A retrospective study of 12,538 internal conical connection implants focused on the long-term integrity of implant-abutment complexes.

OBJECTIVE: To evaluate the long-term integrity of implant-abutment complexes in implant systems with two internal conical angles. MATERIAL AND METHODS: 12,538 bone-level implants of two systems placed between January 2012 and December 2018 were retrospectively analyzed. Cumulative abutment/implant fracture rates in systems with larger (LA, 7.5°) and smaller (SA, 5.7°) internal conical angles were estimated using the Kaplan-Meier analysis and compared between groups. The association between implant systems and jammed abutment retrievability was evaluated by multivariable generalized estimating equation logistic regression modeling. RESULTS: For LA, the 8-year cumulative incident rate was 0.10% (95% confidence interval (CI): 0-0.24%) for implant fracture and 0.26% (95% CI: 0.11%-0.41%) for abutment fracture, demonstrating a significant difference in gender (p = .03), implant diameter (p = .01), jaw (p = .006), and antagonist tooth (p < .001). For SA, the 8-year cumulative incident rate was 0.38% (95% CI: 0-0.79%) for implant fracture and 2.62% (95% CI: 0.05%-5.13%) for abutment fracture, which was influenced by implant diameter (p < .001) and site (p = .03). The cumulative implant/abutment fracture rate was lower for LA implants, particularly for LA implant-supported single crowns (SCs) (p < .05). The abutment-retrieval success rate was 92.9% for LA and 57.1% for SA (p = .055). CONCLUSION: LA implants exhibited a lower incidence of fracture in abutment-implant complexes and a relatively higher retrievability success rate for jammed abutments.

Impact of Intentional Overload on Joint Stability of Internal Implant-Abutment Connection System with Different Diameter.

PURPOSE: To evaluate the axial displacement of the implant-abutment assembly of different implant diameter after static and cyclic loading of overload condition. MATERIALS AND METHODS: An internal conical connection system with three diameters (Ø 4.0, 4.5, and 5.0) applying identical abutment dimension and the same abutment screw was evaluated. Axial displacement of abutment and reverse torque loss of abutment screw were evaluated under static and cyclic loading conditions. Static loading test groups were subjected to vertical static loading of 250, 400, 500, 600, 700, and 800 N consecutively. Cyclic loading test groups were subjected to 500 N cyclic loading to evaluate the effect of excessive masticatory loading. After abutment screw tightening for 30 Ncm, axial displacement was measured upon 1, 3, 10, and 1,000,000 cyclic loadings of 500 N. Repeated-measure ANOVA and 2-way ANOVA were used for statistical analysis (α = 0.05). RESULTS: The increasing magnitude of vertical load and thinner wall thickness of implant increased axial displacement of abutment and reverse torque loss of abutment screw (p < 0.05). Implants in the Ø 5.0 diameter group demonstrated significantly low axial displacement, and reverse torque loss after static loading than Ø 4.0 and Ø 4.5 diameter groups (p < 0.05). In the cyclic loading test, all diameter groups of implant showed significant axial displacement after 1 cycle of loading of 500 N (p < 0.05). There was no significant axial displacement after 3, 10, or 1,000,000 cycles of loading (p = 0.603). CONCLUSIONS: Implants with Ø 5.0 diameter demonstrated significantly low axial displacement and reverse torque loss after the cyclic and static loading of overload condition.

Clinical Evaluation of Two Distinct Materials for Implant-Supported Interim Fixed Partial Prostheses: An Original Research.

Aim: This study aimed to evaluate the clinical efficacy of posterior resin implant-supported fixed partial dentures (FPDs) made from two different computer-aided design and computer-aided manufacturing (CAD-CAM) materials: polymethylmethacrylate (PMMA) and polyoxymethylene (POM). Materials and Methods: Twenty-one patients received a total of 49 interim implant-supported FPDs. The same participant received PMMA and POM as part of the control and experimental groups, respectively. The restorations were evaluated 1 week, 3 months, and 6 months after placement. In addition, their functional wear and color stability were assessed. Nonparametric statistics (α = 0.05) were used to analyze the data. Results: The study found that PMMA outperformed POM in surface and color parameters, with more fractures occurring with internal conical connection implants. The color stability analysis showed ΔE*ab values of 7.18 for PMMA and 8.8 for POM, with no significant differences. After 6 months of operation, both materials showed a significant increase in wear, but no significant differences were found within the materials. Conclusion: The study found that PMMA interim implant-supported FPDs outperformed POM in surface and color parameters, while polymer posterior implant-supported FPDs with internal conical connection implants were more fracture-prone.

Clinical and radiographic results of crestal vs. subcrestal placement of implants in posterior areas: A split-mouth randomized controlled clinical trial.

OBJECTIVE: The objective of this study was to evaluate the peri-implant soft tissue and marginal bone loss (MBL) around implants with platform-switching and internal conical connection placed at crestal and subcrestal levels in posterior areas. MATERIALS AND METHODS: Nineteen partially edentulous patients with at least two adjacent missing teeth in posterior areas unilaterally or bilaterally were included. Forty-two implants were placed randomly at the crestal or subcrestal (1 mm) level in a split-mouth design. Implant-supported fixed dental prostheses with screw retention were delivered after 4 months of healing. Clinical and radiological measurements were performed at implant placement (T0), restoration delivery (T1), and 1-year follow-up after loading (T2). MBL was calculated as the change in distance from the implant-abutment interface to the first radiographically visible bone-implant contact. A repeated-measures mixed ANOVA followed by a paired Student's t-test with the Bonferroni correction was used for statistical analysis. p < 0.05 was considered statistically significant. RESULTS: Eighteen patients with thirty-eight implants completed the study at T2. The MBL was lower in the subcrestal group than in the crestal group (0.04 ± 0.08 vs. 0.17 ± 0.17 mm, p = 0.004). The peri-implant probing depth (PD) was 2.31 ± 0.48 mm in the subcrestal group and 1.92 ± 0.43 mm in the crestal group; this difference was statistically significant (p = 0.002). Intragroup comparison showed no significant differences in MBL, or PD around the crestal group and subcrestal group from T1 to T2. CONCLUSION: After 1 year of functional loading, subcrestal placement of implants with platform-switching and internal conical connection showed lower MBL and was associated with greater PD and peri-implant soft tissue height than implants placed at the crestal level.

Implant deformation and implant-abutment fracture resistance after standardized artificial aging: An in vitro study.

BACKGROUND AND PURPOSE: Zirconia abutments have been widely adopted in clinical implant practice. The unique mechanical properties of zirconia may significantly affect the long-term prognosis of implant treatments. The purpose of this study was to investigate the influence of abutment material on implant deformation and fracture resistance of internal conical connection implant-abutment complexes of two diameters after standardized artificial aging. MATERIALS AND METHODS: Thirty original abutments (one-piece titanium, one-piece zirconia, zirconia with alloy base) with two diameters (regular, narrow) were connected to internal conical connection implants and subjected to a standardized artificial aging process consisting of thermal cycling and mechanical cyclic loading. Microcomputed tomography (µCT) scans of implant bodies were performed before and after aging. 3-dimensional images of implant bodies were generated from the µCT scans and aligned for before and after aging to calculate the volumetric deformation amount. Finally, fracture resistance was measured using a mechanical static loading test for the surviving aged and 30 brand-new specimens. RESULTS: All specimens survived artificial aging. No significant difference in implant deformation was found in the regular groups (p = 0.095). In narrow groups, the one-piece zirconia group showed significantly less deformation (p < 0.0001). For fracture resistance, no significant decrease was observed after aging in any group (p > 0.05). One-piece zirconia abutments showed significantly lower strength than the other two materials for both diameters (p < 0.0001). CONCLUSIONS: In the regular diameter system, abutment material had no significant influence on the tested mechanical property degradation after simulated long-term oral use. The mechanical performance of narrow diameter one-piece zirconia abutments differed from the other two materials. For optimal performance, one-piece zirconia abutments should be adopted only in anterior regions.

Screw stability of CAD-CAM titanium and zirconia abutments on different implants: An in vitro study.

BACKGROUND: Limited information is available regarding the removal torque values (RTVs) of screws of different abutment materials when used with different implants. PURPOSE: To evaluate the effect of implant type and abutment material (zirconia; Zir and titanium; Ti) on the RTVs of abutment screws after cyclic loading. MATERIALS AND METHODS: Internal conical connection implants (CC, OsseoSpeed TX) and modified internal conical connection implants (MCC, OsseoSpeed EV) (n = 10) were clamped in resin dies. Zir and Ti (N = 20) custom abutments were tightened to implants (20 Ncm for CC and 25 Ncm for MCC) as specified by their manufacturers. The abutments were cyclically loaded by using a sequentially increased loading protocol; 2-million cycles under 100 N, 3-million cycles under 200 N, and 2-million cycles under 300 N loads with 2 Hz. After 7 million cycles, RTVs (Ncm) were measured by using a torque gauge. The data were analyzed with ANOVA by using the restricted maximum likelihood estimation method. Tukey-Kramer adjustment was used for any significant interaction of implant-abutment pairs (α = 0.05). RESULTS: Two CC implants, 1 with Ti and 1 with Zir abutment, fractured during cyclic loading (under 300 N loads within the 6th and 7th million cycles) and discarded for statistical analysis. Only implant type had a significant effect on RTVs (p <0.001). Screws of Ti abutments on MCC implants had significantly higher RTVs than the screws of Ti (p = 0.003) and Zir (p = 0.005) abutments on CC implants. CONCLUSIONS: Implant type affected the RTVs, however, the RTVs were higher than the initial torque values for all groups. Screws of Ti abutments on implant, which required greater initial torque values had higher RTVs than the screws of Ti and Zir abutments on the implant that required smaller initial torque values. RTVs were similar for Zir and Ti abutment screws within each implant type.

Dynamic and static load performance of dental biomaterial systems with conical implant-abutment connections.

BACKGROUND: The stability of the implant-abutment interface is an important factor that influences load distribution on the marginal bone. OBJECTIVE: In this study, three dental implants with the same connection were subjected to different dynamic loading cycles. The fracture strengths and the horizontal compatibility of implants were assessed. METHODS: Eighty four implant specimens were embedded in a polyacetal cylinder as simulated bone loss of 3 mm from the implant platform. Three of the implants were used to determine the endurance limit. The other specimens were subdivided into four subgroups (n = 6): three for dynamic + static loading, and one for static loading (control group). The tests were performed by applying a compression load. The dynamic loading experiments included three different cycles with endurance upper limit loads at a frequency of 10 Hz. RESULTS: The differences between the fracture strength values of the implant brands were found to be statistically significant. However, there were no meaningful differences between the fracture strength values of implants of the same brand. The specimens of the DTI implant system had the lowest strength (647.9 ± 41.5 N) and the SEM analysis indicated that the Implantium implant system had the shortest horizontal gaps. CONCLUSIONS: There was a negative correlation between the fracture strengths and size of the microgaps. The importance of these in vitro results needs to be validated by clinical trials because the loads in the mouth can be applied from various angles.