Allyn Luke

An in vitro analysis of implant screw torque loss with external hex and internal connection implant systems.

Purpose:The purpose of this study was to examine, in a controlled environment, effects of connection design upon screw stability. Implant fixtures have 2 types of connections to the abutment: internal connection and external hex. Four implant systems were tested: Bio-Lok (external hex; Bio-Lok International, Inc., Deerfield Beach, FL); Zimmer (internal connection; Zimmer Dental, Carlsbad, CA); Nobel Biocare (external hex; Nobel Biocare USA, Inc., Yorba Linda, CA); and Astra Tech (internal connection; Astra Tech Inc., Waltham, MA). Materials and Methods:Ten samples of each system, including base, implant, abutment, and molar crown, were loaded to 200 N for 1 × 106 cycles. Screws were tightened to manufacturers’ recommendations,and torque audits done at 2.5 × 105, 5 × 105, 7.5 × 105, and 1 × 106 cycles. Results:The Bio-Lok samples lost an average of 10% of the original torque values, the Astra Tech group lost almost all of the torque and loosened, while the Zimmer and Nobel Biocare samples lost an average of 50% of the torque but did not loosen (P ≤ 0.05). Conclusions:It may be concluded from this study that although internal connections are clinically favored, this study did not show any advantage relative to screw loosening. However, screw design may be a significant factor in loosening of the joint.

Analysis of changes in implant screws subject to occlusal loading: a preliminary analysis.

Loosening of the abutment screw can present a problem for the stability of the implant-supported crown or prosthesis. The purpose of this study was to understand the parameters of screw loosening, using an in vitro model, including loss of torque, screw head rotation, changes in screw dimension, and distortion of the implant-abutment joint. Implants (4 × 10 mm) were potted in autopolymerizing blocks. Abutments were placed with screws tightened with a 35-Ncm torque and standardized crowns fabricated. There were 3 implant systems used: Nobel Biocare USA, Inc. (Yorba Linda, CA), 3i Implant Innovations, Inc. (Palm Beach Gardens, FL), and Bio-Lok International, Inc. (Deerfield Beach, FL). Seven samples were tested for each system. Samples were loaded with 300-N loads for 50,000 cycles at 1 Hz. Torque turn audits were performed at 10,000, 25,000, and 50,000 cycles. At the conclusion of the loading, counterclockwise rotation of the abutment screw was measured. The screws were retrieved and measurements made compared with the controls. Finally, 1 sample from each group was embedded in resin, sectioned longitudinally, and examined under the standard error of the mean. The Nobel Biocare system showed a 9.4-Ncm loss of torque from the loading protocol. This result was accompanied by a counterclockwise rotation of 7° and a 200-ìm elongation of the screw. Finally, there was compression and distortion of the longitudinally sectioned joint architecture observed with the standard error of the mean. From the 3i and Bio-Lok International groups, no loss of torque, counterclockwise rotation, or lengthening of the screws was observed. Intimate adaptation of the joint without distortion was seen in the longitudinal sections. Screw loosening appears to follow specific parameters that include counterclockwise rotation, lengthening of the screw, and distortion of the screw joint. This process is likely associated with both the physical properties of the screw as well as its configuration.

Changes in abutment screw dimensions after off-axis loading of implant-supported crowns: a pilot study.

Introduction:Loss of screw tightness resulting in abutment movement and displacement of the crown or prosthesis may occur from plastic deformation of the screw. This study correlates changes in screw length and diameter with previously reported loss of screw tightness. Materials and Methods:Samples consisting of a 4 × 10-mm implant (potted in polymethylmethacrylate resin), a standard abutment, and the cemented crown were loaded with a 200-N force for 1 × 106 cycles. Torque audits were performed and the screws retrieved. Measurements were made of the shank length and diameter for 4 groups of implants—BioLok, external connection; Zimmer, internal connection; NobelBiocare, external connection; and AstraTech, internal connection. Results:Elongation of the screw shanks were observed for NobelBiocare (77.9 &mgr;m) and Zimmer (52.5 &mgr;m) systems. This correlated with a loss of tightness of 50% (15 N cm). The BioLok system did not exhibit loss of screw tightness or shank lengthening. The Astra Tech system showed no change in screw shank length, but all the screws loosened multiple times. However, no changes in midshank width were observed for any of the systems. Conclusions:For both internal connection and external hexed systems, loss of screw tightness can be correlated with plastic deformation of the screw. This does not seem to be true, however, for a conical interface implant system.

Analysis of dimensional changes in the screw and the surface topography at the interface of a titanium screw and a zirconia abutment under cyclic loading: an in vitro study.

PURPOSE The purpose of this experiment was to analyze the mechanics of the ceramic abutment-implant joint and the dimensional changes in the abutment screws from cyclic loading. MATERIALS AND METHODS Two groups of experimental assemblies were used, one with zirconia abutments and the other with titanium abutments (n = 10). Each specimen consisted of an implant, an abutment, and a metal crown affixed in an acrylic resin base. The specimens were subjected to cyclic loading of 200 N for 1 million cycles at 10 Hz. After loading, a torque-angle signature analysis was done, the dimensions of the screws were measured, and the implant-abutment interfaces were examined with scanning electron microscopy. RESULTS There was a statistically significant increase in the total length of the screws: 121 μm in the titanium group versus 88 μm in the zirconia group (P < .004). Microscopic analysis showed collected debris on the zirconia abutment undersurface and the screws. A statistically similar decrease in torque was observed: 18% for zirconia versus 13.5% for titanium. Radiographic microanalysis revealed that the debris collected in the zirconia assemblies was essentially a collection of titanium, vanadium, and aluminum, with traces of zirconium. CONCLUSIONS While there was a loss of torque in both types of abutments, the stability of the zirconia abutment-implant joint was not affected by the loading. The study provides a better understanding of zirconia abutments, screw designs, and the mechanism holding together the implant-abutment assembly.

The effects of loading on the preload and dimensions of the abutment screw for a 3-unit cantilever-fixed prosthesis design.

Objective:The purpose of this study was to use an in vitro model system to compare the effects on the screw torque and screw dimensions within 2 commercially available implant systems from occlusal loading on a cantilevered-fixed partial denture. Materials and Methods:Cantilevered implant-supported 3-unit prostheses with 2 premolar abutments and 1 premolar pontic (7.3 mm in length) were made on resin casts containing 2 implant analogs for 2 implant systems: BioLok Silhouette Tapered Implant System (Birmingham, AL) and Zimmer Tapered Screw-Vent Implant System (Carlsbad, CA) with 10 samples in each group. Each sample was loaded with either of 2 protocols: (1) a load of 50 N on the cantilevered pontic unit and (2) a loading of 150 N on all 3 units. The outcome measures were (1) changes in residual torque of the abutment screws and (2) changes in screw dimension. Results:The BioLok Silhouette Tapered Implant group demonstrated slight but statistically significant torque loss 18.8% to 28.5% in both abutment screws for both protocols, P ⩽ 0.05, without any changes in screw dimension. In the Zimmer Tapered Screw-Vent Implant group, there was a significant elongation of the abutment screws and a markedly significant 44.4%, (P ⩽ 0.01) loss in torque in the mesial screw and a 28.5%, (P ⩽ 0.05) loss in torque in the distal screw when the cantilever alone was loaded. Conclusions:Differences in screw design influence the maintenance of preload and distortion of the shank. The influence of the interface design, namely an internal hex of 1 mm versus an external hex did not influence the preload. Cantilevered prostheses can cause loss of torque and dimensional changes in abutment screws.