Esthetic outcome of two different veneering procedures based on zirconia implant abutments – 1-year follow-up of a randomized controlled clinical trial

Thesis

Reference

Esthetic outcome of two different veneering procedures based on zirconia implant abutments – 1-year follow-up of a randomized

controlled clinical trial

GAVRIC, Jelena

Abstract

Comparaison des performances cliniques et esthétiques de couronnes implantaires maxillaires antérieures basées, soit sur un pilier préfabriqué en zircone sur lequel la céramique cosmétique est pressée (groupe test), soit sur un pilier individualisé (CAD/CAM) sur lequel le cosmétique est stratifié (contrôle). 20 patients avec implant et couronne provisoire ont été recrutés et randomisés après empreinte définitive. Une semaine après insertion des couronnes définitives, des paramètres cliniques, radiographiques et esthétiques ont été enregistrés et puis réévalués pour les deux groupes après une année. Les paramètres examinés n'ont pas montré de différences statistiquement significatives entre les deux modalités de fabrication. En revanche, l'analyse du temps de fabrication des couronnes s'est avérée différente entre les groupes, clairement moins importante pour le groupe test. Il a été démontré que les deux approches atteignent un bon niveau esthétique, mais sont significativement différentes quant à leur complexité, leur temps de fabrication et en conséquence, leur coûts.

GAVRIC, Jelena. Esthetic outcome of two different veneering procedures based on zirconia implant abutments – 1-year follow-up of a randomized controlled clinical trial. Thèse de doctorat : Univ. Genève, 2014, no. Méd. dent. 727

URN : urn:nbn:ch:unige-390220

DOI : 10.13097/archive-ouverte/unige:39022

Available at:

http://archive-ouverte.unige.ch/unige:39022

Disclaimer: layout of this document may differ from the published version.

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54 Table 1:

Diagram of two different restorative options based on either prefabricated or CAD-CAM generated zirconia abutments.

Green line: less complex, less time consuming, less expensive (test group) Red line: more complex, more time consuming, more expensive (control group)

55 Table 2:

Ceramic system with different veneering possibilities on zirconia.

56 Table 3:

Soft tissue parameters of the implant-supported single crowns at the three time points analyzed for groups A (test) and B (control) (mean values ± standard deviation).

Exam mPLI mSBI PD (mm)

Baseline A

Baseline B

6 mos A

6 mos B

12 mos A

12 mos B

0.18 (±0.27)

0.18 (±0.39)

0.05 (±0.16)

0.03 (±0.08)

0.18 (±0.24)

0.13 (±0.18)

0.15 (±0.21)

0.10 (±0.24)

0.10 (±0.18)

010 (±0.18)

0.30 (±0.23)

0.15 (±0.24)

2.93 (±0.61)

2.85 (±0.57)

2.93 (±1.08)

2.90 (±0.34)

2.88 (±1.11)

2.98 (±0.56)

mPLI = Modified plaque index

mSBI = Modified sulcus bleeding index PD = Probing depth

57 Table 4:

PES and WES values of the implant-supported single crowns at the three time points analyzed for groups A (test) and B (control) (mean values).

Pink Esthetic Score (PES) White Esthetic Score (WES)

Timepoint Mesial Papilla Distal Papilla

Curvature labial Mucosa

Level labial Mucosa

Root convexity

Soft tissue colour and texture

Mean PES Tooth

Form

Tooth Volume/

Outline

Colour Surface Texture Trans-

lucency Mean WES

Total PES

&

WES

Baseline

A 1.60 0.80 1.50 1.60 1.20 6.50 1.50 1.40 1.60 1.80 1.90 8.30 14.80

Baseline

B 1.40 1.20 1.70 1.60 1.20 7.10 1.60 1.60 1.40 1.70 1.90 8.20 15.30

6 mos A 1.50 0.70 1.50 1.50 1.20 6.20 1.50 1.40 1.60 1.80 1.90 8.30 14.50

6 mos B 1.40 1.10 1.60 1.50 1.00 6.60 1.60 1.60 1.40 1.70 1.90 8.20 14.80

12 mos A 1.50 0.80 1.50 1.50 1.30 6.60 1.50 1.40 1.60 1.80 1.90 8.30 14.90

12 mos B 1.50 1.00 1.70 1.50 1.00 6.70 1.60 1.60 1.40 1.70 1.90 8.20 14.90

58 Table 5:

Cast analysis regarding the length of the IC (implant crown) and contralateral TC (tooth crown) (mm; mean ± SD) for groups A (test) and B (control) over the course of one year.

Exam n (per group)

IC A IC B TC A TC B ΔIC-TC A ΔIC-TC B

Baseline

6 months

1 year

10

10

10

9.38 (±1.32)

9.36 (±1.21)

9.73 (±1.17)

10.35 (±1.21)

10.28 (±1.25)

10.56 (±1.22)

8.97 (±1.07)^a

9.00 (±1.16)

9.31 (±0.95)

10.03 (±1.42)^a

10.05 (±1.16)

10.38 (±1.32)

0.55 (±0.36)

0.42 (±0.22)

0.48 (±0.27)

0.52 (±0.64)

0.52 (±0.41)

0.50 (±0.49)

C = Height of implant crown

TC = Height of contralateral tooth crown SD = Standard deviation

59 Table 6:

Radiographic parameters (DIB) of the 10 implants in each group analyzed over the course of one year.

Exam Baseline A Baseline B 6 mos A 6 mos B 12mos A 12 mos B

Mean Maximum

Minimum

SD Significance

-0.04 1.15 -1.95

±1.01 .

0.17 0.8 -1.85

±0.89 .

-0.10 1.20 -2.10

±1.05 .

0.16 1.35 -1.90

±0.95 .

0.01 1.30 -1.70

±1.01 .

0.24 0.95 -1.85

±1.01 .

DIB = Radiographic distance (in mm) between implant shoulder and first visible bone-to- implant contact

SD = Standard deviation

60 Table 7:

Fabrication time (in minutes) for the restorations in twenty patients analyzed for groups A (test) and B (control).

Statistically significant differences between the fabrication time parameter values are marked with the same letters.

Time for restoration group A Time for restoration group B

Patient

Abutment modfifcati

on Modelling / pressing

Cut back / veneering

Painting / glazing /

polishing Mean Scan / design

Veneering

Painting / glazing /

polishing Mean

1 25 40 50 45 160 35 110 145 255

2 20 65 80 50 215 30 180 70 280

3 25 55 60 40 180 60 275 90 425

4 25 55 60 40 180 50 200 75 325

5 20 60 70 45 195 45 110 45 200

6 20 45 65 35 165 40 100 60 200

7 25 40 65 35 165 45 125 55 225

8 25 40 65 35 165 50 105 50 205

9 25 65 60 70 220 45 120 60 225

10 20 60 50 50 180 50 150 60 210

Mean 23.00 52.50 62.50 44.50 182.50^a 45.00 144.50 66.60 255^a

61 Table 8:

VAS values of the twenty patients analyzed for groups A (test) and B (control).

Vis V.Analogue Scale (VAS) values A Vis V.Analogue Scale (VAS) values B

Patie nt

Satisfactio n (Overall)

Comfort with implant prosthesis

Esthetics (crown)

Esthetics (gingiva)

Satisfacti on (Overall)

Comfort with implant prosthesis

Esthetic s (crown)

Esthetics (gingiva)

1 96.5 99.1 97.4 98.2 100 99.4 89 99.12

2 95.6 96.5 99.1 84.2 100 100 100 100

3 99.1 99.2 92.9 98.2 97 100 97 96.5

4 99.1 99.2 100 93 90 80 100 100

5 92.1 94.8 98.2 92.9 97 100 96.4 94.2

6 90 100 80 80 99.1 90.4 92.9 86.8

7 95 100 93.6 94.2 92.9 99.2 83.3 96.5

8 100 100 100 100 70.2 91.3 93.8 94.7

9 100 100 90 80 98.2 96.5 86 96.5

10 86 100 81.56 71.05 89.5 99.2 86.6 90.2

Mean 95.34 98.61 93.28 89.28 94.13 93.39 95.6 92.50 95.45 94.23

62 Fig. 1.

Detailed description of PES and WES parameters.

(Adapted from Belser et al. 2009)

63 Fig. 2.

Photograph of a cast to allow the measurement of IC and TC.

The millimeter grid serves as reference; below the corresponding intraoral situation.

64 Fig. 3.

Measurement first bone-to-implant contact to reference line (implant shoulder) in millimeters (positive values, when bone apical of the implant shoulder). BL, marginal bone level.

65 Fig. 4.

The BL, 6- and 12-month periapical radiographs confirm the stable peri-implant bone situation.

BL 6 months 12 months

66 Fig. 5.

Clinical and radiographic situation of an all-ceramic implant crown, (control group (B) at BL, 6-, 12-months).

67 Fig. 6.

Clinical and radiographic situation of an all-ceramic implant crown, (test group (A) at BL, 6-, 12-months).

68 Fig. 7.

The questionnaire that visualizes the patients’ satisfaction score.