Two-piece Abutments Research Articles

One-Piece Versus Two-Piece Abutments for Single Crowns in the Esthetic Zone: A Clinical Trial.

To evaluate whether a two-piece abutment is equivalent to a one-piece in peri-implant esthetics, patients' satisfaction, and oral health-related quality of life (OHRQOL) for implant-supported anterior single crown placement. Thirty implants were allocated sequentially: 15 in the one-piece abutment group (OP) and 15 in the two-piece abutment group (TP). Peri-implant esthetics were evaluated by the pink esthetic score (PES) at temporary crown insertion (T1), after tissue conditioning (T2), and at 30 days after the final crown insertion (T3). OHRQOL was measured using the OHIP-14 and satisfaction was evaluated using the visual analog scale (VAS) at baseline, T1, and T3. Treatment was considered equivalent if the 95% coefficient interval (CI) for mean difference in PES was between -1.5 and +1.5 points. Statistical analysis was performed using Mann-Whitney, SPANOVA, and Student's t-test, with Sidak's posttest, adopting p < 0.05. No differences were found between the groups for any variable and during follow-up. A significant increase in OHRQOL and satisfaction was observed at T3, when compared to baseline (p < 0.05) for both groups. Significant improvements in peri-implant esthetics were also observed throughout the treatment, particularly after tissue conditioning (p < 0.05). Primary and secondary outcomes were evaluated for equivalence, and both abutment types were considered equivalent following the insertion of the temporary crowns. Two-piece abutment was equivalent to one-piece abutment for peri-implant esthetics, quality of life, or the satisfaction of patients rehabilitated with metal-free single crowns. Tissue conditioning and final crown insertion appear to play a role in improving these outcomes.

Clinical efficacy of a two-piece abutment conforming to the concept of one abutment one time in the posterior region: A clinical pilot study.

To assess the impact of a two-piece abutment workflow on enhancing the stability of the alveolar bone and gingiva surrounding the dental implant, and to determine the level of patient satisfaction. A total of 48 patients with dentition defect in the posterior region were included and divided into two groups: the two-piece abutment workflow (TAW) and the sealing screw with submerged healing workflow (SHW). Marginal bone level (MBL), soft tissue indicators, oral hygiene indicators, and patient satisfaction were assessed and recorded partially at 0, 3, 6, and 12 months after surgery. The primary outcome was the change of MBL in different time periods. A generalized linear mixed model (GLMM) was used to take into account the correlated nature of the data, and adjust for potential confounding factors within inter-group differences. The survival rate of implants and prosthesis reached 100% at 12-month follow-up, with an average decrease of 0.25 mm (SD 0.23 mm) of MBL in the TAW group and 0.48 mm (SD 0.45 mm) in the SHW group. The change of MBL in the TAW group (0.15 ± 0.31 mm) was significantly lower than the SHW group (0.41 ± 0.41 mm) through the analysis of GLMM within 6 months, while no significance was found in 12 months. Moreover, less gingival pain and oppression during prosthesis loading, and less time consumption overall duration were showed in the TAW group through Visual Analogue Scale (VAS, p < 0.05). Within a 6-month period, the two-piece abutment workflow showed superior efficacy in preserving the integrity of the marginal bone level. Furthermore, it streamlined treatment procedures and mitigated discomfort, hence increasing patient satisfaction.

Longevity of different abutments placed on narrow diameter implants: Assessment of structural damage and loosening

ObjectivesTo evaluate structural damage and loosening of abutments placed on narrow diameter implants after cyclic fatigue. MethodsSixty Morse taper narrow diameter implants (Neodent, Brazil) received two types of abutments (1PA- one-piece abutment or 2PA- two-piece abutment), which were randomly divided into 3 fatigue experiments (n = 10). The implants were placed into a customized supporting holder and a software-assisted digital torque wrench secured the manufacturer recommended torque for each abutment. Cone beam computed tomography (CBCT) scans were acquired, before and after fatigue, and post-processed (software e-Vol DX) to assess damage and abutment displacement. The boundary fatigue method was adapted to use 2 × 106 cycles, 2 Hz of frequency and constant peak load of 80 N (first experiment) that varied according to the failure rate of previous specimens (second and third experiments). Failure was evaluated using CBCT scans and removal torque values. Data were used to estimate long-term torque degradation, probability of failure and Weibull modulus (software ALTA PRO9). ResultsAll 2PA specimens became loosen independently of the applied fatigue load, and structural bending was observed in 14 abutments. Eight 1PA got loosen during the fatigue experiment. The Weibull analysis showed a lower modulus (m = 1.0; 0.7, 1.4) for 1PA than for 2PA (m = 2.6; 2, 3.4) resulting in longer predicted lifetimes and slower torque degradation for 1PA than for 2PA specimens. Significance1PA showed greater long-term survival probability than 2PA. Predicting the lifetime and mechanical behavior of implant-abutment systems are useful information to clinicians during the decision-making process of oral rehabilitations.

Fracture resistance of cement-retained lithium disilicate implant-supported crowns: Effect of material used for two-piece abutments.

This study compared the fracture strength of single lithium disilicate implant-supported crowns fabricated on two-piece abutments with various materials: ceramic-reinforced PEEK, zirconia, and lithium disilicate. Thirty-six implants were embedded in acrylic cylinders. A two-piece abutment and a crown were designed following a pre-operation scan for a maxillary left central incisor. The designed crown was used to fabricate 36 lithium disilicate crowns. The designed abutment was used to manufacture 36 abutments from 3 materials, 12 each: (A) zirconia; (B) lithium disilicate; and (C) ceramic-reinforced PEEK. Abutments were surface treated and bonded on the titanium base abutments with resin cement. Then, lithium disilicate crowns were bonded on the assigned abutments. Specimens were then subjected to dynamic loading for 1,200,000 cycles. The fracture strength (N) of the assembly was assessed using a universal testing machine. One-way ANOVA followed by multiple comparison tests was used to evaluate the effect of abutment material on the fracture strength of single implant-supported restorations at a significance of .05. The average fracture strength for the groups with zirconia, PEEK, and lithium disilicate two-piece abutments were 1362N ± 218N, 1235N ± 115N, and 1472N ± 171N, respectively. There was a significant (p < 0.05) difference in fracture strength among the groups. The lithium disilicate group had significantly higher fracture strength (p = 0.0058) than the group with PEEK; however, there was no significant (p > 0.05) difference between the other groups. Two-piece abutments restored with lithium disilicate crowns investigated in the study have the potential to withstand the average physiological occlusal forces in the anterior region.

Segmentation of process-related contaminations on two-piece abutments using pixel-based machine learning: a new quantification approach?

A reference method for quantifying contaminations on two-piece abutments manufactured using CAD/CAM has not yet been established. In the present in vitro study, a pixel--based machine learning (ML) method for detecting contamination on customized two-piece abutments was investigated and embedded in a semiautomated quantification pipeline. Forty-nine CAD/CAM zirconia abutments were fabricated and bonded to a prefabricated titanium base. All samples were analyzed for contamination by scanning electron microscopy (SEM) imaging followed by pixel--based ML and thresholding (SW) for contamination detection; quantification was performed in the postprocessing pipeline. Wilcoxon signed-rank test and Bland-Altmann plot were applied to compare both methods. The contaminated area fraction was recorded as a percentage. There was no statistically significant difference between the percentages of contamination areas (median = 0.004) measured with ML (median = 0.008) and with SW (median = 0.012), asymptotic Wilcoxon test: P = 0.22. The Bland-Altmann plot demonstrated a mean difference of -0.006% (95% confidence interval [CI] from -0.011% to 0.0001%) with increased values from a contamination area fraction of > 0.03% for ML. Both segmentation methods showed comparable results in evaluating surface cleanliness; pixel-based ML is a promising assessment tool for detecting external contaminations on zirconia abutments. Further studies are required to investigate the clinical performance of this tool.

Influence of exposure of customized dental implant abutments to different cleaning procedures: an in vitro study using AI-assisted SEM/EDS analysis

PurposeDental implant abutments are defined as medical devices by their intended use. Surfaces of custom-made CAD/CAM two-piece abutments may become contaminated during the manufacturing process in the dental lab. Inadequate reprocessing prior to patient care may contribute to implant-associated complications. Risk-adapted hygiene management is required to meet the requirements for medical devices.MethodsA total of 49 CAD/CAM-manufactured zirconia copings were bonded to prefabricated titanium bases. One group was bonded, polished, and cleaned separately in dental laboratories throughout Germany (LA). Another group was left untreated (NC). Five groups received the following hygiene regimen: three-stage ultrasonic cleaning (CP and FP), steam (SC), argon–oxygen plasma (PL), and simple ultrasonic cleaning (UD). Contaminants were detected using scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) and segmented and quantified using interactive machine learning (ML) and thresholding (SW). The data were statistically analysed using non-parametric tests (Kruskal–Wallis test, Dunn’s test).ResultsSignificant differences in contamination levels with the different cleaning procedures were found (p ≤ 0.01). The FP–NC/LA groups showed the most significant difference in contamination levels for both measurement methods (ML, SW), followed by CP–LA/NC and UD–LA/NC for SW and CP–LA/NC and PL–LA/NC for ML (p ≤ 0.05). EDS revealed organic contamination in all specimens; traces of aluminum, silicon, and calcium were detected.ConclusionsChemothermal cleaning methods based on ultrasound and argon–oxygen plasma effectively removed process-related contamination from zirconia surfaces. Machine learning is a promising assessment tool for quantifying and monitoring external contamination on zirconia abutments.Graphical

Mechanical Behavior of One-Piece and Two-Piece Tapered Prosthetic Abutments with 11.5 and 16 Degrees.

The objective of this study is to examine the mechanical behavior of two-piece abutments (Morse taper with 16° internal angulation and Morse taper with 11.5° internal angulation) before and after cyclic fatigue testing, following ISO 14801:2016 guidelines. The specimens were divided into three groups: a modified Morse taper with a taper angle of 16° (GM group), a conventional Morse taper (taper angle of 11.5° deg) with a two-piece (CMt group), and one-piece abutments (CMo group). Each experimental group was formed by ten implants and ten abutments (n = 10) for a total of 30 specimens (n = 30). The abutments were tightened and loosened, and a fatigue test was applied with 15 Hz and 5 × 106 cycles. Subsequently, the abutments were loosened, and a pull-out test was performed on the CMt group. Finite element analysis (FEA) was conducted on stress concentration regions. The statistical analysis of the loosening test was performed using two-way ANOVA and Tukey's tests (p < 0.05) to compare screw loosening within each group and between the groups with and without mechanical fatigue. Significant differences were found among the three groups in the loosening test when analyzing the values with and without fatigue (p < 0.001) within each group. When the groups were compared with each other, there was also a significant difference between them (p < 0.001), except between groups GM and CMt without fatigue (p = 0.840). In the pull-out test of the CMt group, the sample exhibited frictional locking only after fatigue (mean = 94.2 N). The FEA demonstrated a varied stress distribution in all groups. The stress was found to be more concentrated in the upper third and middle third regions of the implant, as well as in the opposite region of the load application for all three groups. Although the CMo group showed lower rates of loosening, it displayed a poorer stress distribution in comparison to the GM and CMt groups. On the other hand, the CMt group exhibited a satisfactory frictional lock after undergoing the fatigue tests.

Influence of a new abutment design concept on the biomechanics of peri-implant bone, implant components, and microgap formation: a finite element analysis

BackgroundA new two-piece abutment design consisting of an upper prosthetic component and tissue-level base has been introduced; however, the biomechanical behavior of such a design has not been documented. This study aimed to investigate the effect of a two-piece abutment design on the stress in the implant components and surrounding bone, as well as its influence on microgap formation.MethodsTo simulate the implant models in the mandibular left first molar area, we established nine experimental groups that included three bone qualities (type II, III, and IV) and three implant–abutment designs (internal bone level, tissue level, and a two-piece design). After the screw was preloaded, the maximum occlusal (600 N) and masticatory (225 N) forces were established. Finite element analysis was performed to analyze the maximum and minimum principal stresses on the peri-implant bone; the von Mises stresses in the implants, abutments, bases, and screws, and the microgaps at the implant–abutment, implant–base, and base–abutment interfaces.ResultsFor all three loading methods, the two-piece abutment design and bone-level connection exhibited similarities in the maximum and minimum principal stresses in the peri-implant bone. The von Mises stresses in both screws and bases were greater for the two-piece design than for the other connection types. The smallest microgap was detected in the tissue-level connection; the largest was observed at the implant–base interface in the two-piece design.ConclusionsThe present study found no evidence that the abutment design exerts a significant effect on peri-implant bone stress. However, the mechanical effects associated with the base and screws should be noted when using a two-piece abutment design. The two-piece abutment design also had no advantage in eliminating the microgap.

Influence of cold atmospheric-pressure-plasma in combination with different pretreatment methods on the pull-off tensile load in two-piece abutment-crowns: an in-vitro study

BackgroundIn implant prosthetic dentistry, the adhesive connection of individualized ceramic crowns and prefabricated titanium bases leads to several benefits. However, the durability of the bonding could be a weak point and especially depends on sufficient surface pretreatment. Cold atmospheric-pressure plasma (CAP) is a pretreatment method that should improve the surface properties without physical damage. Thus, the purpose of this study was to investigate the influence of CAP treatment on pull-off tensile load in two-piece abutment crowns.MethodsEighty zirconia crowns and titanium bases were divided into eight groups (n = 10) according to their surface pretreatment prior to cementation with Panavia V5: no treatment (A); sandblasting (B); 10-MDP primer (C); sandblasting and primer (D); CAP (AP); sandblasting and CAP (BP); CAP and primer (CP); sandblasting, CAP and primer (DP). The specimens were thermocycled (5°/55°, 5000 cycles), and then the pull-off tensile load (TL) was measured. Statistical analyses were performed using three-way ANOVA with Tukey post-hoc and Fisher’s exact tests.ResultsThe results showed that the TL was highest in group D (p < 0.0001). Some combinations of different treatments led to effects that were greater than the sum of the individual effects. These effects were modified by interactions. Only in combination with primer, CAP treatment had a small but positive significant effect (group CP vs. C and CP vs. AP, p < 0.0001) which however did not come close to the strong interaction effect that resulted from the combination of sandblasting and primer.ConclusionWithin the limitations of this study, CAP treatment cannot be recommended in this specific field of indication due to its unreliable influence on TL in combination with other pretreatment methods.

The Effect of mechanical loading cycles on different abutment types in implants with tapered internal connection

Aim The purpose of this in vitro study was to evaluate the influence of the application of cyclic mechanical load on torque loss and on the seating installation of internal tapered abutments. Materials and methods Forty tapered implants and 40 abutments were used and divided into four groups (n=10): Group 1 (Titamax CM) and Group 2 (Strong SW Morse) received one-piece abutments; Group 3 (Titamax CM) and Group 4 (Strong SW Morse) received two-piece abutments. Tightening torque and reverse torque were applied, after 5 minutes, on all abutments. After that, tightening torque was applied to all the abutments, and were mechanically loaded and uninstalled. The two-piece abutments of Group 3 and Group 4 were divided in two subgroups (Subgroup 3a and Subgroup 4a: traction test required to remove the implant - pull out). The specimens were submitted to fatigue tests consisting of 1.200.000 cycles at a frequency of 2 Hz, dynamic compressive load of 50 N, and an angle of 30°. Data were analyzed through the normal distribution (Shapiro-Wilk, p> 0.05), followed by parametric statistical tests. Results After mechanical loading torque loss was higher in Group 4 (over 70% loss), followed by Group 1, Group 2 and Group 3 (over 50% loss). Group 1 and Group 2 presented no statistical difference. Subgroup 3a presented higher traction strength seating in post removal after mechanical loading (67.91 N), while Subgroup 4a presented only 1.92 N, it may present greater loosening of abutments. Conclusions The mechanical load significantly reduced the removal torque of the four groups of abutments tested, in addition to increasing frictional lock installation to the abutments of Subgroup 3a in the pull out test.

Influence of Abutment Design on Stress Distribution in Narrow Implants with Marginal Bone Loss: A Finite Element Analysis.

The aim of this study was to determine the effect of solid (one-piece) and two-piece abutments on the stress profile of narrow implants with marginal bone loss. Solid and two-piece abutments were connected to a conical internal octagon-connection implant (3.3 mm in diameter, 10 mm in length) and restored with a single crown. Three-dimensional finite element analysis was used to simulate the stress distribution in implant models with different levels of marginal bone resorption (0, 1, 2, and 3 mm). The effect of the design variables under increased bone resorption scenarios, including abutment screw length and diameter, was assessed. Static loading was applied to determine the mechanical response of the implant and cortical and trabecular bone. Marginal bone resorption levels dominated the mechanical response under static loading conditions. A marginal bone loss of 3 mm significantly increased stress values in the implant vicinity and abutment screw. Both abutment designs displayed similar stress distribution in the surrounding bone, but lower stress values were observed in the implant body with two-piece abutments. The abutment screw length was more effective in the resultant stress, as the longer screws reduced the stress in the implants. Marginal bone resorption magnitude is the crucial parameter in biomechanics to determine the mechanical behavior. As bone loss increases, resultant stress around implants under mastication forces may lead to implant failure, regardless of abutment type.

Hybrid Implant Abutments: A Literature Review

AbstractCeramic implant abutments are becoming increasingly popular due to the growing esthetic demands of patients. Two-piece ceramic abutments have the advantages of both ceramic and titanium abutments. This study aimed to review the published articles regarding hybrid abutments and their characteristics.Published articles regarding two-piece abutments were retrieved by electronic search of PubMed, Embase, Scopus, Medline, and Google Scholar databases using certain keywords. Articles highly relevant to our topic of interest were selected and reviewed.The presence of titanium inserts in hybrid abutments can overcome the brittleness of ceramic, increase the overall fracture resistance, prevent the implant connection wear, and provide better marginal fit compared with one-piece zirconia abutments. Hybrid abutments enable the fabrication of monolithic metal-free implant restorations with optimal esthetics. Furthermore, the risk of porcelain chipping, which is a common complication of implant restorations, is eliminated due to the monolithic structure of these restorations.According to the available literature, hybrid implant abutments have shown promising results with regard to optimal esthetics in the rehabilitation of the esthetic zone. However, long-term clinical studies are required to assess the long-term durability of all-ceramic restorations supported by hybrid abutments.

Clinical Performance of a Novel Two-Piece Abutment Concept: Results from a Prospective Study with a 1-Year Follow-Up.

Development of a stable and healthy soft-tissue barrier around dental implants is key to long-term success of implant-supported prostheses. The novel two-piece abutment concept shifts the prosthetic interface to the soft-tissue level to protect bone interface/connective tissue during the healing phase and restorative procedures. This prospective study included 72 patients treated with 106 implants to support a single-tooth or a three-unit bridge restored with two-piece abutments. The evaluation included marginal bone level change (MBLC), implant and prosthetic survival, soft-tissue health including keratinized mucosa height and mucosal margin position, patient quality of life (QoL) and satisfaction, and clinician satisfaction and ease-of-use rating of the concept. Mean MBLC from implant placement to 1 year was −0.36 ± 1.26 mm (n = 89), the 1-year implant and prosthetic survival rates were 97.1 and 96.7%, respectively, while keratinized mucosa height increased from 2.9 ± 1.2 mm at prosthetic delivery to 3.2 ± 1.3 mm, and mucosal margin migrated coronally by 0.49 ± 0.61 mm by 1 year. Patient satisfaction and QoL were high. Clinicians were satisfied with the esthetic and functional results and rated the concept as easy to use. In conclusion, the novel two-piece abutment concept promotes good peri-implant tissue health, while providing an easy-to-use workflow and high treatment satisfaction to both patients and clinicians.

Fracture strength analysis of titanium insert-reinforced zirconia abutments according to the axial height of the titanium insert with an internal connection.

This study aimed to analyze fracture strength in vitro by varying the axial height of the titanium insert and the labial height of the zirconia abutment in an internal connection implant to identify the titanium insert axial height with optimal mechanical stability. Sixty implants with an internal connection system were used. Two-piece zirconia abutments were used with the titanium inserts. Combinations of different titanium insert axial heights (mm) and zirconia abutment labial heights (mm) constituted five groups: Gr1 (1-3), Gr2 (3-3), Gr3 (3-5), Gr4 (5-3), and Gr5 (5-5). After thermocycling, a fracture load test was performed with a universal testing machine. The initial deformation load and the fracture load were measured and analyzed. The fractured surface and cross-section of the specimens were examined by scanning electron microscopy (SEM). The groups of titanium inserts with axial heights of 3 mm and 5 mm showed significantly greater initial deformation load and fracture load than the group with an axial height of 1 mm (p < 0.05), but there was no significant difference between the two groups with axial heights of 3 mm and 5 mm. The labial height of the zirconia abutment had no significant influence on the initial deformation load and fracture load. In some specimens in Gr4 and Gr5, cracking or bending of the titanium insert and abutment screw was observed on SEM. The axial height of the titanium insert should be designed to not be less than 3 mm to increase the fracture strength and promote the long-term stability of implants.

Tribological Behaviour of Ti or Ti Alloy vs. Zirconia in Presence of Artificial Saliva

Abutment is the transmucosal component in a dental implant system and its eventual appearance has a major impact on aesthetics: use of zirconia abutments can be greatly advantageous in avoiding this problem. Both in the case of one and two-piece zirconia abutments, a critical issue is severe wear between the zirconia and titanium components. High friction at this interface can induce loosening of the abutment connection, production of titanium wear debris, and finally, peri-implant gingivitis, gingival discoloration, or marginal bone adsorption can occur. As in vivo wear measurements are highly complex and time-consuming, wear analysis is usually performed in simulators in the presence of artificial saliva. Different commercial products and recipes for artificial saliva are available and the effects of the different mixtures on the tribological behaviour is not widely explored. The specific purpose of this research was to compare two types of artificial saliva as a lubricant in titanium–zirconia contact by using the ball on disc test as a standard tribological test for materials characterisation. Moreover, a new methodology is suggested by using electrokinetic zeta potential titration and contact angle measurements to investigate the chemical stability at the titanium–lubricant interface. This investigation is of relevance both in the case of using zirconia abutments and artificial saliva against chronic dry mouth. Results suggest that an artificial saliva containing organic corrosion inhibitors is able to be firmly mechanically and chemically adsorb on the surface of the Ti c.p. or Ti6Al4V alloy and form a protective film with high wettability. This type of artificial saliva can significantly reduce the friction coefficient and wear of both the titanium and zirconia surfaces. The use of this type of artificial saliva in standard wear tests has to be carefully considered because the wear resistance of the materials can be overestimated while it can be useful in some specific clinical applications. When saliva is free from organic corrosion inhibitors, wear occurs with a galling mechanism. The occurrence of a super-hydrophilic saliva film that is not firmly adsorbed on the surface is not efficient in order to reduce wear. The results give both suggestions about the experimental conditions for lab testing and in vivo performance of components of dental implants when artificial saliva is used.

Biomechanical behavior of three different types of internal tapered connections after cyclic and static loading tests: experimental in vitro

BackgroundIn the long-term success of a dental implant, the reliability and stability of the implant-abutment interface are important. Studies of maximum force of dental implants with different loading values have been used. This study aims to evaluate the influence of the oblique cyclic loading on the maximum force supported in one-piece and two-piece abutments installed on internal tapered implants.FindingsSixty implants and sixty prosthetic abutments were divided into six groups (n = 10): G1 and G2 (two-piece abutments with 16°), G3 and G4 (two-piece abutments with 11.5°), and G5 and G6 (one-piece abutments with 11.5°). A 2-Hz cyclic loading was applied to specimens of G2, G4, and G6, with a number of cycles of 2,400,000. All specimens were inclined by 30° from the vertical axis, and a vertical loading was applied over the tapered connections (ISO 14801). Then, the maximum force was tested by applying a static compression load on the specimens of the 6 groups tested (30°) at a rate of 0.5 mm/s. Statistical analysis was performed using the Shapiro-Wilk (p > 0.05) and Levene (p = 0.789) tests to determine if the data presented homoscedasticity and the Tukey test for multiple comparisons. Tukey test showed that the maximum force supported by G1 and G2 was not affected by the cyclic load, while in G3 and G4 it decreased significantly when subjected to the cyclic load. The G5 and G6 had a significant increase in maximum force supported when subjected to cyclic load.ConclusionsCyclic loading influenced the maximum force supported of G4 and G6 but did not influence G2.

Retentive Force of Glass-Ceramic Soldered Customized Zirconia Abutment Copings with Prefabricated Titanium Bases.

Two-piece abutments consisting of customized zirconia abutment copings and prefabricated titanium bases are popular due to their biological and esthetic advantages. Glass–ceramic solder (GS) is an alternative biocompatible connective agent. This in vitro study evaluated the retentive force of GS in comparison to classical resin composite cements (RC) after artificial aging and autoclaving. Ninety specimens consisting of prefabricated titanium bases and zirconia abutment copings were fabricated. The two parts of each specimen were fixed either by RC (n = 30) or GS with a luting space of either 30 µm (n = 30) or 100 µm (n = 30). Ten specimens of each group underwent autoclaving before artificial aging (water storage, thermocycling). Twenty specimens (including the 10 autoclaved specimens) of each group were exposed to a mechanical load. The retentive force between the zirconia and titanium in all specimens was determined. A fractographic analysis was performed to analyze the fracture surfaces of the GS specimens. The RC- and GS-connected two-piece abutments showed no relevant differences, independent of the luting space. RC appears to be more vulnerable to the thermal and mechanical loads than GS. Thus, GS may be an appropriate alternative to RC for two-piece abutments, especially for patients with enhanced biocompatibility requirements.

Laboratory Evaluation of Torque Loss in Titanium, One-Piece and Two-Piece Zirconia Abutments Under Cyclic Loading

Background: Screw loosening is one of the most common problems associated with implant-supported prostheses. The type and material of the abutment play an important role in the esthetic appearance of implant-supported restorations. Metal abutments create an unaesthetic grayish halo in the gingival margin of the implant due to the reflection of light from the surface of titanium abutment. Zirconia is highly popular for the fabrication of abutments due to its optimal color, along with the quality of light transmission and its resistance. The present study aimed to evaluate the torque loss in titanium and one- and two-piece zirconia abutments under cyclic loading. Methods: In general, 24 abutments in three groups (n=8) of one- and two-piece zirconia abutments, and titanium abutments were evaluated in this experimental study. The abutments were attached to the analog of fixtures with 30 N/cm torque and the samples were subjected to loads applied to the center of abutments at 30° angle. After cyclic loading, the removal torque value was measured for each abutment and its numerical mean was calculated as well. Finally, the groups were compared using SPSS16 via ANOVA and Games-Howell tests at a 0.05 level of significance. Results: The mean removal torque value was 23.925, 23.913, and 22.538 N/cm in titanium and two- and one-piece zirconia abutments, respectively, with no statistically significant difference in between (P&gt;0.05). Conclusions: The highest mean removal torque value belonged to prefabricated titanium abutments while the lowest value was related to one-piece zirconia abutments.

The Influence of a Positioning Hex on Abutment Rotation in Tapered Internal Implants: A 3D Finite Element Model Study

The purpose of this study was to investigate the resistance against rotation of a two-piece abutment with or without the presence of a positioning hex in tapered internal connection implant systems. A tapered internal connection implant with an 11-degree internal oblique angle was placed into a constructed three-dimensional (3D) bone model. Two types of abutments were compared: hex-type abutments with a positioning hex and two-piece round-type nonhex abutments. Vertical compressions equivalent to the screw tightening torque of 30 Ncm and 40 Ncm were applied to the abutment screws. A horizontal load of 150 N was applied to the superstructure to create moments. The contact area between the implant and abutment was compared and analyzed. The rotational displacement of the abutments was investigated as well. When a preload equivalent to 40 Ncm of tightening torque was applied, the round-type abutment exhibited a larger contact area than the hex-type abutment by approximately 2.5% to 3.5% in contrast to the internal surface area of the implant. When the screw tightening torque of 30 Ncm was applied, the rotational displacement of the hex-type abutment was approximately 0.54 degrees and the round-type was approximately 1.16 degrees under clockwise moment loading. Within the limitations of this study, it can be assumed that the hexagonal design of the abutment acts as rotational resistance against moments.

Axial Displacements and Removal Torque Changes of Five Different Implant-Abutment Connections under Static Vertical Loading.

The aim of this study was to examine the settling of abutments into implants and the removal torque value under static loading. Five different implant-abutment connections were selected (Ext: external butt joint + two-piece abutment; Int-H2: internal hexagon + two-piece abutment; Int-H1: internal hexagon + one-piece abutment; Int-O2: internal octagon + two-piece abutment; Int-O1: internal octagon + one-piece abutment). Ten implant-abutment assemblies were loaded vertically downward with a 700 N load cell at a displacement rate of 1 mm/min in a universal testing machine. The settling of the abutment was obtained from the change in the total length of the entire implant-abutment unit before and after loading using an electronic digital micrometer. The post-loading removal torque value was compared to the initial torque value with a digital torque gauge. The settling values and removal torque values after 700 N static loading were in the following order, respectively: Ext < Int-H1, Int-H2 < Int-O2 < Int-O1 and Int-O2 < Int-H2 < Ext < Int-H1, Int-O1 (α = 0.05). After 700 N vertical static loading, the removal torque values were statistically different from the initial values, and the post-loading values increased in the Int-O1 group and Int-H1 group (α = 0.05) and decreased in the Ext group, Int-H2 group, and Int-O2 group (α = 0.05). On the basis of the results of this study, it should be taken into consideration that a loss of the preload due to the settling effect can lead to screw loosening during a clinical procedure in the molar region where masticatory force is relatively greater.