Steam sterilization effect on the accuracy of friction-style mechanical torque limiting devices.

AIM: This study was aimed to evaluate the effect of steam sterilization on the accuracy (within 10%) of friction-style mechanical torque limiting devices (F-S MTLDs) to achieve their target torque values. MATERIALS AND METHODS: Fifteen new F-S MTLDs were selected from Astra Tech (25 Ncm, Hader SA, La Chaux-de-Fonds, Switzerland), BioHorizons (30 Ncm, Dynatorq ITL, Irvine, California, USA), Dr. Idhe (15-60 Ncm, Dr. Idhe Dental, Eching/Munich, Germany). Every peak torque measurement was tested ten times before steam sterilization using Tohnichi torque gauge (6Tohnichi-BTG (-S), Japan). Steam sterilization was performed using a 100 cycle autoclave. Preparation steps were carried out for the devices before each autoclave sterilization cycle. Peak torque measurements were repeated after every sterilization cycle. Mean difference between the measured and the targeted torque values were evaluated before and after aging. Repeated-measures of ANOVA were used to compare the differences of accuracy between subjects. Bonferroni post-hoc test was used for pairwise comparison. RESULTS: Autoclaving resulted in an increase in the error values (the difference between peak torque and target torque values) in all the three groups studied (P < 0.05), with only Astra Tech devices showing >10% (maximum 12%) difference from their torque values in 5% of the measurements. CONCLUSION: Steam sterilization effect differs between target torque and measured peak values with an increase trend. The peak torque values showed a significant decrease for BioHorizons, while a significant increase was noted for Astra Tech and no significant change in Dr. Idhe group after sterilization. CLINICAL IMPLICATION: Within the limitation of this study the torque output of each individual device deviated in varying degrees from target torque values. However, the majority of the new frictional-style devices tested in this study, delivered fairly consistent torque output within 10% of their preset target values after sterilization. Astra Tech devices were the only one showing more than 10% difference from their torque values in 5% of the measurements. Combined effects of sterilization and aging still needs to be determined.

The effect of sterilization and number of use on the accuracy of friction-style mechanical torque limiting devices for dental implants.

BACKGROUND: Mechanical torque limiting devices (MTLDs) are necessary tools to control a peak torque and achieving target values of screw component of dental implants. Due to probable effect of autoclaving and number of use on the accuracy of these devices, this study aimed to evaluate the effect of sterilization and number of use on the accuracy of friction-style mechanical torque limiting devices (F-S MTLDs) in achieving their target torque values. MATERIALS AND METHODS: Peak torque measurements of 15 new F-S MTLDs from three different manufacturers (Astra Tech, BioHorizons, Dr. Idhe) were measured ten times before and after 100 steam sterilization using a digital torque gauge. To simulate the clinical situation of aging (number of use) target torque application process was repeated 10 times after each sterilization cycle and the peak torque values were registered. Comparison of the mean differences with target torque in each cycle was performed using one sample t test. Considering the type of MTLDs as inter subject comparison, One-way repeated measure ANOVA was used to evaluate the absolute values of differences between devices of each manufacturer in each group (α = 0.05). RESULTS: The results of this study in Dr. Idhe group showed that, mean of difference values significantly differed from the target torque (P = 0.002) until 75 cycles. In Astra Tech group, also mean of difference values with under estimation trend, showed a significant difference with the target torque (P < 0.001). Mean of difference values significantly differed from the target torque with under estimation trend during all the 100 cycles in BioHorizons group (P < 0.05). CONCLUSION: The torque output of each individual device stayed in 10% difference from target torque values before 100 sterilization cycles, but more than 10% difference from the target torque was seen in varying degrees during these consequent cycles.

Onlay bone augmentation and bilateral open sinus lifting with simultaneous implant placement in a cherubic patient.

A 20-year-old edentulous woman, who was previously treated with the shave of the inferior border of the mandible and malar prominent region for aesthetic facial contouring, was selected for full mouth rehabilitation of the maxillomandibular region. The patient was treated with bilateral open sinus lifting through a lateral approach in the posterior of the maxilla and an onlay bone graft with lateral ramus as a donor site in the mandible anterior. Eight implants in the maxilla and 7 in the mandible were inserted, and implant-supported prostheses were fabricated. The 18-month follow-up showed good bone condition that suggests graft interventions and implant treatment as a good treatment modality for patients with cherubism.

The combined effect of dismantling for steam sterilization and aging on the accuracy of spring-style mechanical torque devices.

PURPOSE: This study aimed to assess the combined effect of dismantling before sterilization and aging on the accuracy (±10% of the target torque) of spring-style mechanical torque devices (S-S MTDs). METHODS: Twenty new S-SMTDs from two different manufacturers (Nobel Biocare and Straumann: 10 of each type) were selected and divided into two groups, namely, case (group A) and control (group B). For sterilization, 100 cycles of autoclaving were performed in 100 sequences. In each sequence, 10 repetitions of peak torque values were registered for aging. To measure and assess the output of each device, a Tohnichi torque gauge was used (P<0.05). RESULTS: Before steam sterilization, all of the tested devices stayed within 10% of their target values. After 100 cycles of steam sterilization and aging with or without dismantling of the devices, the Nobel Biocare devices stayed within 10% of their target torque. In the Straumann devices, despite the significant difference between the peak torque and target torque values, the absolute error values stayed within 10% of their target torque. CONCLUSION: Within the limitations of this study, there was no significant difference between the mean and absolute value of error between Nobel Biocare and Straumann S-S MTDs.

The effect of aging on the accuracy of new friction-style mechanical torque limiting devices for dental implants.

OBJECTIVE: High variability in delivering the target torque is reported for friction-style mechanical torque limiting devices (F-S MTLDs). The effect of aging (number of use) on the accuracy of these devices is not clear. The purpose of this study was to assess the effect of aging on the accuracy (±10% of the target torque) of F-S MTLDs. MATERIALS AND METHODS: Fifteen new F-S MTLDs and their appropriate drivers from three different implant manufacturers (Astra Tech, Biohorizon and Dr Idhe), five for each type, were selected. The procedure of peak torque measurement was performed in ten sequences before and after aging. In each sequence, ten repetitions of peak torque values were registered for the aging procedure. To measure the output of each device, a Tohnichi torque gauge was used. RESULTS: Before aging, peak torque measurements of all the devices tested in this study falled within 10% of their preset target values. After aging, a significant difference was seen between raw error values of three groups of MTLDs (P<0.05). More than 50% of all peak torque measurements demonstrated more than 10% difference from their torque values after aging. CONCLUSION: Within the limitation of this study, aging as an independent factor affects the accuracy of F-S MTLDs. Astra Tech MTLDs presented the most consistent torque output for 25 Ncm target torque.

A new, simple implant-level impression technique for dental implants in limited interproximal space.

Making an implant-level impression when implants are placed in limited interproximal space or compromising angulations can be a time-consuming procedure. This article presents a new method for developing a master cast for two implants clinically placed convergent and very close to each other. The technique consists of making an implant-level impression using a transfer jig fabricated on dental abutments.

The effect of steam sterilization on the accuracy of spring-style mechanical torque devices for dental implants.

BACKGROUND: Mechanical torque devices (MTDs) are one of the most commonly recommended devices used to deliver optimal torque to the screw of dental implants. Recently, high variability has been reported about the accuracy of spring-style mechanical torque devices (S-S MTDs). Joint stability and survival rate of fixed implant supported prosthesis depends on the accuracy of these devices. Currently, there is limited information on the steam sterilization influence on the accuracy of MTDs. The purpose of this study was to assess the effect of steam sterilization on the accuracy (±10% of the target torque) of spring-style mechanical torque devices for dental implants. MATERIALS AND METHODS: Fifteen new S-S MTDs and their appropriate drivers from three different manufacturers (Nobel Biocare, Straumann [ITI], and Biomet 3i [3i]) were selected. Peak torque of devices (5 in each subgroup) was measured before and after autoclaving using a Tohnichi torque gauge. Descriptive statistical analysis was used and a repeated-measures ANOVA with type of device as a between-subject comparison was performed to assess the difference in accuracy among the three groups of spring-style mechanical torque devices after sterilization. A Bonferroni post hoc test was used to assess pairwise comparisons. RESULTS: Before steam sterilization, all the tested devices stayed within 10% of their target values. After 100 sterilization cycles, results didn't show any significant difference between raw and absolute error values in the Nobel Biocare and ITI devices; however the results demonstrated an increase of error values in the 3i group (P < 0.05). Raw error values increased with a predictable pattern in 3i devices and showed more than a 10% difference from target torque values (maximum difference of 14% from target torque was seen in 17% of peak torque measurements). CONCLUSION: Within the limitation of this study, steam sterilization did not affect the accuracy (±10% of the target torque) of the Nobel Biocare and ITI MTDs. Raw error values increased with a predictable pattern in 3i devices and showed more than 10% difference from target torque values. Before expanding upon the clinical implications, the controlled and combined effect of aging (frequency of use) and steam sterilization needs more investigation.