External Implant-abutment Connections Research Articles

Effect of the geometry of butt-joint implant-supported restorations on the fatigue life of prosthetic screws

Statement of problemDental implant geometry affects the mechanical performance and fatigue behavior of butt-joint implant-supported restorations. However, failure of the implant component has been generally studied by ignoring the prosthetic screw, which is frequently the critical restoration component. PurposeThe purpose of this in vitro study was to evaluate the effect of 3 main implant geometric parameters: the implant body diameter, the platform diameter, and the implant-abutment connection type (external versus internal butt-joint) on the fatigue life of the prosthetic screw. The experimental values were further compared with the theoretical ones obtained by using a previously published methodology. Material and methodsFour different designs of direct-to-implant dental restorations from the manufacturer BTI were tested. Forty-eight fatigue tests were performed in an axial fatigue testing machine according to the International Organization for Standardization (ISO) 14801. Linear regression models, 95% interval confidence bands for the linear regression, and 95% prediction intervals of the fatigue load-life (F-N) results were obtained and compared through an analysis of covariance (ANCOVA) to determine the influence of the 3 parameters under study on the fatigue behavior (α=.05). ResultsLinear regression models showed a statistical difference (P<.001) when the implant body diameter was increased by 1 mm; an average 3.5-fold increase in fatigue life was observed. Increasing the implant abutment connection diameter by 1.4 mm also showed a significant difference (P<.001), leading to 7-fold longer fatigue life on average. No significant statistical evidence was found to demonstrate a difference in fatigue life between internal and external implant-abutment connection types. ConclusionsIncreasing the implant platform and body diameter significantly improved (P<.001) the fatigue life of the prosthetic screw, whereas external and internal connections provided similar results. In addition, experimental results proved the accuracy of the fatigue life prediction methodology.

Enhancement of Bone Ingrowth into a Porous Titanium Structure to Improve Osseointegration of Dental Implants: A Pilot Study in the Canine Model.

A porous titanium structure was suggested to improve implant stability in the early healing period or in poor bone quality. This study investigated the effect of a porous structure on the osseointegration of dental implants. A total of 28 implants (14 implants in each group) were placed in the posterior mandibles of four beagle dogs at 3 months after extraction. The control group included machined surface implants with an external implant–abutment connection, whereas test group implants had a porous titanium structure added to the apical portion. Resonance frequency analysis (RFA); removal torque values (RTV); and surface topographic and histometric parameters including bone-to-implant contact length and ratio, inter-thread bone area and ratio in total, and the coronal and apical parts of the implants were measured after 4 weeks of healing. RTV showed a significant difference between the groups after 4 weeks of healing (p = 0.032), whereas no difference was observed in RFA. In the test group, surface topography showed bone tissue integrated into the porous structures. In the apical part of the test group, all the histometric parameters exhibited significant increases compared to the control group. Within the limitations of this study, enhanced bone growth into the porous structure was achieved, which consequently improved osseointegration of the implant.

Clinical study on screw loosening in dental implant prostheses: a 6-year retrospective study.

ObjectivesIn this study, we determined the incidence and pattern of screw loosening in patients who received dental implants.Materials and MethodsPatients who received implants between January 2008 and October 2013 and completed their prosthetic rehabilitation were evaluated for the incidence, frequency, and onset of screw loosening using dental charts and radiographs. The association between each factor and screw loosening was analyzed using the chi-square test and a multivariate analysis with binary logistic regression models (P<0.05).ResultsTotal 1,928 implants were placed in 837 patients (448 males, 389 females), whose follow-up period after loading varied from 0.25 to 70 months (mean period, 31.5 months). Screw loosening occurred in 7.2% of implants. Most cases occurred less than six months after loading. Among those, 22.3% experienced recurrent screw loosening. Screw loosening was most common in the molar region (8.5%) and frequently associated with an implant diameter of ≥5 mm (14.2%). External implant–abutment connections (8.9%) and screw-retained implant prostheses (10.1%) showed higher incidence of problems than internal implant–abutment connections and cement-retained implants, respectively. Screw loosening was most common in implant prostheses with single crowns (14.0%).ConclusionWithin the limits of the current study, we conclude that the incidence of screw loosening differs significantly according to the position of implant placement, the type of implant and manufacturer, implant diameter, the type of implant–abutment connection, the type of retention in the implant prosthesis, and the type of implant prosthesis.

Very low certainty in evidence suggesting that internal implant-abutment connections result in negligible bone loss and similar survival and complication rates compared with external implant-abutment connections

Very low certainty in evidence suggesting that internal implant-abutment connections result in negligible bone loss and similar survival and complication rates compared with external implant-abutment connections

Fracture strength of zirconia implant abutments on narrow diameter implants with internal and external implant abutment connections: a study on the titanium resin base concept

Fracture strength of zirconia implant abutments on narrow diameter implants with internal and external implant abutment connections: a study on the titanium resin base concept

Stress and strain distribution in three different mini dental implant designs using in implant retained overdenture: a finite element analysis study.

Purpose of this study was to characterize and analyze stress and strain distribution occurring in bone and implants and to compare stress and strain of three different implant designs. Three different mini dental implant designs were included in this study: 1. a mini dental implant with an internal implant-abutment connection (MDIi); 2. a mini dental implant with an external implant-abutment connection (MDIe); 3. a single piece mini dental implant (MDIs). All implant designs were scanned using micro-CT scans. The imaging details of the implants were used to simulate models for FEA. An artificial bone volume of 9×9 mm in size was constructed and each implant was placed separately at the center of each bone model. All bone-implant models were simulatively loaded under an axial compressive force of 100 N and a 45-degree force of 100 N loading at the top of the implants using computer software to evaluate stress and strain distribution. There was no difference in stress or strain between the three implant designs. The stress and strain occurring in all three mini dental implant designs were mainly localized at the cortical bone around the bone-implant interface. Oblique 45° loading caused increased deformation, magnitude and distribution of stress and strain in all implant models. Within the limits of this study, the average stress and strain in bone and implant models with MDIi were similar to those with MDIe and MDIs. The oblique 45° load played an important role in dramatically increased average stress and strain in all bone-implant models. Mini dental implants with external or internal connections have similar stress distribution to single piece mini dental implants. In clinical situations, the three types of mini dental implant should exhibit the same behavior to chewing force.

A Strain Gauge Analysis Comparing External and Internal Implant-Abutment Connections

This study compared the load transfer characteristics of a complete-arch restoration supported by 4 implants, with external and internal implant-abutment connections. Three loading positions were applied to the prostheses. Epoxy resin models were used to simulate bone. Two types of implants (ReplaceSelect Internal-Interface Tapered Implants and ReplaceSelect External-Interface Tapered Implants) were placed in the models. Complete-arch metal frameworks were constructed on the abutments. Artificial teeth were arranged on the framework, and the prosthesis was screwed onto the abutments. The strain gauges were bonded at the implant-abutment connection level of the specimens with 3 loading conditions (a) 4-point load, (b) 2-point anterior load, and (c) 2-point lateral load. The reading of strain values were recorded and compared. In all load conditions, there were strain differences between the external implant-abutment connection and internal implant-abutment connection. The internal implant-abutment connection resulted in lower stresses at the connection level. When loaded vertically, the internal implant-abutment connection produced less strain when compared with the external implant-abutment connection.

Bending moments of zirconia and titanium implant abutments supporting all‐ceramic crowns after aging

To test the fracture load and fracture patterns of zirconia abutments restored with all-ceramic crowns after fatigue loading, exhibiting internal and external implant-abutment connections as compared to restored and internally fixed titanium abutments. A master abutment was used for the customization of 5 groups of zirconia abutments to a similar shape (test). The groups differed according to their implant-abutment connections: one-piece internal connection (BL; Straumann Bonelevel), two-piece internal connection (RS; Nobel Biocare ReplaceSelect), external connection (B; Branemark MkIII), two-piece internal connection (SP, Straumann StandardPlus) and one-piece internal connection (A; Astra Tech AB OsseoSpeed). Titanium abutments with internal implant-abutment connection (T; Straumann Bonelevel) served as control group. In each group, 12 abutments were fabricated, mounted to the respective implants and restored with glass-ceramic crowns. All samples were embedded in acrylic holders (ISO-Norm 14801). After aging by means of thermocycling in a chewing simulator, static load was applied until failure (ISO-Norm 14801). Fracture load was analyzed by calculating the bending moments. Values of all groups were compared with one-way ANOVA followed by Scheffé post hoc test (P-value<0.05). Failure mode was analyzed descriptively. The mean bending moments were 464.9±106.6N cm (BL), 581.8±172.8N cm (RS), 556.7±128.4N cm (B), 605.4±54.7N cm (SP), 216.4±90.0N cm (A) and 1042.0±86.8N cm (T). No difference of mean bending moments was found between groups BL, RS, B and SP. Test group A exhibited significantly lower mean bending moment than the other test groups. Control group T had significantly higher bending moments than all test groups. Failure due to fracture of the abutment and/or crown occurred in the test groups. In groups BL and A, fractures were located in the internal part of the connection, whereas in groups RS and SP, a partial deformation of the implant components occurred and cracks and fractures of the zirconia abutment were detected. The differently connected zirconia abutments exhibited similar bending moments with the exception of one group. Hence, the type of connection only had a minor effect on the stability of restored zirconia abutments. In general, restored titanium abutments exhibited the highest bending moments.

Photoelastic stress analysis of external versus internal implant-abutment connections

Common complications of implant restorations are abutment screw loosening and screw fracture. The geometry of the implant-abutment connection may affect stresses generated from loading, and these stresses may have a role in screw loosening or fracture. This study compared the load transfer characteristics of a complete-arch restoration supported by 4 implants with external and internal implant-abutment connections. Loads were applied to the prostheses in 3 positions. Two-dimensional photoelastic models were used to simulate bone. Two types of implants (ReplaceSelect Internal-Interface Tapered Implants and ReplaceSelect External-Interface Tapered Implants) were placed in the photoelastic models. Complete-arch metal frameworks were fabricated on the abutments. Artificial teeth were arranged on the framework, and the prosthesis was screwed onto the abutments. The specimens were analyzed at 2 levels (implant-abutment level and apical to the implant level) with 3 loading conditions (4-point load; 2-point anterior load; and 2-point lateral load). The numbers of fringe orders were recorded and compared. With the 4-point load, no stress differences occurred between the external-implant abutment connection and internal-implant abutment connection at the connection level and at the apical level. With the 2-point anterior load, the internal-implant abutment connection resulted in lower stresses at the connection level both in the loaded and non-loaded areas. With the 2-point lateral load, the internal-implant abutment connection resulted in lower stresses at the connection level at the non-loaded area. When loaded off-center, the internal-implant abutment connection produced less stress when compared with the external-implant abutment connection.

Effect of implant connection and restoration design (screwed vs. cemented) in reliability and failure modes of anterior crowns

The mechanical performance of cemented or screw-retained implant-supported crowns with an internal or external configuration is yet to be understood. This in vitro study evaluated the effect of screw-retained and cement-retained prostheses on internal and external implant-abutment connections. Thereby, the reliability and failure modes of crowns were investigated. Eighty-four implants (Emfils; Colosso Evolution system) were divided into four groups (n=21 each): screw-retained and internal connection (Si), screw-retained and external connection (Se), cement-retained and internal connection (Ci), and cement-retained and external connection (Ce). Ti-6Al-4V abutments were torqued (30 Ncm) to the implants, and maxillary central incisor metal crowns were torqued (30 Ncm) or cemented (Rely X Unicem; 3M-ESPE) and subjected to accelerated life-testing in water. Use-level probability Weibull curves and reliability for 50,000 cycles at 150 N were calculated. The β values for Si (1.72), Se (1.50), Ci (1.34), and Ce (1.77) groups indicated that fatigue/damage accumulation accelerated their failure. The Ci group presented the highest reliability, the Se group presented the lowest reliability, and Si and Ce groups presented intermediate reliability. Screw-retained restorations presented mainly abutment fracture. Cement-retained restorations resulted in failures of the screw in the Ce group, but implant/screw fracture in the Ci group.

Bending moments of zirconia and titanium abutments with internal and external implant–abutment connections after aging and chewing simulation

To test the fracture load of zirconia abutments with different types of implant-abutment connections after chewing simulation and to compare their bending moments to internally connected identical titanium abutments. Forty-eight identical customized zirconia abutments with different implant-abutment connections were fabricated for four different test groups: one-piece internal implant-abutment connection (BL; Straumann Bonelevel), two-piece internal implant-abutment connection (RS; Nobel Biocare Replace Select), external implant-abutment connection (B; Brånemark MK III), two-piece internal implant-abutment connection (SP; Straumann Standard Plus). Twelve titanium abutments with one-piece internal implant-abutment connection (T; Straumann Bonelevel) served as control group. After aging by means of thermocycling (5-50°C, 120 s) and chewing simulation (1,200,000 cycles, 49 N load, 1.67 Hz), static load was applied at a 30° angle to the palatal surface until failure. Bending moments were calculated for comparison of the groups. Data were analyzed descriptively and by performing the Kruskal-Wallis test with Bonferroni correction. The mean bending moments of the abutments were 714.1 ± 184.9 N cm (T), 331.7 ± 57.8 N cm (BL), 429.7 ± 62.8 N cm (RS), 285.8 ± 64.4 N cm (B) and 379.9 ± 59.1 N cm (SP). The bending moments of control group T were significantly higher than those of all other groups. The values of group RS were significantly higher than those of group B but within the value range of groups SP and BL. The bending moments of the different tested types of zirconia abutments vary with different implant-abutment connections after chewing simulation. The use of a secondary metallic component might have a beneficial influence on the stability of zirconia abutments.