Journal of Prosthetic Dentistry

Clinical performance of posterior monolithic zirconia implant-supported fixed dental prostheses with angulated screw channels: A 3-year prospective cohort study

  • Adolfo Di Fiore
    Corresponding author: Dr Adolfo Di Fiore, Department of Neurosciences, Dental School, Section of Prosthodontics and Digital Dentistry, University of Padova, via Giustiniani 2, 35100, Padova, ITALY
    Adjunct Professor, Department of Neurosciences, School of Dentistry, Section of Prosthodontics and Digital Dentistry, University of Padova, Padova, Italy
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  • Stefano Granata
    Adjunct Professor, Department of Neurosciences, School of Dentistry, Section of Prosthodontics and Digital Dentistry, University of Padova, Padova, Italy
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  • Carlo Monaco
    Researcher, Assistant Professor, Division of Prosthodontics and Maxillofacial Rehabilitation, Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum— University of Bologna, Bologna, Italy
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  • Edoardo Stellini
    Full Professor and Head of Dental Clinic and School of Dentistry, Department of Neurosciences, University of Padova, Padova, Italy
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  • Burak Yilmaz
    Associate Professor, Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, Bern, Switzerland

    Associate Professor, Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, Bern, Switzerland

    Adjunct Professor, Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, Ohio
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      Statement of problem

      The choice of retention type of an implant-supported fixed dental prosthesis (FDP) becomes critical when the dental implant is not placed in a prosthetically ideal location. In recent years, computer-aided design and computer-aided manufacturing (CAD-CAM) technology has enabled the correction of the location of screw access hole depending on the clinical needs of the patient. However, how FPDs with angulated screw channels (ASCs) perform clinically is unclear.


      The purpose of this prospective clinical study was to evaluate the mechanical complications and crestal bone loss (CBL) when posterior monolithic zirconia implant-supported FDPs with an ASC are used.

      Material and methods

      Participants (N=37) with a missing single posterior tooth or multiple teeth, sufficient bone height, and an implant site without infection were included. Each participant received parallel-walled implants (Nobel Parallel CC) of 7-, 8.5-, or 10-mm length by using a 1-stage approach. After 4 months of healing, a conventional impression was made, and a digital workflow was followed. Monolithic zirconia restorations (Katana ML) were milled, stained, and mechanically attached to a titanium base (NobelProcera ASC abutment). CBL was measured from radiographs at 6, 12, 24, and 36 months after the placement of the prosthesis. Implant and prosthetic characteristics including implant diameter, implant length, screw channel angle (angle≤15 degrees versus angle>16 degrees), prosthetic type (single crown versus multiple-unit FDP), and antagonist dentition (natural versus prosthesis) were also recorded. A generalized linear mixed model with a log link was estimated to assess the independent predictors of CBL among the angles of ASC-retained definitive restorations and the clinically relevant variables (α=.05).


      Thirty-seven participants received 51 implants, and the median follow-up period was 30 months (interquartile range: 22-36). Two single-crown implants failed within the first 12 months of delivery. The implant and restoration survival rate was 96% at 36 months. Screw loosening was recorded in 2 study participants. After a follow-up of 36 months, the mean ±standard deviation CBL value was 0.15 ±0.14 mm with an increase over time (P<.001). The effect of the angle of ASC, implant diameter, implant length, prosthetic type, and antagonist on the CBL was not statistically significant (P>.05).


      CBL was not associated with the angle of ASC, implant diameter, implant length, prosthetic type, or antagonist when posterior monolithic zirconia implant-supported FDPs with ASCs were used. Screw loosening in 2 situations was the only mechanical complication during the first 3 years of service.
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