Fracture of Reduced-Diameter Zirconia Dental Implants Following Repeated Insertion.

PURPOSE: Achievement of high insertion torque values indicating good primary stability is a goal during dental implant placement. The objective of this study was to evaluate whether or not two-piece implants made from zirconia ceramic may be damaged as a result of torque application. MATERIALS AND METHODS: A total of 10 two-piece zirconia implants were repeatedly inserted into polyurethane foam material with increasing density and decreasing osteotomy size. The insertion torque applied was measured, and implants were checked for fractures by applying the fluorescent penetrant method. Weibull probability of failure was calculated based on the recorded insertion torque values. RESULTS: Catastrophic failures could be seen in five of the implants from two different batches at insertion torques ranging from 46.0 to 70.5 Ncm, while the remaining implants (all belonging to one batch) survived. Weibull probability of failure seems to be low at the manufacturer-recommended maximum insertion torque of 35 Ncm. Chipping fractures at the thread tips as well as tool marks were the only otherwise observed irregularities. CONCLUSION: While high insertion torques may be desirable for immediate loading protocols, zirconia implants may fracture when manufacturer-recommended insertion torques are exceeded. Evaluating bone quality prior to implant insertion may be useful.

Screw Joint Stability in Conventional and Abutment-Free Implant-Supported Fixed Restorations.

PURPOSE: Procera Implant Bridges (PIBs) do not engage supporting implant shoulders and are fixed using comparably long retention screws. The aim of this in vitro clinical study was to determine the detorque values in PIBs and conventionally fabricated fixed dental prostheses (FDPs). MATERIALS AND METHODS: Two groups of screw-retained implant-supported three-unit FDPs (n=10) were fabricated by means of conventional casting or computer-aided design/computer-assisted manufacture to fit an in vitro situation with two implants. Following fixation, the restorations were subjected to masticatory simulation (100,000 cycles, 100 N) and subsequent detorquing of the retention screws. In the clinical part, a total of 10 patients received PIB restorations in the premolar/molar region that were detorqued after 2, 4, and 6 months. One-sample t tests adjusted for multiple testing by the Bonferroni-Holm method were applied for statistical analysis based on percentage detorque values (α=.05). RESULTS: 60% of the initial torque values were maintained in screws directly retaining restorations, while the abutment screws used in the conventional restorations showed detorque levels in the range of 80%. No significant difference in detorque levels between screws retaining PIBs and conventional FDPs could be detected (P=.5186). The abutment screws showed significantly greater detorque values compared with screws directly retaining restorations (P=.0002; P=.0000). In vivo, a significant increase in detorque values ranging from 21.64 Ncm after 2 months to 27.81 Ncm after 6 months was recorded. CONCLUSION: Prosthetic screws retaining implant-supported FDPs show torque loss during the initial period of service. Retightening reduces the amount of future torque loss.