Porcelain Fractures: Most Frequent Implant Complication?

Do not connect implants with mobile teeth. Take a perfect impression. Implant analog has to be stabile in the impression material. Gold casting is perfecter. Make short bridges if possible. Antagonist can be also important....... This problem is multifactorial.

It is vitally important to adjust the occlusion properly in any implant supported restorations. Teeth will move about 100 microns, implants on the other hand have an order to magnitude less movement, i.e. no shock-absorbing mechanism. If you can obtain them, use three Shimstock papers stacked on top of each other (each is 33 microns) and check for the necessary clearance in all working and non-working side, as well as protrusive excursives. Hope this will clear up the problem, notwithstanding that you lab may not be stacking the glass properly.

The most common cause of porcelain fracture is lack of support from the framework, whether that be metal or zirconia. The framework should be a smaller version of the final shape so that, as much as possible, there is an even thickness of ceramic with particular attention to supporting the marginal ridges, cusps, and incisal edges. Implant restorations are particularly prone to this because of lack of shock absorbtion.

Is this any different from bridges on natural teeth? Mmmmmmm, if you dont know the differences, maybe you shouldnt be doing implant supported bridges.

As I have tried to explain, the fundamentals regarding supporting the ceramic applies in any circumstance. That's why the many implant supported and natural teeth supported bridges constructed in my laboratory don't fracture. Are you trying to tell me there is a difference?? Mmmmmm, how interesting.

Pay attention to the occlusion! Check, Misch-Implant Prosthetics and the reasons for the various occlusal methods.

Occlusion and unsupported porcelain. It would help if you identified the nature of the porcelain fracture - but if it is in the marginal ridge area it is almost always unsupported porcelain. Check the wax-up of the sub-structure to insure that there is only 1.25 mm of space to be built up in porcelain. Get a T-Scan to insure that your implant is loaded after the natural teeth. And firstly remove any sharp and pointed cusp tips in the opposing restorations or teeth.

If the most frequent complicaton you see is fractured porcelain ..this is odd I suspect your lab isdesigning the frameworks improperly It is likely you have insufficient metal (as John has stated above ) I assume you know what you are doing regarding bridge design ..spans ..natural tooth connection etc

I agree with Dr. S SenGupta.

There are numerous factors to be taken into account : Framework design - support Quality of materials used Misuse of technology Occlusion should be feather light in centric, working, balancing and protrusive movements, ie, NO premature contacts on bridge Must have passive fit of framework on fixture heads - do you employ Sheffield test when placing implant bridges ? Lack of interocclusal space may present problems Suspect poor impressioning on your part, or poor laboratory practises. Suggest that you sit down face to face with your technicians and practise good communication to try to resolve this continuing problem.

hi . sorry to hear you are having these problems with # s . In all the years i have been a ceramist the most common reason for fracture would be poor bonding from porcelain to framework . poor design of metalwork . bruxist . poor impression ( especially posteriors . as i see the impression material here is thicker and has a tendency to pull out giving a false bite . ) . ..... i could go on but i won t . the conclusion would be to check your protocol for restoring implant bridges thoroughly . you only give a small amount of info. are all the implant bridge # s from the same lab ? do you after one year expect the lab to do free work ? perhaps your other collegues don t experience as many failures as you in the small time frame . do they use this said ( unsaid ! ) lab ? to finish off ; the high price of implant restorations usually demand the high price framework . experience and quality are an excellent way of judging a labs ability . price may not be . in the long term perhaps what appears to be a keen price may end up costing you more with irreparable circumstances .

Other possibilities are a high gold content alloy should not be used, higher in pallaidium based alloys should be used. Why not use a high quality composite, new generation ie; shofu ceramarge is an excellent long term restoration as long it's polished correctly. Ceramarge has very similar wear rate as natural the tooth.

HELP please someone. I need an answer. I currently have 7 maxillary implants with the goal of a fixed full porcelain fixed prosthesis that has the metal framework. I've had a long road with complications and only have 7 implants to use in the maxilla. Have my own lower teeth. I've had the hip graft etc. Are 7 enough? PLEASE everyone give me opinions. The surgeon needs them to get splinted together so I don't lose any more! I'm only 57. Lost my teeth due to abuse 45 years ago so the bone is not great quality.

Sorry, but I forgot to add that I think I've read a minimum of 8. Some say 6 but with my age just how long will the fixed prosthesis last???????

Dear Karen, you may ask your physician or implant surgeon if a one month course of calcinotin by nose would be of any benefit. Also get a Dexa scan to determine if this in needed and ask your implant surgeon about the quality of your bone.....R. Hughes, DDS, FAAID, FAAIP, Dipl.ABOI/ID

OK so again the question is......... are 7 implants enough for the "superstructure" prosthesis which is titanium and porcelain? Seems everywhere I've read 8 is the minimum. Any opinions?