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FRACTURED ZIRCONIA

DENTAL IMPLANTS
FORENSIC ENGINEERING PROCESS REVIEW
BANGAYANDELA MERCEDEBUENFERNANDEZLIMROMAN

CASE BACKGROUND
A team lead by the Dr. Michael Gahlert evaluated the source
of failure of 13 out of 170 test zirconia dental implants, Z-Look3
(3.25 mm, 4mm, 5mm)
-randomly recruited 79 test patients in Germany
-test monitoring period: Oct. 2004- Sept. 2007
-Why? clinical evaluation studies that focus on the
long-term loading of new generation zirconia implants are
limited and rare
M. Ghalert, et. al (2011) Failure analysis of
fractured dental zirconia implants

Z-Look3 Series

Image from: http://zsystemsusa.com/ceramic-dental-implants/

Made from a high performance zirconium oxide ceramic,


ZrO2-TZP-A-Bio HIP:
Zirconium Dioxide(95%)
Yttrium and Aluminum oxides as Stabilizers (5%)
Aesthetically Superior to Titanium Implants
Remarkable Soft Tissue and Bone Integration
Non-allergenic and Inert

Zsystems:

The Study:

1 out 50 dental
implant patients
experience implant
failure

about 3 out of 50
patients
experienced
implant failure

Almost all of the failed


implants are of the smallest
thread diameter: 3.25 mm
All of the failed implants are
located along the anterior
(front) area
All of the failed implants
fractured under a loading
condition similar to a
classical bite off an apple.

The Basics of Tooth Implants


Crown - dental resin or porcelain replacement tooth
shaped like a real tooth

Abutment - connects the implant to the crown


Implant - a special type of screw that takes the place of
the original tooth root that is drilled into the jaw-bone.
Made of materials that the jawbone can fused with in a
process called osseointegration.

Implant sizes
Image from: http://beautysetter.com/dental-implants-101

[Standard (4mm), Wide (5mm), Narrow (3.25mm)] are


recommended to match the patients bone density
and bone availability.

What causes these implants to fail?


Occlusion - the contact between teeth.
Your mandibular muscles can
exert thousand pounds of force
per square inch on your teeth.
These stresses can attack a
tooth in different directions as
teeth grind against each other.

But unlike natural tooth,


dental implants are not
thoroughly equipped against
these
stresses
because
theyre are technologically
limited by design.

Image from: http://www.iadet.net/course-detail?id=34

Long-term exposure against these stresses will lead


to OCCLUSAL OVERLOADING which causes:
-loosening of implant fixture
-on areas with notches, fracturing of the implant
M. Ghalert, et. al (2011) Failure analysis of fractured dental zirconia implants

Looking at the ZLook3 implant processing


to find possible root cause of failure
One-piece design- to improve stability
Special forming process (3.25mm thread
diameter)
Surface enlargement of the screw area, via
sandblasting, through increased macro and
micro roughness. This leads to an improved
bone integration
Plasma sterilization, which cleans thoroughly
but is also gentle to the material
A special coating is applied to improve bone
and gum integration

Stress concentration in the


grooves of the screw
+
Small thread diameter
+
Micro-notches formed from
sandblasting
=
Stress concentration
leading to overloading of
the material and
subsequent onset cracking

14Step Procedure in Failure Analysis


1. Collection of background data and sample collection
2. Preliminary examination of the failed part
3. Non-destructive testing
4. Mechanical testing
5. Specimen selection, ID, preservation, and/or cleaning
6. Macroscopic examination and analysis
7. Microscopic examination and analysis
8. Metallographic selection, selection and preparation
9. Metallographic section examination and analysis
10. Determination of failure mechanism
11. Chemical analysis
12. Analysis of fracture mechanics
13. Testing under simulated service conditions
14. Analysis of all evidence, formulation of conclusions, report writing
*Steps above are taken from the Stages in Failure Analysis in ASM
Handbook - Practices in Failure Analysis

METHODOLOGY
1. Collection of background data and sample collection
2. Preliminary examination of the failed part
3. Non-destructive testing
4. Mechanical testing
5. Specimen selection, ID, preservation, and/or cleaning
6. Macroscopic examination and analysis
7. Microscopic examination and analysis
8. Metallographic selection, selection and preparation
9. Metallographic section examination and analysis
10. Determination of failure mechanism
11. Chemical analysis
12. Analysis of fracture mechanics
13. Testing under simulated service conditions
14. Analysis of all evidence, formulation of conclusions, report writing
*Steps above are taken from the Stages in Failure Analysis in ASM
Handbook - Practices in Failure Analysis

METHODOLOGY
1. Collection of background data and sample collection
2. Preliminary examination of the failed part
3. Specimen selection, ID, preservation, and/or cleaning
4. Macroscopic examination and analysis
5. Microscopic examination and analysis

6. Determination of failure mechanism


7. Analysis of fracture mechanics
8. Analysis of all evidence, formulation of conclusions, report writing

METHODOLOGY:

1. Collection of background
data and sample collection

Z-Look3
Manufacturer: Z-Systems AG, Konstanz, Germany
Composition: Zirconium Dioxide(95%)
Yttrium and Aluminum oxides as Stabilizers (5%)

13 FAILED implants
10 implants from single tooth replacement
2 implants from bridge placed on two implants in
the mandible
1 implant from cantilever bridge post
M. Ghalert, et. al (2011) Failure analysis of fractured
dental zirconia implants

METHODOLOGY:

1. Collection of background
data and sample collection

METHODOLOGY:

1. Collection of background
data and sample collection

METHODOLOGY:

1. Collection of background
data and sample collection

- 12 out of 13 implants had diameters of 3.25mm (smallest size)


- patient with the fracture of the 4 mm diameter implant was
adversely affected by strong bruxism

METHODOLOGY:

2. Preliminary Examination of
the Failed Part

*Implants were removed from the bone stock by OSTEOTOMY

PHOTOGRAPH OF IMPLANT FRAGMENTS

Images from: http://beautysetter.com/dental-implants-101


M. Ghalert, et. al (2011) Failure analysis of fractured dental zirconia
implants

METHODOLOGY:

2. Preliminary Examination of
the Failed Part

* Majority of fracture implants


are single-bone replacements
* Fractures occurred within a
period between 8-26 months
after

M. Ghalert, et. al (2011) Failure analysis of fractured dental zirconia


implants

METHODOLOGY:

3. Specimen selection, ID,


preservation, and/or cleaning

Ultrasonic bath of failed samples:


In ethanol (3 mins) In distilled (5mins) In ethanol (3mins)
Sputter failed samples with gold (SEM)

METHODOLOGY:

4/5. Macroscopic/Microscopic
examination and analysis

Macroscopic and Microscopic examination and analysis (SEM)

Microscopic examination using SEM was


done to investigate for material defects,
marks from manufacturing and crack
initiation point.

Macroscopic and Microscopic examination and analysis (SEM)


crack initiation at the first thread
good implant

crack initiation at the third thread


poor implant

Patient #1

Patient #5
M. Ghalert, et. al (2011) Failure analysis of fractured dental zirconia implants

Macroscopic and Microscopic examination and analysis (SEM)


absence of mirror zones which is
usually seen around the origin of the
crack
no stable growth of cracks

Patient #7

crack propagation

M. Ghalert, et. al (2011) Failure analysis of fractured dental zirconia implants


image from http://www.scielo.br/img/revistas/jaos/v13n1/23775f7.gif

Macroscopic and Microscopic examination and analysis (SEM)


Patient #11

crack initiation found at the


ground of the first thread

M. Ghalert, et. al (2011) Failure analysis of fractured dental zirconia implants

threaded part implants was sandblasted


which causes roughening

Macroscopic and Microscopic examination and analysis (SEM)


results to surface grooves
and notches

notch
- initiated crack

Macroscopic and Microscopic examination and analysis (SEM)


No fractures from machining

No pores or inclusions in the


implant

Images from: http://beautysetter.com/dental-implants-101


M. Ghalert, et. al (2011) Failure analysis of fractured dental zirconia implants

METHODOLOGY:
LATERAL VIEW

image from

6. Determination of Failure
Mechanism
PATH OF PROPAGATION

M. Ghalert, et. al (2011) Failure analysis of fractured dental zirconia implants

http://www.sporcle.com/games/kingzak0014/anatomyofskulllateral

PALATAL - tooth surface nearest to the tongue


(upper jaw)
BUCCAL - tooth surface nearest to the lips

*forced rupture due to bending


direction from palatal towards buccal

METHODOLOGY:

6. Determination of Failure
Mechanism

10 of 13 implants failed at the first turn of the thread

METHODOLOGY:

notch
- initiated crack

6. Determination of Failure
Mechanism

The groove produced during


sandblasting causes stress
concentration resulting to high
mechanical stresses

Micro-notches also added


its effect to stress
concentration

M. Ghalert, et. al (2011) Failure analysis of fractured dental zirconia implants

METHODOLOGY:

7. Analysis of Failure
Mechanics
M. Ghalert, et. al (2011) Failure analysis
of fractured dental zirconia implants

Fracture due to
OVERLOAD BREAKAGE
/ FORCED RUPTURE

METHODOLOGY:

7. Analysis of Failure
Mechanics
M. Ghalert, et. al (2011) Failure analysis
of fractured dental zirconia implants

Failure of implant from


BENDING LOAD directed
from palatal/lingual
towards buccal

METHODOLOGY:

8. Analysis of all evidence,


formulation of conclusions,
report writing

- The cause of most failure is due to bending loads


- Crack propagation is from palatal/lingual to buccal
- Modifying implant geometry (especially at the neck) and
removal of sandblasting procedure (thereby decreasing
notches) will improve strength of the implant

CONSEQUENCES
In the main article, there
are no stated litigation and
criminal implications.
However, Z-Look3 units
were removed from the
market during 2011.
In 2010, the paper Failure
analysis of fractured dental
zirconia implants involving
Z-Look3 implants were
submitted.
Every preceding year, a
new generation of zirconia
implants were released in
the market.

http://zsystems.com/en/zsystems/history.html

CONSEQUENCES:PRODUCT COMPARISON
SOURCE: ZIRKOLITH PRODUCT CATALOG
http://zsystems.com/fileadmin/user_upload/pdf/zsystems_produktkatalog_11_15_en.pdf

2013

2014

2012

2013/2014

CONSEQUENCES:PRODUCT COMPARISON

http://zsystems.com/en/doctors/products-z5-zirkolithr-ceramic-implants/z5m-zirkolithr-implant.html

CONSEQUENCES:PRODUCT COMPARISON

http://zsystems.com/en/doctors/products-z5-zirkolithr-ceramic-implants/z5m-zirkolithr-implant.html

CONSEQUENCES:PRODUCT COMPARISON

http://zsystems.com/en/doctors/products-z5-zirkolithr-ceramic-implants/z5m-zirkolithr-implant.html

CONSEQUENCES:PRODUCT COMPARISON

http://zsystems.com/en/doctors/products-z5-zirkolithr-ceramic-implants/z5m-zirkolithr-implant.html

CONSEQUENCES: What is SLM

Use of Selective
Laser Melting (SLM)
procedure to
develop and patent
the SLM(R) surface.
SOURCE: ZIRKOLITH PRODUCT CATALOG http://zsystems.com/fileadmin/user_upload/pdf/zsystems_produktkatalog_11_15_en.pdf

CONSEQUENCES: Advantage of SLM


Increased surface roughness and
improved bone to implant contact
provides excellent osseointegration
and a maximum of safety
With SLM procedures, only the
flanks of the thread are roughened
Prevents defects on other part
other than the flanks
SOURCE: ZIRKOLITH PRODUCT CATALOG
http://zsystems.com/fileadmin/user_upload/pdf/zsystems_produktkata
log_11_15_en.pdf

Lowers stress concentrators

CONSEQUENCES: Osseointegration
Improved osseointegration
The osseointegration of the latest
generation of Zirkolith ceramic
implants is > 98% and is comparable
with leading titanium implants.

Osseointegration refers to a direct structural


and
functional
connection
between
ordered, living bone and the surface of a
load-carrying implant. Currently, an implant
is considered as osseointegrated when there
is no progressive relative movement
between the implant and the bone with
which it has direct contact.
SOURCE: dentalimplants.uchc.edu/about/surgery_osseointegration.html

CONSEQUENCES: Advantage of SLM


Increased surface roughness and
improved bone to implant contact
provides excellent osseointegration
and a maximum of safety
With SLM procedures, only the
flanks of the thread are roughened
Prevents defects on other part
other than the flanks
SOURCE: ZIRKOLITH PRODUCT CATALOG
http://zsystems.com/fileadmin/user_upload/pdf/zsystems_produktkata
log_11_15_en.pdf

Lowers stress concentrators

RECOMMENDATIONS
1. Collection of background data and sample collection
2. Preliminary examination of the failed part
3. Non-destructive testing
4. Mechanical testing
5. Specimen selection, ID, preservation, and/or cleaning
6. Macroscopic examination and analysis
7. Microscopic examination and analysis
8. Metallographic selection, selection and preparation
9. Metallographic section examination and analysis
10. Determination of failure mechanism
11. Chemical analysis
12. Analysis of fracture mechanics
13. Testing under simulated service conditions
14. Analysis of all evidence, formulation of conclusions, report
writing

RECOMMENDATIONS
Acquire previous studies on the mechanical
behavior of zirconia dental implants.
Perform additional preliminary
investigations (NDT) on both the as
prepared (in vitro) and clinically used
dental implants
Perform mechanical tests on both the as
prepared (in vitro) and clinically used
dental implants

Device a testing mechanism that


simulates in vivo performance of the
dental implants

References
M. Ghalert, et. al. Failure analysis of fractured dental zirconia implants, Vol. 23. John
Wiley and Sons, 2011.
ASM Handbook - Practices in Failure Analysis
ZIRKOLITH PRODUCT CATALOG
http://zsystems.com/fileadmin/user_upload/pdf/zsystems_produktkatalog_11_15_en.pdf

dentalimplants.uchc.edu/about/surgery_osseointegration.html
http://zsystems.com/en/doctors/products-z5-zirkolithr-ceramic-implants/z5m-zirkolithrimplant.html
http://zsystems.com/en/zsystems/history.html