Fracture strength of zirconia implant abutments on narrow diameter implants with internal and external implant abutment connections: A study on the titanium resin base concept

BackgroundThere is limited knowledge regarding the strength of zirconia abutments with internal and external implant abutment connections and zirconia abutments supported by a titanium resin base (Variobase, Straumann) for narrow diameter implants. ObjectivesTo compare the fracture strength of narrow diameter abutments with different types of implant abutment connections after chewing simulation. Material and methodsHundred and twenty identical customized abutments with different materials and implant abutment connections were fabricated for five groups: 1-piece zirconia abutment with internal connection (T1, Cares-abutment-Straumann BL-NC implant, Straumann Switzerland), 1-piece zirconia abutment with external hex connection (T2, Procera abutment-Branemark NP implant, Nobel Biocare, Sweden), 2-piece zirconia abutments with metallic insert for internal connection (T3, Procera abutment-Replace NP implant, Nobel Biocare), 2-piece zirconia abutment on titanium resin base (T4, LavaPlus abutment-VarioBase-Straumann BL-NC implant, 3M ESPE, Germany) and 1-piece titanium abutment with internal connection (C, Cares-abutment-Straumann BL-NC implant, Straumann, Switzerland). All implants had a narrow diameter ranging from 3.3 to 3.5mm. Sixty un-restored abutments and 60 abutments restored with glass-ceramic crowns were tested. Mean bending moments were compared using ANOVA with p-values adjusted for multiple comparisons using Tukey's procedure. ResultsThe mean bending moments were 52133Ncm (T4), 404 +/- 36Ncm (C), 311 +/- 106Ncm (T1) 265 +/- 22Ncm (T3) and 225 +/- 29 (T2) for un-restored abutments and 278 +/- 84Ncm (T4), 302 +/- 170Ncm (C), 190 +/- 55Ncm (T1) 80 +/- 102Ncm (T3) and 125 +/- 57 (T2) for restored abutments. For un-restored abutments, C and T4 had similar mean bending moments, significantly higher than those of the three other groups (p<.05). Titanium abutments (C) had significantly higher bending moments than identical zirconia abutments (T1) (p<.05). Zirconia abutments (T1) with internal connection had higher bending moments than zirconia abutments with external connection (T2) (p<.05). For all test groups, the bending moments were significantly reduced when restored with all-ceramic crowns. ConclusionsFor narrow diameter abutments, the fracture strength of 2-piece internal connected zirconia abutments fixed on titanium resin bases was similar to those obtained for 1-piece titanium abutments. Narrow diameter zirconia abutments with internal connection exhibited higher fracture strength than zirconia abutments with an external connection. Titanium abutments with an internal connection were significantly stronger than identical zirconia abutments.