Comparing the Incidence of Chipping in Tooth- Supported and Implant-Supported Ceramically Veneered Restorations

Special Article - Prosthodontics

Austin J Dent. 2018; 5(6): 1121.

Comparing the Incidence of Chipping in Tooth- Supported and Implant-Supported Ceramically Veneered Restorations

Brandt S¹*, Lochmann CH², Lauer H-CH¹, Brandt J¹ and Winter A³

¹Department of Prosthodontics, School of Dentistry Goethe University Frankfurt am Main, Germany

²Dentist in private practice, Bruchköbel, Germany

³Department of Prosthodontics, School of Dentistry Julius Maximilians University Würzburg, Germany

*Corresponding author: Brandt S, Department of Prosthodontics, School of Dentistry Goethe University Frankfurt am Main, Germany

Received: October 29, 2018; Accepted: November 26, 2018; Published: December 03, 2018


Purpose: Chipping is very common in dentistry, with up to 40% of ceramically veneered restorations being affected. The purpose of the study was to examine possible differences in chipping rates between tooth-supported and implant-supported restorations in the same environments.

Materials and Methods: A total of 563 restorations in 148 patients were clinically re-examined. The study included only patients with a tooth-supported and an implant-supported ceramically veneered restoration placed within a limited time of each other.

Results: Both the tooth-supported and the implant-supported restorations exhibited chipping. However, there was no significant difference in chipping rates between tooth-supported and implant-supported ceramically veneered restorations. Also the region of the crown does not depend significant to the chipping.

Conclusions: Factors such as appropriate processing of the ceramic materials, polishing of finished or adjusted surfaces prior to delivery, and providing night guards for e.g. bruxism patients have a much greater impact on the incidence of chipping than whether the crown was placed on a natural tooth or an implant.

Keywords: Tooth and implant abutments; Chipping; Veneered restoration


CAD/CAM: Computer Aided Design/Computer Aided Manufacturing; e.g.: for example; Fig: Figure; MPa: Megapascal; N: Newton


The use of ceramics in dentistry was firstly mentioned 1733 in Fauchard’s book Französischer Zahn-Arzt , oder Traktat von den Zähnen “French Dentist, or Treatise of the Teeth”. He describes a procedure for firing ceramic veneers onto fixed partial dentures made of gold. However, his technique did not gain much ground due to the insufficient bond of the two materials [1].

Thanks to manifold improvements in chemical compositions and processing techniques, ceramics have now become established as an important material in restorative dentistry, combining excellent esthetics with high biocompatibility and a low affinity to plaque [2].

Dental ceramics can be subdivided into two main categories (oxide ceramics and silicate ceramics) with further subdivisions. Due to their stability and favorable shade, oxide ceramics are perfectly suited as framework materials, either fully or partially veneered or in fully contoured crowns [3]. Modern oxide ceramics are characterized by phase-transformation consolidation, a process in which the ceramic is stabilized in its tetragonal phase by oxide additives [4].

If cracks occur within the ceramics, the associated stress-induced release of energy causes a transformation from the tetragonal to the monoclinic phase [5]. The volume increase of 3%-5% halts the cracking [6]. Together with the high flexural strength (up to 1,200MPa) and cracking resistance (9-10 MPa m-1), this property makes oxide ceramics resistant to damage to a certain extent [7].

Silicate ceramics, which come in different translucencies and opacities, have a clear advantage over oxide ceramics in the esthetic zone [8]. Their generally low bending strength (approx. 100MPa) can be increased to up to 450MPa by adding lithium or a similar material. This added stability is accompanied by an increase in opacity, at the expense of esthetics [9].

All ceramic materials, despite their fundamental differences, must be able to resist the functional (and parafunctional) loads of the masticatory system. The maximum physiological load in the molar region, as measured in the normal dentition, is around 250N, according to Fernandes, et al. [10]. For implant-supported restoration, Morneburg, et al. reported values of 264-284 N [11]. These masticatory forces that impact the ceramics manifest themselves as compressive and tensile stress as well as shear forces. Compressive stress is much more readily tolerated by ceramic materials than tensile stress. When the forces applied exceed the elastic limits of the framework material, fracture becomes inevitable. This brittle fracture behavior, often mentioned in the literature, is to be attributed to the plastic deformation of ceramics, which is not present in metals [12].

Ceramic fractures can be cohesive or adhesive in nature. A cohesion fracture (Figure 1) is defined as a fracture within the veneering ceramics, without an imminent framework exposure. An adhesion fracture is defined as a fracture at the veneer/framework interface (Figure 2), resulting in parts of the framework being exposed.