The influence of functional forces on the biomechanics of implant-supported prostheses—a review

Statement of Problem. Because of reported mechanical failures, alternative implant system components with suggested optimized strength have been manufactured. However, the endurance of these products has not been well investigated. Purpose. This study was designed to assess the effect of joint design on the fatigue strength and failure mode of 2 single-tooth implant systems: Branemark and ITI, in which a hex mediated-butt joint and 8-degree internal conical implant/abutment interface are used, respectively. Material and Methods. Seven 10-mm implants from each implant system were embedded to a depth of 7 mm in cylindrical acrylic resin blocks. CeraOne and Solid abutments with cement-retained castings were assembled to the Branemark and ITI implants, respectively. The assembled units were mounted in a lever-type-testing machine that was equipped with an automatic counting device and shutoff sensors, enabling the recording of the number of cycles till failure. A cyclic load of 100 N was applied perpendicular to the long axis of the assemblies at a rate of 75 cycles/min. To investigate specimen resistance to fatigue during 6 years of simulated function, a target of 1,800,000 cycles was defined. Specimen preparation and testing was performed by the same operator. The association of the joint design with the occurrence of failure was verified by Fisher's exact probability test ( P Results. For the Branemark group, the gold alloy abutment screw in all specimens fractured between 1,178,023 and 1,733,526 cycles with a standard deviation of 224,477 cycles. For the ITI group, all specimens had no failure until 1,800,000 cycles. Statistical analysis showed a highly significant difference between the 2 groups ( P =.000582). Conclusion. Within the limitations of this in vitro study, the effect of joint design on the fatigue strength and failure mode of the ITI single tooth implant system was significantly better ( P >.001) than the Branemark single-tooth implant system tested. (J Prosthet Dent 2002;88:604-10.)

Fatigue resistance of two implant/abutment joint designs.

PURPOSE: The purpose of this study was to systematically review clinical studies on the incidence of abutment screw loosening in single-implant restorations with different implant-abutment connection geometries. 
MATERIALS AND METHODS: The literature search was conducted using several electronic databases. Specific terms were used for the database search, which spanned the years 1990 to 2006. The search was augmented by using the option of “related articles” as well as hand searching of references and relevant journals. Relevant studies were selected according to predetermined inclusion and exclusion criteria. Agreement between reviewers was determined by using Cohen’s kappa coefficients. Three-year complication-free rates (survival proportions) were calculated with the aid of a survival function, assuming constant failure rates. Summary estimates per group for complication-free rate after 3 years (M-estimator) were calculated using Tukey’s biweight estimator. RESULTS: The initial database search yielded 1,526 relevant titles. After the subsequent filtering process, 27 studies were finally selected. Interexaminer agreement ranged from good to perfect. The external-connection group comprised 12 studies following 586 single-implant restorations for a mean follow-up time that ranged from 3 to 5 years. The estimated percent of complication-free single-implant restorations after 3 years was 97.3% (95% CI: 95.6–98.3). The internal connection group comprised 15 studies following 1,113 single-implant restorations for a mean follow-up time that ranged from 3 to 10 years. The estimated percentage of complication-free single-implant restorations after 3 years was 97.6% (95% CI: 96.5–98.3). CONCLUSION: The results show that abutment screw loosening is a rare event in single-implant restorations regardless of the geometry of implant-abutment connection, provided that proper antirotational features and torque are employed. Int J Oral Maxillofac Implants 2008;23:681–690

Abutment screw loosening in single-implant restorations: a systematic review.

summary The aim of this study was to clarify the difference in the stress distribution patterns between implants with external-hex or internal-hex connection systems using in vitro models. Three 13 mm fixtures with external-hex and internal-hex connections were installed into an acrylic bone analogue. One piece abutments of 7 mm height was connected. Strain gauges were attached to the abutment surface, and the cervical and fixture tip areas of the bone analogue surface. Vertical and horizontal load applied was 30 N. Data were normalized for each model by obtaining values relative to the sum of the three values. Almost the same force distribution pattern was found under vertical load in both systems. Fixtures with external-hex showed an increase in strain at the cervical area under horizontal load, while in internal-hex fixtures the strain was at the fixture tip area. Within limitations of our model study, it was suggested that fixtures with internal-hex showed widely spread force distribution down to the fixture tip compared with external hex ones.

In vitro differences of stress concentrations for internal and external hex implant–abutment connections: a short communication

The objectives of the review were (1) to evaluate the accuracy of implant-level impressions in cases with internal and external connection abutments/reconstructions, and (2) to evaluate the incidence of technical complications of internal and external connection metal- or zirconia-based abutments and single-implant reconstructions.

http://www.unitau.br/files/arquivos/category_1/Prtese__ARTIGO_1_1424871029.pdf

Internal vs. external connections for abutments/reconstructions: a systematic review

This paper presents aa comparison between the 8-degree Morse Taper and the butt joint aa connections between an implant and an abutment. Three-dimensional, non-linear finite element models were created to compare the 2 connection principles under equal conditions. The loading configuration was thereby modeled according to a test setup actually used for the dynamic long-term testing of dental implants as required for regulatory purposes. The results give insight into the mechanics involved in each type of connection and are compared to actual findings with the testing machine. The comparison indicates the superior mechanics of conical abutment connections and helps to explain their significantly better long-term stability in the clinical application.

/pdf/mechanics-of-the-implant-abutment-connection-an-8-degree-36nn6ldq9u.pdf

Stephan Hunenbart

Papers

Mechanics of the implant-abutment connection: an 8-degree taper compared to a butt joint connection.