Abstract Metal ceramic restorations have been used in fixed prosthodontics since the 1950s, but the lack of aesthetics, the inclination to use metal-free materials, possible allergic reactions to metals, and the high cost of high noble alloys have increased the use of all-ceramic materials. The ongoing development of ceramic materials led to the introduction of zirconia to fixed prosthodontics over a decade ago. The mechanical properties of zirconia have proven to be excellent, but the clinical outcome of conventional fixed zirconia restorations over the long term is unclear. This retrospective clinical study evaluated two- to seven-year outcomes, early complications during prosthetic treatment and short-term failures during the first year of use of zirconia single crowns and fixed dental prostheses (FDPs). The usefulness and durability of zirconia single crowns in abutment teeth of partial removable dental prostheses (RDPs) was also evaluated. The material consisted of 173 patients treated with zirconia single crowns or FDPs by undergraduate dental students between 2007 and 2010. Of these patients 94 were women and 79 men (mean age 55 years, range 18–79 years). Altogether 268 zirconia single crowns (mean 3 crowns, range 1–12 crowns per patient) had been fabricated for 88 patients and 120 zirconia FDPs (range 3–12 units, mean 4.5 units) for 102 patients. Seventeen patients had received both crown(s) and FDP(s). The results show that zirconia single crowns and FDPs are a suitable treatment alternative in fixed prosthodontics. Early complications during prosthetic treatment and short-term failures during the first year of use were few. The survival rate of the zirconia single crowns after 3.9 years (2–6 years) was 89% and the success rate was 80%. The survival rate of zirconia FDPs after 4.9 years (3–7 years) was 100% and the success rate was 89%. Zirconia single crowns perform well as abutment teeth of partial RDPs with a metal framework, but fractures in the veneering porcelain remain a problem. / Tiivistelmä Metallokeraamisia rakenteita on käytetty kiinteässä protetiikassa 1950-luvulta lähtien, mutta puutteet estetiikassa, pyrkimys metallittomiin materiaaleihin, mahdolliset allergiset reaktiot ja jalojen metallien korkea hinta ovat lisänneet kokokeraamisten materiaalien käyttöä. Kokokeraamisten materiaalien kehitystyö on tuonut zirkonian kiinteän protetiikan materiaaliksi. Zirkonian mekaaniset ominaisuudet ovat osoittautuneet erinomaisiksi, mutta hammaskantoisten kiinteiden zirkonia-runkoisten proteesien kliiniset pitkäaikaistulokset puuttuvat. Tämän retrospektiivisen kliinisen tutkimuksen tarkoituksena oli selvittää zirkonia-runkoisten yksittäisten kruunujen ja zirkonia-runkoisten siltojen menestymistä 2–7 vuoden aikavälillä sekä kartoittaa niiden valmistuksen aikaiset ongelmat ja varhaiset epäonnistumiset ensimmäisen vuoden aikana. Lisäksi tutkittiin zirkonia-runkoisten yksittäisten kruunujen käyttökelpoisuutta ja kestävyyttä metallirunkoisten rankaproteesien tukihampaina. Materiaali koostui 173 potilaasta, joille hammaslääketieteen opiskelijat olivat tehneet zirkonia-runkoisia yksittäisiä kruunuja tai zirkonia-runkoisia siltoja vuosina 2007–2010. Potilaista 94 oli naisia ja 79 miehiä (keski-ikä 55 vuotta, jakauma 18–79 vuotta). Kaiken kaikkiaan 268 zirkonia-kruunua (keskimäärin 3 kruunua, jakauma 1–12 kruunua potilasta kohti) oli valmistettu 88 potilaalle ja 120 siltaa (keskimäärin 4,5 yksikköä, jakauma 4,5 yksikköä) 102 potilaalle. Seitsemälletoista potilaalle oli tehty sekä kruunuja että siltoja. Tulokset osoittavat, että zirkonia-runkoiset kruunut ja sillat ovat käyttökelpoisia kiinteässä protetiikassa. Valmistuksenaikaiset ongelmat ja varhaiset epäonnistumiset ovat vähäisiä. Yksittäisten kruunujen selviytymisprosentti 3,9 vuoden jälkeen (2–6 vuotta) oli 89 % ja onnistumis-prosentti 80 %. Siltojen selviytymisprosentti 4,9 vuoden jälkeen (3–7 vuotta) oli 100 % ja onnistumisprosentti 89 %. Zirkonia-runkoiset kruunut toimivat hyvin rankojen tukihampaina, mutta niiden ongelmana ovat päällepolttoposliinin lohkeamat.

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No. of bitstreams: 1 costa_akf_dr_sjc.pdf: 2862170 bytes, checksum: d49986540a33df5c364771ff7f6659c6 (MD5) Previous issue date: 2016-01-28 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / O objetivo desse trabalho foi identificar por meio da utilização de geometrias complexas (pela análise de elemento finito) e simplificadas, se novas tecnologias (sistema CAD/CAM) resultam em um comportamento biomecânico mais favorável na cerâmica de cobertura quando comparado à técnica de aplicação convencional (estratificação). Foram modelados três diferentes estruturas de prótese parcial fixa de três elementos com diferentes técnicas de fabricação: convencional, Rapid Layer (feldspática, cimento resinoso e zircônia) e CAD-on (dissilicato, material vítrio de baixa fusão e zircônia) a fim de analisar a distribuição tensão de tração gerada durante um ensaio mecânico pelo método por elementos finitos. Discos (cerâmica de cobertura e zircônia) foram unidos seguindo as três diferentes técnicas (convencional, Rapid Layer e CAD-on). Foram também confeccionadas próteses parciais fixas de 3 elementos pela técnica de multicamada seguindo as mesmas configurações dos modelos utilizados na análise por elementos finitos. Essas coroas foram cicladas durante 2x106 ciclos para analisar falhas na cerâmica de cobertura, como trincas, lascamento, delaminação e falha catastrófica. Os resultados mostraram que as coroas confeccionadas com cerâmica de dissilicato de lítio e material vítreo na interface infraestrutura/cerâmica de cobertura apresentaram menor concentração de tensão de tração quando comparadas aos modelos confeccionados pela técnica convencional, que demonstraram maior concentração de tensão de tração entre as camadas (cerâmica de cobertura, interface e infraestrutura). Para os discos, o acréscimo de material na interface cerâmica de cobertura e infraestrutura mostrou maior resistência à fratura biaxial e menor propagação da trinca entre as camadas de cerâmica. As coroas cicladas não apresentaram falhas como: trincas, lascamento, delaminação e catastrófica nos primeiros 500.000 ciclos. Porém, as próteses confeccionadas com cerâmica feldspática apresentaram trincas a partir de 1x106 ciclos, diferentemente das coroas confeccionadas na técnica Rapid Layer e CAD-on. As coroas confeccionadas pela técnica RL e CAD-on podem ser consideradas um sistema favorável por prevenir a propagação de trincas radiais em direção à superfície da restauração e melhorar a tenacidade à fratura do material. / The aim was to identify whether the CAD/CAM approach resulted in more favourable stressing patterns in the veneer-ceramic when compared with a conventionally sintered Y-TZP core/veneer-ceramic. Three different designs crowns of prosthesis with three elements and different manufacturing techniques were modeled: conventional technique, Rapid Layer (feldspathic ceramic, resin cement and zirconia) and CAD-on (disilicate, fusion glass ceramic and zirconia) techniques to analyze the distribution stress tensile generated during a mechanical test by the finite element method. Moreover, were made feldspathic ceramic discs, lithium disilicate discs and Y-TZP zirconia discs to analyze the influence of biaxial flexure stress of these three different techniques. These discs (veneer ceramic and zirconia ceramic) were joined following the three different techniques (conventional, Rapid Layer and CAD-on). They were also made FPDs 3 elements: following the same design of models used in finite element analysis. These crowns were cycled during 2x106 cycles to analyze failure at veneer ceramic, such as cracks, chipping, delamination and catastrophic failure. The results showed that the crowns made from ceramic lithium disilicate and low fusion glass ceramic at the interface veneer ceramic/infraestructure showed low concentration of tensile stress when compared to models made by the conventional technique, which showed a greater concentration of tensile stress between layers (veneer ceramic, interface and infrastructure). For the discs samples, the multilayer materials showed lower crack propagation between the ceramic layers. The cycled crowns showed no failure as cracks, chipping, delamination and catastrophic failure for the first 500,000 cycles. However, the prostheses made with feldspathic ceramic showed cracks from 1.106 cycles. The incorporation of functionally and aesthetically graded layers would be realisable, considerable research would be required before the feasibility of the conceptual approach could be accurately assessed. / FAPESP: 2012/11095-0