for all data.

Results

A total of 1472 monolithic zirconia FDPs (1279 on abutments and 193 on pontics) placed in 1189 patients (982 males and 490 females) from February 2017 to September 2020 were analyzed. The mean follow-up was 44 months (range 36–61 months), and the overall survival rate was 98.5%. There were 931 single crowns, 96 were 3-unit FDPs, 33 were 4-unit FDPs, 11 were 5-unit FDPs, and 6-unit FDPs. Three single crowns had irreparable cracks, and 6 single crowns and one 4-unit FDP were fractured. One 3-unit FDP failed due to tooth fracture and 5 single crowns failed due to endodontic failure. The loss of retention was noted in 25 monolithic zirconia FDPs and hypersensitivity in 44 single crowns. Biologic complications were uncommon.

Conclusions

Based on the results and its limitations, the monolithic zirconia FPDs and digital impressions represent a favorable prosthetic treatment similar to that reported with other margin designs

Clinical relevance

Monolithic zirconia restorations on vertical-margin abutments fabricated using a digital workflow demonstrate excellent clinical performance. The digital clinical workflow without the use of a cast means a reduction in costs, steps, and operating time.

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References

  1. Pjetursson BE, Valente NA, Strasding M, Zwahlen M, Liu S, Sailer I (2018) A systematic review of the survival and complication rates of zirconia-ceramic and metal-ceramic single crowns. Clin Oral Implants Res 29(Suppl 16):199–214. https://doi.org/10.1111/clr.13306

    Article  PubMed  Google Scholar 

  2. Stawarczyk B, Keul C, Eichberger M, Figge D, Edelhoff D, Lümkemann N (2017) Three generations of zirconia: from veneered to monolithic. Part I. Quintessence Int 48:369–380. https://doi.org/10.3290/j.qi.a38057

    Article  PubMed  Google Scholar 

  3. Pjetursson BE, Sailer I, Zwahlen M, Hämmerle CH (2017) A systematic review of the survival and complication rates of all-ceramic and metal-ceramic reconstructions after an observation period of at least 3 years. Part I: Single crowns. Clin Oral Implants Res 18(Suppl 3):73–85. https://doi.org/10.1111/j.1600-0501.2007.01467.x

    Article  Google Scholar 

  4. Zhang Y, Lawn BR (2018) Novel zirconia materials in dentistry. J Dent Res 97:140–147. https://doi.org/10.1177/0022034517737483

    Article  PubMed  Google Scholar 

  5. Blatz MB, Vonderheide M, Conejo J (2018) The effect of resin bonding on long-term success of high-strength ceramics. J Dent Res 97:132139. https://doi.org/10.1177/0022034517729134

    Article  Google Scholar 

  6. Arena A, Prete F, Rambaldi E, Bignozzi MC, Monaco C, Di Fiore A, Chevalier J (2019) Nanostructured zirconia-based ceramics and composites in dentistry: a state-of-the-art review. Nanomaterials (Basel) 9(10):1393. https://doi.org/10.3390/nano9101393

    Article  PubMed  Google Scholar 

  7. Passia N, Stampf S, Strub JR (2013) Five-year results of a prospective randomised controlled clinical trial of posterior computer-aided design-computer-aided manufacturing ZrSiO4 -ceramic crowns. J Oral Rehabil 40:609–617. https://doi.org/10.1111/joor.12075

    Article  PubMed  Google Scholar 

  8. Di Fiore A, Vigolo P, Graiff L, Stellini E (2018) Digital vs conventional workflow for screw-retained single-implant crowns: a comparison of key considerations. Int J Prosthodont 31:577–579. https://doi.org/10.11607/ijp.5938

    Article  PubMed  Google Scholar 

  9. Wu L, Sun Z, Zhao J, Zheng Y (2022) Retrospective clinical study of monolithic zirconia crowns fabricated with a straightforward completely digital workflow. J Prosthet Dent 128:913–918. https://doi.org/10.1016/j.prosdent.2021.01.018

    Article  PubMed  Google Scholar 

  10. Pontevedra P, Lopez-Suarez C, Pelaez J, Garcia-Serdio S, Suarez MJ (2021) Prospective clinical evaluation of posterior monolithic zirconia fixed partial dentures using a complete digital workflow: two-year follow-up. J Prosthodont 30:298–304. https://doi.org/10.1111/jopr.13251

    Article  PubMed  Google Scholar 

  11. Li R, Chen H, Wang Y, Sun Y (2021) Performance of stereolithography and milling in fabricating monolithic zirconia crowns with different finish line designs. J Mech Behav Biomed Mater 115:104255. https://doi.org/10.1016/j.jmbbm.2020.104255

    Article  PubMed  Google Scholar 

  12. Miura S, Kasahara S, Yamauchi S, Egusa H (2018) Effect of finish line design on stress distribution in bilayer and monolithic zirconia crowns: a three-dimensional finite element analysis study. Eur J Oral Sci 126:159–165. https://doi.org/10.1111/eos.12402

    Article  PubMed  Google Scholar 

  13. Loi I, Di Felice A (2013) Biologically oriented preparation technique (BOPT): a new approach for prosthetic restoration of periodontically healthy teeth. Eur J Esthet Dent 8:10–23

    PubMed  Google Scholar 

  14. Serra-Pastor B, Loi I, Fons-Font A, Solá-Ruíz MF, Agustín-Panadero R (2019) Periodontal and prosthetic outcomes on teeth prepared with biologically oriented preparation technique: a 4-year follow-up prospective clinical study. J Prosthodont Res 63:415–420. https://doi.org/10.1016/j.jpor.2019.03.006

    Article  PubMed  Google Scholar 

  15. Monaco C, Caldari M, Scotti R, AIOP Clinical Research Group (2013) Clinical evaluation of 1,132 zirconia-based single crowns: a retrospective cohort study from the AIOP clinical research group. Int J Prosthodont 26:435–442. https://doi.org/10.11607/ijp.3099

    Article  PubMed  Google Scholar 

  16. Poggio CE, Dosoli R, Ercoli C (2012) A retrospective analysis of 102 zirconia single crowns with knife-edge margins. J Prosthet Dent 107:316–321. https://doi.org/10.1016/S0022-3913(12)60083-3

    Article  PubMed  Google Scholar 

  17. Di Fiore A, Monaco C, Brunello G, Granata S, Stellini E, Yilmaz B (2021) Automatic digital design of the occlusal anatomy of monolithic zirconia crowns compared to dental technicians’ digital waxing: a controlled clinical trial. J Prosthodont 30:104–110. https://doi.org/10.1111/jopr.13268

    Article  PubMed  Google Scholar 

  18. Di Fiore A, Vigolo P, Monaco C, Graiff L, Ferrari M, Stellini E (2019) Digital impression of teeth prepared with a subgingival vertical finish line: a new clinical approach to manage the interim crown. J Osseointegration 11:544–547. https://doi.org/10.23805/JO.2019.11.03.14

    Article  Google Scholar 

  19. Schmitz JH, Valenti M (2020) Interim restoration technique for gingival displacement with a feather-edge preparation design and digital scan. J Prosthet Dent 123:580–583 https://doi.org/10.1016/j.prosdent.2020.06.018

    Article  PubMed  Google Scholar 

  20. The glossary of prosthodontic terms: ninth edition (2017) J Prosthet Dent 117:e1–e105. https://doi.org/10.1016/j.prosdent.2016.12.001

    Article  Google Scholar 

  21. Ferrari Cagidiaco E, Zarone F, Discepoli N, Joda T, Ferrari M (2021) Analysis of the reproducibility of subgingival vertical margins using intraoral optical scanning (IOS): a randomized controlled pilot trial. J Clin Med 10:941. https://doi.org/10.3390/jcm10050941

    Article  PubMed  PubMed Central  Google Scholar 

  22. Kina JR, Dos Santos PH, Kina EF, Suzuki TY, Dos Santos PL (2011) Periodontal and prosthetic biologic considerations to restore biological width in posterior teeth. J Craniofac Surg 22:1913–1916. https://doi.org/10.1097/SCS.0b013e31822ea701

    Article  PubMed  Google Scholar 

  23. Dumbrigue HB (2003) Composite indirect-direct method for fabricating multiple-unit provisional restorations. J Prosthet Dent 89:86–88. https://doi.org/10.1067/mpr.2003.8

    Article  PubMed  Google Scholar 

  24. Zhang R, Ding Q, Sun Y, Zhang L, Xie Q (2018) Assessment of CAD-CAM zirconia crowns designed with 2 different methods: a self-controlled clinical trial. J Prosthet Dent 120:686–692. https://doi.org/10.1016/j.prosdent.2017.11.027

    Article  PubMed  Google Scholar 

  25. Cvar JF, Ryge G (2005) Reprint of criteria for the clinical evaluation of dental restorative materials. 1971. Clin Oral Investig 9:215–232. https://doi.org/10.1007/s00784-005-0018-z

    Article  PubMed  Google Scholar 

  26. Silness J (1970) Periodontal conditions in patients treated with dental bridges. J Periodontal Res 5:60–68. https://doi.org/10.1111/j.1600-0765.1970.tb01839.x

    Article  PubMed  Google Scholar 

  27. Comlekoglu M, Dundar M, Ozcan M, Gungor M, Gokce B, Artunc C (2009) Influence of cervical finish line type on the marginal adaptation of zirconia ceramic crowns. Operative Dent 34:586–592. https://doi.org/10.2341/08-076-L

    Article  Google Scholar 

  28. Beuer F, Aggstaller H, Edelhoff D, Gernet W (2008) Effect of preparation design on the fracture resistance of zirconia crown copings. Dent Mater J 27:362–367. https://doi.org/10.4012/dmj.27.362

    Article  PubMed  Google Scholar 

  29. Cehreli MC, Kkat AM, Aka K (2009) CAD/CAM Zirconia vs. slip cast glass-infiltrated alumina/zirconia all-ceramic crowns: 2-year results of a randomized controlled clinical trial. J Appl Oral Sci 17:49–55. https://doi.org/10.1590/s1678-77572009000100010

    Article  PubMed  PubMed Central  Google Scholar 

  30. Ortorp A, Kihl M, Carlsson G (2009) A 3-year retrospective and clinical follow-up study of zirconia single crowns in a private practice. J Dent 37:731–736. https://doi.org/10.1016/j.jdent.2009.06.002

    Article  PubMed  Google Scholar 

  31. Groten M, Huttig F (2010) The performance of zirconium oxide crowns: a clinical follow-up. Int J Prosthodont 23:429–423

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Neuroscience, School of Dentistry, Division of Prosthodontics and Digital Dentistry, University of Padova, Padova, Italy

    Adolfo Di Fiore & Edoardo Stellini

  2. Department of Surgery, Medicine, and Dentistry, University of Modena and Reggio Emilia, Modena, Italy

    Carlo Monaco

Authors
  1. Adolfo Di Fiore
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  2. Carlo Monaco
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Contributions

A. Di Fiore contributed to data acquisition, analysis, data interpretation, and drafted and critically revised the manuscript; B. Monaco critically revised the manuscript; C. Stellini critically revised the manuscript. All authors gave fnal approval and agree to be accountable for all aspects of the work.

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Correspondence to Adolfo Di Fiore.

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All participants respectively their guardians provided their informed written consent.

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Di Fiore, A., Monaco, C. & Stellini, E. Retrospective clinical study of 1472-unit monolithic zirconia restorations with feather-edge margins realized with digital workflow. Clin Oral Invest 27, 6567–6575 (2023). https://doi.org/10.1007/s00784-023-05262-1

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