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today EAO Paris Sep. 28

science & practice 25th EAO Annual Scientific Meeting 18 „ All dental implant restorations are not created equal. That’s confirmed by a new study from leading materi- als scientist Prof. J. Robert Kelly. Here he discusses the research, which has just been published in the Interna- tional Journal of Oral and Maxillofa- cial Implants. The findings make for positive reading for NobelProcera customers. today international: Your latest re- search1 tests the fatigue behavior of zirconia implant abutments from four major manufacturers. What led you to take this approach? Prof. J. Robert Kelly: We wanted to study commercial prod- ucts, not in order to make commercial comparisons, but to study realistic products. Our goal was to look for pro- cessing problems and design issues, so it made sense to see what would happen with products on the market. We selected Straumann Bone Level (BL) implants as our reference and the study received funding from the ITI Foundation. Our search for com- parison third-party abutments for the BL implants led us to abutments from NobelProcera and Glidewell—for BL implants these two manufacturers only produce hybrid zirconia abut- ments that have a titanium insert in- terface to the implant—and the avail- able abutments from Astra and Strau- mann that are fully zirconia. What was your methodology for test- ing these products? To set up the method, we first took six of the abutments in each of the four groups and tested them with repeated loads of 200 Newtons. We chose 200 Newtons for the acceler- ated aging based on our previous work. We didn’t want to break the im- plants so we thought that was a fair load to start with. The results then allowed us to design phase two, de- termining the loads that we would use in testing with another 12 im- plants. But by the time we got the phase one data, we were astounded. There were clearly significant differences between manufacturers in each of the categories. This was subsequently verified in full sam- ple testing. The NobelProcera product performed outstandingly in this study, is that fair to say? Yes, absolutely. While with some of the other abutments we had to re- duce the load, with the NobelProcera product we ran-out (no fractures at 25 million cycles), so the load had to keep going higher and higher. How would you explain this weak- ness of the other abutments? The vast differences were unex- pected as the macrodesigns are simi- lar across manufacturers. To help de- termine why we were seeing such varied results I asked my colleague Dr Isabelle Denry to do SEM analy- ses. Looking at one of the poor- est-performing abutments in the study, she identified that the weak- ness was built in through damage arising from the manufacturing pro- cess—subsurface grinding damage, large cracks, inhomogeneous crystals and a diffuse layer of porosity. We clearly see that the manufacturer matters. There are many reports of issues caused by third-party abutments be- ing used with a system that they were not designed for. As the manu- facturer matters, are you an advo- cate of using only authentic compo- nents? In general, I advise against using lower cost third-party abutments. There’s too much to lose. From what we’ve seen over the years, the quality of the materials is inferior and the outcome has such a high value—the patient has such high expectations of the clinician—why would you risk that to save 100 dollars? Considering the results of your study for the NobelProcera third-party abutment for Straumann Bone Level implants, what are your thoughts? NobelProcera is a high-quality manufacturer. Nobel Biocare manu- factures components that are de- signed, tested and then verified for the BL implant system. Thank you very much for this inter- view. Editorial note: This interview was orig- inally published in the today Nobel Biocare Global Symposium, 24 Mai 2016, page 6. References 1. Kelly JR, Rungruanganunt P. Fatigue Behav- ior of Computer-Aided Design/Computer- Assisted Manufacture Ceramic Abutments as a Function of Design and Ceramics Process- ing. Int J Oral Maxillofac Implants. 2016 May- Jun;31(3):601-9.w Zirconia abutments with titanium base Full zirconia abutments NobelProcera Glidewell Straumann® Atlantis™ 1 sextillion cycles Extrapolated cycles for 10% failure at 70N (expected clinical load) 1 million cycles 30 million cycles 20 million cycles 0 107 1014 1021 “Manufacturer matters”: the four abutments look very similar in clinical examination, DWVFKHHGTGFUKIPKƂECPVN[KPRGTHQTOCPEGKPFKECVKPIVJGKORCEVQHFGUKIPCPF RTQFWEVKQPOGVJQF -GNN[,44WPITWCPICPWPV2(CVKIWG$GJCXKQTQH%QORWVGT#KFGF&GUKIP%QORWVGT#UUKUVGF/CPWHCEVWTG%GTCOKE#DWVOGPVUCUC(WPEVKQPQH &GUKIPCPF%GTCOKEU2TQEGUUKPI+PV,1TCN/CZKNNQHCE+ORNCPVU +PXKVTQHCVKIWGVGUVQH %#&%#/|CDWVOGPVU #DWVOGPVU PGCEJHTQO#VNCPVKUv)NKFGYGNN 0QDGN|$KQECTGCPF|5VTCWOCPPŠCNNVGUVGFQP 5VTCWOCPPŠ$QPG.GXGNKORNCPVU Prof. J. Robert Kelly Zirconia abutment D1. Manufacturer matters when it comes to ceramic abutments An interview with materials scientist Prof. J. Robert Kelly, USA 0107

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