The longitudinal accuracy of fit of titanium implant superstructures superplastically formed on investment models

Retention force and stress distribution analysis of the cementless double crown-type implant-supported prosthesis

STATEMENT OF PROBLEM

Implant-supported fixed dental prostheses have been classified into screw-retained and cement-retained types, and each retaining type has complications. A novel retentive cementless double crown (CLD) type of the implant-supported fixed prosthesis has been developed. CLD has air pockets in the intaglio surface of the crown and does not require cement or a screw hole. However, studies on the retention force and stress distribution of the system are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate the retention force and stress distribution in the CLD system.

MATERIAL AND METHODS

The specimen comprised an implant, a titanium abutment, and a zirconia crown. Retention forces of 10 specimens of the CLD type were measured at no loading and after cyclic loading for 50, 100, 200, 600, 10 000, and 1 000 000 cycles by using a universal testing machine with a custom attachment device. Forty specimens of the stress distribution test were divided into 4 groups based on the retention type (cement-retained or CLD type) and load direction (vertical or oblique). Strain gauges were attached onto the buccal and lingual sides of the implant, and microstrain values were measured. One-way analysis of variance with the post hoc Tukey honestly significant difference test was performed on the retention force data, and the t test was performed to analyze the microstrain value data (α=.05).

RESULTS

Retention forces after 0, 50, 100, 200, 600, 10 000, and 1 000 000 load cycles were 18.12 ±6.16 N, 20.47 ±5.78 N, 19.79 ±6.61 N, 18.46 ±5.23 N, 19.60 ±6.93 N, 21.75 ±5.03 N, and 40.91 ±9.32 N, respectively, and after 1 000 000 cycles, the retention force was significantly higher than that of other load cycles (P<.05). The mean of maximum microstrain values under the vertical load were similar in the cement-retained type (buccal side, 834.96 ±53.69 μm/m; lingual side, 490.76 ±34.12 μm/m) and the CLD type (buccal side, 814.28 ±71.20 μm/m; lingual side, 479.10 ±30.74) (P>.05), and the mean of maximum microstrain values under the oblique load was also similar in the cement-retained type (buccal side, 1991.04 ±109.89 μm/m; lingual side, -2232.41 ±189.88) and the CLD type (buccal side, 1932.47 ±152.51 μm/m; lingual side, -2097.47 ±130.69 μm/m) (P>.05).

CONCLUSIONS

The CLD type had clinically acceptable retention during 1 000 000 load cycles and had a similar or better stress distribution capability than the cement-retained type.

Implant-abutment fit influences the mechanical performance of single-crown prostheses

OBJECTIVES

To evaluate the three-dimensional fit of abutments fabricated by the industry to those either milled or cast by a commercial laboratory and to correlate the implant-abutment connection fit with stress at fatigue failure of prostheses. Probability of survival (reliability) and fractography to characterize failure modes were also performed for cemented and screw-retained prostheses.

METHODS

One-hundred and twenty-six maxillary central incisor crowns were milled to restore implants and divided in 3 cemented and 3 screwed-retained groups (n = 21/each), as follows: [Digital-Sc]: milled one-piece monolithic abutment/crown; [TiB-Sc]: milled crowns cemented onto Ti-base abutments; [UCLA]: screw-retained crown using UCLA abutments; [Digital-Ce]: milled two-piece assembly comprised by screwed monolithic abutment and a cemented crown; [TiB-Ce]: milled coping cemented onto Ti-base abutments to receive a cemented crown; [UCLA-Ce]: UCLA abutments that received an overcast coping and a cemented crown. Implant-abutment volume misfit was assessed by micro-computed tomography using the silicone replica technique. Implant/crown systems were subjected to step-stress accelerated life testing (SSALT) in water. The use-level probability Weibull curves and reliability for a mission of 50,000 cycles at calculated stress at failure of 2,300, 3300 and 4300 MPa were plotted. Fractographic analysis was performed with scanning electron microscopy. Internal misfit was analyzed through one-way ANOVA following post-hoc comparisons by Tukey test (p < 0.05). Correlation between misfit volume and the stress at fatigue failure was assessed by Pearson test.

RESULTS

Similar misfit volumes were observed for TiB-Sc (0.458 mm³), TiB-Ce (0.461 mm³), UCLA (0.471 mm³) and UCLA-Ce (0.480 mm³), which were significantly lower than Digital-Sc (0.676 mm³) and Digital-Ce (0.633 mm³). The mean β values were: 1.68, 1.39, 1.48, 2.41, 2.27 and 0.71 for Digital-Sc, TiB-Sc, UCLA, Digital-Ce, TiB-Ce and UCLA-Ce, respectively, indicating that fatigue was an accelerating factor for failure of all groups. Higher stress at failure decreased the reliability of all groups, more significantly for screw compared to cement-retained groups, especially for Digital-Sc that demonstrated the lowest reliability. The failure mode was restricted to abutment screw fracture. A negative correlation was observed between misfit values and stress at failure (r = -0.302, p = 0.01).

CONCLUSIONS

Abutments milled by a commercial lab presented higher misfit compared to those provided by the industry and a moderate correlation was observed between higher misfit and lower stress at failure during fatigue. Probability of survival decreased at higher stress, especially for screw compared to cement-retained groups, and failures were confined to abutment screws.

An initial study of diffusion bonds between superplastic Ti-6Al-4V for implant dentistry applications

STATEMENT OF PROBLEM

Production of precisely fitting fixed partial denture implant superstructures with titanium alloys is limited by casting techniques that introduce distortion. After alignment of the framework with existing implants, the remaining misfit may generate stresses that cause screw loosening and adversely affect the implant/bone interface.

PURPOSE

The purpose of this study was to prepare diffusion-bonded joints between superplastic (SP) Ti-6Al-4V plates and indenters (representing analogs to implant-supported fixed frameworks and abutments) and determine if this process has potential for producing strong, dimensionally precise prostheses.

MATERIAL AND METHODS

Seven sets of trial indenter and plate specimens with dimensions of 6.4 mm x 6.4 mm x 5 cm and 8.5 mm x 1.5 cm, respectively, were prepared. Several indenter designs were used (35- or 45-degree half-angle, presence or absence of a notch, and SP versus no SP condition for Ti-6Al-4V); all plates were prepared from SP Ti-6Al-4V. For the results-guided experimental design, there was 1 trial indenter/plate combination for each design/processing condition. Diffusion bonding was performed at 10(-6) Torr, while the temperature was increased 10 degrees C/min to 900 degrees or 920 degrees C. Following 10 minutes of equilibration, the indenter was pressed 2.5 mm into the plate at 0.13 mm/min. Joint strength was evaluated in tension, and the ductile or brittle character of fracture surfaces was assessed by the presence or absence of a dimpled rupture surface from secondary electron SEM observations. Fractured specimens were cross-sectioned and examined with an optical microscope to evaluate overall joint integrity and quality, and used for Vickers hardness measurements to gain insight into the variation in mechanical properties of the indenter and plate with distance from the joint. One-way ANOVA (alpha=.05) was used to compare hardness at the joint for the trial specimen with highest joint strength with hardness values for adjacent regions at 125-mum intervals in the indenter and plate. The Ryan-Einot-Gabriel-Welsch (REGW) multiple range test was used to identify any specific location having significantly (alpha=.05) different hardness. Backscattered electron SEM observations were also performed on the cross-sectioned specimens to investigate whether a layer of alpha-stabilized titanium, which would decrease joint strength, was present. Fits of Ti-6Al-4V implant analogs prepared by this diffusion-bonding process were assessed qualitatively from visual observation.

RESULTS

The maximum joint strength of 820 MPa was achieved for a diffusion bonding temperature of 900 degrees C for an SP Ti-6Al-4V indenter with a 35-degree half-angle and no notch. This joint strength is nearly 90% of the maximum tensile strength of the parent Ti-6Al-4V, which can range from approximately 930 to 1015 MPa. The hardness at the joint was significantly higher (P<.05) than the hardness of the indenter and plate at 125-mum distances from the joint. The mean hardness of the indenter at 125 mum from the joint was significantly greater (P<.05) than the mean hardness of the plate at a distance of 500 mum from the joint. All other mean hardness values at the different measurement distances from the joint were not significantly different. Ductile fracture occurred for all superplastic processing conditions, and no alpha-titanium layer was present. Minimal asperities were observed with the optical microscope, and fits of implant prosthesis analogs were considered acceptable.

CONCLUSIONS

A 900 degrees C processing condition for diffusion-bonding an SP Ti-6Al-4V indenter with a 35-degree half-angle and no notch to a Ti-6Al-4V SP plate yielded a joint with nearly the same strength as the parent alloy. Use of this processing temperature with a 0.13 mm/min rate of pressing the indenter into the plate yielded minimal distortions for implant prosthesis analogs when observed visually.

Cross-sectional analysis of the implant?abutment interface

The purpose of this study was to develop a technique to evaluate the implant-abutment gap of an external hexagon implant system as a function of radius. Six implants of 3.75 mm in diameter (Conexao Sistema de Protese Ltda, Sao Paulo, Brazil) and their respective abutments were screw connected and torqued to 20 N cm(-1). The implants were mounted in epoxy assuring an implant long-axis position perpendicular to the vertical axis. Each implant was grounded through its thickness parallel to implant long-axis at six different distance interval. Implant-abutment gap distances were recorded along the implant-abutment region for each section. Individual measurements were related to their radial position through trigonometric inferences. A sixth degree polynomial line fit approach determined radial adaptation patterns for each implant. Micrographs along implant sections showed a approximately 300 mum length implant-abutment engagement region. All implants presented communication between external and internal regions through connection gaps and inaccurate implant-abutment alignment. Average gap distances were not significantly different between implants (P > 0.086). Polynomial lines showed implant-abutment gap values below 10 mum from 0 mum to approximately 250 mum of the implant-abutment engagement region. Gap distances significantly increased from approximately 250 mum to the outer radius of the implant-abutment engagement region. The technique described provided a broader scenario of the implant-abutment gap adaptation compared with previous work concerning implant-abutment gap determination, and should be considered for better understanding mechanical aspects or biological effects of implant-abutment adaptation on peri-implant tissues.