Influence of torsional strength on different types of dental implant platforms

Influence of Insertion Torques on the Surface Integrity in Different Dental Implants: An Ex Vivo Descriptive Study

BACKGROUND

The primary objective of this ex vivo study was to assess the influence of increasing insertion torques on three types of dental implants and possible alterations of their microgeometry after the application of three different torque intensities.

METHODS

27 implants of 3 different implant brands (Groups A, B and C) were placed in cow ribs using 30 Ncm, 45 Ncm and 55 Ncm insertion torques. The implants were subsequently removed using trephine burs, and SEM analysis was carried out in order to detect implant surface and connection changes, as compared to the implant controls.

RESULTS

Surface deformations were predominantly observed on the third apical part of the implants. The alterations presented with increasing insertion torques, with 45 Ncm being the threshold value. Prosthetic connections were also compromised.

CONCLUSIONS

The changes sustained by the implants were proportional to the insertion torque they were subjected to; 45 Ncm and greater insertion torques resulted in more consistent damage, both on the implant surface and the implant connection.

Effects of insertion torque on the structure of dental implants with different connections: Experimental pilot study in vitro

OBJECTIVE

During the insertion of dental implants in the bone tissue, different torque values can be applied. However, the high applied torque can cause damage to the implant connection. Our study sought to evaluate, by measuring the angle of rotation of the insertion drive and, later microscopic observation, possible changes in the structure of implants of different diameters with 3 different types of connections after the application of 4 different torque intensities.

MATERIALS AND METHODS

Three hundred tapered dental implants and three hundred insertion drivers were used in the present study. Implants of 3.5 and 4 mm in diameter with 3 connection models were tested: external hexagon (EH), internal hexagon (IH) and Morse taper (MT). Then, sis groups were performed: EH3 group, EH4 group, IH3 group, IH4 group, MT3 group and MT4 group. The samples were submitted to the torque/torsion force at 4 intensities (n = 10 samples per group and intensity): 60, 80, 100 and 120 Ncm. The turning angle of the insertion driver was measured in each test. In addition, in 10 samples from each group, the maximum torque value supported by each implant model was measured. After the tests, all samples were inspected microscopically to describe the observed changes.

RESULTS

The maximum torque supported by the different implant models showed statistically significant difference (p < 0.0001). The values of the measured angles showed statistically significant differences between the torque values applied within each group (p < 0.001) and between groups with the same torque value (p < 0.001).

CONCLUSIONS

Within the limitations of the present study in vitro, the results showed that high torque values cause mechanical damage to the implants.

Influence of Connection Type and Platform Diameter on Titanium Dental Implants Fatigue: Non-Axial Loading Cyclic Test Analysis

Two-pieces dental implants must provide stability of the implant-abutment-interface. The connection type and platform diameter could influence the biomechanical resistance and stress distribution. This study aims to evaluate the fatigue for different types of connections, external and internal, and different platform diameters. Three implant designs with the same length were used: (a) external hexagon/narrow platform; (b) internal double hexagon/narrow platform; (c) internal octagon/regular platform. A fatigue test was developed to establish the number of cycles needed before fracture. A 30º oblique load with a sinusoidal function of fatigue at a frequency of 15 Hz and 10% stress variation was applied to each system. The fatigue load limit (FLL) for design (a) was 190 N, being the nominal-curvature-moment (NCM) = 1.045; FLL = 150 N, with a NCM = 0.825 for (b), and FLL = 325 N, with a NCM = 1.788 for (c). The platform diameter affects the FLL, obtaining lower FLL on a narrow platform. The connection type interferes with the implant walls’ width, especially in narrow implants, making internal connections more unstable at this level. Long-term clinical studies to assess the restoration’s success rate and survival are mandatory.

Influence of Bone Quality, Drilling Protocol, Implant Diameter/Length on Primary Stability: An In Vitro Comparative Study on Insertion Torque and Resonance Frequency Analysis

The aim of this study was to evaluate the influence of bone quality, drilling technique, implant diameter, and implant length on insertion torque (IT) and resonance frequency analysis (RFA) of a prototype-tapered implant with knife-edge threads. The investigators hypothesized that IT would be affected by variations in bone quality and drilling protocol, whereas RFA would be less influenced by such variables. The investigators implemented an in vitro experiment in which a prototype implant was inserted with different testing conditions into rigid polyurethane foam blocks. The independent variables were: bone quality, drilling protocol, implant diameter, and implant length. Group A implants were inserted with a conventional drilling protocol, whereas Group B implants were inserted with an undersized drilling protocol. Values of IT and RFA were measured at implant installation. IT and RFA values were significantly correlated (Pearson correlation coefficient: 0.54). A multivariable analysis showed a strong model. Higher IT values were associated with drilling protocol B vs A (mean difference: 71.7 Ncm), implant length (3.6 Ncm increase per mm in length), and substrate density (0.199 Ncm increase per mg/cm3 in density). Higher RFA values were associated with drilling protocol B vs A (mean difference: 3.9), implant length (1.0 increase per mm in length), and substrate density (0.032 increase per mg/cm3 in density). Implant diameter was not associated with RFA or IT. Within the limitations of an in vitro study, the results of this study suggest that the studied implant can achieve good level of primary stability in terms of IT and RFA. A strong correlation was found between values of IT and RFA. Both parameters are influenced by the drilling protocol, implant length, and substrate density. Further studies are required to investigate the clinical response in primary stability and marginal bone response.

Volumetric Changes in Morse Taper Connections After Implant Placement in Dense Bone. In-Vitro Study

The stability of the implant-abutment interface is crucial for the maintenance of the implant index integrity. Several factors are capable of inducing deformation in implant-abutment connection, such as the actual insertion of the implant into the bone. This study aimed to evaluate the deformations produced in the connection after the insertion of the implant. Ten implants with two different implant carriers (Type A: carrier attached to platform and Type B: carrier attached inside the index-connection) were placed in artificial Type II bone, and volumetric changes were evaluated for different connection features with a 3D digital microscope. ANOVA (analysis of variance), Wilcoxon, and Tukey HSD post-test were used for statistical comparisons. Type A implants presented deformation at the platform level (inner slot angles and slot width), but no volumetric changes were observed inside the connection. Type B implants presented deformation in three parameters inside the connection (outer channel length, coronal step width, and coronal step length). Within the limitations of this study, we can conclude that more deformation is expected at the internal connection when the implant carrier engages this area. The engagement area should be as far away as possible from the index connection.

Primary Stability Optimization by Using Fixtures with Different Thread Depth According To Bone Density: A Clinical Prospective Study on Early Loaded Implants

Background: Macro- and micro-geometry are among the factors influencing implant stability and potentially determining loading protocol. The purpose of this study was to test a protocol for early loading by controlling implant stability with the selection of fixtures with different thread depth according to the bone density of the implant site. Materials and Methods: Patients needing implant therapy for fixed prosthetic rehabilitation were treated by inserting fixtures with four different thread diameters, selected based on clinical assessment of bone quality at placement (D1, D2, D3, and D4, according to Misch classification). Final insertion torque (IT) and implant stability quotient (ISQ) were recorded at baseline and ISQ measurements repeated after one, two, three, and four weeks. At the three-week measurement (four weeks after implant replacement), implants with ISQ > 70 Ncm were functionally loaded with provisional restorations. Marginal bone level was radiographically measured 12 months after implant insertion. Results: Fourteen patients were treated with the insertion of forty implants: Among them, 39 implants showing ISQ > 70 after 3 weeks of healing were loaded with provisional restoration. Mean IT value was 82.3 ± 33.2 Ncm and varied between the four different types of bone (107.2 ± 35.6 Ncm, 74.7 ± 14.0 Ncm, 76.5 ± 31.1 Ncm, and 55.2 ± 22.6 Ncm in D1, D2, D3, and D4 bone, respectively). Results showed significant differences except between D2 and D3 bone types. Mean ISQ at baseline was 79.3 ± 4.3 and values in D1, D2, D3, and D4 bone were 81.9 ± 2.0, 81.1 ± 1.0, 78.3 ± 3.7, and 73.2 ± 4.9, respectively. Results showed significant differences except between D1 and D2 bone types. IT and ISQ showed a significant positive correlation when analyzing the entire sample (p = 0.0002) and D4 bone type (p = 0.0008). The correlation between IT and ISQ was not significant when considering D1, D2, and D3 types (p = 0.28; p = 0.31; p = 0.16, respectively). ISQ values showed a slight drop at three weeks for D1, D2, and D3 bone while remaining almost unchanged in D4 bone. At 12-month follow-up, all implants (39 early loading, 1 conventional loading) had satisfactory function, showing an average marginal bone loss of 0.12 ± 0.12 mm, when compared to baseline levels. Conclusion: Matching implant macro-geometry to bone density can lead to adequate implant stability both in hard and soft bone. High primary stability and limited implant stability loss during the first month of healing could allow the application of early loading protocols with predictable clinical outcomes.

Deformation of the Internal Connection of Narrow Implants after Insertion in Dense Bone: An in Vitro Study

Implant connections must resist surgical and prosthetic procedures without deformation. This study evaluated the deformation of different internal connections (IC) of narrow dental implants (NDI) after their insertion in artificial dense bone. Thirty NDI, with different IC geometries, Group A (internal hexagon), Group B (tri-channeled), and Group C (four-channeled), with the same length and similar narrow diameters, were inserted in type II density bone blocks. Drilling protocols for dense bone from each implant manufacturer were followed. The Insertion torque (IT), connection length, vertex angles, and wall deformations were analyzed before and after the insertion of the implants. ANOVA (Analysis of Variance) and Tukey post-test were used for statistical comparisons. IT values were higher for Group A, surface damage, and titanium particles were observed in the IC in all the groups. Angle deformations between 5 and 70 degrees were present in all the groups, and the walls of Group B connection were the most affected by deformations (p < 0.05). Within the limitations of this experiment, it can be concluded that narrow diameter implants will suffer deformation of the implant connection and will also experience surface damage and titanium particle release when inserted in type II bone density.

Correlation between Insertion Torque and Implant Stability Quotient in Tapered Implants with Knife-Edge Thread Design

Aim

To evaluate the correlation between insertion torque (IT) and implant stability quotient (ISQ) in tapered implants with knife-edge threads.

Methods

Seventy-five identical implants (Anyridge, Megagen) were inserted by using a surgical drilling unit with torque control and an integrated resonance frequency analysis module (Implantmed, W&H). IT (N/cm) and ISQ were recorded and implants were divided into three groups (n = 25) according to the IT: low (<30), medium (30 < IT < 50), and high torque (>50). ISQ difference among groups was assessed by Kruskal-Wallis test, followed by Bonferroni-corrected Mann–Whitney U-test for pairwise comparisons. The strength of the association between IT and ISQ was assessed by Spearman Rho correlation coefficient (α = 0.05).

Results

At the pairwise comparisons, a significant difference of ISQ values was demonstrated only between low torque and high torque groups. The strength of the association between IT and ISQ value was significant for both the entire sample and the medium torque group, while it was not significant in low and high torque groups.

Conclusions

For the investigated implant, ISQ and IT showed a positive correlation up to values around 50 N/cm: higher torques subject the bone-implant system to unnecessary biological and mechanical stress without additional benefits in terms of implant stability. This trial is registered with NCT03222219.