Broken Zirconia Abutment

[Brett Hansen CDT]

Last April, I fabricated a CARES(Strauman) Zirconia custom abutment to support an e.Max monolithic crown on #3. The implant was an Straumann RC bone-level. According to the doctor, she had no problems delivering the abutment and crown. The abutment was never ground on in the lab and she did not grind on it during delivery. A month ago, the abutment broke. It fractured horizontally near where the abutment interfaces with the implant. Here are a couple of pics:


I have never had a custom zirconia abutment fracture before. The Straumann reps believe that some sort of trauma caused the failure. I wondered if the width of the abutment in relation to the "stem" of the abutment that interfaces with the implant may have created a weakness where it fractured. I know that when I edit the Atlantis abutment design, there is a limit as to how far laterally the abutment margin can be from the implant. With Strauman's system, I am only limited by the geometry of the blank.

I suggested to the doctor that we do the new abutment in titanium rather than zirconia to be on the safe side. The Straumann reps told me that there is no advantage to using titanium over zirconia to prevent the failure that occured on this case. I don't really buy that. He did send me a scientific study to back up his claim, but after reading it, I am not sure if the study's conclusions are what he thinks they are. I am attaching the study. I would love to get some feedback from some of you as to what you think may have lead to the failure and the conclusions of the attached study. Thanks!

 

[Marcusthegladiator CDT]

That's a hell of a break!
Nice pics!

 

[rkm rdt]

Tell me again Straumann why 3rd party ti base hybrids are inferior to your " patented" "warrantied products!

 

[rkm rdt]

If this keeps up maybe Straumann will need us labs to keep these "elites' afloat!!!

 

[DarrenS]

Last April, I fabricated a CARES(Strauman) Zirconia custom abutment to support an e.Max monolithic crown on #3. The implant was an Straumann RC bone-level. According to the doctor, she had no problems delivering the abutment and crown. The abutment was never ground on in the lab and she did not grind on it during delivery. A month ago, the abutment broke. It fractured horizontally near where the abutment interfaces with the implant. Here are a couple of pics:
View attachment 14550 View attachment 14551 View attachment 14552

I have never had a custom zirconia abutment fracture before. The Straumann reps believe that some sort of trauma caused the failure. I wondered if the width of the abutment in relation to the "stem" of the abutment that interfaces with the implant may have created a weakness where it fractured. I know that when I edit the Atlantis abutment design, there is a limit as to how far laterally the abutment margin can be from the implant. With Strauman's system, I am only limited by the geometry of the blank.

I suggested to the doctor that we do the new abutment in titanium rather than zirconia to be on the safe side. The Straumann reps told me that there is no advantage to using titanium over zirconia to prevent the failure that occured on this case. I don't really buy that. He did send me a scientific study to back up his claim, but after reading it, I am not sure if the study's conclusions are what he thinks they are. I am attaching the study. I

They get hit with an aluminum bat?

 

[Brett Hansen CDT]

Darren, that is the only thing I can come up with. Or maybe he was trying to open a beer bottle with it?

 

[disturbed]

fatigue failure.loving this.

 

[Brett Hansen CDT]

Disturbed, this abutment isn't even a year old. Fatigue isn't the issue. I have placed hundreds of zirconia abutments....this is the first failure. Take your agenda to your own thread.

 

[JohnWilson]

fatigue failure.loving this.

This obviously not a fatigue failure. Failure from function is not going to have this type of fracture.

Do you ever get tired of posting such obviously wrong information?

 

[BobCDT]

We have had many zirconia abutment fail made by several different manufacturers (not sure if any were Straumann). We no longer offer the zirconia abutment solution. The break in your photos looks pretty much like what we have seen.
Interesting study! The basis of the study does imply no additional risk of Zirconia abutment failure on the Straumann Bone level SLA RC implants. However, this bench top study does not necessarily simulate what happen intraorally.
My conclusion, I have never had a titanium abutment break and have had many Zi abutment failures. This is not based on any study. Just real world experience. I would definitely remake in Titanium I really don't think the titanium will break.

 

[disturbed]

had it been ti the ti would have provided a little flex and give. this did not. if it was cracked after seat it would of lasted a few weeks or days. as the material FATIGUED it snapped.may have been the screw that was the stress point but it was the zr that ,over months, FATIGUED and broke. parafunction(interference) may have added to the process. was this a full arch impression?

 

[JohnWilson]

We can not prove any of our ASSUMPTIONS on this case but from what I see it looks like trauma.

I would bet I have at least 3000 Zi abutments in the mouth that I either milled or outsourced or prepped stock parts. Some had the manufacturers ti base, some a machined parts some all zirconia. The absolute worst offending product for me is an ALL ZIRCONIA interface. We will not guarantee them and suggest hybrid abutments.

Zirconia is just another tool, if the case is contraindicated because of off axis load because of angle or if the dimensions can not be achieved per the manufacturer's recommendation for milled ZIRCONIA then well don't make it.

I agree that Ti is way more bullet proof but they are not practical in the esthetic zone. On this case it looks like it could easily have been done with a Ti abutment and a FCZ with perfect results.

 

[Brett Hansen CDT]

Thanks for the input John and Bob.

 

[RJS8669]

Its interesting that we just received a recall letter for zirconia abutments manufactured by Biomet 3. I have only had two Zi failures, and both were pure zirconia interfaces - not hybrids.

 

[RJS8669]

Spoke to soon. Got aBiomet Zi abutment yesterday that cracked very similarly to the one pictured above. Manufactured in March 2011. Just prior to Biomet's recall date. I wonder how they will respond...

 

[rkm rdt]

The only abutments that have fractured on me were the Astra 3.0 15 degree stock titanium.

3 abutments on the same case!!!!!

 

[Jmvisa]

I suggested to the doctor that we do the new abutment in titanium rather than zirconia to be on the safe side. The Straumann reps told me that there is no advantage to using titanium over zirconia to prevent the failure that occured on this case. I don't really buy that. He did send me a scientific study to back up his claim, but after reading it, I am not sure if the study's conclusions are what he thinks they are. I am attaching the study. I would love to get some feedback from some of you as to what you think may have lead to the failure and the conclusions of the attached study. Thanks!

I have had the same problem! with different platform switch implant brands, as Bob from CAP, we do not offer Zi abutments passing second Bicuspid; in some cases when the occlusion and patient history elevates the case to high risk, not even there. For Posterior cases we offer now Zi with Ti interface or Zi with Zi interface for large diameter implants ONLY. Let's see what happens in the future with the Zi using Ti interface, I fear cement fatigue in some cases. I sleep better with abutments fabricated inTi in the posterior region, no one broken so far ; )

 

[Gabriel]

If the patient or doctor insist on an esthetic abutment, offer a hybrid abutment, I didn't have any come back broken.

 

[TheLabGuy]

I had the same problem Brett, full zirconia abutment, broke exactly like yours, but what made it worse was that the patient was from Kansas (Kansas Doc too) but was attending University of Kentucky (I'm guessing she fit right in after losing the tooth...lol). I stick to Ti and hybrids now, but you gotta be careful with hybrids too, especially if you're the one cementing the zirconia to the titanium connection to make sure no cement gets into the screw path. Had two screws get permanently stuck on new hybrids because of this...grrrr

 

[ed 3]

we had broken zir posts, broken zir connectors and so on. I guess zir industry adds brainwashed us with their "100% guarantee" thingy. Wait until patients will need to extract their fullzir molar-crowns due to rut-canals. Hmmm...someone said periodontist or
lawyer???