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for
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VOLUME 41
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Q U I N T E S S E N C E I N T E R N AT I O N A L
Philipp et al
The third and the fourth studies, however, analyzed the high-strength ceramic zirconia as
framework material.3,6 With frameworks made
of zirconia, the failure rate of the FDPs was significantly lower than for frameworks with glassinfiltrated alumina. In the clinical studies, failure
rates of those FDPs ranged from 0%3 to 2.2%.6
The most frequent reason for failure of
FDPs made of glass-infiltrated alumina
was fracture of the ceramic framework.5
Interestingly, after the same observation period for zirconia-based FDPs, fracture of
framework was a rare clinical complication.3,6
314
Prosthodontic procedures
Four patients were treated by experienced clinicians and four patients by undergraduate
students under strict guidance by experienced
clinicians. Treatment was performed according to standard techniques applied for metalceramic reconstructions. The procedures
were published in detail elsewhere18 and will
therefore be briefly summarized with respect
to the abutment tooth preparation.
The abutment teeth were prepared as follows (Fig 1): margin with a circumferentially
rounded shoulder (width 1.0 mm), tapering
angle of 6 to 10 degrees for both premolars
and molars, and occlusal reduction of 1.5 to
2.0 mm.
VOLUME 41
NUMBER 4
APRIL 2010
2009 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE
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Q U I N T E S S E N C E I N T E R N AT I O N A L
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Fig 2 View of the intaglio surface of a veneered Ce-TZP/Ananocomposite FDP with marginal area in zirconia.
VOLUME 41
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Ta b l e 1
Integrity of framework
Integrity of veneering ceramic
Occlusal wear
Marginal adaptation
Anatomical shape
6 mo
12 mo
8
8
8
5
5
0
0
0
3
3
0
0
0
0
0
0
0
0
0
0
8
8
7
3
5
0
0
1
5
3
0
0
0
0
0
0
0
0
0
0
8
8
5
2
5
0
0
2
6
3
0
0
1
0
0
0
0
0
0
0
RESULTS
316
VOLUME 41
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VOLUME 41
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APRIL 2010
Fig 5a Buccal view of the FDP after 1 year of clinical service showing
the occlusal wear facet (box).
Fig 5c Detailed SEM aspect of Fig 5b. Rough surface of the veneering ceramic is visible (original
magnification 5,000).
Ta b l e 2
PPD (mm)
BOP
PCR
Control sites
Baseline
12 mo
Baseline
12 mo
2.5 0.8
0.1 0.1
0.2 0.3
2.6 0.8
0.2 0.2
0.1 0.1
2.4 0.4
0.1 0.1
0.2 0.4
2.6 0.6
0.1 0.1
0.2 0.2
317
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DISCUSSION
At 12 months of observation, the new CeTZP/A nanocomposite FDPs exhibited a survival rate of 100%. Within the limitations of
the present case series, the new framework
material was found to be clinically reliable.
Furthermore, the performance of the veneering ceramic was very good at this new type
of zirconia ceramic. No chipping or fracture
of the veneering ceramic occurred.
The performance of the zirconia frameworks in the present case series is in accordance with the findings of various other
studies analyzing zirconia as framework
material in posterior regions of the
jaws.46,21,22 In these studies, survival rates of
98.8% to 100% of zirconia-based FDPs were
reported, however, after longer observation
periods of up to 5 years.46,21,22 Hence, a
longer observation time of the FDPs in the
present case series, and additional studies
of Ce-TZP/A nanocompositebased reconstructions with a higher sample size, are
needed to verify the positive primary findings. Furthermore, comparison of the present results with the ones of metal-ceramic
FDPs (golden standard) is needed in the
future. As an example, two meta-analyses
observed failure rates of only 8%23 and
10%24 of FDPs with metallic frameworks after
10 years. These results are considered to be
the benchmark for new types of FDP.
Besides good mechanical strength of the
framework, the stability of the veneering
ceramics is one further prerequisite for the
clinical success. The fact that no chippings
occurred in the present case series is very
promising. Problems such as chipping or
fracturing of the veneering ceramic were the
main technical complication in previous
studies analyzing Y-TZP.3,6,18 Metal-ceramic
or alumina-ceramic FDPs exhibited lower
complication rates of the veneering ceramic
than zirconia-based FDPs.46,2224 Clinical
studies reported chipping or fracture rates of
the metal veneering ceramic of only 2.5%.25
Even more, with veneered glass-infiltrated
alumina FPDs no failures of the veneering
ceramic were observed at all after 5 years of
clinical function.4,5 Veneered Y-TZP frameworks, however, showed varying chipping
318
CONCLUSIONS
At 12 months of clinical service, Ce-TZP/A
nanocomposite proved to be a promising and
reliable framework material for posterior FDPs.
Yet, before final conclusions can be drawn,
longer observation periods, studies with more
patients, and randomized clinical long-term trials are needed to validate the clinical performance of this first preliminary case series.
VOLUME 41
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APRIL 2010
2009 BY QUINTESSENCE PUBLISHING CO, INC. PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY. NO PART OF THIS ARTICLE
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ACKNOWLEDGMENTS
REFERENCES
17. OLeary TJ, Drake RB, Naylor JE. The plaque control
record. J Periodontol 1972;43:38.
2002;14:188191.
2002;14:313319.
2004;92:557562.
459471.
22. Tinschert J, Schulze KA, Natt G, Latzke P, Heussen N,
2009;13:445451.
82:117.
2009;25:419423.
29. Raigrodski AJ, Chiche GJ, Potiket N, et al. The efficacy of posterior three-unit zirconium-oxidebased
96:237244.
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