Assessment of Preload Loss after Cyclic Loading in the OT Bridge System in an "All-on-Four" Rehabilitation Model in the Absence of One and Two Prosthesis Screws.

The aim of this study was to evaluate the stability of prosthetic screws after applying cyclic loadings in an "all-on-four" rehabilitation model with the OT Bridge system. The model was tested both with and without anterior screws. Four implant analogues following the "all-on-four" concept were inserted in an edentulous mandibular resin model. An OT Bridge system with a Cr-Co prosthetic framework was fabricated. Depending on the presence or absence of one or two anterior screws on the implant analogues, three groups were created, i.e., Gr.1: three tightening screws, Gr.2: two tightening screws, Control Group: four tightening screws. Each single group underwent subsequent 400,000 cyclic loads, simulating approximately a year of chewing by using a dynamometer machine. This cycle was repeated five times for each group, and preload loss values were evaluated on each prosthetic screw after each cycle. All the data obtained were analyzed by one-way ANOVA and Student's t-test. No statistically significant differences after intragroup analysis were found. A statistically significant difference within the Gr.1 between the screws in positions 33 and 36, equal to 15.2% (p-value = 0.0176), was found. The OT Bridge seems a useful system to maintain the retention of a prosthesis during mechanical stress conditions even in the absence of one screw in an "all-on-four" rehabilitation. This could represent a good solution to solve the esthetic problem of the screw buccal access hole for fixed solutions.

Accuracy of different electronic torque drivers: A comparative evaluation.

PURPOSE: This study aims to evaluate the loosening torque on the implant fixture, and to assess the accuracy of difference electronic torque drivers. MATERIALS AND METHODS: Three electronic torque drivers were used to measure the loosening torque on the implant system (AnyOne; MegaGen). The implant fixtures were divided among the 3 electronic torque driver types (W&H, SAESHIN, and NSK group) and 9 for each group. The screws were fastened at the implant fixture by three electronic torque drivers using the tightening torques recommended by the manufacturers of the drivers. After 10 minutes, the screws were again fastened at the implant fixture with equal torque. Then, the loosening torques were measured with an MGT12 torque gauge (MARK-10, Inc.). This measurement procedure was repeated 10 times under loosening torques of 15 Ncm, 25 Ncm, and 35 Ncm. In the statistical analysis, all values of loosening torque were analyzed with the one-way ANOVA and Kruskal-Wallis test (α=.05) for comparative evaluation. RESULTS: There were significant inter-group differences at loosening torques of 15 Ncm and 25 Ncm (P<.05). The accuracy of the NSK driver was the highest, followed by SAESHIN and W&H. There was no significant difference between NSK and W&H at 35 Ncm (P>.05). The SAESHIN driver showed the closest loosening torque at 35 Ncm. CONCLUSION: The most accurate loosening torques were SAESHIN at 35 Ncm, and NSK at 15 Ncm and 25 Ncm. Since the loosening torque may vary depending on the tightening torques and electronic torque drivers, periodic calibration of the electronic torque driver is recommended.

Accuracy of different electronic torque drivers: A comparative evaluation

PURPOSE: This study aims to evaluate the loosening torque on the implant fixture, and to assess the accuracy of difference electronic torque drivers.MATERIALS AND METHODS: Three electronic torque drivers were used to measure the loosening torque on the implant system (AnyOne; MegaGen). The implant fixtures were divided among the 3 electronic torque driver types (W&H, SAESHIN, and NSK group) and 9 for each group. The screws were fastened at the implant fixture by three electronic torque drivers using the tightening torques recommended by the manufacturers of the drivers. After 10 minutes, the screws were again fastened at the implant fixture with equal torque. Then, the loosening torques were measured with an MGT12 torque gauge (MARK-10, Inc.). This measurement procedure was repeated 10 times under loosening torques of 15 Ncm, 25 Ncm, and 35 Ncm. In the statistical analysis, all values of loosening torque were analyzed with the one-way ANOVA and Kruskal-Wallis test (α=.05) for comparative evaluation.RESULTS: There were significant inter-group differences at loosening torques of 15 Ncm and 25 Ncm (P<.05). The accuracy of the NSK driver was the highest, followed by SAESHIN and W&H. There was no significant difference between NSK and W&H at 35 Ncm (P>.05). The SAESHIN driver showed the closest loosening torque at 35 Ncm.CONCLUSION: The most accurate loosening torques were SAESHIN at 35 Ncm, and NSK at 15 Ncm and 25 Ncm. Since the loosening torque may vary depending on the tightening torques and electronic torque drivers, periodic calibration of the electronic torque driver is recommended.

Intended and Achieved Torque of Implant Abutment's Screw using Manual Wrenches in Simulated Clinical Setting.

OBJECTIVE: To measure the difference between the intended torque and the achieved torque by the operator using the spring-style mechanical torque-limiting device (MTLD). MATERIALS AND METHODS: Inexperienced and experienced clinicians used one spring-type MTLD to torque two abutment screws of each anterior and posterior implants, which were attached to two digital torque meters through a jaw model. The jaw model was part of a preclinical bench manikin attached to a dental chair. The intended torque value was 35 N cm (recommended by manufacturer) and the technique of torquing was observed for all the participants (instantaneous and repeated). The mean torque value was calculated for each subject for the anterior and posterior implants independently; t-test was used to compare between the intended and achieved torque values and to compare between the experienced and inexperienced clinicians (p ≤ 0.05). RESULTS: Thirty-seven clinicians participated, with an overall mean torque value of 34.30 N cm. The mean torque value of the achieved torque (34.30 ± 4.13 N cm) was statistically significantly less than the intended torque (p = 0.041). The male clinicians produced more statistically significantly accurate torque value (34.54 ± 3.78 N cm) than the female clinicians (p = 0.034), and the experienced clinicians produced more accurate torque values (34.9 ± 5.13 N cm) than the inexperienced clinicians (p = 0.048). CONCLUSION: Within the limitation of this study, the use of MTLDs did not always produce consistent torque values and the technique by which the operators use the MTLD might affect the torque value.

Effect of retorque on loosening torque of prosthetic screws under two levels of fit of implant-supported dentures

This study evaluated the influence of retorque on loosening torque (Lt) of prosthetic screws in implant-supported dentures with different fit levels. Ten mandibular implant-supported dentures were fabricated and then 20 cast models were then prepared using prosthetic structures to create 2 fit levels: passive fit (Pf) and misfit (Mf). Two tightening techniques were also evaluated: initial torque only (T1); and initial torque and retorque after 10 min (T2). Gold or titanium screws were used, resulting in 4 groups to each one: Pf/T1, Pf/T2, Mf/T1, Mf/T2. The Lt was measured 24 h after the tightening torque using digital torque meter. Data were analyzed statistically by two-way ANOVA and Tukey's test (α=0.05), separately for each screw material. For titanium screws, no significant difference (p>0.05) was found between Pf/T1 and Pf/T2, or between Pf/T2 and Mf/T2. However, statistically significant difference (p<0.05) was found between Pf/T1 and Mf/T1, and between Mf/T1 and Mf/T2. Mf reduced the Lt using T1, while and T2 increased the Lt for Mf. Retorque and fit were shown to have no significant influence on the Lt of the gold screws. Retorque application made insignificant the misfit effect on the Lt of the titanium screws, suggesting that this procedure should be performed routinely during the screw tightening in multi-unit dentures.

Este estudo avaliou a influência do retorque no Ta dos parafusos protéticos em próteses implantossuportadas com diferentes níveis de adaptação. Foram confeccionadas 10 próteses mandibulares implantossuportadas. Vinte modelos de gesso foram fabricados utilizando as estruturas protéticas para criar os 2 níveis de adaptação: adaptação passiva (AP) e desajuste (D). Foram avaliadas 2 técnicas de aperto do parafuso: inicial torque (T1); e inicial torque e retorque após 10 min (T2). Foram usados parafusos de ouro e titânio, resultando em 4 grupos para cada material do parafuso: AP/T1, AP/T2, D/T1, D/T2. O Ta foi mensurado 24 h após o torque de aperto utilizando torquímetro digital. Os resultados foram analisados pela ANOVA (2 fatores) e teste de Tukey (α=0,05), separadamente para cada material dos parafusos. Para os parafusos de titânio, não foi encontrada diferença estatística significante entre AP/T1 e AP/T2, ou AP/T2 e D/T2; porém, diferença significante foi encontrada entre AP/T1 e D/T1, ou D/T1 e D/T2. Onde, D reduziu a Ta utilizando T1; e T2 aumentou o Ta para D. Retorque e adaptação não apresentaram influência significante no Ta dos parafusos de ouro. A aplicação do retorque tornou insignificante o efeito do desajuste no Ta dos parafusos de titânio, sugerindo que este procedimento deveria ser usado rotineiramente durante os parafusos protéticos de titânio em próteses múltiplas.

Influence of prosthetic screw material on joint stability in passive and non-passive implant-supported dentures.

OBJECTIVES: This study evaluated the influence of prosthetic screw material on joint stability in implantsupported dentures at two levels of fit. METHODS: Ten mandibular implant-supported dentures were fabricated. Twenty cast models were fabricated using these dentures. Four groups (n=10) were tested, according to the vertical fit of the dentures [passive and non-passive] and prosthetic screw materials [titanium (Ti) or gold (Au) alloy]. The one-screw test was performed to quantify the vertical misfits using an optic microscope. The loosening torque for the prosthetic screws was measured 24 hours after the tightening torque (10 Ncm) using a digital torque meter. Data were analyzed by two-way ANOVA and Tukey's test (alpha=0.05). RESULTS: Overall, dentures with passive fit and Ti screws resulted in significantly higher loosening torque of the prosthetic screws (p<0.05). No significant interaction was found between fit level and screw material (p=0.199). The prosthetic screw material and fit of implant-supported dentures have an influence on screw joint stability. Ti screws presented higher joint stability than Au screws and minimum of misfit should be found clinically to improve the mechanical behavior of the screw joint.