Objective
To evaluate the effect of screw access hole design on the
 fracture resistance of cement‐retained implant‐supported zirconia‐based
 restorations with screw access holes.
            
         
            
            
 Materials and Methods
Thirty cement‐retained implant‐supported zirconia‐based 
molar crown specimens were fabricated. The specimens were divided into 3
 groups of 10: without access holes (C), with screw access holes (S), 
and with screw access holes accompanied with a surrounding zirconia wall
 (W). The veneering ceramic thickness was 0.8 mm in all groups. Implants
 were vertically mounted in a metal block. Abutments were screwed on the
 implants and the specimens were cemented to the abutments. A universal 
testing machine applied compressive forces to the specimens until 
fracture. Fracture resistance values of the specimens were measured. 
One‐way analysis of variance (ANOVA) and Tukey HSD tests were used to 
analyze data (P < .05).
            
            
         
            
            
 Results
The mean fracture resistance values were 5794.85 N for C,
 2691.48 N for S, and 3878.06 N for W. The screw access hole design 
significantly affected the fracture resistance (P < .0001). Significant differences were found between C and S (P < .001), C and W (P < .001), and S and W (P = .026).
            
            
         
            
            
 Conclusions
The screw access hole decreased the fracture resistance. A
 surrounding zirconia wall for the screw access hole increased the 
fracture resistance.
            
         
            
            
 Clinical Significance
Screw access hole design may affect the fracture 
resistance of cement‐retained implant‐supported zirconia‐based 
restorations with screw access holes. This study introduced a screw 
access hole design to improve the fracture resistance of these 
restorations.
            
         
 
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