Ceramic Implant Abutments for Bernt Andersson, LDS, Odont Dr/PhDa

Roland Glauser, DDSb

Short-Span FPDs: A Prospective Michele Maglione, MD, DDSc
5-Year Multicenter Study Åsa Taylor, LDSd

Purpose: A prospective, randomized, controlled 5-year multicenter study evaluated the

long-term clinical function of CerAdapt ceramic abutments compared to titanium abutments
on Brånemark implants supporting short-span fixed partial dentures (FPD). Materials and
Methods: Initially, 105 Brånemark implants were placed in a total of 32 patients at three
different clinics; 103 implants remained after initial healing. Fifty-three ceramic and 50
titanium abutments were connected to support 36 FPDs, 19 on ceramic and 17 on titanium
abutments. Results: Thirty patients with 29 FPDs were examined after 5 years. There was a
cumulative success rate of 97.2% for FPDs (94.7% for ceramic and 100% for titanium
abutment–supported FPDs). One of 53 ceramic and none of 50 titanium abutments failed,
giving survival rates of 98.1% and 100%, respectively. There was a mean marginal bone
loss of 0.3 mm and 0.4 mm, respectively, for ceramic and titanium abutments. Soft tissues
around abutments and adjacent teeth appeared healthy, and no significant differences were
recorded for mucosal bleeding and plaque between ceramic and titanium abutments.
Crown margins at FPD insertion were positioned as follows: 21% submucosally, 33% at the
mucosal margin, and 46% supramucosally. Changes in mucosal level were recorded at
12% of the abutments, with 73% of all changes recorded at ceramic abutments. There was
a balance between more or less exposed crown margins during the first 2 years, in contrast
to the 2- to 5-year period, when all changes meant less exposed margins. Conclusion: Safe
long-term functional and esthetic results can be achieved with CerAdapt alumina ceramic
abutments on Brånemark implants for short-span FPDs. Int J Prosthodont 2003;16:640–646.

C erAdapt alumina implant abutments (Nobel

Biocare) are tooth colored and optically favorable
in comparison with titanium abutments. These ce-
ramic abutments, which were introduced in 1993,1–3
were developed for both single crowns and fixed par-
tial dentures (FPD), and they were specially intended
for situations when patients and clinicians had specific
esthetic demands. The CerAdapt abutment is a cylin-
der (12 mm high and 6 mm in diameter) obtained
through a technique using densely sintered and highly
a Head, SIM/Prosthetic Dentistry, Specialist Dental Service,
Sahlgrenska Universitetssjukhuset/Mölndal, Sweden.
bAssistant Professor, Department of Prosthodontics and Dental
Materials, University of Zürich, Switzerland.
cTutor, Department of Dentistry, University of Milan, Italy.
dClinical Research Associate, Department of Clinical Research,
Nobel Biocare, Göteborg, Sweden.
Reprint requests: Dr Bernt Andersson, SIM/Prosthetic Dentistry,
Specialist Dental Service, SU/Mölndal, S-431 80 Mölndal, Sweden.
Fax: + 46 31 86 15 01. e-mail: bernt.andersson@vgregion.se
purified alumina. CerAdapt abutments have to be in-
dividually ground, following established guidelines,4
before impression taking. The grinding can take place
in the dental laboratory or in the dental office, but is
most often done in the dental laboratory.5 Alumina has
been used for the fabrication of CerAdapt abutments
because of the good mechanical properties6–9 and
the esthetic possibilities for crowns and FPDs when
using densely sintered alumina as a core material.
The capacity of high-density alumina as a core ma-
terial for tooth- and implant-supported crowns has
been well-documented in different clinical follow-up
studies.10–12 So far, there have been few articles pub-
lished on the clinical outcome of CerAdapt abutments
supporting single crowns13 or FPDs5 on implants. These
results were encouraging, even though the CerAdapt
abutments were only followed for 1 to 3 years. The 2-
year results of the present study and a more detailed
background have been presented previously.5
The use of zirconia14–16 in implant abutments has
also been tried recently because of the high fracture

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 Andersson et al
resistance shown when zirconia is compared to alu-
mina and other dental ceramics.17,18 Zirconia that is
biocompatible19,20 and capable of development21 is
regarded as an encouraging core material for implant
abutments, crowns, and FPDs. So far, however, no
clinical long-term follow-up studies are available.
The aim of the present multicenter study was to pre-
sent and compare results after 5 years of loading of
short-span FPDs supported by either CerAdapt ce-
ramic abutments or titanium abutments (Nobel
Biocare), with regard to hard and soft tissue reactions.
Materials and Methods
Study Design
This was an open, prospective, randomized con-
trolled study for patients receiving short-span FPDs
supported by alumina or titanium abutments on
Brånemark system implants (Nobel Biocare). Sintered
aluminum oxide abutments (CerAdapt; test group)
were compared to established titanium abutments
(control group). The study was carried out in accor-
dance with the Declaration of Helsinki.22 According
to a randomization list,23 the patients received either
test or control abutments. Patients who needed two
short-span FPDs received one FPD supported by ce-
ramic and one supported by titanium abutments.
Implants were followed for survival according to ac-
cepted criteria.24 The FPDs were recorded as suc-
cessful when function and esthetics were accepted by
patients and clinicians. All patients have been fol-
lowed for 5 years after loading, and this report pre-
sents the final 5-year results.
Patients
The patients were consecutively included in the
study, provided that they fulfilled the following in-
clusion/exclusion criteria:
• The patient was in such a physical and mental
condition that a 5-year follow-up period could be
expected.
• The implant site was healed properly.
• The FPDs were to be supported by two to four im-
plants.
• Cross-arch FPDs were not involved.
• The implants had not been previously loaded.
• Radiation therapy had not been carried out in
the treatment area.
A total of 32 patients at three clinics, 14 males and
18 females, were treated with 36 FPDs. The mean age
at implant placement was 53 years (range 15 to 71
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Ceramic Abutments for Short-Span FPDs
years). Carious lesions were the most common reason
for tooth loss (31%), followed by periodontitis (27%).
Implants, Abutments, and FPDs
Initially, 105 Brånemark implants were placed. After
FPD connection, 53 ceramic abutments supported 19
FPDs, and 50 titanium abutments supported 17 FPDs.
In all, 13 FPDs were placed in the maxilla (8 test, 5
control) and 23 in the mandible (11 test, 12 control).
Three FPDs were placed in the anterior region (2
test, 1 control), 26 in the posterior region (10 test, 16
control), and 7 (7 test) in both the anterior and pos-
terior regions. The FPDs in the test group were ce-
mented to the abutments, while the FPDs in the
control group were screw retained. The ceramic abut-
ments were prepared according to the manufacturer’s
guidelines (Fig 1). The first abutment was placed in
August 1994, and the last in June 1996.
Clinical evaluation included a careful assessment
of the peri-implant mucosa, gingiva, and pocket
depth around implants and adjacent teeth. Further-
more, the position of crown edge in the peri-implant
sulcus and esthetics were evaluated. The examina-
tions were performed as previously described.5
Statistics
Descriptive statistics and conventional life table
analysis with regard to cumulative success rates (CSR)
have been used in the present study.23 The Mann-
Whitney U test was used for comparison of marginal
bone loss between the two abutment types. Test for
trend in contingency table (Mantel-Haenszel chi-
square)25 was used to analyze differences between
the abutment types and between the adjacent teeth
regarding mucosal/gingival bleeding index and
plaque. The statistical tests for the analysis of the
marginal bone level were based on patient as the unit
(not on implants), ie, a mean of all loaded implants
was calculated per patient. For comparison between
groups regarding dichotomous variables, the percent
of surfaces with bleeding and plaque on abutment
types and adjacent teeth, respectively, was calculated
for each patient. Significance tests were two tailed
and conducted at the 5% significance level.
Results
Thirty of the 32 patients with 29 of initially 36 inserted
FPDs, 17 supported by ceramic abutments and 12 sup-
ported by titanium abutments, were examined after 5
years. Of the 105 implants placed, 3 failed, giving an
overall implant survival rate of 97.1%. Two implants
were nonosseointegrated before loading, and one failed
641 The International Journal of Prosthodontics
 Ceramic Abutments for Short-Span FPDs
Fig 1a Patient restored with three
CerAdapt abutments in the right maxilla.
Figs 1b and 1c (right) Radiographs of
FPD at baseline (prosthesis insertion).
Figs 1d and 1e (right) Radiographs of
FPD at the 5-year follow-up visit.
during the second year of loading. The latter implant
loss was recorded in an FPD supported by four implants.
The FPD was modified after implant removal and was
still in function after 5 years. One of the 53 ceramic and
none of the 50 titanium abutments failed, giving a CSR
of 98.1% and 100%, respectively (Table 1). One of 36
FPDs failed, giving an overall CSR of 97.2%. The CSR
was 100% for 12 titanium abutment–supported and
94.7% for 17 ceramic abutment–supported FPDs after
5 years. The failure was due to a fractured abutment in
an FPD on two implants, where the opposing teeth had
been restored with porcelain since the last visit. The pro-
visionally cemented FPD was loose, and both the abut-
ment and FPD were recorded as failures after 1 year.
Six FPDs in five patients were withdrawn. One patient
did not show up for recall visits in spite of repeated re-
minders, and in three patients who had both ceramic-
and titanium-supported FPDs, only the ceramic-
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Andersson et al
supported FPDs were examined due to an administra-
tive mistake. One patient had two mandibular FPDs re-
made, as a change of occlusion was needed before
making a new prosthetic restoration in the maxilla.
Minor abutment fractures, located at the most coro-
nal part of the abutment, were recorded for two pa-
tients during the initial prosthetic work. The prosthetic
treatment was continued for both patients in spite of
the incidents. One patient who was a heavy bruxer
had a porcelain fracture recorded on a mandibular
molar after 5 years. Two antagonist teeth were re-
ported as lost at the 1-year examination. One tooth
in the opposing jaw had been replaced by an implant-
supported crown after 2 years and another one after
3 years. One opposing FPD abutment was changed
to a cantilevered one after 2 years, and a tooth-sup-
ported FPD in the opposing jaw was replaced by
two implants after 3 years.
Volume 16, Number 6, 2003
 Andersson et al Ceramic Abutments for Short-Span FPDs

Table 1 Life Table Analysis of Ceramic Abutments and Fixed Partial Dentures (FPD) Supported by Ceramic Abutments

Abutments FPDs
Time period Successful Failed Withdrawn CSR (%) Successful Failed Withdrawn CSR (%)

Abutment connection– 53 0 0 100.0 — — — —

FPD insertion
FPD insertion–1 y 53 1 1 98.1 19 1 0 94.7
1–2 y 51 0 1 98.1 18 0 0 94.7
2–3 y 50 0 0 98.1 18 0 0 94.7
3–4 y 50 0 3 98.1 18 0 1 94.7
4–5 y 47 0 0 98.1 17 0 0 94.7
CSR = cumulative success rate.

Tooth plaque, titanium

50 50 Tooth plaque, ceramic
Bleeding, titanium
Bleeding, ceramic
40 40
Abutments (%)

30 30

Teeth (%)
Plaque, titanium abutments
Plaque, ceramic abutments
20 20
Bleeding, titanium abutments
Bleeding, ceramic abutments

10 10

0 0
0 1 2 3 4 5 0 1 2 3 4 5
Time (y) Time (y)

Fig 2 Soft tissue bleeding and plaque around abutments. Fig 3 Soft tissue bleeding and plaque around teeth adjacent
to ceramic and titanium abutments.

Plaque was more frequently seen than soft tissue
bleeding at the 1- to 5-year follow-up appointments.
No significant differences were recorded between ce-
ramic and titanium abutments for mucosal bleeding
and plaque (P ⬎ .05) (Fig 2). There were also no sig-
nificant differences for gingival bleeding and plaque
when teeth adjacent to FPDs on ceramic and titanium
abutments were compared after 5 years (Fig 3).
Three pockets of 5 mm were recorded around two
ceramic abutments at the 5-year examination.
Changes of the mucosal level were recorded at 12%
of the abutments. The level of the peri-implant mu-
cosa also showed some differences over time in re-
lation to the level of the abutment/crown (Table 2).
More changes were recorded from FPD insertion to
2 years (seven) than from 2 to 5 years (four). Seventy-
three percent of all changes were recorded at ceramic
abutments. No pathologic mobility was recorded for
implants or adjacent teeth.
An independent radiologist used radiographs taken
at FPD insertion and 1, 3, and 5 years later to analyze
40 of 52 ceramic and 39 of 50 titanium abutments.
There was a mean marginal bone loss of 0.3 mm (stan-
dard deviation [SD] 0.5) for the ceramic abutments and
of 0.4 mm (SD 0.9) for the titanium abutments. The
marginal bone loss from baseline (FPD insertion) to the
5-year follow-up did not show any statistically signif-
icant difference between the two groups (P ⬎ .30).
The clinicians rated the esthetic result as excellent
or good in 92% and acceptable in 8% of the cases
at FPD insertion. The results were comparable for ce-
ramic and titanium abutments with regard to the fre-
quency of FPDs that were rated excellent or good. At
the 5-year follow-up appointment, the correspond-
ing figures were 100% and 0%. All patients were fully
satisfied with the achieved esthetic results at both FPD
insertion and the 5-year appointment.
Discussion
This study was a randomized controlled trial; there is
universal agreement that this study design constitutes

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 Ceramic Abutments for Short-Span FPDs Andersson et al

Table 2 Changes in Crown Margin Position from Fixed Partial Denture (FPD) Insertion to 5-Year Follow-up

Crown margin at FPD insertion Change from insertion to 2-y follow-up Change from 2- to 5-y follow-up
Position Ceramic Titanium Position Ceramic Titanium Ceramic Titanium

Submucosal 7 13 Submucosal to mucosal 0/5* 0/11† 0/5 0/14

Submucosal to supramucosal 0/5* 0/11† 0/5 0/14
At mucosal margin 20 11 Mucosal margin to submucosal 2/20 0/11 0/16 0/3‡
Mucosal margin to supramucosal 3/20 0/11 0/16 0/3‡
Supramucosal 25 18 Supramucosal to mucosal margin 1/25 0/18 0/24§ 1/17
Supramucosal to submucosal 0/25 1/18 2/24 1/17
Total 52 42 Total 6/50 1/40 2/45 2/34
*Two implants withdrawn because one FPD was regarded as a failure.
†Missing information for two abutments.
‡Two FPDs (six abutments) had been withdrawn.
§One FPD (three abutments) had been withdrawn.

the best scientific evidence for treatment effective-
ness.26 There have only been a few follow-up studies
on the clinical outcome of ceramic abutments pub-
lished so far.5,13 This is surprising, as there is a great
professional and commercial interest in implants and
ceramic materials in dentistry. An explanation for the
lack of documentation might be that clinical follow-
up studies are very time demanding for both the re-
search team and patients.
Thirty of initially 32 patients remained after 5 years,
since two patients did not complete the study. The
number of patients completing the present study in-
dicates a high level of reliability for the obtained re-
sults. The loss of patients is lower than the with-
drawal rate of 18% reported for a comparable 5-year
multicenter implant study.27
No titanium and one ceramic abutment failed.
This failure, a fracture during the first year of loading,
resulted in the loss of an FPD supported by two abut-
ments. The brittleness of the ceramic abutment was
considered to be the main reason for the fracture5 that
finally resulted in the loss of the FPD. In a longer time
perspective (⬎ 5 to 10 years), however, the design,28
brittleness,28 and tendency for ceramic materials to
undergo static fatigue29 have to be taken into ac-
count regarding the prognosis. There was an overall
CSR of 97.2% for the FPDs, based on a CSR of 100%
and 94.7% for FPDs on titanium and ceramic abut-
ments, respectively. The success rates after 5 years
were encouraging and support the good long-term
prognosis for implant-supported short-span FPDs.30,31
Only minor changes were recorded for teeth oppo-
site the followed FPDs. None of these changes were as-
sessed to have had any influence on the outcome of the
FPDs. No differences were recorded for plaque and soft
tissue bleeding when titanium and ceramic abutments
were compared, and no pathology or complications
were reported for the peri-implant mucosa or gingiva.
A low level of plaque at FPDs and adjacent teeth
was recorded during the follow-up period, even
though plaque was somewhat more often seen than
bleeding. This indicates satisfactory oral hygiene, as
there is a relationship among oral hygiene, bacterial
plaque accumulation, peri-implant mucositis, and
gingivitis.32 Abutments of both commercially pure ti-
tanium and high-density alumina have in experi-
mental studies33,34 demonstrated a high quality of at-
tachment to the peri-implant mucosa.
The mucosal level, in relation to the level of the
abutment/crown, exhibited changes at 12% of the
abutments. Sixty-four percent of the changes oc-
curred during the first 2 years, and 36% occurred dur-
ing the last 3 years. Seventy-three percent of all
changes were recorded at ceramic abutments. There
was a balance between more or less exposures of the
crown margins during the first 2 years, in contrast to
the 2- to 5-year period, when all changes meant less
exposed margins. These results might indicate sys-
tematic changes of the level of the peri-implant
mucosa over a longer period. The results support
previous observations on soft tissue changes at im-
plants,35,36 although it should be remembered that the
number of observations was limited in the present
study.
The radiographic examinations revealed a mar-
ginal bone loss of 0.3 mm and 0.4 mm for titanium
and ceramic abutments, respectively. A steady bone
level was maintained during the 5-year follow-up
period. These observations are in agreement with
those of previous studies.30,37,38
Both clinicians and patients rated the esthetics as ex-
cellent/fully satisfying for all treatments after 5 years.
These ratings are surprisingly high compared to a re-
cent study on ceramic crowns.11 Those patients were
followed for up to 10.5 years, and esthetics was rated
as excellent according to 92% of patients and 59% of
clinicians. It is hard to find any explanation for the
100% ratings in the present study, as clinicians usu-
ally are more critical than patients and also to some
extent focus on other details than patients.39,40

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 Andersson et al
Conclusions
• One of 53 CerAdapt and none of 50 titanium
abutments failed within the 5-year follow-up, giv-
ing a CSR of 98.1% and 100%, respectively. The
CSR for 17 ceramic abutment–supported FPDs
was 94.7%, compared to 100% for 12 titanium-
supported FPDs.
• A mean marginal bone loss of 0.3 mm and 0.4
mm, respectively, was recorded at ceramic and ti-
tanium abutments.
• Healthy soft tissues were recorded at both ceramic
and titanium abutments, as well as at adjacent
teeth. Changes of the mucosal level in relation to
the level of the abutment/crown were recorded at
12% of the abutments, with 73% of all changes
recorded at ceramic abutments. Most changes
(64%) were recorded from FPD insertion to 2 years.
• Clinicians rated esthetics as excellent or good in
92% of cases. All patients were fully satisfied
with the achieved esthetic results.
• Safe long-term functional and esthetic results can
be achieved with CerAdapt alumina ceramic
abutments on Brånemark system implants for
short-span FPDs.
Acknowledgments
The authors are very grateful to all the team members at their clin-
ics, whose help and cooperation made this study possible.
References
1. Prestipino V, Ingber A. Esthetic high strength implant abutments.
Part I. J Esthet Dent 1993;5:29–36.
2. Prestipino V, Ingber A. Esthetic high strength implant abutments.
Part II. J Esthet Dent 1993;5:63–68.
3. Prestipino V, Ingber A. All-ceramic implant abutments. Esthetic
indications. J Esthet Dent 1996;8:255–262.
4. Goodacre CJ, Campagni WV, Aquilino SA. Tooth preparations
for complete crowns: An art form based on scientific principles.
J Prosthet Dent 2001;85:363–376.
5. Andersson B, Schärer P, Simion M, Bergström C. Ceramic implant
abutments used for short-span fixed partial dentures: A prospec-
tive 2-year multicenter study. Int J Prosthodont 1999;12:318–324.
6. Andersson M, Odén A. A new all-ceramic crown. Acta Odontol
Scand 1993;51:59–64.
7. Kaiyang Z, Odén A, Rowcliffe D. Flexure tests on dental ce-
ramics. Int J Prosthodont 1996;9:434–439.
8. Wagner WC, Chu TM. Biaxial flexural strength and indentation
fracture toughness of three new dental core ceramics. J Prosthet
Dent 1996;76:140–144.
9. Wen MY, Mueller HJ, Chai J, Wozniak WT. Comparative me-
chanical property characterization of 3 all-ceramic core mate-
rials. Int J Prosthodont 1999;12:534–541.
10. Odén A, Andersson M, Krystek-Ondracek I, Magnusson D. Five-
year clinical evaluation for procera AllCeram crowns. J Prosthet
Dent 1998;80:450–456.
Volume 16, Number 6, 2003
COPYRIGHT © 2003 BY QUINTESSENCE PUBLISHING CO, INC.
PRINTING OF THIS DOCUMENT IS RESTRICTED TO PERSONAL USE ONLY.
NO PART OF THIS ARTICLE MAY BE REPRODUCED OR TRANSMITTED IN ANY FORM
WITHOUT WRITTEN PERMISSION FROM THE PUBLISHER.
Ceramic Abutments for Short-Span FPDs
11. Ödman P, Andersson B. Procera AllCeram crowns followed for
5 to 10.5 years: A prospective clinical study. Int J Prosthodont
2001;14:504–509.
12. Andersson B, Ödman P, Lindvall A-M, Brånemark P-I. Cemented
single crowns on osseointegrated implants after 5 years: Results
from a prospective study on CeraOne. Int J Prosthodont 1998;11:
212–218.
13. Andersson B, Taylor Å, Lang BR, et al. Alumina ceramic implant
abutments used for single-tooth replacement: A prospective 1-
to 3-year multicenter study. Int J Prosthodont 2001;14:432–438.
14. Yildirim M, Edelhoff D, Hanisch O, Spiekermann H. Ceramic
abutments—A new era in achieving optimal esthetics in implant
dentistry. Int J Periodontics Restorative Dent 2000;20:81–91.
15. Sadoun M, Perelmuter S. Alumina-zirconia machinable abut-
ments for implant-supported single-tooth anterior crowns. Pract
Periodontics Aesthet Dent 1997;9:1047–1053.
16. Wlochowitz A, Wholwend A, Schärer P. Das Zirkonoxid-
abutment—Ein Fallbericht. Implantologie 1998;3:281–294.
17. Tinschert J, Natt G, Mautsch W, Augthun M, Spiekermann H.
Fracture resistance of lithium disilicate–, alumina-, and zirconia-
based three-unit fixed partial dentures: A laboratory study. Int J
Prosthodont 2001;14:231–238.
18. Chong KH, Chai J, Takahashi Y, Wozniak W. Flexural strength
of In-Ceram alumina and In-Ceram zirconia core materials. Int
J Prosthodont 2002;15:183–188.
19. Ichikawa Y, Akagawa Y, Nikai H, Tsuru H. Tissue compatibil-
ity and stability of new zirconia ceramic in vivo. J Prosthet Dent
1992;68:322–326.
20. Akagawa Y, Hosokawa R, Sato Y, Kamayama K. Comparison be-
tween freestanding and tooth-connected partially stabilized zir-
conia implants after two years’ function in monkeys: A clinical
and histologic study. J Prosthet Dent 1998;80:551–558.
21. Kosmac T, Oblak C, Jevnikar P, Funduk N, Marion L. The effect
of surface grinding and sandblasting on flexural strength and re-
liability of Y-TZP zirconia ceramic. Dent Mater 1999;15:426–433.
22. World Medical Association. Declaration of Helsinki: Recom-
mendations Guiding Physicians in Biomedical Research
Involving Human Subjects. Adopted by the 18th World Medical
Assembly, June 1964 Helsinki, Finland, and Amended by the
48th General Assembly, 1996, Republic of South Africa.
23. Pocock SJ. Clinical Trials. A Practical Approach. New York: John
Wiley, 1984.
24. Albrektsson T. On long-term maintenance of the osseointe-
grated response. Aust Prosthodont J 1993;7:15–24.
25. Mantel N, Haenszel W. Statistical aspect of data from retro-
spective studies of disease. J Natl Cancer Inst 1959;22:719–748.
26. Esposito M, Worthington HV, Coulthard P. In search of truth: The
rule of systematic reviews and meta-analyses for assessing the
effectiveness of rehabilitation with oral implants. Clin Implant
Dent Relat Res 2001;3:62–78.
27. Henry PJ, Laney WR, Jemt T, et al. Osseointegrated implants for
single-tooth replacement: A prospective 5-year multicenter
study. Int J Oral Maxillofac Implants 1996;11:450–455.
28. McLean JW. Designing high strength ceramic crowns and
bridges. Excellence 1993:15–18.
29. McCabe JF. Ceramics and metal-bonded ceramics. In: Applied
Dental Materials, ed 7. Oxford, UK: Blackwell, 1990:71–77.
30. Lekholm U, Gunne J, Henry P, et al. Survival of the Brånemark
implant in partially edentulous jaws: A 10-year prospective mul-
ticenter study. Int J Oral Maxillofac Implants 1999;14:639–645.
31. Naert I, Koutsikakis G, Duyck J, Quirynen M, Jacobs R, van
Steenberghe D. Biologic outcome of implant-supported restora-
tions in the treatment of partial edentulism. Part I: A longitudi-
nal clinical evaluation. Clin Oral Implants Res 2002;13:381–389.
645 The International Journal of Prosthodontics
 Ceramic Abutments for Short-Span FPDs Andersson et al

32. Pontoriero R, Tonelli MP, Carnevale G, Mombelli A, Nyman SR,
Lang NP. Experimentally induced peri-implant mucositis. A clin-
ical study in humans. Clin Oral Implants Res 1994;5:354–359.
33. Abrahamsson I, Berglundh T, Glantz P-O, Lindhe J. The mucosal
attachment at different abutments. An experimental study in
dogs. J Clin Periodontol 1998;25:721–727.
34. Berglundh T, Lindhe J, Ericsson I, Marinello CP, Liljenberg B,
Thomsen P. The soft tissue barrier at implants and teeth. Clin Oral
Implants Res 1991;2:81–90.
35. Jemt T. Regeneration of gingival papillae after single implant
treatment. Int J Periodontics Restorative Dent 1997;17:327–333.
36. Jemt T. Restoring the gingival contour by means of provisional resin
crowns after single implant treatment. Int J Periodontics Restorative
Dent 1999;19:21–29.
37. Gunne J, Åstrand P, Lindh T, Borg K, Olsson M. Tooth-implant
and implant supported fixed partial dentures: A 10-year report.
Int J Prosthodont 1999;12:216–221.
38. Naert I, Koutsikakis G, Duyck J, Quirynen M, Jacobs R, van
Steenberghe D. Biologic outcome of implant-supported restora-
tions in the treatment of partial edentulism. Part II: A longitudinal
radiographic evaluation. Clin Oral Implants Res 2002;13:390–395.
39. Carlsson GE, Ödman P, Ekstrand K, et al. An international com-
parative multicenter study of assessment of dental appearance
using a computer-aided image manipulation. Int J Prosthodont
1998;18:246–254.
40. Chang M, Ödman PA, Wennström J, Andersson B. Esthetic out-
come of implant-supported single-tooth replacements assessed by
the patient and prosthodontists. Int J Prosthodont 1999;12:335–341.

Literature Abstracts

Clinical evaluation of a carbon fibre reinforced carbon endodontic post.

This prospective study compared the clinical performance of a carbon fiber–reinforced carbon
(CFRC) endodontic post with that of a prefabricated precious alloy serrated parallel-sided post
(Parapost). Twenty-seven single-rooted maxillary anterior teeth in 18 patients were restored with
either post system. Type III gold-alloy cores were cast on the posts. Resin cement was used for
the CFRC posts, and zinc phosphate was selected for Parapost. The mean observation period
for all patients was 87 months (range 80 to 100 months). In the CFRC group (n = 16), four ce-
mentation failures were found at 24, 29, 56, and 87 months, respectively, and two patients were
lost to recall at 16 and 31 months, respectively. In the control group (n = 11), only one fractured
post was encountered at 84 months, and two patients were lost at 19 and 24 months, respec-
tively. Lost patients were not included for statistical analysis. Kaplan-Meier survival curves
demonstrated that survival of CFRC posts was lower than that of controls from 24 months. Bond
failure appeared to occur between the resin luting cement and internal dentin in all failed CFRC
restorations, but it is impossible to determine the cause. The use of contemporary dentin adhe-
sives in conjunction with resin luting cement may improve the retention of CFRC.

King PA, Setchell DJ, Rees JS. J Oral Rehabil 2003;30:785–789. References: 8. Reprints: Dr J. S. Rees,
Division of Restorative Dentistry, University of Bristol Dental School, Bristol, United Kingdom. e-mail:
j.s.rees@bristol.ac.uk—Frederick C. S. Chu, Hong Kong

In-patient comparison of immediately loaded and non-loaded implants within

6 months.

This study compared clinical parameters of immediately loaded and nonloaded implants at sec-
ond-stage surgery. Outcome measurements were conducted on clinical stability and changes of
marginal bone level within 6 months. Fourteen immediately loaded implants were compared with
28 nonloaded implants. Selection criteria for the subjects were patient driven in that patients de-
clared the need for retentive prostheses. Six Frialit-2 stepped screws were placed between the
mental foramina, with two exposed to the intraoral cavity for immediate loading with a Dolder
bar–retained overdenture. Implants were evaluated for implant survival, Periotest value, and
change of clinical marginal bone level between first- and second-stage surgery. The Mann-
Whitney U test was used to evaluate statistical significance. Median Periotest values were –3 for
the loaded and –6 for the nonloaded implants, which was highly significant but still within the nor-
mal range of osseointegrated implants. Six months postoperative, there was a 1-mm reduction in
peri-implant bone height for loaded implants and a 0.5-mm reduction for nonloaded implants. This
difference was also highly significant. No implant failures were noted within this time period.

Lorenzoni M, Pertl C, Zhang K, Wegscheider WA. Clin Oral Implants Res 2003;14:273–279. References: 32.
Reprints: Dr Martin Lorenzoni, Department of Prosthetic Dentistry, School of Dental Medicine, Karl-Franzens-
University Graz, Auenbruggerplatz 12, A-8036 Graz, Austria. e-mail: Martin.Lorenzoni@uni-graz.at—
Josephine Esquivel-Upshaw, San Antonio, Texas

The International Journal of Prosthodontics 646 Volume 16, Number 6, 2003

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