Comparison of Two Implant Prosthetic Pathways

University of Bern40 enrolled

Overview

To assess and compare the esthetic outcome and clinical performance of anterior maxillary all ceramic implant single crowns based either on prefabricated zirconia abutment veneered with pressed ceramics or on a CAD/CAM (computer-aided design and computer-aided manufacturing) CARES® abutment veneered with hand build-up technique. Participants will be recruited from the patient population who has previously received dental implant treatment, received a provisional restoration and met the inclusion and exclusion criteria according to the study protocol. After final impression, patients will be randomised into Group A (prefabricated anatomic abutments ): one-piece screw retained single crown using a press technique (fluorapatite glass-ceramic, e.max ZirPress) with cut-back technique or Group B (CAD/CAM CARES® abutments): one- piece screw retained single crown with a hand build-up technique (fluorapatite veneering ceramic, e.max Ceram). One week after final restoration (base line visit) the primary and secondary outcome parameters will be assessed. The patients will be followed up to 5 years after final restoration.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Failure of Dental Prosthesis

Interventions

Anatomic e.max AbutmentDEVICE

Implant-supported single crown was fabricated using a prefabricated stock abutment made of yttrium oxide partially stabilized tetragonal zirconia polycrystalline (Y-TZP) (Anatomic IPS e.max Abutment, straight, color M1, Ivoclar, Liechtenstein) and pressed ceramic (fluorapatite glass-ceramic, IPS e.max ZirPress, Ivoclar, Liechtenstein) using the cut-back technique and hand veneered with a thin layer of fluorapatite veneering ceramic (fluorapatite veneering ceramic, IPS e.max Ceram, Ivoclar, Liechtenstein).

CAD/CAM CARES AbutmentDEVICE

Implant-supported single crown was fabricated using an individualized CAD/CAM abutment made of Y-TZP (CARES® Abutment, Institut Straumann AG, Basel, Switzerland) and hand build-up veneering ceramic technique (fluorapatite veneering ceramic, IPS e.max Ceram, Ivoclar, Liechtenstein). All implant-supported crowns were fabricated in the same dental laboratory by the same dental technician (Dominique Vinci, Geneva, Switzerland). The implants were placed by experienced oral surgeons in a prosthetic ideal position.

Eligibility

Sex: ALLMin age: 18 YearsHealthy volunteers:

Medical Language ↔ Plain English

Inclusion Criteria: 1. Subjects must have voluntarily signed the informed consent form before any study-related action 2. Males and females with at least 18 years of age 3. Single tooth gaps in the anterior maxilla position 14-24 (FDI) 4. Successfully osseointegrated single tooth implant inserted at least 16 weeks after tooth extraction 5. Full mouth plaque index according to O'Leary ≤ 25% 6. Implant axis compatible with transocclusal screw retention (screw access palatal of incisal edges) Exclusion Criteria: 1. Systemic disease that would interfere with dental implant therapy 2. Any contraindications for oral surgical procedures 3. History of local irradiation therapy 4. Patients who smoke \>10 cigarettes per day or tobacco equivalents or chew tobacco 5. Subjects who had undergone administration of any investigational device within 30 days of enrolment in the study 6. Conditions or circumstances, in the opinion of the investigator, which would prevent completion of study participation or interfere with analysis of study results, such as history of non-compliance 7. Physical or mental handicaps that would interfere with the ability to perform adequate oral hygiene 8. Pregnant or breastfeeding women 9. Existing implants in the adjacent position 10. Removable dentures or un-restored tooth gaps in the opposing dentition 11. Patients with inadequate oral hygiene or unmotivated for adequate home care 12. Probing pocket depth of ≥ 4 mm on one of the teeth immediately adjacent to the dental implant site 13. Lack of primary stability of the implant 14. Inappropriate implant position for the prosthetic requirements 15. Major simultaneous augmentation procedures 16. Insufficient stability of the implant 17. Screw access position located too close to the planned incisal edge 18. Need of angled abutment due to prosthetic malposition of the implant 19. Height of the abutment is less than 65% of the height of the complete restoration 20. Severe bruxing or clenching habits

Outcomes

Primary Outcomes

Change in Aesthetic scores: Pink Esthetic Score / White Esthetic Score (PES WES) baseline, 6 months, 1, 3, 5 years performed by 2 independent observers in each center