When delivering a full-arch zirconia implant-supported prosthesis, an infrequent but possible complication is the fracture of the zirconia framework. This complication can be seen more commonly on patients who exhibit parafunctional habits.

This visual essay walks through the basic steps of temporarily repairing a fractured implant-supported zirconia prosthesis.

As you will see in Figure 7, I provide a step-by-step reparation protocol:

  • Sandblast two bars of A102 (110 microns)
  • Silane one minute per surface
  • Allow five minutes to evaporate
  • Apply bonding agent
  • Cementation utilizing dual curing resin cement
Frontal view of the fractured zirconia prosthesis, which had been inserted 4.5 years earlier
Figure 1: Frontal view of the fractured zirconia prosthesis, which had been inserted 4.5 years earlier.
Occlusal view of the fractured prosthesis.
Figure 2: Occlusal view of the fractured prosthesis.
Fractured prosthesis and screw. Note the thickness of the prosthesis.
Figure 3: Fractured prosthesis and screw. Note the thickness of the prosthesis.
Fractured screw that probably broke after the prosthesis was fractured.
Figure 4: Fractured screw that probably broke after the prosthesis was fractured.
Fractured prosthesis. Note the thickness of the prosthesis around the temporary cylinder.
Figure 5: Fractured prosthesis. Note the thickness of the prosthesis around the temporary cylinder.
Close -up view of the fractured prosthesis.
Figure 6: Close-up view of the fractured prosthesis.
Step-by-step reparation protocol.
Figure 7: Step-by-step reparation protocol.
Close-up view of silane application.
Figure 8: Close-up view of silane application.
Both pieces of the prosthesis were secured in the master model to confirm the position.
Figure 9: Both pieces of the prosthesis were secured in the master model to confirm the position.
Prosthesis after cementation. Note the chipped part of the layered pink porcelain.
Figure 10: Prosthesis after cementation. Note the chipped part of the layered pink porcelain.
Note the intimate contact of both pieces, making the bonding procedure more predictable.
Figure 11: Note the intimate contact of both pieces, making the bonding procedure more predictable.
Intraoral view of the repaired prosthesis. Note the pink area was repaired with pink composite.
Figure 12: Intraoral view of the repaired prosthesis. Note the pink area was repaired with pink composite.
Intraoral view of the repaired prosthesis in occlusion.
Figure 13: Intraoral view of the repaired prosthesis in occlusion.
Occlusal view of the repaired prosthesis.
Figure 14: Occlusal view of the repaired prosthesis.
Patient's smile with repaired prosthesis.
Figure 15: Patient’s smile with repaired prosthesis.

This is a step-by-step technique on how to repair a fractured zirconia implant-supported framework. It is important to clearly communicate to the patient that this is a temporary repair while a new zirconia prosthesis is fabricated, but it allows to address the emergency in a relatively easy and inexpensive way.

Ricardo Mitrani, D.D.S., M.S.D., is a member of Spear Resident Faculty.


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Comments

Commenter's Profile Image Mark G.
November 7th, 2020
How long will a repair like this last typically? 1 week, 1 month? Did the structure break because it did not have a passive seat to begin with? Will you make a completely new prosthesis (new fixture level impressions or a new digital scan)? I currently have 2 zirc proths on 4 implants each that have lasted 1 year that broke with a week of each other. . First pt reported being hit in the face , hard enough to knock him out. We are reevaluating his implant in that area as it now has 1/2 of the bone missing around the implant. Second pt says his wife keeps telling him how he is really snoring loudly these days. He is a smoker and has lost 2 other implants in the same area as the break a few years ago. We are considering botox for him. Both pts were digitally scanned last year for their final proths.
Commenter's Profile Image Ricardo M.
November 9th, 2020
Hi Mark, Thanks for reaching out with such great questions. As far as how long did the repair last for? in our patient here we were quite successful with the repair for close to a year when we moved on to do a new prosthesis. We did make sure that occlusion wise, the area of the fracture was not heavily loaded in function, reinforced the use of a night guard, which the patient admitted that he was not using it regularly. As far as why it fractured? our patient exhibited heavy parafunction since day one. In fact the reason why he lost his teeth to begin with, had to do with accentuated parafunction and broken teeth that had been previously restored. I do not believe the fracture had to do with a non-passive fit, as we ensured that the prosthesis was fitting passively (verification jig and one screw tests were performed). BTW, for full arch implant supported reconstructions like this, we still utilize an analog impression technique we are not utilizing IOS for these types of prosthesis yet. Cheers Ricardo
Commenter's Profile Image David K.
November 10th, 2020
It seems like we have short memories. Procera by Nobelbiocare came out years ago and we had shearing and fracturing. That is the beauty of good old fashion acrylic!
Commenter's Profile Image Ricardo M.
November 10th, 2020
Hi David, thanks for your comment, While I agree with your statement about our short memory, I hope you agree that fractures in the early days were more frequently seen as “shearing” of the overlying ceramics which was normally due to inadequate framework design. Zr Framework fracture though was less common and it still is pretty uncommon, particularly since at this day and age our Framework design is nearly monolithic (minimal layering). I also agree with your statement that “good old fashion acrylic” is a great option, but this also has clear limitations. The key in any type of prosthetic design is to have a thorough conversation with our patients regarding risks and long-term potential complications that may appear, prior to embarking on therapy.
Commenter's Profile Image David K.
November 11th, 2020
Absolutely agree. As the cost of printing comes down and advances we will have even better options. As you will be able to easily re-mill. And as you know we don't live in a perfectly risk free world! And in this case most likely everything is at risk.
Commenter's Profile Image Ricardo M.
November 11th, 2020
you bet ! As you mention, with costs of printing coming down, as well as new technologies evolving, this calls for new ways of discussing the "longevity" of our implant supported solutions with our patients. We should stay away from "the pervasive notion" that lives in many of our patients minds that " implants are forever" . In fact we wrote a digest article discussing this some time ago, that I would love for you to check out ! https://www.speareducation.com/spear-review/2018/09/the-biggest-dental-lie Cheers Ricardo
Commenter's Profile Image David K.
November 12th, 2020
I agree. I had read that article. Since I have been doing implants since 1987, even in the most ideal situation they wear out. I tell my patients its amazing that things last as long as they do given the thermocycling, forces, acid/base changes that happen. I am not sure why dentistry had decided that everything is permanent. I suspect the perfectionistic training we get in dental school and the "you failed" ethic does not help the situation.