Influence of design and clinical factors on the removal force ratio in tapered implant-abutment interfaces.

STATEMENT OF PROBLEM: A previous study investigated the effects of the preload and taper-angle mismatch in tapered implant systems on the removal force characteristics of the self-locking mechanism. The present study builds upon the previous one and introduces the effects of the time elapsed between insertion and removal and the presence of saliva in the implant-abutment interface as 2 new additional parameters. PURPOSE: The purpose of this in vitro study was to elucidate the influences of design and clinical parameters on the removal force for implant systems that use tapered interference fit (TIF) type connections by measuring the force needed to remove an abutment from an implant. MATERIAL AND METHODS: Ninety-six implants with tapered abutment-implant interfaces specifically built for an unreplicated factorial design were tested on a custom-built workbench for removal force. Four levels were chosen for the preload, FP, and the taper mismatch Δθ; 3 levels for the wait time t; and 2 levels for the saliva presence s at the interface. A regression model was used based on physical reasoning and a theoretical understanding of the interface. A 4-way ANOVA was used to evaluate the influence of the main effects and interactions (α=.05). RESULTS: The experiments strongly indicated that preload, taper mismatch, and saliva presence are relevant variables in removal force. The wait time becomes important when its effect is evaluated along with the preload. CONCLUSIONS: The results of this study can be used for decision making in the design and use of TIF type systems. The study supports the use of artificial saliva in any implant design experiment because of its significance in the removal force of the abutment.

Experimental study of the removal force in tapered implant-abutment interfaces: a pilot study.

STATEMENT OF PROBLEM: Conically tapered interface fits (TIF) provide a reliable and strong self-locking mechanism between a dental implant and its matching abutment. On occasion, it may be necessary to remove the abutment for maintenance purposes. The removal of an indexed implant with a TIF-type connection requires the application of a (removal) force to overcome the friction force due to preload. PURPOSE: The purpose of this study was to measure the removal force needed to extract the abutment from the implant in TIF-type connections. MATERIAL AND METHODS: A workbench was designed and built to measure the forces involved in the abutment removal process. Experiments were conducted to test the removal force (F(R)) for 20 conical interfaces specifically built for the study. The effects of the preload magnitude (F(P)) and the difference between the taper angles of the implant and the abutment (taper mismatch) were investigated experimentally and theoretically. A 2-way factorial ANOVA and regression analysis was used to evaluate the variability in the process and the influence of the 2 variables considered in the experiments (α=.05). RESULTS: Experiments revealed that the (F(R)-F(P)) ratio decreases with the preload F(P), whereas the influence of the taper mismatch cannot be clearly stated. CONCLUSIONS: The removal force increases with increasing preload and the F(R)-F(P) ratio varies widely. This variability is attributed to the variability of the friction coefficient, and it can influence implant-removal applications because the removal force can be, in some restorations, as large as 40% of the preload.

The effect of different implant-abutment connections on screw joint stability.

Dental implants with an internal connection have been designed to establish a better stress distribution when lateral external forces act on the prosthesis and minimize the forces transmitted to the fastening screw. In the present study, 10 externally and 10 internally hexed implants were tested with a compressive force applied with an Instron Universal machine. Four cycles of loading-unloading were applied to each specimen to achieve displacements of 0.5, 1, 2, and 2.5 mm. The mean loads for the first cycle were 256.70 N for the external connection and 256 N for the internal connection implants. The independent t test did not reveal any significant differences among the 2 tested groups (P = .780). For the second cycle, the mean loads needed for a displacement of 1 mm were 818.19 N and 780.20 N for the external connection and the internal connection implants, respectively. The independent t test revealed significant differences among the 2 tested groups (P < .001). In the third cycle, the mean load values for a 2-mm displacement were 1394.10 N and 1225.00 N. The independent t test revealed significant differences among the 2 tested groups (P < .001). The mean loads for the fourth cycle were 1488.00 N for the external connection and 1029.00 N for the internal connection implants. These loads were required for a displacement of 2.5 mm. The independent t test revealed significant differences among the 2 tested groups (P < .001). The results of this in vitro study suggest that the internal connection design of the examined implant system could not prevent screw loosening during overloading. No implant or prosthesis failure was noticed in either group.

On computational predictions of fluid flow and its effects on bone healing in dental implant treatments: an investigation of spatiotemporal fluid flow in cyclic loading.

Fluid flow in (porous) bone plays an important role in its maintenance, adaptation, and healing after an injury. Experimental and computational studies apply mechanical loading on bone to predict fluid flow development and/or to find its material properties. In most cases, mechanical loading is applied as a linear function in time. Multiple loading functions-with identical peak load and loading frequency-were used to investigate load-induced fluid flow and predict bone healing surrounding a dental implant. Implementing an instantaneous healing stimulus led to major differences in healing predictions for slightly different loading functions. Load-induced fluid flow was found to be displacement-rate dependent with complex spatial-temporal variations and not necessarily symmetrical during loading and unloading phases. Haversine loading resulted in more numerical stability compared to ramped/triangular loading, providing the opportunity for further investigation of the effects of various physiological masticatory loadings. It was concluded that using the average healing stimulus during cyclic loading gives the most robust bone healing predictions.

Combined effects of implant insertion depth and alveolar bone quality on periimplant bone strain induced by a wide-diameter, short implant and a narrow-diameter, long implant.

STATEMENT OF PROBLEM: Strain levels in periimplant bone are affected by implant dimensions, bone quality, and implant insertion depth, resulting in different bone maintenance characteristics. PURPOSE: The purpose of this study was to evaluate the biomechanical response of the jaw bone to a wide-diameter, short (WDS) implant, and a narrow-diameter, long (NDL) implant for various simulated clinical scenarios. MATERIAL AND METHODS: The finite element method was used to evaluate periimplant bone strain distribution for 5 × 6-mm (WDS) and 3.5 × 10.7-mm (NDL) implants. A 3-dimensional segment of the mandible was constructed from a computerized tomography image of the premolar region. Occlusal force was simulated by applying a 100-N oblique load on the abutment. Bone strain distributions for 5 different implant insertion depths and 2 different levels of alveolar bone quality were evaluated. RESULTS: For an NDL implant, approximately 60% to 80% of the bone volume surrounding the implant was subjected to 200-1000 µstrain (µÉ›), and 15% to 35% was subjected to 1000-3000 µÉ›, regardless of the alveolar bone quality. For a WDS implant, the bone volume subjected to 1000-3000 µÉ› increased, and the bone volume subjected to 200-1000 µÉ› decreased in lower quality alveolar bone. For both implant types, bone volume experiencing strain levels less than 200 µÉ›, and/or greater than 3000 µÉ›, was predicted to be relatively small. CONCLUSIONS: In general, the thread design promoted relatively high strain around the thread tips, and the bone inside grooves was less strained. A more even and higher strain distribution in the periimplant bone was generated by the WDS implant as compared to the NDL implant. Regardless of the implant dimensions and simulated clinical scenarios, the development of high strain in the alveolar region was inevitable. Strain levels in periimplant bone were reduced as the insertion depth of the implant was increased.

The interplay between bone healing and remodeling around dental implants.

Long-term bone healing/adaptation after a dental implant treatment starts with diffusion of mesenchymal stem cells to the wounded region and their subsequent differentiation. The healing phase is followed by the bone-remodeling phase. In this work, a mechano-regulatory cellular differentiation model was used to simulate tissue healing around an immediately loaded dental implant. All tissue types were modeled as poroelastic in the healing phase. Material properties of the healing region were updated after each loading cycle for 30 cycles (days). The tissue distribution in the healed state was then used as the initial condition for the remodeling phase during which regions healed into bone adapt their apparent density with respect to a homeostatic remodeling stimulus. The short- (bone healing) and long-term (bone remodeling) effects of initial implant micromotion during the healing phase were studied. Development of soft tissue was observed both in the coronal region due to high fluid velocity, and on the vertical sides of the healing-gap due to high shear stress. In cases with small implant micromotion, tissue between the implant threads differentiated into bone during the healing phase but resorbed during remodeling. In cases with large implant micromotion, higher percentage of the healing region differentiated into soft tissue resulting in smaller volume of bone tissue available for remodeling. However, the remaining bone region developed higher density bone tissue. It was concluded that an optimal range of initial implant micromotion could be designed for a specific patient in order to achieve the desired long-term functional properties.

Quantification of colloidal filtration of polystyrene micro-particles on glass substrate using a microfluidic device.

A microfluidic device was designed to investigate filtration of particles in an electrolyte in the presence of liquid flow. Polystyrene spheres in potassium chloride solution at concentrations of 3-100 mM were allowed to settle and adhere to a glass substrate. A particle free solution at the same concentration was then flushed through the microfluidic channel at 0.03-4.0 mL/h. As the hydrodynamic drag on the adhered particles exceeded the intersurface interaction with the substrate, "pull-off" occurred and the particles detached. Filtration efficiency, α, was shown to a function of both ionic concentration of the liquid medium and flow speed, consistent with a phenomenological model based on the classical DLVO theory. The results elucidates the underlying physics of filtration.

Mechanics of the taper integrated screwed-in (TIS) abutments used in dental implants.

The tapered implant-abutment interface is becoming more popular due to the mechanical reliability of retention it provides. Consequently, understanding the mechanical properties of the tapered interface with or without a screw at the bottom has been the subject of a considerable amount of studies involving experiments and finite element (FE) analysis. This paper focuses on the tapered implant-abutment interface with a screw integrated at the bottom of the abutment. The tightening and loosening torques are the main factors in determining the reliability and the stability of the attachment. Analytical formulas are developed to predict tightening and loosening torque values by combining the equations related to the tapered interface with screw mechanics equations. This enables the identification of the effects of the parameters such as friction, geometric properties of the screw, the taper angle, and the elastic properties of the materials on the mechanics of the system. In particular, a relation between the tightening torque and the screw pretension is identified. It was shown that the loosening torque is smaller than the tightening torque for typical values of the parameters. Most of the tightening load is carried by the tapered section of the abutment, and in certain combinations of the parameters the pretension in the screw may become zero. The calculations performed to determine the loosening torque as a percentage of tightening torque resulted in the range 85-137%, depending on the values of taper angle and the friction coefficient.

Influence of mastication and edentulism on mandibular bone density.

The aim of this study was to demonstrate that external loading due to daily activities, including mastication, speech and involuntary open-close cycles of the jaw contributes to the internal architecture of the mandible. A bone remodelling algorithm that regulates the bone density as a function of stress and loading cycles is incorporated into finite element analysis. A three-dimensional computational model is constructed on the basis of computerised tomography (CT) images of a human mandible. Masticatory muscle activation involved during clenching is modelled by static analysis using linear optimisation. Other loading conditions are approximated by imposing mandibular flexure. The simulations predict that mandibular bone density distribution results in a tubular structure similar to what is observed in the CT images. Such bone architecture is known to provide the bone optimum strength to resist bending and torsion during mastication while reducing the bone mass. The remodelling algorithm is used to simulate the influence of edentulism on mandibular bone loss. It is shown that depending on the location and number of missing teeth, up to one-third of the mandibular bone mass can be lost due to lack of adequate mechanical stimulation.

Mechanics of the tapered interference fit in dental implants.

In evaluation of the long-term success of a dental implant, the reliability and the stability of the implant-abutment interface plays a great role. Tapered interference fits provide a reliable connection method between the abutment and the implant. In this work, the mechanics of the tapered interference fits were analyzed using a closed-form formula and the finite element (FE) method. An analytical solution, which is used to predict the contact pressure in a straight interference, was modified to predict the contact pressure in the tapered implant-abutment interface. Elastic-plastic FE analysis was used to simulate the implant and abutment material behavior. The validity and the applicability of the analytical solution were investigated by comparisons with the FE model for a range of problem parameters. It was shown that the analytical solution could be used to determine the pull-out force and loosening-torque with 5-10% error. Detailed analysis of the stress distribution due to tapered interference fit, in a commercially available, abutment-implant system was carried out. This analysis shows that plastic deformation in the implant limits the increase in the pull-out force that would have been otherwise predicted by higher interference values.

Simulation of peri-implant bone healing due to immediate loading in dental implant treatments.

The goal of this work was to investigate the role of immediate loading on the peri-implant bone healing in dental implant treatments. A mechano-regulatory tissue differentiation model that takes into account the stimuli through the solid and the fluid components of the healing tissue, and the diffusion of pluripotent stem cells into the healing callus was used. A two-dimensional axisymmetric model consisting of a dental implant, the healing callus tissue and the host bone tissue was constructed for the finite element analysis. Poroelastic material properties were assigned to the healing callus and the bone tissue. The effects of micro-motion, healing callus size, and implant thread design on the length of the bone-to-implant contact (BIC) and the bone volume (BV) formed in the healing callus were investigated. In general, the analysis predicted formation of a continuous layer of soft tissue along the faces of the implant which are parallel to the loading direction. This was predicted to be correlated with the high levels of distortional strain transferred through the solid component of the stimulus. It was also predicted that the external threads on the implant, redistribute the interfacial load, thus help reduce the high distortional stimulus and also help the cells to differentiate to bone tissue. In addition, the region underneath the implant apex was predicted to experience high fluid stimulus that results in the development of soft tissue. The relationship between the variables considered in this study and the outcome measures, BV and BIC, was found to be highly nonlinear. A three-way analysis of variance (ANOVA) of the results was conducted and it showed that micro-motion presents the largest hindrance to bone formation during healing.

Peri-implant bone remodeling around an extraction socket: predictions of bone maintenance by finite element method.

PURPOSE: The aim of this study was to investigate peri-implant bone remodeling as a response to biomechanical factors, including implant size and contour, magnitude of occlusal load, and properties of osteogenic bone grafts through the use of a computational algorithm. MATERIALS AND METHODS: A bone-remodeling algorithm was incorporated into the finite element method, where bone remodeling takes place as a result of the biomechanical alteration caused by dental implant placement and continues until the difference between the homeostatic state and the altered state is minimized. The site-specific homeostatic state was based on a model consisting of a natural tooth. Three long (11-mm) implants and two short (5-mm) implants were investigated. A three-dimensional segment of the mandible was constructed from a computed tomographic image of the premolar region, and an extraction socket was filled with bone graft. RESULTS: Generally, the extent of bone loss in the cortical region was greater and denser bone developed at both the implant crest and apex with increased occlusal loads. The areas between implant threads were prone to bone resorption. Bone graft materials that were relatively stiff and that had high equilibrium stimulus values appeared to cause increased bone loss. CONCLUSIONS: Short implants are better for conserving the mechanotransductive signaling environment of the natural tooth than long implants. Also, short implants are predicted to lead to less interfacial bone loss at high loads over the long term, while long implants are associated with a more consistent level of bone loss for different amounts of loading. It is also predicted that in the long term, bone grafts with relatively low elastic modulus lead to lower levels of interfacial bone loss.

Load transfer along the bone-dental implant interface.

In this paper the variation of normal and shear stresses along a path defined on the bone-dental implant interface is investigated. In particular, the effects of implant diameter, collar length and slope, body length, and the effects of four different types of external threads on the interfacial stress distribution are studied. The geometry of the bone is digitized from a CT scan of a mandibular incisor and the surrounding bone. The bone and the implant are assumed to be perfectly bonded. The finite element method with 2D plane strain assumption is used to compute interfacial stresses. Highest continuous interfacial stresses are encountered in the region where the implant collar engages the cortical region, and near the apex of the implant in the subcortical region. Stress concentrations in the interfacial stresses occur near the geometric discontinuities on the implant contour, and jumps in stress values occur where the elastic modulus of the bone transitions between the cortical and trabecular bone values. Among the six contour parameters, the slope and the length of the implant collar, and the implant diameter influence the interfacial stress levels the most, and the effects of changing these parameters are significantly noticed only in the cortical bone (alveolar ridge) area. External threads cause significant stress concentrations in interfacial stresses in otherwise smoothly varying regions. This work shows that the presence of external threads could cause significant variations in both normal and shear stresses along the bone-implant interface, but not reduction in shear stress as previously thought.

Efficiency considerations for the purely tapered interference fit (TIF) abutments used in dental implants.

A tapered interference fit provides a mechanically reliable retention mechanism for the implant-abutment interface in a dental implant. Understanding the mechanical properties of the tapered interface with or without a screw at the bottom has been the subject of a considerable amount of studies involving experiments and finite element (FE) analysis. In this paper, approximate closed-form formulas are developed to analyze the mechanics of a tapered interference fit. In particular, the insertion force, the efficiency, defined as the ratio of the pull-out force to insertion force, and the critical insertion depth, which causes the onset of plastic deformation, are analyzed. It is shown that the insertion force is a function of the taper angle, the contact length, the inner and outer radii of the implant, the static and the kinetic coefficients of friction, and the elastic modulii of the implant/abutment materials. The efficiency of the tapered interference fit, which is defined as the ratio of the pull-out force to insertion force, is found to be greater than one, for taper angles that are less than 6 deg when the friction coefficient is 0.3. A safe range of insertion forces has been shown to exist. The lower end of this range depends on the maximum pull-out force that may occur due to occlusion in the multiple tooth restorations and the efficiency of the system; and the upper end of this range depends on the plastic deformation of the abutment and the implant due to interference fit. It has been shown that using a small taper angle and a long contact length widens the safe range of insertion forces.

Evaluation of load transfer characteristics of five different implants in compact bone at different load levels by finite elements analysis.

STATEMENT OF PROBLEM: The external contour of an implant and the magnitude of occlusal loading can have significant effects on the load transfer characteristics and may result in different bone failure rates for different implant systems. PURPOSE: The goal of this study was to investigate the effects of external geometry and occlusal load magnitude on bone failure modes for 5 commercially available dental implant systems. MATERIAL AND METHODS: Five different implant systems; Ankylos, Astra, Bicon, ITI, and Nobel Biocare, comparable in size, but different in thread profile and crest module shapes, were compared using the finite element method. Type II bone quality was approximated and complete osseous integration was assumed. Occlusal loads of varying magnitudes (0 to 2000 N) were applied on the abutments supporting single tooth restorations at 11.3 degrees from the vertical axis with a 1-mm offset. Total overloaded bone area, where tensile and compressive normal stresses fell outside of the recommended limits of 100 and 170 MPa, respectively, was investigated for different load levels. RESULTS: For moderate levels of occlusal loads up to 300 N, the compact bone was not overloaded by any of the implant systems. At the extreme end of the occlusal load range (1000 N or more) the overloading characteristics of implants may be dependent on geometric shape. CONCLUSION: In general, overloading occurs near the superior region of compact bone, in compression, and it is primarily caused by the normal and lateral components of the occlusal load. At the region of intersection of compact and trabecular bone, overloading occurs in tension due to the vertical component of the occlusal load. For excessive forces greater than 1000 N, the overloaded areas of the bone varied considerably among 5 different implants systems evaluated.