Proof testing to improve the reliability and lifetime of ceramic dental prostheses

OBJECTIVES: Ceramic dental prostheses exhibit increasing failure rates with service time. In particular, veneered crowns and bridges are susceptible to chipping and other fracture modes of failure. The purpose of this manuscript is to introduce a computational methodology and associated software that can predict the time-dependent probability of failure for ceramic prostheses and subsequently design proof test protocols to significantly enhance their reliabilities and lifetimes. METHODS: Transient reliability and corresponding proof testing theories are introduced. These theories are coded in the Ceramic Analysis and Reliability Evaluation of Structures (CARES/Life) code. This software will be used to demonstrate the predictive capability of the theory as well as its use in designing proof test protocols to significantly improve the reliability (survival probability) and lifetime for dental prostheses. A three-unit fixed dental prosthesis (FDP) with zirconia core (ZirCAD) and veneering ceramic (ZirPress) are used to compare the predicted probabilities of failure to general clinical results. In addition, the capability to use proof testing to significantly improve the performance (reliability and lifetime) for this restoration is demonstrated. RESULTS: The probability of failure, P, after five years without proof testing is predicted to be 0.337. This compares to clinical studies showing the failure rate to be between 0.2 and 0.23 after 5 years. After 10 years, reference 18 found the clinical failure rate for similar bridges (but not the same) to be up to 0.28 compared to the predicted P of 0.38. The difference may be due to the analysis applying the load at an inclination of 75° which is more critical than vertical loading. In addition, clinical studies often report a simple survival rate instead of using Kaplan-Meier analysis to properly account for late enrollees. Therefore, true clinical failure rates may be higher than reported and may more closely match the predictions of this manuscript. The effectiveness of proof testing increases with selecting materials less susceptible to slow crack growth (higher SCG exponent, N). For example, proof testing the ZirPress glass-veneered bridges with N = 43.4 analyzed in this manuscript at 400 N bite force for 1 s which induces a failure rate during proof testing of 0.31, reduces the P of bridges not proof tested from 0.45 to an attenuated-proof-tested probability of failure P of 0.21 after 20 years of usage. If another material is selected with improved resistance to SCG of N = 60 and the same loading conditions, the failure rate for the proof tested bridges after 20 years of service drops to 2 in 10,000 from 2.4 in 100 had they been not proof tested. The failure rate during proof testing for this material would be 5.1 in 100. Proof testing a material with absolutely no susceptibility to SCG at the same service load (in this case 285 N, not even the 400 N load used above) results in 0 % failure rate and is of course independent of time. SIGNIFICANCE: The transient reliability and proof test theory presented in this paper and associated computational software CARES/Life were successful in predicting the performance of ceramic dental restorations when compared to clinical data. Well-designed proof test protocols combined with proper material selection can significantly enhance the reliabilities and lifetimes of ceramic prostheses. This proof test capability can be a translational technology if properly applied to dental restorations

Three-Dimensional Finite Element Analysis of Different Connector Designs for All-Ceramic Implant-Supported Fixed Dental Prostheses

All-ceramic fixed dental prostheses (FDPs) tend to fracture at the connector regions due to high stress concentration at these areas influenced by their design. This study was performed as an adjunct to an existing clinical study to evaluate the influence of the different radii of curvature of gingival embrasure on the stress distribution of a three-unit all-ceramic implanted supported FDP. Three three-dimensional (3D) models were created by scanning two titanium dental implants, their suitable zirconia abutments, and a patient-retrieved dental prosthesis using a micro-CT scanner. The radius of curvature of the gingival embrasure for the distal connector of the FDP was altered to measure 0.25 mm, 0.50 mm, and 0.75 mm. A finite element analysis (FEA) software (ABAQUS) was used to evaluate the impact of different connector designs on the distribution of stresses. Maximum Principal Stress data was collected from the individual components (veneer, framework, and abutments). The radius of curvature of gingival embrasure had a significant influence on the stress distribution at the assessed components. The tensile peak stresses at all structures were highest in the 0.25 mm model, while the 0.50 mm and 0.75 mm models presented similar values and more uniform stress distribution

Finite Element Analysis of an Implant-Supported FDP with Different Connector Heights

All-ceramic fixed dental prostheses (FDPs) tend to fracture in the connector areas, due to the concentration of tensile stresses. This study aimed to evaluate the role of connector height on the stress distribution of a posterior three-unit implant-supported all-ceramic FDP using finite element analysis (FEA). Two titanium dental implants, their abutments, screws, and a three-unit all-ceramic FDP were scanned using a micro-CT scanner. Three 3D models with altered distal connector heights (3, 4, and 5 mm) were generated and analyzed on ABAQUS FEA software. The maximum principal stress values in MPa observed for each model with different connector heights and their respective locations (MA = mesial abutment; DA = distal abutment; F = framework; V = veneer) were: 3 mm—219 (MA), 88 (DA), 11 (F), 16 (V); 4 mm—194 (MA), 82 (DA), 8 (F), 18 (V); 5 mm—194 (MA), 80 (DA), 8 (F), and 18 (V). All the assembled models demonstrated the peak stresses at the neck area on the mesial abutments. The connector height had a significant influence on the stress distribution of the prosthesis. The models with higher distal connectors (4 and 5 mm) had a lower and more uniform distribution of maximum principal stresses (except for the veneer layer) when compared with the model with the smallest distal connector

Finite Element Analysis of an Implant-Supported FDP with Different Connector Heights

All-ceramic fixed dental prostheses (FDPs) tend to fracture in the connector areas, due to the concentration of tensile stresses. This study aimed to evaluate the role of connector height on the stress distribution of a posterior three-unit implant-supported all-ceramic FDP using finite element analysis (FEA). Two titanium dental implants, their abutments, screws, and a three-unit all-ceramic FDP were scanned using a micro-CT scanner. Three 3D models with altered distal connector heights (3, 4, and 5 mm) were generated and analyzed on ABAQUS FEA software. The maximum principal stress values in MPa observed for each model with different connector heights and their respective locations (MA = mesial abutment; DA = distal abutment; F = framework; V = veneer) were: 3 mm—219 (MA), 88 (DA), 11 (F), 16 (V); 4 mm—194 (MA), 82 (DA), 8 (F), 18 (V); 5 mm—194 (MA), 80 (DA), 8 (F), and 18 (V). All the assembled models demonstrated the peak stresses at the neck area on the mesial abutments. The connector height had a significant influence on the stress distribution of the prosthesis. The models with higher distal connectors (4 and 5 mm) had a lower and more uniform distribution of maximum principal stresses (except for the veneer layer) when compared with the model with the smallest distal connector

Three-Dimensional Finite Element Analysis of Different Connector Designs for All-Ceramic Implant-Supported Fixed Dental Prostheses

All-ceramic fixed dental prostheses (FDPs) tend to fracture at the connector regions due to high stress concentration at these areas influenced by their design. This study was performed as an adjunct to an existing clinical study to evaluate the influence of the different radii of curvature of gingival embrasure on the stress distribution of a three-unit all-ceramic implanted supported FDP. Three three-dimensional (3D) models were created by scanning two titanium dental implants, their suitable zirconia abutments, and a patient-retrieved dental prosthesis using a micro-CT scanner. The radius of curvature of the gingival embrasure for the distal connector of the FDP was altered to measure 0.25 mm, 0.50 mm, and 0.75 mm. A finite element analysis (FEA) software (ABAQUS) was used to evaluate the impact of different connector designs on the distribution of stresses. Maximum Principal Stress data was collected from the individual components (veneer, framework, and abutments). The radius of curvature of gingival embrasure had a significant influence on the stress distribution at the assessed components. The tensile peak stresses at all structures were highest in the 0.25 mm model, while the 0.50 mm and 0.75 mm models presented similar values and more uniform stress distribution