A comparative study of gold UCLA-type and CAD/CAM titanium implant abutments

PURPOSE: The aim of this study was to evaluate the interface accuracy of computer-assisted designed and manufactured (CAD/CAM) titanium abutments and implant fixture compared to gold-cast UCLA abutments. MATERIALS AND METHODS: An external connection implant system (Mark III, n=10) and an internal connection implant system (Replace Select, n=10) were used, 5 of each group were connected to milled titanium abutment and the rest were connected to the gold-cast UCLA abutments. The implant fixture and abutment were tightened to torque of 35 Ncm using a digital torque gauge, and initial detorque values were measured 10 minutes after tightening. To mimic the mastication, a cyclic loading was applied at 14 Hz for one million cycles, with the stress amplitude range being within 0 N to 100 N. After the cyclic loading, detorque values were measured again. The fixture-abutment gaps were measured under a microscope and recorded with an accuracy of +/-0.1 microm at 50 points. RESULTS: Initial detorque values of milled abutment were significantly higher than those of cast abutment (P.05). After cyclic loading, detorque values of cast abutment increased, but those of milled abutment decreased (P<.05). There was no significant difference of gap dimension between the milled abutment group and the cast abutment group after cyclic loading. CONCLUSION: In conclusion, CAD/CAM milled titanium abutment can be fabricated with sufficient accuracy to permit screw joint stability between abutment and fixture comparable to that of the traditional gold cast UCLA abutment.

The effect of screw tightening techniques on the detorque value in internal connection implant superstructure / 대한치과보철학회지

PURPOSE: This study evaluated the effect of different screw tightening sequences and methods on detorque values in a well-fitting implant superstructure. MATERIAL AND METHODS: A fully edentulous mandibular master model and a metal framework directly connected to four parallel implants (Astra Tech) with a passive fit to each other were fabricated. Six stone casts were made with a splinted impression technique to represent a 'well-fitting' situation with the metal framework. Detorque values were measured twice after screw tightening using 20 Ncm. Detorque values and minimum detorque values for three screw tightening sequences (1-2-3-4, 2-4-3-1, and 2-3-1-4) and for two tightening methods (two-step and one-step) were analyzed using multi-way analysis of variance and two-way analysis of variance, respectively, at a .05 level of significance. RESULTS: The mean detorque values for screw tightening sequences ranged from 12.8 Ncm (2-4-3-1) to 13.1 Ncm (2-3-1-4), and for screw tightening methods were 13.1 Ncm (two-step) and 11.8 Ncm (one-step). The mean of mimimum detorque values for screw tightening sequences were 11.1 Ncm (1-2-3-4) and 11.2 Ncm (2-4-3-1 and 2-3-1-4), and for screw tightening methods were 11.2 Ncm (two-step) and 9.9 Ncm (one-step). No statistically significant differences among three screw tightening sequences were found for detorque values and for mimimum detorque values. But, statistically significant differences between two screw tightening methods were found for two values. Two-step screw tightening method showed higher detorque value (P = .0003) and higher minimum detorque value (P = .0035) than one-step method. CONCLUSION: Within the limitations of this study, the screw tightening sequence was not a critical factor for the detorque values in a well-fitting implant superstructure by the splinted impression technique. But, two-step screw tightening method showed greater detorque values than one-step method.

Detorque values of abutment screws in a multiple implant-supported prosthesis / 대한치과보철학회지

PURPOSE: This study evaluated the detorque values of screws in a multiple implant-supported superstructure using stone casts made with 2 different impression techniques. MATERIAL AND METHODS: A fully edentulous mandibular master model and a metal framework directly connected to four implants (Branemark System(R); Nobel Biocare AB) with a passive fit to each other were fabricated. Six experimental stone casts (Group 1) were made with 6 non-splinted impressions on a master cast and another 6 experimental casts (Group 2) were made with 6 acrylic resin splinted impressions. The detorque values of screws (TorqTite(R) GoldAdapt Abutment Screw; Nobel Biocare AB) were measured twice after the metal framework was fastened onto each experimental stone cast with 20 Ncm torque. Detorque values were analyzed using the mixed model with the fixed effect of screw and reading and the random effect of model for the repeated measured data at a .05 level of significance. RESULTS: The mean detorque values were 7.9 Ncm (Group 1) and 8.1 Ncm (Group 2), and the mean of minimum detorque values were 6.1 Ncm (Group 1) and 6.5 Ncm (Group 2). No statistically significant differences between 2 groups were found and no statistically significant differences among 4 screws were found for detorque values. No statistically significant differences between 2 groups were also found for minimum detorque values. CONCLUSION: In a multiple external hexagon implant-supported prosthesis, no significant differences between 2 groups were found for detorque values and for minimum detorque values. There seems to be no significant differences in screw joint stability between 2 stone cast groups made with 2 different impression techniques.

Effect of casting procedure on screw loosening of UCLA abutment in two implant-abutment connection systems / 대한치과보철학회지

STATEMENT OF PROBLEM: The cast abutment has advantages of overcoming angulation problem and esthetic problem. However, when a gold-machined UCLA abutment undergoes casting, the abutment surfaces in contact with the implant may change. PURPOSE: The purpose of this study was to compare the detorque values of prefabricated machined abutments with gold-premachined cast-on UCLA abutments before and after casting in two types of internal implant-abutment connection systems: (1) internal hexagonal joint, (2) internal octagonal joint. Furthermore, the detorque values of two implant-abutment connection systems were compared. MATERIALS AND METHODS: Twenty internal hexagonal implants with an 11-degree taper and twenty internal octagonal implants with an 8-degree taper were acquired. Ten prefabricated titanium abutments and ten gold-premachined UCLA abutments were used for each systems. Each abutment was torqued to 30 Ncm according to the manufacturer's instructions and detorque value was recorded. The detorque values were measured once more, after casting with gold alloy for UCLA abutment, and preparation for titanium abutments. Group means were calculated and compared using independent t-test and paired t-test (alpha=0.05). RESULTS: The results were as follows: 1. The detorque values between titanium abutments and UCLA-type abutments showed significant differences in internal octagonal implants (P0.05). 2. In comparison of internal hexagonal and octagonal implants, the detorque values of titanium abutments had significant differences between two connection systems on the initial analysis (P0.05) and the detorque values of UCLA-type abutments were not significantly different between two connection systems (P>0.05). 3. The detorque values of titanium abutments and UCLA-type abutments decreased significantly on the second analysis than the initial analysis in internal hexagonal implants (P0.05). CONCLUSION: Casting procedures of UCLA-type abutments had no significant effect on screw loosening in internal implant-abutment connection systems, and UCLA-type abutments showed higher detorque values than titanium abutments in internal octagonal implants.

The effect of screw tightening sequence and tightening method on the detorque value in implant-supported superstructure / 대한치과보철학회지

STATEMENT OF PROBLEM: The screw detorque value is a measure of the preload remaining in the screw just before detorquing. PURPOSE: This study evaluated the effect of different screw tightening sequences and tightening methods on detorque values for a well-fitting implant superstructure. MATERIAL AND METHOD: An implant superstructure that connected directly to four implants (Astra Tech) was fabricated on a fully edentulous mandibular acrylic resin model. Six wellfitting dental stone casts were made with a pickup impression of the superstructure from the acrylic resin model. To evaluate the effect of three screw tightening sequences (1-2-3-4, 2-4-3-1, and 2-3-1-4) and two tightening methods (2-step and 1-step) on the stability of screw joint, the detorque values for a well-fitting implant superstructure were measured twice after screw tightening using 20 Ncm. Detorque values were analyzed using multi-way analysis of variance and two-way analysis of variance at a .05 level of significance. RESULTS: 1. The mean detorque values for three screw tightening sequences were 12.3 Ncm, 12.6 Ncm, and 12.0 Ncm, respectively. 2. The mean detorque values for two screw tightening methods were 12.0 Ncm, and 12.2 Ncm, respectively. 3. The mean of mimimum detorque values for three screw tightening sequences and for two tightening methods were 10.6 Ncm, 11.1 Ncm, 10.5 Ncm, and 9.8 Ncm, respectively. 4. No statistically significant differences among the variables of screw tightening sequence and tightening method were found (p>.05) for detorque values and for mimimum detorque values. CONCLUSION: Within the limitations of this study, the screw tightening sequence and tightening method did not have a significant effect on the detorque values for a well-fitting implant superstructure.

The influence of implant fixture-abutment connection design on screw loosening / 대한치과보철학회지

PURPOSE: Current trend in implant dentistry is changing from external connection to internal connection. To evaluate the splinting of external and internal connection implant on screw loosening, 2-units prosthesis was fabricated with BioPlant System(R) of external connection type and Lifecore STAGE-1 Single Stage Implant System(R) of internal connection type. MATERIAL AND METHOD: Experimental group is classified into three groups. 1) G1-EE: 2-units prosthesis was fabricated with two BioPlant System. of external connection type. 2) G1-EI: 2-units prosthesis was fabricated with one BioPlant System(R) of external connection type and one Lifecore STAGE-1 Single Stage Implant System(R) of internal connection type. 3) G1-II: 2-units prosthesis was fabricated with two Lifecore STAGE-1 Single Stage Implant System(R) of internal connection type. In fabricating 2-units prosthesis, two hexed abutments are recommended when two implants are installed parallel, otherwise one hexed abutment is used on major occlusal force area and one nonhexed abutment is used on the other area. Since it is rare to find two implants being parallel, it is hard to fabricate prosthesis with passive adaptation using two hexed abutments. It is much more difficult to acquire passive adaptation when using hex abutment compared to nonhex abutment. To evaluate the influence of hexed and nonhexed abutment on screw loosening, 2-units prosthesis was fabricated with hexed and nonhexed abutment. Experimental group is classified into three groups. 1) G2-HH: 2-units prosthesis was fabricated with two hexed abutments. 2) G2-HN: 2-units prosthesis was fabricated with one hexed abutment and one nonhexed abutment. 3) G2-NN: 2-units prosthesis was fabricated with two nonhexed abutments. RESULT: The results of comparing the detorque value after loading on a each prosthesis periodically are as follows. 1. In splinting group of external and internal connection implant, G1-II group demonstrated the biggest detorque value, followed by G1-EI group and G1-EE group. 2. There is no notable significance between external connection implant of G1-EI group and G1-EE group and also no significance between internal connection implant of G1-EI group and G1-II group. 3. G2-HH group showed higher detorque value than G2-HN and G2-NN group. From the results, we can concluded that using both external connection and internal connection implant together is clinically acceptable and in order to acquire a good passive adaptation in fabricating 2-units implant prosthesis we can use two nonhexed abutments.

The effect of internal implant-abutment connection and diameter on screw loosening / 대한치과보철학회지

STATEMENT OF PROBLEM: One of the common problems of dental implant prosthesis is the loosening of the screw that connects each component, and this problem is more common in single implant-supported prostheses with external connection, and in molars. PURPOSE: The purposes of this study were: (1) to compare the initial abutment screw detorque values of the six different implant-abutment interface designs, (2) to compare the detorque values of the six different implant-abutment interface designs after cyclic loading, (3) to compare the detorque values of regular and wide diameter implants and (4) to compare the initial detorque values with the detorque values after cyclic loading. MATERIAL AND METHODS: Six different implant-abutment connection systems were used. The cement retained abutment and titanium screw of each system were assembled and tightened to 32Ncmwith digital torque gauge. After 10 minutes, initial detorque values were measured. The custom titanium crown were cemented temporarily and a cyclic sine curve load(20 to 320N, 14Hz) was applied. The detorque values were measured after cyclic loading of one million times by loading machine. One-way ANOVA test, scheffe's test and Mann-Whitney U test were used. RESULTS: The results were as follows : 1. The initial detorque values of six different implant-abutment connections were not significantly different(p> 0.05). 2. The detorque values after one million dynamic cyclic loading were significantly different (p <0.05). 3. The SS-II regular and wide implant both recorded the higher detorque values than other groups after cyclic loading(p <0.05). 4. Of the wide implants, the initial detorque values of Avana Self Tapping Implant, MIS and Tapered Screw Vent, and the detorque values of MIS implant after cyclic loading were higher than their regular counterparts(p <0.05). 5. After cyclic loading, SS-II regular and wide implants showed higher detorque values than before(p <0.05).

The effect of abutment height on screw loosening in single implant-supported prostheses after dynamic cyclic loading / 대한치과보철학회지

STATEMENT OF PROBLEM: One of the common problems of dental implant prosthesis is the loosening of the screw that connects each component, and this problem is more common in single implant-supported prostheses with external connection. PURPOSE: The purpose of this study was to examine the changes of detorque values of abutment screws with external connection in different abutment heights. MATERIALS AND METHODS: After cyclic loading on three different abutment heights, detorque values were measured. Abutments were retained with titanium abutment screws tightened to 30 Ncm (30.5 kgmm) with digital torque gauge as recommended by the manufacturer. Replacing abutments, implants and titanium abutment screws with new ones at every measurement, initial detorque values were measured six times. In measuring detorque values after cyclic loading, Avana Cemented Abutments of 4.0 mm collar, 7.0 mm height (Osstem Co., Ltd., Seoul, Korea) were used with three different lengths of 5.0, 8.0, 11.0 mm. Shorter abutments were made by milling of 11.0 mm abutment to have the same force-exercised area of 4.5 mm diameter. Sine curve force (20N-320N, 14Hz) was applied, and detorque values were measured after cyclic loading of 2 million times by loading machine. Detorque values of initial and after-loading were measured by digital torque gauge. One-way ANOVA was employed to see if there was any influence from different abutment heights. RESULTS: The results were as follows : 1. The initial detorque value was 27.8+/-0.93 kgmm, and the ratio of the initial detorque value to the tightening torque was 0.91(27.8/30.5). 2. Measured detorque values after cyclic loading were declined as the height of the abutment increased, that was, 5.0 mm; 22.3+/-0.82 kgmm, 8.0 mm; 21.8+/-0.93 kgmm, and 11.0 mm; 21.3+/-0.94 kgmm. 3. One-way ANOVA showed no statistically significant differences among these (p> 0.05). 4. Noticeable mobility at the implant-abutment interface was not observed in any case after cyclic loading at all.

A study of screw loosening after dynamic continous fatigue test of several abutment screw / 대한치과보철학회지

STATEMENT OF PROBLEM: Chronic implant screw loosening remains a problem in restorative practices. Some implant manufactureres have introduced abutment screws with treated material, surfaces and macrostructures in an effort to reduce potential loosening. PURPOSE: This study evaluated the materials and loading cycles on detorque value after dynamic continous fatigue test in the sinulated conditions of posterior single restoration. MATERIAL AND METHOD: Fourteen of each of the following abutment screws - titanium alloy, gold alloy, gold-tite, and titanium alloy modified - were used in test. SEM is used to verify macrostructures of each screws. ZrO2/Al2O3 composite abutment was tightened on 4x10.0mm titanium external implant at 30 Ncm. Cyclic loading machine delivered dynamic loading forces between 20 and 320N for 100,000, 200,000, 300,000, 500,000, and 1,000,000 cycles at frequencies 14Hz. Torque and detorque value after loading was measured. RESULTS: All measued screws had different screw length and thread form. Titanium modified screw had greater detorque value than others before and after cyclic loadings(p<0.05). All abutment screws had no significant change in mean percentage of detorque value after loading to initial value after less than 500,000 cyclic loadings, but significant lower value after 1,000,000 cycles(p<0.05). CONCLUSION: Within limintations of this study, all abutment screws may be loosend after about1 year use. Annual check-up is nessasary to prevent screw loosening.