Does implantoplasty affect the failure strength of narrow and regular diameter implants? A laboratory study

Kristina Bertl,Flemming Isidor,Per Vult Von Steyern,Andreas Stavropoulos

doi:10.1007/s00784-020-03534-8

Abstract

ObjectiveTo assess whether the impact of implantoplasty (IP) on the maximum implant failure strength depends on implant type/design, diameter, or material.MethodsFourteen implants each of different type/design [bone (BL) and tissue level (TL)], diameter [narrow (3.3 mm) and regular (4.1 mm)], and material [titanium grade IV (Ti) and titanium-zirconium alloy (TiZr)] of one company were used. Half of the implants were subjected to IP in a computerized torn. All implants were subjected to dynamic loading prior to loading until failure to simulate regular mastication. Multiple linear regression analyses were performed with maximum implant failure strength as dependent variable and IP, implant type/design, diameter, and material as predictors.ResultsImplants subjected to IP and TL implants showed statistically significant reduced implant failure strength irrespective of the diameter compared with implants without IP and BL implants, respectively. Implant material had a significant impact for TL implants and for regular diameter implants, with TiZr being stronger than Ti. During dynamic loading, 1 narrow Ti TL implant without IP, 4 narrow Ti TL implants subjected to IP, and 1 narrow TiZr TL implant subjected to IP were fractured.ConclusionIP significantly reduced the maximum implant failure strength, irrespective implant type/design, diameter, or material, but the maximum implant failure strength of regular diameter implants and of narrow BL implants remained high.Clinical RelevanceIP seems to have no clinically relevant impact on the majority of cases, except from those of single narrow Ti TL implants, which may have an increased risk for mechanical complications. This should be considered for peri-implantitis treatment planning (e.g., communication of potential complications to the patient), but also in the planning of implant installation (e.g., choosing TiZr instead of Ti for narrow implants).

Highlights

Overt peri-implantitis lesions regularly require a surgical intervention to achieve disease resolution [1, 2]
The highest failure rate was present among the narrow diameter titanium grade IV (Ti) tissue level (TL) implants subjected to IP, where 4 out of 7 implants were fractured; the remaining fractured implants were one narrow diameter Ti TL implant without IP and one narrow diameter titanium-zirconium alloy (TiZr) TL implant subjected to IP
A multiple linear regression analysis was performed for all implants with maximum implant failure strength as dependent variable and IP, implant type/design, diameter, and material as predictors

Summary

Introduction

Overt peri-implantitis lesions regularly require a surgical intervention to achieve disease resolution [1, 2]. Depending on defect morphology and treatment approach, implantoplasty (IP), i.e., the mechanical removal of the implant threads and smoothening of the implant surface [3, 4], can be part of the surgical treatment protocol for implants with a rough surface. IP aims to achieve implant surface decontamination and to reduce the risk of reinfection, and is recommended at those aspects of the implant, where bone healing and/or reosseointegration is not expected. IP unavoidably causes a reduction of the implant mass, and it may weaken implant strength and increase implant fracture rate. In 2 out of 3 laboratory studies identified [14,15,16], IP reduced implant strength; i.e., standard/regular diameter implants suffered up to 40% strength reduction [14, 16]. Several other factors (e.g., implant type/design, implant material, etc.) may affect implant strength after IP, but were not addressed in those studies

Methods

Results

Conclusion