Radiographical Evaluation of the Gap at the Implant‐Abutment Interface

Abstract

The detection of marginal gaps at the implant-abutment interface is a common clinical task in prosthodontic treatment. For the detection of the gap intraorally, especially under thick soft tissues the most common method is dental radiography. The objective of this experimental study was to investigate the accuracy of conservative dental radiography to detect marginal gaps at the implant-abutment interface. For these reasons radiographs were taken on internal and external hex implants with different experimental gaps and inclinations. The abutment (with a space created by plastic sheets 0.5 and 0.2 mm in thickness) was screwed on the implant, and the implant was placed into a box filled with silicone impression material. The X-ray film was placed parallel to the implant at the back of the box, the borders of the box were marked to the base and the box. A ruler of 10 cm was fixed at a long X-ray tube to ensure parallelism to the implant, X-ray film. Sets of radiographs were made at 0 degrees, 5 degrees, 10 degrees, 15 degrees, 20 degrees, 25 degrees, 30 degrees (to the abutment) and -5 degrees, -10 degrees, -15 degrees, -20 degrees, -25 degrees, -30 degrees (to the implant) degrees. The X-ray images were observed with visual examination, under magnification, and in higher magnification in a slide projector. The phenomenal and the true gap at the implant-abutment interface were calculated in order to determine the distortion. There were significant differences between the internal and external hex implants because of the different morphology of the implants. The detecting ability to diagnose a gap at the implant-abutment interface varied significantly with the angulation degree of the X-ray tube. At inclinations to the implant (- inclination) the gap diminished earlier than those inclinations to the prosthetic abutment (+ inclinations). In all examinations the gap was not detectable at angulations higher than 20 degrees. In visual examination at 25 degrees and 30 degrees an average clinician could diagnose the distortion. The X-ray diagnosis of gap at the interface can be significantly influenced by the inclination of the X-ray tube in relation to the long axis of the implant. To achieve accurate results, the use of a paralleling device is advocated in order to achieve greater detection ability. Dental radiography is often used for detection of marginal gaps at the implant-abutment interface. The angulation of the X-ray beam may lead to inaccurate diagnosis in gap detection. The use of a paralleling device is indicated for evaluation of marginal accuracy. The geometry of the implant (internal or external hexagon) influences the gap evaluation.