Stresses in Implant-Supported Fixed Complete Dentures with Different Screw-Tightening Sequences and Torque Application Modes.

PURPOSE: To compare the effects of different screw-tightening sequences and torque applications on stresses in implant-supported fixed complete dentures supported by five abutments. MATERIALS AND METHODS: Strain gauges fixed to the abutments were used to test the sequences 2-4-3-1-5; 1-2-3-4-5; 3-2-4-1-5; and 2-5-4-1-3 with direct 10-Ncm torque or progressive torque (5 + 10 Ncm). Data were analyzed using analysis of variance and standardized effect size. RESULTS: No effects of tightening sequence or torque application were found except for the sequence 3-2-4-1-5 and some small to moderate effect sizes. CONCLUSION: Screw-tightening sequences and torque application modes have only a marginal effect on residual stresses.

Effect of removal and reinsertion of force-closed stems on deformation of total hip arthroplasty.

OBJECTIVES: This study investigated removal of a force-closed stem, done in order to improve acetabular exposure during revision, with reinsertion afterwards. It is unknown how much this procedure modifies the stem/cement interface. METHODS: Three tapered stem models were implanted into composite femurs. Strain gauges were embedded in the medial aspect of the cement mantle and in several positions on the outer surface of the femurs. The deformation was measured during static loading, which was applied at two different times: after implantation and after one million loading cycles, followed by stem removal and reinsertion. The t test was performed. The differences in deformation were compared (at p ≤ 0.05) between the two static loading times and among the three stem designs. RESULTS: No significant differences in deformation were found after the two loading times for the three models. No significant differences in the initial deformations of the three models were found for most of the gauges attached to the femurs. CONCLUSIONS: Reinsertion of the force-closed stem does not alter the load transmission from the stem to the cement and to the surface of the femur, even after one million loading cycles.

OBJETIVOS: Estudo da remoção de haste do tipo force-closed e a sua reinserção posterior para aumentar a exposição do acetábulo durante a revisão. Não é conhecido o quanto esse procedimento modifica a interface haste/cimento. MÉTODOS: Três modelos de hastes afiladas foram implantadas em fêmures compósitos. Extensômetros de deformação foram embebidos no aspecto medial do manto de cimento e em diversas posições sobre a superfície externa dos fêmures. As deformações foram medidas durante cargas estáticas, as quais foram aplicadas em dois diferentes momentos: após a implantação e após um milhão de ciclos de carga, seguido pela remoção e reinserção. O teste t foi feito. As diferenças entre as deformações foram confrontadas com p ≤ 0,05 entre os dois momentos de carga estática e entre os três projetos de hastes. RESULTADOS: Não foram encontradas diferenças significativas nas deformações após os dois momentos de carga para os três modelos. Não foram encontradas diferenças significativas nas deformações iniciais dos três modelos para a maioria dos extensômetros aderidos aos fêmures. CONCLUSÕES: A reinserção de haste do tipo force-closed não altera a transmissão de carga da haste para o cimento e para a superfície do fêmur, mesmo após um milhão de ciclos.

Effect of removal and reinsertion of force-closed stems on deformation of total hip arthroplasty / Efeito da remoção e reinserção de hastes tipo force-closed nas deformações da artroplastia total de quadril

This study investigated removal of a force-closed stem, done in order to improve acetabular exposure during revision, with reinsertion afterwards. It is unknown how much this procedure modifies the stem/cement interface. METHODS: Three tapered stem models were implanted into composite femurs. Strain gauges were embedded in the medial aspect of the cement mantle and in several positions on the outer surface of the femurs. The deformation was measured during static loading, which was applied at two different times: after implantation and after one million loading cycles, followed by stem removal and reinsertion. The t test was performed. The differences in deformation were compared (at p ≤ 0.05) between the two static loading times and among the three stem designs. RESULTS: No significant differences in deformation were found after the two loading times for the three models. No significant differences in the initial deformations of the three models were found for most of the gauges attached to the femurs. CONCLUSIONS: Reinsertion of the force-closed stem does not alter the load transmission from the stem to the cement and to the surface of the femur, even after one million loading cycles.

Estudo da remoção de haste do tipo force-closed e a sua reinserção posterior para aumentar a exposição do acetábulo durante a revisão. Não é conhecido o quanto esse procedimento modifica a interface haste/cimento. MÉTODOS: Três modelos de hastes afiladas foram implantadas em fêmures compósitos. Extensômetros de deformação foram embebidos no aspecto medial do manto de cimento e em diversas posições sobre a superfície externa dos fêmures. As deformações foram medidas durante cargas estáticas, as quais foram aplicadas em dois diferentes momentos: após a implantação e após um milhão de ciclos de carga, seguido pela remoção e reinserção. O teste t foi feito. As diferenças entre as deformações foram confrontadas com p ≤ 0,05 entre os dois momentos de carga estática e entre os três projetos de hastes. RESULTADOS: Não foram encontradas diferenças significativas nas deformações após os dois momentos de carga para os três modelos. Não foram encontradas diferenças significativas nas deformações iniciais dos três modelos para a maioria dos extensômetros aderidos aos fêmures. CONCLUSÕES: A reinserção de haste do tipo force-closed não altera a transmissão de carga da haste para o cimento e para a superfície do fêmur, mesmo após um milhão de ciclos.

Migration and strains induced by different designs of force-closed stems for THA / Migração e deformações induzidas por diferentes hastes do tipo force-closed para ATQ

Subtle differences in stem design can result in different mechanical responses of the total hip arthroplasty. Tests measuring migration of the stem relative to the femur, as well as the strains in the cement mantle and on the femur can detect different mechanical behavior between stems. Methods: In this article, conical, double and triple tapered stems were implanted in composite femurs and subjected to static and cyclic loads. Stems differed mainly on taper angle, calcar radius and proximal stiffness. Stem migration and strains on the femur and in the cement mantle were achieved. Results: Significant differences (p < 0.05) were noted in the permanent rotation between double and triple tapers, in the strains on the proximal medial femur between triple and both conical and double tapers, and in the strains on the lateral proximal femur between double tapers and both conical and triple tapers. Conclusion: The proposed mechanical tests were able to detect significant differences in the behavior of these resembling stems. Stem proximal stiffness and the calcar radius of the stem influence its rotational stability and the strain transmission to the femur.

Diferenças sutis no projeto da haste podem resultar em diferentes respostas mecânicas da artroplastia total do quadril. Testes que meçam a migração da haste em relação ao fêmur, bem como as deformações no cimento e no fêmur, podem salientar as diferenças entre diferentes projetos de hastes. MÉTODOS: Neste artigo foram implantadas hastes cônicas, hastes duplamente afiladas e triplamente afiladas em fêmures compósitos e submetidas a cargas estáticas e cíclicas. As hastes diferenciaram-se principalmente em relação aos afilamentos, ao raio do calcar e à rigidez proximal. A migração das hastes e as deformações tanto no fêmur quanto no cimento foram medidas. RESULTADOS: Foram observadas diferenças significativas (p < 0,05) na rotação permanente entre as hastes duplamente e triplamente afiladas, nas deformações do nível proximal medial do fêmur entre as hastes triplamente afiladas e ambas cônicas e duplamente afiladas e nas deformações do nível proximal lateral do fêmur entre as hastes duplamente afiladas e ambas cônicas e triplamente afiladas. CONCLUSÃO: Os ensaios mecânicos propostos foram capazes de produzir diferenças significativas no comportamento dessas hastes semelhantes. A rigidez proximal da haste e o raio do calcar influenciam a estabilidade rotacional e a transmissão de deformação da haste ao femur.

Stress on implant-supported fixed prostheses with different numbers of abutments after the application of acrylic resin.

STATEMENT OF PROBLEM: Clinical procedures and laboratory processing techniques inevitably induce stress in the implant/abutment/prosthesis system and may have negative effects when different numbers of implants are used. PURPOSE: The purpose of the study was to evaluate the tension on the abutments of implant-supported fixed prostheses and to determine the effect of the application of an esthetic veneer (acrylic resin) and the number of abutments (5 or 4). MATERIAL AND METHODS: Four palladium-silver alloy cast bars were fabricated to simulate implant-supported fixed complete prostheses. Strain gauges were fixed on the abutments to measure the tension before and after the application of the esthetic veneer. The values of tension were measured in models with 5 or 4 abutments. Data were analyzed with a repeated measures ANOVA. RESULTS: No statistically significant differences were found for the main factors (esthetic veneer, P=.22; number of abutments, P=.14) despite the large effect size. CONCLUSIONS: The results of this study suggest that the tension in the abutments of an implant-supported fixed prosthesis is not affected by the application of acrylic resin veneering or by reducing the number of abutments.

Migration and strains induced by different designs of force-closed stems for THA.

OBJECTIVES: Subtle differences in stem design can result in different mechanical responses of the total hip arthroplasty. Tests measuring migration of the stem relative to the femur, as well as the strains in the cement mantle and on the femur can detect different mechanical behavior between stems. METHODS: In this article, conical, double and triple tapered stems were implanted in composite femurs and subjected to static and cyclic loads. Stems differed mainly on taper angle, calcar radius and proximal stiffness. Stem migration and strains on the femur and in the cement mantle were achieved. RESULTS: Significant differences (p < 0.05) were noted in the permanent rotation between double and triple tapers, in the strains on the proximal medial femur between triple and both conical and double tapers, and in the strains on the lateral proximal femur between double tapers and both conical and triple tapers. CONCLUSION: The proposed mechanical tests were able to detect significant differences in the behavior of these resembling stems. Stem proximal stiffness and the calcar radius of the stem influence its rotational stability and the strain transmission to the femur.

OBJETIVOS: Diferenças sutis no projeto da haste podem resultar em diferentes respostas mecânicas da artroplastia total do quadril. Testes que meçam a migração da haste em relação ao fêmur, bem como as deformações no cimento e no fêmur, podem salientar as diferenças entre diferentes projetos de hastes. MÉTODOS: Neste artigo foram implantadas hastes cônicas, hastes duplamente afiladas e triplamente afiladas em fêmures compósitos e submetidas a cargas estáticas e cíclicas. As hastes diferenciaram-se principalmente em relação aos afilamentos, ao raio do calcar e à rigidez proximal. A migração das hastes e as deformações tanto no fêmur quanto no cimento foram medidas. RESULTADOS: Foram observadas diferenças significativas (p < 0,05) na rotação permanente entre as hastes duplamente e triplamente afiladas, nas deformações do nível proximal medial do fêmur entre as hastes triplamente afiladas e ambas cônicas e duplamente afiladas e nas deformações do nível proximal lateral do fêmur entre as hastes duplamente afiladas e ambas cônicas e triplamente afiladas. CONCLUSÃO: Os ensaios mecânicos propostos foram capazes de produzir diferenças significativas no comportamento dessas hastes semelhantes. A rigidez proximal da haste e o raio do calcar influenciam a estabilidade rotacional e a transmissão de deformação da haste ao femur.

The effect of a positioning index on the biomechanical stability of tapered implant-abutment connections.

The biomechanical stability of the implant-abutment connection is critical for the success of implant-supported restorations. This study investigated the effect of a positioning index on the abutment screw preload values of tapered connection implants. Twenty Morse taper implants presenting an internal locking hex received 10 solid and 10 straight screw retained abutments for cemented single-crown restorations. Ten abutments had a positioning index to fit the internal locking hex of the implant (straight), and 10 were locked only by the implant taper (solid). The preload values for each abutment screw after a tightening torque were registered by strain gauges. Prosthetic crowns were placed on each abutment and subjected to mechanical cycling. Detorque forces were applied to each abutment and compared with the initial torque values. Data were statistically analyzed using Kolmogorov-Smirnov and Student t tests. The nonindexed group presented higher initial preload (6.05 N ± 0.95 N) compared with the indexed group (4.88 N ± 0.92 N; P < .05). After cycling, the nonindexed group exhibited less reduction of preload (13.84% ± 6.43%) compared with the indexed group (52.65% ± 14.81%; P < .01). Indexed tapered abutments for single-crown restorations might represent greater biomechanical risk under function.

Thermally induced strains and total shrinkage of the polymethyl-methacrylate cement in simplified models of total hip arthroplasty.

An evaluation of transient and stabilized strains in the cement mantle during polymerization was carried out in simplified cemented total hip arthroplasty (THA) model. A mathematical approach combined with a simple finite element simulation was used to compare measured and calculated stabilized strain values and to provide the Von Mises stresses at the stem/cement interface due to shrinkage related to temperature decrease after exothermal reaction. A second similar model was carried out to measure stem/cement/mold interfacial shear strength and dimensional changes of the cement mantle to obtain total shrinkage due to temperature decrease plus cement polymerization. The results indicated that positive strain peaks found during the exothermic stage of polymerization have the potential to produce pre-loading cracking. After the initial expansion, it was observed a progressive strain decrease pattern down to stabilized values that takes place near 2h after the cementation. Even though there is a great deal of dispersion in the measured stabilized strain values, in average those values match quite well with the numerical simulations, indicating 4,7 MPa von Mises interfacial stress due to thermal shrinkage. The total cement shrinkage leads to a negative radial stress of 11 MPa and 14 MPa von Mises interfacial stress. Finally, total shrinkage has the potential to enhance gaps in the cement/mold interface.

Effect of the number of abutments on biomechanics of Branemark prosthesis with straight and tilted distal implants.

OBJECTIVE: This study aimed to evaluate the bending moments, and compressive and tensile forces in implant-supported prostheses with three, four or five abutments. MATERIAL AND METHODS: Ten Pd-Ag frameworks were tested over two master models with: 1) parallel vertical implants, and 2) tilted distal implants. Strain gauges were fixed on the abutments of each master model to measure the deformation when a static load of 50 N was applied on the cantilever (15 mm). The deformation values were measured when the metallic frameworks were tested over three, four or five abutments, and transformed into force and bending moment values. Data were analyzed by ANOVA and Tukey's test for multiple comparisons at 5% level of significance. RESULTS: Abutment #1 (adjacent to the cantilever) had the highest values of force and sagittal bending moment for all tests with three, four or five abutments. Independently from the number of abutments, axial force in abutment #1 was higher in the vertical model than in the tilted model. Total moment was higher with three abutments than with four or five abutments. Independently from the inclination of implants, the mean force with four or five abutments was lower than that with three abutments. CONCLUSION: The results suggest that in the set-ups with four or five abutments tilted distal implants reduced axial force and did not increase bending moments.

Effect of the number of abutments on biomechanics of Branemark prosthesis with straight and tilted distal implants

OBJECTIVE: This study aimed to evaluate the bending moments, and compressive and tensile forces in implant-supported prostheses with three, four or five abutments. MATERIAL AND METHODS: Ten Pd-Ag frameworks were tested over two master models with: 1) parallel vertical implants, and 2) tilted distal implants. Strain gauges were fixed on the abutments of each master model to measure the deformation when a static load of 50 N was applied on the cantilever (15 mm). The deformation values were measured when the metallic frameworks were tested over three, four or five abutments, and transformed into force and bending moment values. Data were analyzed by ANOVA and Tukey's test for multiple comparisons at 5 percent level of significance. RESULTS: Abutment #1 (adjacent to the cantilever) had the highest values of force and sagittal bending moment for all tests with three, four or five abutments. Independently from the number of abutments, axial force in abutment #1 was higher in the vertical model than in the tilted model. Total moment was higher with three abutments than with four or five abutments. Independently from the inclination of implants, the mean force with four or five abutments was lower than that with three abutments. CONCLUSION: The results suggest that in the set-ups with four or five abutments tilted distal implants reduced axial force and did not increase bending moments.

Effect of cantilever length and inclined implants on axial force and bending moment in implant-supported fixed prostheses / Efeito do cantilever e de implantes inclinados na força axial e momento fletor em próteses fixas implantossuportadas

Purpose: To assess the magnitude and distribution of axial forces and bending moments in abutments as a function of cantilever length and inclination of implants. Methods: Ten metallic bars simulated frameworks of fixed implant-supported prosthesis over two master models with five implants: one with all implants straight and parallel (n=5) and one with the two distal implants tilted (n=5). Strain gauges were fixed on abutments to measure deformation when a 50N-load was applied on the cantilever at 10, 15, and 20mm-distance from the distal abutment. Deformation values were transformed into axial force and bending moment and analyzed by ANOVA and Tukey test (α = 5%). Results: Comparing 10mm- to 20mm-cantilever, there was an increase of approximately 50% for axial force and of 70% for saggital bending moment. On the abutment adjacent to the cantilever, the axial force in the inclined model was 70% lower than in the straight model, and bending moments did not vary. Conclusion: The results suggest that the inclination of distal implants does not have any deleterious biomechanical effect on abutments of the tested models and may reduce the cantilever effect on force magnitude.

Objetivo: Avaliar a magnitude e a distribuição de forças axiais e momentos fletores em pilares em função da extensão do cantilever e da inclinação dos implantes. Metodologia: Dez barras metálicas simularam infraestruturas de prótese fixa implantossuportada sobre dois modelos mestre com 5 implantes: um modelo com todos os implantes retos e paralelos (n=5) e um com os dois implantes distais inclinados (n=5). Extensômetros foram fixados nos pilares para medir sua deformação quando uma carga de 50N foi aplicada no cantilever a 10, 15 e 20 mm do implante distal. Os valores de deformação foram convertidos em força axial e momento fletor e analisados por ANOVA e teste de Tukey (α = 5%). Resultados: Comparando-se as distâncias de 10 e 20 mm, houve um aumento de aproximadamente 50% da força axial e de 70% do momento fletor sagital. No pilar adjacente ao cantilever, a força axial no modelo com implantes inclinados foi 70% menor que no modelo com implantes retos, e os momentos fletores não variaram. Conclusão: Os resultados sugerem que a inclinação dos implantes distais não promoveu nenhum efeito deletério sobre os pilares nos modelos testados e pode reduzir o efeito do cantilever na magnitude da força.

Evaluation of the accuracy of 3 transfer techniques for implant-supported prostheses with multiple abutments.

PURPOSE: This study evaluated the deformation of a metallic framework connected to 15 stone casts fabricated using 3 transfer techniques to determine the most accurate impression procedure. MATERIALS AND METHODS: Five stone casts were made from polyether impressions of an epoxy resin master model for each transfer technique. Group 1 samples were created by the direct splinted technique (square transfer copings splinted with carbon steel pins and autopolymerizing acrylic resin, custom tray); group 2 samples were made by the direct nonsplinted technique (square transfer copings, custom tray); and group 3 samples were fabricated using the indirect technique (tapered transfer copings, custom tray). Sixteen strain gauges were fixed on the framework to measure the degree of framework deformation for each stone cast. Pairs of strain gauges placed opposite each other constituted 1 channel to read deformation (half Wheatstone bridge). Deformation readings were collected at the 4 segments between abutments in 4 directions (anterior, posterior, superior, and inferior). Deformation data were analyzed using analysis of variance and the Tukey test at the .05 and .01 levels of significance. RESULTS: Group 1 samples allowed the most accurate reproduction of analog position compared to the samples made using the other techniques. No significant difference was found between the direct nonsplinted (group 2) and indirect (group 3) techniques. DISCUSSION: Although some studies have evaluated transfer techniques with similar methodology, this study demonstrated the most suitable strain gauge setup to record framework deformations in all directions and simultaneously offset the effects of temperature variation. CONCLUSIONS: The direct splinted technique was the most accurate transfer method for multiple abutments compared to direct nonsplinted and indirect techniques.