Fracture Resistance of Titanium, Zirconia, and Ceramic-Reinforced Polyetheretherketone Implant Abutments Supporting CAD/CAM Monolithic Lithium Disilicate Ceramic Crowns After Aging

Purpose: The purpose of this study was to compare the fracture resistances and the fracture types of titanium, zirconia, and ceramic-reinforced polyetheretherketone (PEEK) implant abutments supporting computer-aided design/computer-aided manufacturing (CAD/CAM) monolithic lithium disilicate ceramic crowns after in vitro dynamic loading and thermocycling aging. Materials and Methods: Three implant abutment (SKY Implant) groups-titanium (group Ti, control); zirconia with titanium base (group Zr); and ceramic-reinforced PEEK (BioHPP) with titanium base (group RPEEK); n = 12 each-were used. Thirty-six CAD/CAM monolithic lithium disilicate crowns (IPS e. max CAD) in the form of a maxillary central incisor were cemented with Panavia V5 on the abutments. The specimens were subjected to dynamic loading and thermocycling. Fracture resistances of the restorations were tested with a universal testing machine (0.5 mm/min), and their fracture patterns were analyzed. One-way analysis of variance (ANOVA) and Tukey post hoc test were used for statistical analyses (alpha = .05). Results: All samples survived after aging. The fracture strength values (mean +/- standard deviation) of the groups were as follows: group Ti, 787.8 +/- 120.9 N; group Zr, 623.9 +/- 97.4 N; and group RPEEK, 602.9 +/- 121 N. The fracture strengths were significantly higher in group Ti compared to groups Zr and RPEEK (P =.001). No significant difference was observed between groups Zr and RPEEK. Failures generally occurred due to fracture of the screw in group Ti, abutment and crown in group Zr, and crown in group RPEEK. Conclusion: Ceramic-reinforced PEEK abutments may be an alternative to zirconia abutments with a titanium base for single-implant restorations in the anterior region. However, there is need for further in vitro and clinical studies to evaluate the long-term performance of ceramic-reinforced PEEK abutments.