Comparison of screw loosening, rotation, and deflection among three implant designs

Implants with original and non-original abutment connections

AIM

To test in vitro the mechanical resistance, rotational misfit and failure mode of three original implant-abutment connections and to compare them to two connections between non-original abutments connected to one of the original implants.

MATERIAL AND METHODS

Three different implants with small diameters (3.3 mm for Straumann Roxolid, 3.5 mm for Nobel Biocare Replace and Astra Tech Osseospeed TX) were connected with individualized titanium abutments. Twelve implants from each system were connected to their original abutments (Straumann CARES, Nobel Biocare Procera, Astra Tech Atlantis). Twenty-four Roxolid implants were connected with non-original abutments using CAD/CAM procedures from the other two manufacturers (12 Nobel Biocare Procera and 12 Astra Tech Atlantis). For the critical bending test, a Zwick/Roell 1475 machine and the Xpert Zwick/Roell software were used.

RESULTS

The rotational misfit varied when comparing the different interfaces. The use of non-original grade V titanium abutments on Roxolid implants increased the force needed for deformation. The fracture mode was different with one of the original connections.

CONCLUSIONS

Non-original abutments differ in design of the connecting surfaces and material and demonstrate higher rotational misfit. These differences may result in unexpected failure modes.

Effect of using a titanium washer on the removal torque of an abutment screw in the external connection type of dental implant

PURPOSE

The aim of this study was to determine the effect of using a washer on the removal torque of an abutment screw in the external connection type of dental implant and abutment complex.

MATERIALS AND METHODS

Four experimental groups with titanium washers of different types (CP titanium or Ti6Al4V titanium alloy) and thicknesses (1.0 or 2.0 mm) included between the abutment and external connection type of implant were investigated. No washer was applied in the control group. The removal torque was measured with a resolution of 0.1 Ncm. One-way analysis of variance (α = 0.05) and Scheffé's post hoc test were used for statistical analysis.

RESULTS

The removal torque was higher in all the groups with a washer than in the control group (α = 0.05), higher with a CP titanium washer than with a titanium alloy washer of the same thickness, and higher with a 2.0-mm-thick washer than with a 1.0-mm-thick washer (α = 0.05).

CONCLUSIONS

Inclusion of a washer between the titanium screw and the abutment seems to increase the removal torque. A 2.0-mm-thick CP titanium washer might provide the largest increase in the removal torque.

In vitro analysis of post-fatigue reverse-torque values at the dental abutment/implant interface for a unitarian abutment design

PURPOSE

This study analyzed baseline and post-fatigue reverse-torque values (RTVs) for a specific brand control abutment relative to a third party compatible abutment. The purpose of this study was to compare the abutments' fatigue resistance to simulated function, using RTVs as an indication of residual preload at the implant/abutment interface.

MATERIALS AND METHODS

Forty Straumann tissue-level implants were mounted in resin and divided into four groups (n = 10). Forty abutments were seated, 20 control and 20 third-party abutments, according to manufacturer guidelines. Ten abutments from each manufacturer were evaluated for RTV without fatigue loading, using a calibrated digital torque gauge to provide a baseline RTVs. Fatigue loading was carried out on the remaining ten specimens from each manufacturer according to ISO 14801 guidelines. A moving-magnet linear motor was used to load one specimen per sequence, alternating from 10 to 200 N at 15 Hz for 5×10(6) cycles. RTV was recorded post-fatigue loading. The results were subjected to two-sample t-testing and two-way ANOVA. Scanning electron microphotography was carried out on three specimens from both manufacturers at baseline and post-fatigue cycling to visualize thread geometry and the abutment/implant interface.

RESULTS

The data indicated that mean post-fatigue RTV observed for the control group was significantly higher than the third-party group (RTV 42.65 ± 6.70 N vs. 36.25 ± 2.63 N, p= 0.0161). Visual differences at the macro/microscopic level were also apparent for thread geometry, with third-party abutments demonstrating considerably greater variation in geometrical architecture than control specimens.

CONCLUSIONS

Within the limitations of this in vitro model, the effect of component manufacturer resulted in a significantly higher RTV in the control group (two-way ANOVA, p= 0.0032) indicating greater residual preload; however, there was no significant decrease in post-fatigue RTV for either manufacturer compared to baseline.

Analysis and Structural Examination of Screw Loosening in Oral Implants

Biological and technical failures of implants have already been reported. Mechanical factors are certainly of importance in implant failures, even if their exact nature has not yet been established. The abutment screw fracture or loosening represents a rare, but quite unpleasant failure. The aim of the present research is an analysis and structural examination of screw thread or abutment. In this study broken screws were excluded. A total of 58 screw thread loosening were observed, 5 Branemark, (Nobel Biocare, Gothenburg, Sweden) 4 Implant Innovation (Riverside Drive Palm Beach Gardens, FL, USA) and 7 Restore (Lifecore Biomedical, Chaska, Minnesota, USA) and 42 T.B.R. implant (Benax, Ancona, Italy). The loosened abutment screws were retrieved and analyzed under SEM. Many alterations and deformations were present in concavities and convexities of screw threads.

Effect of cyclic load on vertical misfit of prefabricated and cast implant single abutment

Objective

The purpose of this in vitro study was to evaluate misfit alterations at the implant/abutment interface of external and internal connection implant systems when subjected to cyclic loading.

Material and Methods

Standard metal crowns were fabricated for 5 groups (n=10) of implant/abutment assemblies: Group 1, external hexagon implant and UCLA cast-on premachined abutment; Group 2, internal hexagon implant and premachined abutment; Group 3, internal octagon implant and prefabricated abutment; Group 4, external hexagon implant and UCLA cast-on premachined abutment; and Group 5, external hexagon implant and Ceraone abutment. For groups 1, 2, 3 and 5, the crowns were cemented on the abutments and in group 4 crowns were screwed directly on the implant. The specimens were subjected to 500,000 cycles at 19.1 Hz of frequency and non-axial load of 133 N in a MTS 810 machine. The vertical misfit (μm) at the implant/abutment interface was evaluated before (B) and after (A) application of the cyclic loading. Data were analyzed statistically by using two-away ANOVA and Tukey’s post-hoc test (p<0.05).

Results

Before loading values showed no difference among groups 2 (4.33±3.13), 3 (4.79±3.43) and 5 (3.86±4.60); between groups 1 (12.88±6.43) and 4 (9.67±3.08), and among groups 2, 3 and 4. However, groups 1 and 4 were significantly different from groups 2, 3 and 5. After loading values of groups 1 (17.28±8.77) and 4 (17.78±10.99) were significantly different from those of groups 2 (4.83±4.50), 3 (8.07±4.31) and 5 (3.81±4.84). There was a significant increase in misfit values of groups 1, 3 and 4 after cyclic loading, but not for groups 2 and 5.

Conclusion

The cyclic loading and type of implant/abutment connection may develop a role on the vertical misfit at the implant/abutment interface.

Effect of unilateral misfit on preload of retention screws of implant-supported prostheses submitted to mechanical cycling

PURPOSE

The aim of this study was to evaluate the effect of different levels of unilateral angular misfit on preload maintenance of retention screws of single implant-supported prostheses submitted to mechanical cycling.

MATERIALS AND METHODS

Premachined UCLA abutments were cast with cobalt-chromium alloy to obtain 48 crowns divided into four groups (n=12). The crowns presented no misfit in Group A (control group) and unilateral misfits of 50 μm, 100 μm and 200 μm in the groups B, C and D, respectively. The crowns were attached to external hexagon implants with a titanium retention screw with torque of 30 N/cm. Oblique loading of 130 N at 2 Hz was applied on each replica, totalizing 5×10⁴ and 1×10⁶ cycles. Detorque values were measured initially and after each cycling period. Data were evaluated by analysis of variance and Tukey's HSD test (p<0.05).

RESULTS

All groups presented reduced initial detorque values (p<0.05) in comparison to the insertion torque (30±0.5 N/cm) and Group A (25.18 N/cm) exhibited the lowest reduction. After mechanical cycling, all groups presented detorque values from 19.5 N/cm to 22.38 N/cm and the mechanical cycling did not statistically influence the detorque values regardless the misfit level of the replicas.

CONCLUSION

The unilateral misfit influenced the preload maintenance only before mechanical cycling. The mechanical cycling did not influence the torque reduction.

Effect of retorque on loosening torque of prosthetic screws under two levels of fit of implant-supported dentures

This study evaluated the influence of retorque on loosening torque (Lt) of prosthetic screws in implant-supported dentures with different fit levels. Ten mandibular implant-supported dentures were fabricated and then 20 cast models were then prepared using prosthetic structures to create 2 fit levels: passive fit (Pf) and misfit (Mf). Two tightening techniques were also evaluated: initial torque only (T1); and initial torque and retorque after 10 min (T2). Gold or titanium screws were used, resulting in 4 groups to each one: Pf/T1, Pf/T2, Mf/T1, Mf/T2. The Lt was measured 24 h after the tightening torque using digital torque meter. Data were analyzed statistically by two-way ANOVA and Tukey's test (α=0.05), separately for each screw material. For titanium screws, no significant difference (p>0.05) was found between Pf/T1 and Pf/T2, or between Pf/T2 and Mf/T2. However, statistically significant difference (p<0.05) was found between Pf/T1 and Mf/T1, and between Mf/T1 and Mf/T2. Mf reduced the Lt using T1, while and T2 increased the Lt for Mf. Retorque and fit were shown to have no significant influence on the Lt of the gold screws. Retorque application made insignificant the misfit effect on the Lt of the titanium screws, suggesting that this procedure should be performed routinely during the screw tightening in multi-unit dentures.

Influence of lateral-oblique cyclic loading on abutment screw loosening of internal and external hexagon implants

To date, there is no evidence that internal anti-rotation configurations are better than external ones. The purpose of this study was to evaluate the effect of eccentric cyclic loading on abutment screw loosening in internal and external hexagon implants with either of these two screw materials, titanium (Ti) alloy versus gold alloy. The reverse torque value of the abutment screw was measured before (initial preload) and after loading (post-loading). The prepared assemblies were divided into four groups (A to D). Groups A and B used internal hex implants with gold alloy and Ti alloy abutment screws respectively. Groups C and D used external hex implants with gold alloy and Ti alloy abutment screws respectively. In all the groups, post-loading preload was significantly (p<0.05) higher than initial preload. Further, two-way ANOVA indicated that the implant-abutment connection did not have an effect, but the abutment screw material did. In particular, Ti abutment screws were less likely to come loose.

Effect of repeated torque/mechanical loading cycles on two different abutment types in implants with internal tapered connections: an in vitro study

OBJECTIVES

Internal tapered connections were developed to improve biomechanical properties and to reduce mechanical problems found in other implant connection systems. The purpose of this study was to evaluate the effects of mechanical loading and repeated insertion/removal cycles on the torque loss of abutments with internal tapered connections.

MATERIAL AND METHODS

Sixty-eight conical implants and 68 abutments of two types were used. They were divided into four groups: groups 1 and 3 received solid abutments, and groups 2 and 4 received two-piece abutments. In groups 1 and 2, abutments were simply installed and uninstalled; torque-in and torque-out values were measured. In groups 3 and 4, abutments were installed, mechanically loaded and uninstalled; torque-in and torque-out values were measured. Under mechanical loading, two-piece abutments were frictionally locked into the implant; thus, data of group 4 were catalogued under two subgroups (4a: torque-out value necessary to loosen the fixation screw; 4b: torque-out value necessary to remove the abutment from the implant). Ten insertion/removal cycles were performed for every implant/abutment assembly. Data were analyzed with a mixed linear model (P< or =0.05).

RESULTS

Torque loss was higher in groups 4a and 2 (over 30% loss), followed by group 1 (10.5% loss), group 3 (5.4% loss) and group 4b (39% torque gain). All the results were significantly different. As the number of insertion/removal cycles increased, removal torques tended to be lower. It was concluded that mechanical loading increased removal torque of loaded abutments in comparison with unloaded abutments, and removal torque values tended to decrease as the number of insertion/removal cycles increased.

The implant-abutment interface of alumina and zirconia abutments

BACKGROUND

Although ceramic and titanium abutments are widely used in clinical practice, the mechanical characterization of the implant-abutment interface for ceramic abutments has not been evaluated after the dynamic loading.

PURPOSE

The purpose of this study was to assess the implant-abutment interface after the dynamic loading of titanium, alumina, and zirconia abutments.

MATERIALS AND METHODS

Fifteen aluminum oxide, zirconium oxide, and titanium abutments were manufactured by the Procera System (Nobel Biocare AB, Göteborg, Sweden) and were connected to Ø 3.75 x 13-mm regular platform implants (MK III, Nobel Biocare AB) secured in a 30 degrees inclined plane. A mechanical testing machine applied compressive dynamic loading between 20 and 200 N at 1 Hz on a standard contact area of copings cemented on abutments for 47.250 cycles. The measurements of microgaps at the implant-abutment interface from the labial, palatinal, mesial, and distal surfaces of each specimen were undertaken by scanning electron microscope analyses prior to and after the experiments. The data of the microgaps before and after the dynamic loading were statistically assessed using the Wilcoxon signed rank test and the Kruskal-Wallis variance analysis (alpha = 0.05).

RESULTS

Coping fracture, abutment fracture, or abutment screw loosening or fracture was not detected in any specimen during the entire test period. After the dynamic loading, the titanium abutment control group revealed an increased microgap (3.47 microm) than zirconia (1.45 microm) and alumina (1.82 microm) groups at the palatinal site (p < .05). The mean measurement values at different measurement sites of specimens within and between each abutment group were similar (p > .05).

CONCLUSION

Owing to their comparable microgap values at the implant-abutment interface after the dynamic loading, ceramic abutments can withstand functional forces like conventional titanium abutments.

A systematic review of single crowns on endodontically treated teeth

OBJECTIVES

To test the hypothesis that the placement of a crown is associated with improved (long term) survival of root canal treated teeth, using a systematic review process of clinical studies.

DATA SOURCES

Papers referring to single crowns on endodontically treated teeth were located by a MEDLINE search and hand searching. One thousand six hundred and nine references were found, and they were subjected to a systematic review procedure.

STUDY SELECTION

A three-step inclusion-exclusion procedure was applied to identify papers that represented; good scientific practice (GSP), reported results of all patients, restorations on root canal treated teeth (RCT) for more than 2 years and had sufficient data to generate life table analyses. The outcomes were 'survival of RCT restored with crowns' and 'survival of RCT with direct restorations'. Ten studies survived. These data showed an overall mean GSP of 0.605 with a 10-year survival of 81% for crowned RCT and a 10-year survival of 63% for RCT with direct restorations (resin composites, amalgam, cements).

CONCLUSION

RCTs restored with crowns show an acceptable long-term survival of 10 years, while direct restorations have a satisfactory survival only for a short period.

Peri-implant soft-tissue health surrounding cement- and screw-retained implant restorations: a multi-center, 3-year prospective study

OBJECTIVE

The purpose of this prospective clinical study was to evaluate peri-implant soft-tissue conditions and esthetic fulfillment during a 3-year follow-up period following prosthetic rehabilitation.

MATERIAL AND METHODS

As part of a prospective multi-center study, 152 ITI dental implants were placed in 80 patients in the maxillary anterior region. Fifty-nine crowns (38.82%) were cement retained, while 93 (61.18%) crowns were screw retained. At loading and 3, 6, 12 and 36 months post-loading, modified plaque index (MPI), sulcus bleeding index (SBI), keratinized mucosa (KM), gingival level (GL), and esthetic fulfillment were recorded.

RESULTS

All patients completed the study and no complications were reported. While statistically not significant at all time points, cement-retained crowns seemed to present a worsening trend in MPI and SBI scores. Interestingly, screw-retained crowns seemed to present an opposite picture, their MPI and SBI scores improved over time. While plaque accumulation, prophylaxis and depth of crown margin significantly affected levels of sulcus bleeding, prophylaxis alone played a key role in reducing plaque accumulation. No soft tissue recession was observed in either cement- or screw-retained crowns up to 3 years post-loading. Esthetic fulfillment survey revealed that patients did not have a preference for crown types; however, dentists favored cement-retained over screw-retained crowns.

CONCLUSIONS

Peri-implant soft tissues responded more favorably to screw-retained crowns when compared with cement-retained crowns. However, no soft-tissue recession was observed in either type of crowns. Cement-retained crowns were preferred by dentists, while patients were equally satisfied with either type of crowns they received.

Effect of casting procedures on screw loosening in UCLA-type abutments

BACKGROUND

Screw loosening of implant restorations continues to be a complication in implant prosthodontics. Screw joints are subjected to a loss of initially applied torque because of friction and component misfit. It has been suggested that the loss of applied torque is less in machined metal abutments than in cast plastic abutments.

PURPOSE

This study compared the loss of applied torque (detorque) values in machined titanium and in cast UCLA-type abutments for external hex abutment/implant interface.

MATERIALS AND METHODS

Four groups of 12 samples each were evaluated: (1) machined titanium abutments, (2) premachined palladium abutments cast with palladium, (3) plastic abutments cast with nickel-chromium, and (4) plastic abutments cast with cobalt-chromium. Each abutment was torqued to 30 Ncm according to the manufacturer's instructions and detorqued three times. The mean loss of applied torque (detorque) was recorded as a percentage of the torque applied. Group means were calculated and compared using ANOVA and Tukey's LSD test.

RESULTS

Mean detorque values were (1) 92.3 +/- 2.9%, (2) 81.6 +/- 5.0%, (3) 86.4 +/- 4.6%, and (4) 84.0 +/- 7.0%. Machined abutments demonstrated significantly greater detorque values compared with all cast groups (p < 0.05). No significant differences were found among cast groups.

CONCLUSION

Machined abutments retained a significantly greater percentage of torque compared with cast abutments. Casting procedures decrease the percentage of applied torque, which may influence final screw joint stability.

Abutment rotational displacement of external hexagon implant system under lateral cyclic loading

PURPOSE

This in vitro study investigated the effect of lateral cyclic loading with different load positions and periods on abutment rotational displacement (RD) of external hexagon implant system.

MATERIALS AND METHODS

Four groups of five implant assemblies each were used. Each assembly consisted of Brånemark System Mk IV implant (Nobel Biocare AB, Göteborg, Sweden), CeraOne abutment (Nobel Biocare AB), and a cement-retained casting. A cyclic load of 50 N was applied centrally and perpendicular to the long axis of the implant for groups A and B for 0.25 and 0.50 x 10(6) cycles, respectively, while for groups C and D, the same load was applied at 4-mm distance eccentrically for 0.25 and 0.50 x 10(6) cycles, respectively. The displacement was evaluated by hand drawing a longitudinal line across the implant-abutment interface. Before and after loading, the lateral distance between two reference points on the abutment and implant was measured under high resolution (x200) and the difference formed the RD value. The data were analyzed with one-way analysis of variance and compared with Tukey test (alpha=0.05).

RESULTS

Group D had the highest mean of RD value (55.00 +/- 1.871 microm), while group A had the lowest (2.800 +/- 0.837 microm). Groups A and B had a high statistically significant difference in RD values, as compared to groups C or D (p < .001). Moreover, group C had statistically significant difference from group D (p=.011). Conversely, no statistical significance was obtained when group A was compared with group B.

CONCLUSION

Within the limits of this in vitro study, the RD of the external hexagon joint components occurred significantly under eccentric lateral loading when compared to centric loading. The displacement increased significantly with longer period of eccentric lateral loading.

Fracture resistance of single-tooth implant-supported all-ceramic restorations: An in vitro study

STATEMENT OF PROBLEM

High-strength ceramic materials can be used to fabricate esthetic and stable implant-supported single-tooth restorations. No study was identified that compared the fracture resistance of individual components of single-tooth implant-supported all-ceramic restorative systems after artificial aging.

PURPOSE

The purpose of this in vitro study was to evaluate the fracture resistance of single-tooth implant-supported all-ceramic restorations consisting of alumina all-ceramic restorations on different implant abutments and to identify the weakest component of the restorative system.

MATERIAL AND METHODS

Forty-eight standardized maxillary central incisor alumina crowns (Procera) were fabricated for each of the 3 test groups (n = 16) (Control group Ti, titanium abutments; Group Al, alumina abutments; Group Zr, zirconia abutments) for the Replace implant system. The crowns were adhesively luted using a resin luting agent (Panavia 21) and artificially aged through dynamic loading and thermal cycling. Afterwards, all specimens were tested for fracture resistance using compressive load on the palatal surfaces of the crowns. Kruskal-Wallis analysis of variance and post hoc Wilcoxon rank sum tests were performed to test for differences in fracture resistance values (alpha = .05).

RESULTS

All test specimens survived the artificial aging process using simulated oral conditions. No screw loosening was recorded. The median fracture resistance was 1454 N, 422.5 N, and 443.6 N for groups Ti, Al, and Zr, respectively. Significant differences were found for the fracture resistance comparisons of group Ti with groups Al and Zr (Kruskal-Wallis test, P < .001). The test results for the comparison of groups Al and Zr were not significant.

CONCLUSION

All 3 implant-supported restorations have the potential to withstand physiologic occlusal forces applied in the anterior region.

Stability of Implant-Abutment Interface with a Hexagon-Mediated Butt Joint: Failure Mode and Bending Resistance

BACKGROUND

Clinical data showed that the external hexagon implant system with a gold abutment screw has reduced the problem of screw loosening or fracture. However, the behavior of the implant-abutment joint components with respect to unfavorable bending force is still unclear.

PURPOSE

This study investigated the joint instability and bending resistance of a single-tooth external hexagon implant system after lateral cyclic loading.

MATERIALS AND METHODS

Fifteen implant assemblies (Nobel Biocare, Göteborg, Sweden) were divided equally into three groups: A, B, and C. Each assembly consisted of a Brånemark System Mk IV implant (4 x 10 mm) mounted in a brass block, a CeraOne abutment (3 mm), and an experimental cement-retained superstructure. For group A, a centric lateral cyclic load of 50 N was applied for 1.0 x 10(6), whereas for group B, the same load was eccentrically applied for 1.0 x 10(6) cycles. Group C, the control, was not loaded. After cyclic loading, specimens were mounted in a universal testing machine, and the yield and bending strengths were measured (kg). The external hexagon surface texture was examined using a secondary electron microscope. The data were analyzed with one-way analysis of variance and compared by the Tukey test (alpha = .05).

RESULTS

For all test specimens, the abutment screw was plastically bent in the unthreaded portion. Group B had a significantly lower mean yield and bending strengths than group C (p = .005 and .010, respectively). Post-cyclic loading photographs showed that group B implants had marked burnishing around the hexagon corners. The bending force abraded both corner areas of the hexagon surface but left the middle area nearly intact for all tested groups. However, group B had the significantly lowest mean abraded area.

CONCLUSION

Within the limits of this study, eccentric rather than centric lateral cyclic loading negatively affected the resistance of the implant-abutment joint to static bending.

An abutment screw loosening study of a Diamond Like Carbon-coated CP titanium implant

The aim of this study was to quantify the extent of abutment screw loosening and thus understand the role of frictional and wear factors in abutment screw loosening by using a cyclic loading device to compare Diamond Like Carbon (DLC)-coated and non-coated implants. The properties of DLC films, including hardness, wear resistance, chemical stability, and biocompatibility, are similar to those of real diamond materials. In this study, a 1-mum thick DLC film served to protect and lubricate a layer of commercially-pure titanium affixed to the top of a dental implant (external hexagon-shaped implant). A cyclic loading force was then applied to the top of the prosthetic portion of the implants in order to determine the difference in looseness of the titanium abutment screw between ten DLC-coated implants and ten non-coated implants. The abutment screw loosening tests were performed with 100 N of force at a frequency of 20 Hz. Data indicate that implants with a DLC coating are more resistant to an applied force (P = 0.002) than are those without the coating. We hope these results will be useful for preventing implant abutment screw loosening.

Finite element analysis of three designs of an implant-supported molar crown

STATEMENT OF PROBLEM

The optimal method of implant support for a single mandibular molar crown is controversial because commonly used, threaded, root-form implants developed by Branemark were not originally designed to support individual crowns.

PURPOSE

The purpose of this study was to develop a finite element model of a single mandibular first molar crown supported by (1) a standard 3.75-mm-diameter implant, (2) a 5-mm, wide-diameter implant, and (3) double standard-diameter implants, and to compare the induced displacements as a result of various loading conditions.

MATERIAL AND METHODS

Three-dimensional finite element models were made to simulate the 3 single-molar implant designs. Each model was analyzed with 2 force magnitudes (35 N and 70 N) and with 2 force directions (vertical and 15 degrees to the vertical axis). Displacements in 3-dimensional space as a result of the simulated loading conditions were evaluated along 3 primary axes, mesiodistal, faciolingual, and superior-inferior.

RESULTS

Mesiodistal and buccolingual displacements for the crown supported by the 5-mm-diameter implant were reduced by approximately 50% compared with the crown supported by the 3.75-mm implant when the crowns were loaded at the distobuccal cusp tip or the distal marginal ridge. The double-implant design recorded the least mesiodistal displacement with off-center loading of the crown.

CONCLUSION

When the crown was loaded off-center, the double-implant design produced substantially less displacement when compared with either of the single-implant designs.

Stability of the Implant/Abutment Joint in a Single-Tooth External-Hexagon Implant System: Clinical and Mechanical Review

Rigorous efforts have recently been made to reduce the recurrence of implant/abutment joint failure in single-tooth implant restorations. However, the current knowledge about the stability of implant/abutment joints in an external hexagon implant system is incomplete. We reviewed clinical data regarding single-tooth implant treatment with Brånemark implants, specifically the CeraOne abutment system (Nobel Biocare AB, Göteborg, Sweden). In vitro studies on joint stability were systematically assessed. Bending overload and the presence of misfit at the implant/abutment joint interface are the critical mechanical conditions that can make the joint unstable. Appropriate joint fitness and proper alignment of the implant should be assessed, and occlusal adjustment by narrowing the restoration width and flattening cuspal inclination should be applied to avoid bending moments caused by the lateral component of occlusal forces. Sufficient clinical reports of longer duration that evaluate and verify longer-term success of the newly manufactured joint components were unavailable.

Abutment Screw Loosening and Bending Resistance of External Hexagon Implant System after Lateral Cyclic Loading

BACKGROUND

Rigorous efforts to reduce the recurrence of abutment screw loosening in single-tooth implant restorations have recently been made. However, the behavior of the implant/abutment joint components with respect to critical bending force is still unclear.

PURPOSE

This study investigated the effect of different cyclic loading periods on abutment screw loosening and bending resistance of a single-tooth external hexagon implant system.

MATERIAL AND METHODS

Fifteen Brånemark implant assemblies were divided equally into groups A, B, and C. Each assembly consisted of a Brånemark System Mk IV 4 x 10 mm implant (Nobel Biocare AB, Gothenburg, Sweden) mounted in a brass block, a CeraOne 3 mm abutment (Nobel Biocare AB), and an experimental cement-retained superstructure. For groups A and B a cyclic load of 50 N was applied centrally and perpendicular to the long axis of the implant. Targets of 1.0 x 10(6) cycles (40 months of simulated function) and 0.5 x 10(6) cycles (20 months of simulated function) were defined for groups A and B, respectively. Group C (control) was left unloaded for the same loading time period as was group B. Reverse torque was recorded before and after loading, and the difference was calculated. After cyclic loading, specimens were mounted in a testing machine, and the yielding and bending strengths were measured. The data were analyzed with one-way analysis of variance and were compared by means of the Tukey test (p < .05).

RESULTS

There were statistically significant differences (p < .001) in the reverse torque difference values of group A ([-5.6 to -3.4] +/- 0.86 Ncm) as compared to those of group B ([-2.4 to -1.6] +/- 0.32 Ncm) and group C ([-0.7 to 0.0] +/- 0.26 Ncm). Likewise, group B showed a significant difference compared to group C (p = .002). On the other hand there was no statistically significant difference in the mean values among the test groups in regard to the yielding and bending strengths (p >.050).

CONCLUSION

Within the limitations of this study, long-term fatigue significantly affected the reverse torque values under centric lateral load (p <.001) whereas it had no significant effect on the resistance of the implant/abutment joint to static bending.

Effect of lateral cyclic loading on abutment screw loosening of an external hexagon implant system

STATEMENT OF PROBLEM

Efforts to reduce the recurrence of abutment screw loosening with single tooth implant-supported restorations have been reported. However, the current knowledge about the role of the implant external hexagon is incomplete.

PURPOSE

This in vitro study investigated the effect of lateral cyclic loading with different load positions on abutment screw loosening of an external hexagon implant system.

MATERIAL AND METHODS

Fifteen Brånemark implant assemblies were divided equally into 3 groups, A, B, and C. Each assembly consisted of a Mark IV implant (4 x 10 mm) mounted in a brass block, a CeraOne abutment (3 mm), and an experimental cement-retained superstructure. For group A, a cyclic load of 50 N was applied centrally and perpendicular to the long axis of the implant, whereas for group B, the same load was applied eccentrically (at a distance of 4 mm) in a loosening direction. A target of 1.0 x 10(6) cycles (40 months of simulated function) was defined. Group C (control) was left unloaded for the same loading time period as groups A and B. Reverse torque was recorded before and after loading and the difference was calculated. The data were analyzed with 1-way analysis of variance and compared with the Tukey test (alpha=.05).

RESULTS

Group A exhibited a significant difference in the reverse torque difference values ([-5.6 to -3.4] +/- 0.86 N.cm) compared with groups B ([-1.9 to 0.5] +/- 0.99 N.cm) and C ([-0.7 to 0.0] +/- 0.26 N.cm) (P<.001). Groups B and C were not significantly different from each other.

CONCLUSION

Within the limitations of this study, reverse torque values of the screw joint were preserved under eccentric lateral loading, as compared with centric loading (P<.001).

Prosthodontic complications of Spline dental implants

Access to accurate clinical data on the frequency of prosthodontic complications encountered in dental implant restorations can provide dentists with important information for evaluating dental implant systems. The complication of prosthetic screw loosening, for example, has often been ignored or under-reported. Only limited published clinical data exists on the use of the Spline connections for dental implant restorations. This paper reports on an in-vitro investigation of prosthodontic complications encountered with the Spline dental implant system restored by students and residents at The Ohio State University's School of Dentistry. From a comprehensive list of implant patients generated from the University's computer records, an extensive chart review was conducted, and all patients who were treated with Spline dental implants were entered into the study. During a second chart review, data on all prosthodontic complications with Spline implant restorations were gathered on reporting forms then entered into a computer database and subjected to statistical analysis. The results showed that 95.75% of the prostheses were free of any complications. Iatrogenic factors that resulted in screw loosening were identified. Based on the findings of this relatively short-term study ranging from 29 to 59 months of post-restoration clinical follow-up, Spline dental implants provided a stable implant prosthetic connection.

Spline implant prospective multicenter study: interim report on prosthetic screw stability in partially edentulous patients

Loosening of implant abutment and prosthesis screws during functional loading is an industry-wide phenomenon that is especially well documented with the external hexagon implant connection. Although numerous efforts to reduce or eliminate screw loosening have been attempted, the problem still persists, especially with implant restorations in the partially edentulous patient. In 1992, the spline was developed as an alternative to the external hexagon implant-abutment connection. A prospective multicenter study was begun in 1996 to evaluate the abutment and prosthesis screw joint stability of Spline dental implants (Centerpulse Dental Division, Carlsbad, California) over 5 years of post-loading clinical follow-up. From October 1996 to December 2000, 73 partially edentulous patients were consecutively treated with 113 Spline implants placed in two private dental practices. Three patients with 1 implant each withdrew from the study for various reasons; of the remaining 110 implants in 70 patients who continued in the study, 82% (n = 90) were placed between 1997 and 1998. No cases of abutment or prosthesis screw loosening occurred with up to 54 months (mean = 38.95 mo; range, 3-54 mo; mode, 20 mo) of post-loading clinical follow-up. These interim findings of the ongoing study suggest that Spline dental implants may provide a stable prosthetic connection in partially edentulous cases during short-term clinical follow-up.

Prosthetic treatment for severely misaligned implants: a clinical report

This clinical report describes a procedure that allows for prosthetic use of severely misaligned implants resulting from surgical placement.

Dynamic fatigue properties of the dental implant-abutment interface: joint opening in wide-diameter versus standard-diameter hex-type implants

STATEMENT OF PROBLEM

The clinical long-term success of single-tooth implant restorations depends, in part, on a stable connection between the prosthetic restoration and the implant body.

PURPOSE

The purpose of this experiment was to investigate the fatigue life of UCLA-style abutment screws in wide-diameter versus conventionally sized dental implant restorations.

MATERIAL AND METHODS

Five 3.75 x 15-mm and five 6.0 x 15-mm hexed dental implants were used. Ten frameworks were fabricated, 5 with a single UCLA-style, 3.75-mm hexed gold alloy cylinder, and 5 with a single UCLA-style, 6.0-mm hexed gold alloy cylinder. To simulate a common laboratory procedure, 2 abutment interfaces were relieved with a one-quarter round bur for both diameters. The 3.75-mm implant used a Gold-Tite central abutment screw torqued to 32 Ncm, and the 6.0-mm implant used a titanium central abutment screw torqued to 25 Ncm. Frameworks were dynamically loaded ( approximately 10 Hz) with a 120 +/- 10-N, 4-mm off-axis force. Liquid metal strain gauges were used to measure joint opening. Measurements were made at intervals of 10(3), 10(4), 10(5), and 5x10(5) cycles. Gauge output data were converted to displacement with a conversion factor determined by calibration. Linear regression analysis then was performed.

RESULTS

Two observations were made in this study. Two of three 3.75-mm nonadjusted specimens and all three 6.0-mm nonadjusted specimens maintained joint closure (range of opening 0-20 microm) while measured under dynamic loading. The median joint opening at 5x10(5) cycles for 3.75-mm nonadjusted specimens was 14 +/- 7 microm; for 6.0-mm specimens, it was 11 +/- 10 microm. Both 3.75-mm adjusted specimens and 1 nonadjusted specimen failed to maintain joint closure (excess joint opening >50 microm). One of the 3.75-mm adjusted specimens had abutment screw fracture. One of two 6.0-mm adjusted specimens failed to maintain joint closure because of screw fracture.

CONCLUSION

The dental implant-abutment interface of 3.75-mm and 6.0-mm externally hexed implants experienced similar joint opening after periods of dynamic loading. Laboratory adjustment of the interface significantly decreased the service life of the abutment screw joint.

Examination of the implant-abutment interface after fatigue testing

PURPOSE

This study examined potential differences in detorque values of abutment screws after fatigue testing when the dimensions between external implant hexagon and internal abutment hexagon were altered or the implant external hexagonal shape was eliminated.

MATERIAL AND METHODS

Three subsets (N = 10) of NobelBiocare implants were assessed: (1) standard external hexagon (R), (2) modified hexagon (M), and (3) circular (C) platform geometry. Thirty Procera machined abutments with 25-degree angulated loading platforms were manufactured. Abutments were retained with gold Unigrip abutment screws tightened to 32 N/cm with an electronic torque controller. Vertical scribes across the implant-abutment interface allowed longitudinal displacement evaluation. A carousel-type fatigue testing device delivered dynamic loading forces between 20 and 200 N for 5,000,000 cycles, or the approximate equivalent of 5 years in vivo mastication, through a piston to the abutment platform. Macroscopic and radiographic examination of the implant/abutment specimens was performed. The abutment screws were removed and the detorque values recorded. Bearing surfaces were examined microscopically.

RESULTS

No abutment looseness or longitudinal displacements at the implant-abutment interface were noted. Radiographic examination demonstrated no indication of screw bending or displacement. The mean detorque values for R, M, and C were 14.40 +/- 1.84 N/cm, 14.70 +/- 1.89 N/cm, and 16.40 +/- 2.17 N/cm, respectively. The analysis of variance demonstrated significant differences between only designs R and C (P=.031).

CONCLUSION

Increasing the vertical height, or degree of fit tolerance, between the implant external hexagon and the abutment internal hexagon or completely eliminating the implant external hexagon did not produce a significant effect on the detorque values of the abutment screws after 5,000,000 cycles in fatigue testing, or the equivalent of 5 years' of mastication for the implant/abutment specimens evaluated.

Micromotion and dynamic fatigue properties of the dental implant-abutment interface

STATEMENT OF PROBLEM

Clinical loading may result in micromotion and metal fatigue in apparently stable implant screw joints. This micromotion may contribute to tissue inflammation and prosthesis failure.

PURPOSE

This study investigated dental implant screw joint micromotion and dynamic fatigue as a function of varied preload torque applied to abutment screws when tested under simulated clinical loading.

MATERIAL AND METHODS

Fifteen noble alloy single-tooth implant restorations, each containing a hexed UCLA-style gold cylinder, were randomly assigned to 3 preload groups (16, 32, and 48 N.cm). Each group consisted of 5 implants (each 3.75 x 15 mm) and 5 square gold alloy abutment screws. A mechanical testing machine applied a compressive cyclic sine wave load between 20 and 130 N at 6 Hz to a contact point on each implant crown. A liquid metal strain gauge recorded the micromotion of the screw joint interface after 100, 500, 1,000, 5,000, 10,000, 50,000, and 100,000 cycles. Baseline data at 0 N.cm were collected before the application of the specified preload torque.

RESULTS

The 16 N.cm group exhibited greater micromotion (P<.001) than both the 32 and 48 N.cm groups at all cycle intervals (2-way ANOVA, Tukey HSD). Micromotion of the implant-abutment interface remained constant (P=.99) for each of the preload groups through 105 cycles.

CONCLUSION

Under the loading parameters of this study, no measurable fatigue of the implant-abutment interface occurred. However, dental implant screw joints tightened to lower preload values exhibited significantly greater micromotion at the implant-abutment interface.

A systematic review of single-tooth restorations supported by implants

OBJECTIVES

To make an inventory of clinical studies on single-tooth restorations supported by implants using a systematic review procedure and to aggregate overall survival results.

DATA SOURCES

Papers referring to single-tooth implants were located by a MEDLINE search 1990 to April 1998. Three hundred and twenty references were found, and they were subjected to a systematic review procedure.

STUDY SELECTION

A three-step inclusion/exclusion procedure was applied to identify papers that represented: good scientific practice (GSP), reported results of all patients, implants and crowns for more than 2years, and had sufficient data to generate life-table analyses. The outcomes were 'implant failure' and 'crown completion'. Nine studies survived. These data showed an overall mean GSP of 0.37 with a predicted 4year implant survival of 97% (n=459), and an uncomplicated crown maintenance of 83% (n=240).

CONCLUSION

Single-tooth implants show an acceptable short-term survival of 4years, but crown complications are common.

Influence of hex geometry and prosthetic table width on static and fatigue strength of dental implants

STATEMENT OF PROBLEM

Component fracture and screw loosening are prevalent concerns of contemporary dental implants.

PURPOSE

This laboratory investigation examined the influence of design factors such as the platform diameter and the hex height on the mechanical strength and quality of fit of the implant-abutment interface.

MATERIAL AND METHODS

Static and cyclic compressive bending tests were conducted on 4 and 5 mm diameter bone density-based implants. SEM evaluation of the implant-abutment interface was also conducted to assess quality of fit between the mating components.Results. The 5 mm diameter implant was stronger in both static and fatigue conditions than the 4 mm diameter implants. A comparison of the results to published literature indicated that both implants were equal to or superior to alternative prosthetic connections in an identical testing configuration.

CONCLUSION

Test results demonstrated the validity of wide diameter implants to reduce the likelihood of component fracture in contemporary dental implant systems.

An in vitro study of implant--tooth-supported connections using a robot test system

Many unsolved problems in dental implant research concern the interfacial stress distributions between the implant components, as well as between the implant surface and contacting bone. To obtain a mechanical understanding of how vertical and horizontal occlusal forces are distributed in this context, it is crucial to develop in vitro testing systems to measure the force transmission between dental implants and attached prostheses. A new approach to such testing, involving a robotic system, is described in this investigation. The system has been designed to produce simulated mandibular movements and occlusal contact forces so that various implant designs and procedures can be thoroughly tested and evaluated before animal testing or human clinical trials. Two commonly used fixed prosthesis designs used to connect an implant and a tooth, a rigid connection and a nonrigid connection, were fabricated and used for experimental verification. The displacement and force distributions generated during simulated chewing activities were measured in vitro. Force levels, potentially harmful to human bone surrounding the connected dental implant and tooth, were analyzed. These results are useful in the design of prostheses and connecting components that will reduce failures and limit stress transfer to the implant/bone interface.

A screw lock for single-tooth implant superstructures

BACKGROUND

The most common complication in a single-tooth implant restoration is abutment screw loosening. Instability of the prosthetic superstructure is expressed by difficulty in chewing and functioning, as well as soft-tissue soreness and/or swelling that could lead to screw fracture. Manufacturers of oral implants have attempted to refine the connecting parts of the prosthesis to achieve a more predictable tightening method for the screws.

METHODS

To maintain the abutment screw tightly in its correct position, the authors developed a technique in which an elongated hexagonal titanium bar is inserted into the hexed fixed screw head. The screw is locked, and the bar is then fixed with a light-cured composite resin material that serves to seal the retaining screw access hole. The occlusal hexagonal bar thus serves as a secure screw lock that can be easily removed if needed.

RESULTS

The authors have used the hexagonal bar for almost three years on 120 single-tooth screw-retained prostheses in 100 patients (65 in the first and second premolar region, 40 in the incisor region and 15 in the posterior molar region). All of these prostheses functioned successfully, including those with wider occlusal planes and increasing occlusal forces. No screw loosening or fractures were noted in any of the fixtures.

CLINICAL IMPLICATIONS

This technique secures and stabilizes the single-tooth prosthesis, reduces chair time on follow-up procedures and reduces unnecessary frustration in patients and dental team members.

Affordable implant prosthetics using a screwless implant system

Many dentists have been reluctant to place dental implants because they have found that most implants are costly and time-consuming to place and have long-term maintenance problems. Most of these problems are caused by using screws to connect the abutment to the implant, the crown to the abutment or both. The use of a screwless implant system and conventional prosthetics, the author contends, can make implant dentistry affordable, versatile and easy to incorporate into all general dental practices.

Replacing posterior teeth with freestanding implants: four-year prosthodontic results of a prospective study

This article presents prospective four-year prosthetic results of the placement of 432 posterior freestanding, conventionally cemented prosthetic tooth implants in posterior edentulous spaces using the Bicon Dental Implants system (Bicon Dental Implants). Over four years, 0.74 percent of the abutments loosened, 0.5 percent of the abutments fractured, and 2.47 percent of the crowns experienced porcelain fracture, (all porcelain fractures occurred at time of placement). This low rate of problems appears to make free-standing single-tooth implant restorations a reliable solution to treating posterior edentulism.