Phase transformation and fracture load of stock and CAD/CAM-customized zirconia abutments after 1 year of clinical function

Objectives Functional loading and low-temperature degradation may give rise to impaired clinical long-term service of zirconia implant abutments. The aim of this study was to compare the fracture strength (primary outcome measure) and the volume percentage of monoclinic surface zirconia (m-ZrO2) of stock and CAD/CAM-customized zirconia implant abutments that functioned clinically for 1 year with geometrically identical pristine controls in an ex vivo experiment. Material and methods Twenty-three stock (ZirDesign (TM)) and 23 CAD/CAM-customized (Atlantis (TM)) zirconia implant abutments were retrieved after 1 year of clinical service. They were compared with pristine copies with respect to the volume fraction of the monoclinic phase using Raman spectroscopy and their fracture load by means of a single load-to-fracture test. Failure analysis was performed using optical and SEM microscopy. After verification of normal distribution, paired t tests were used for comparison of fracture loads between pristine and clinically aged specimen. All statistical tests employed a level of significance of alpha = 0.05. Results The fracture loads of the stock zirconia abutments were significantly (p < 0.05) reduced to 78.8% (SD 29.5%) after one year of clinical function. For the CAD/CAM abutments, no reduction in fracture load was found. No m-ZrO2 volume percentages beyond the detection threshold of 5% were observed in any of the samples. Conclusions After 1 year of clinical service, no difference in fracture strength of the CAD/CAM-customized zirconia implant abutments could be demonstrated, whereas the stock zirconia abutments decreased considerably in fracture strength. No substantial tetragonal-to-monoclinic transformation was observed.