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Insua A, Galindo-Moreno P, Miron RJ, Wang HL, Monje A. Emerging factors affecting peri-implant bone metabolism. Periodontol 2000 2024; 94:27-78. [PMID: 37904311 DOI: 10.1111/prd.12532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 08/05/2023] [Accepted: 09/10/2023] [Indexed: 11/01/2023]
Abstract
Implant dentistry has evolved to the point that standard implant osseointegration is predictable. This is attributed in part to the advancements in material sciences that have led toward improvements in implant surface technology and characteristics. Nonetheless, there remain several cases where implant therapy fails (specifically at early time points), most commonly attributed to factors affecting bone metabolism. Among these patients, smokers are known to have impaired bone metabolism and thus be subject to higher risks of early implant failure and/or late complications related to the stability of the peri-implant bone and mucosal tissues. Notably, however, emerging data have unveiled other critical factors affecting osseointegration, namely, those related to the metabolism of bone tissues. The aim of this review is to shed light on the effects of implant-related factors, like implant surface or titanium particle release; surgical-related factors, like osseodensification or implanted biomaterials; various drugs, like selective serotonin reuptake inhibitors, proton pump inhibitors, anti-hypertensives, nonsteroidal anti-inflammatory medication, and statins, and host-related factors, like smoking, diet, and metabolic syndrome on bone metabolism, and aseptic peri-implant bone loss. Despite the infectious nature of peri-implant biological complications, these factors must be surveyed for the effective prevention and management of peri-implantitis.
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Affiliation(s)
- Angel Insua
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Pablo Galindo-Moreno
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Oral Surgery and Implant Dentistry, University of Granada, Granada, Spain
| | - Richard J Miron
- Department of Periodontology, University of Bern, Bern, Switzerland
| | - Hom-Lay Wang
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alberto Monje
- Department of Periodontology and Oral Medicine, University of Michigan, Ann Arbor, Michigan, USA
- Department of Periodontology, University of Bern, Bern, Switzerland
- Department of Periodontology, Universitat Internacional de Catalunya, Barcelona, Spain
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Sun F, Cheng W, Zhao B, Lin Z. Fatigue properties of plasma nitriding for dental implant application. J Prosthet Dent 2024; 131:329.e1-329.e8. [PMID: 35339281 DOI: 10.1016/j.prosdent.2022.01.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 01/10/2022] [Accepted: 01/10/2022] [Indexed: 10/18/2022]
Abstract
STATEMENT OF PROBLEM Fatigue failure of implant components is a common clinical problem. Plasma nitriding, an in situ surface-strengthening method, may improve fatigue properties of dental implants. PURPOSE The purpose of this in vitro study was to evaluate the effect of plasma nitriding on the fatigue behavior of implant systems. MATERIAL AND METHODS The preload and friction coefficient of plasma nitrided abutment screws, as well as settlement of the implant-abutment interface, were measured. Then, the reverse torque values and pullout force were evaluated after cyclic loading. Finally, the fatigue properties of the implant system were investigated with static fracture and dynamic fatigue life tests, and the morphology of the fracture on the surface of the implant system was observed. RESULTS The plasma nitriding treatment reduced the friction coefficient; increased the preload, settlement value, reverse torque values, pullout force, and static fracture load; and prolonged fatigue life. Furthermore, abutment screws with plasma nitriding treatment showed a different fatigue fracture mode. CONCLUSIONS Plasma nitriding improved mechanical performance and may be a suitable way to optimize the fatigue behavior of dental implants.
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Affiliation(s)
- Fei Sun
- PhD student, School of Mechanical Engineering and Automation, Northeastern University, Shenyang, PR China
| | - Wei Cheng
- Postgraduate student, School of Mechanical Engineering and Automation, Northeastern University, Shenyang, PR China
| | - Baohong Zhao
- Professor, School and Hospital of Stomatology, Key Laboratory of Oral Diseases of Liaoning province, China Medical University, Shenyang, PR China
| | - Zeng Lin
- Professor, School of Mechanical Engineering and Automation, Key Laboratory of Implant device and Interface Science of Liaoning province, Northeastern University, Shenyang, PR China.
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Yao KT, Chang TY, Huang GJ, Fang HW, Wang DH, Hsu ML. Survival of Four Conical Implant Abutment Connections After Removal of the Abutment Screw and Simulated Cyclic Loading: An In Vitro Comparative Study. J ORAL IMPLANTOL 2023; 49:393-400. [PMID: 37527179 DOI: 10.1563/aaid-joi-d-22-00037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 04/22/2023] [Accepted: 05/29/2023] [Indexed: 08/03/2023]
Abstract
This in vitro study evaluated the mechanical behavior of different conical connection implant systems after abutment screw withdrawal. Four conical connection systems were selected based on different conical half-angles: Ankylos (5.7°), Cowell (7.0°), Straumann (7.5°), and Astra (11.0°). In each system, 5 implants and abutments were used (n = 5). According to the recommended value, each abutment screw was torqued to settle the abutment and then withdrawn through a predesigned hole of the cemented crown. The retentiveness of the abutment was evaluated by the following mechanical testing. All specimens were subjected to cyclic loading of 20-200 N, 30°, and 4-mm off-axis to the implant axis, for 106 cycles. The pullout forces and axial displacements of the abutments were measured. The data of the Cowell system was obtained from our previous work. All groups other than Astra group, in which abutment loosened after abutment screw withdrawal, passed the cyclic loading test. Straumann group demonstrated a significantly lower pullout force (27.4 ± 21.1 N) than Ankylos (160.1 ± 41.4 N) and Cowell (183.7 ± 30.5 N) groups. All groups showed abutment rebound after screw withdrawal except Straumann group. In addition, Ankylos, Cowell, and Straumann groups demonstrated axial displacement after cyclic loading. In terms of the retentiveness of the abutment after abutment screw withdrawal examined in this study, Ankylos and Cowell groups had much higher retentiveness than Straumann group, while Astra group had none. Conical angle could be a key design parameter to make abutment screw withdrawal after conical abutment settlement feasible, but more studies must be conducted for clinical application.
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Affiliation(s)
- Kuang-Ta Yao
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsai-Yu Chang
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Guan-Jhong Huang
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsu-Wei Fang
- Department of Chemical Engineering and Biotechnology & Institute of Chemical Engineering, National Taipei University of Technology, Taipei, Taiwan
| | - Ding-Han Wang
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Lun Hsu
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Hsieh MC, Huang CH, Hsu ML. Effect of cutting flute design features on primary stability of immediate implant placement and restoration: a dynamic experimental analysis. Med Biol Eng Comput 2023; 61:475-484. [PMID: 36515776 DOI: 10.1007/s11517-022-02722-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 11/20/2022] [Indexed: 12/15/2022]
Abstract
Self-tapping implants with self-cutting flutes may influence primary stability, especially for the immediate implant placement and restoration protocol in which implants are affixed to the bone in the apical portion. Screw geometry differs between brands, and the effect of apical design on its clinical outcomes remains unclear. This study is aimed at investigating the influence of cutting flute shape (spiral, straight, and without flute) on primary stability by using a dynamic experimental test. Six types of dental implants were designed using computer-aided design and computer-aided manufacturing technology, consisting of three types of cutting flute shapes along with two types of screw features. A dynamic mechanical test was performed using a cyclic loading scheme. The mechanical behaviors of resistance to lateral load (RLL), maximum force, and energy dissipation were compared between groups. In the dynamic test, implants without cutting flute also exhibited higher values in RLL, maximum force, and energy dissipation. The aggressive thread implant with straight flute displayed higher RLL and had a significantly higher values in RLL (p = 0.033) at the threshold point of bone-implant interface breakdown. The implants without cutting flutes exhibited higher primary stability. Straight flute design would improve RLL for aggressive thread implant.
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Affiliation(s)
- Min-Chieh Hsieh
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Dentistry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chang-Hung Huang
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan
| | - Ming-Lun Hsu
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Epifania E, di Lauro AE, Ausiello P, Mancone A, Garcia-Godoy F, Mendes Tribst JP. Effect of crown stiffness and prosthetic screw absence on the stress distribution in implant-supported restoration: A 3D finite element analysis. PLoS One 2023; 18:e0285421. [PMID: 37146083 PMCID: PMC10162567 DOI: 10.1371/journal.pone.0285421] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 04/21/2023] [Indexed: 05/07/2023] Open
Abstract
This in-silico investigation evaluated the mechanical impact of Morse tape implant-abutment interface and retention system (with and without screw) and restorative materials (composite block and monolithic zirconia) by means of a three-dimensional finite element analysis (3D-FEA). Four 3D models were designed for the lower first molar. A dental implant (4.5 × 10 mm B&B Dental Implant Company) was digitized (micro CT) and exported to computer-aided design (CAD) software. Non-uniform rational B-spline surfaces were reconstructed, generating a 3D volumetric model. Four different models were generated with the same Morse-type connection, but with a different locking system (with and without active screw) and a different crown material made of composite block and zirconia. The D2 bone type, which contains cortical and trabecular tissues, was designed using data from the database. The implants were juxtaposed inside the model after Boolean subtraction. Implant placement depth was simulated for the implant model precisely at crestal bone level. Each acquired model was then imported into the finite element analysis (FEA) software as STEP files. The Von Mises equivalent strains were calculated for the peri-implant bone and the Von Mises stress for the prosthetic structures. The highest strain values in bone tissue occurred in the peri-implant bone interface and were comparable in the four implant models (8.2918e-004-8.6622e-004 mm/mm). The stress peak in the zirconia crown (64.4 MPa) was higher than in the composite crown (52.2 MPa) regardless of the presence of the prosthetic screw. The abutment showed the lowest stress peaks (99.71-92.28 MPa) when the screw was present (126.63-114.25 MPa). Based on this linear analysis, it is suggested that the absence of prosthetic screw increases the stress inside the abutment and implant, without effect on the crown and around the bone tissue. Stiffer crowns concentrate more stress on its structure, reducing the amount of stress on the abutment.
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Affiliation(s)
- Ettore Epifania
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Dentistry, University of Naples Federico II, Naples, Italy
| | - Alessandro E di Lauro
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Dentistry, University of Naples Federico II, Naples, Italy
| | - Pietro Ausiello
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Dentistry, University of Naples Federico II, Naples, Italy
| | - Alessia Mancone
- Department of Neurosciences, Reproductive and Odontostomatological Sciences, School of Dentistry, University of Naples Federico II, Naples, Italy
| | - Franklin Garcia-Godoy
- Department of Bioscience Research, College of Dentistry-University of Tennessee Health Science Center, Memphis, TN, United States of America
| | - João Paulo Mendes Tribst
- Department of Reconstructive Oral Care, Academic Centre for Dentistry Amsterdam (ACTA), Universiteit van Amsterdam en Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Zhang WT, Cheng KJ, Liu YF, Wang R, Chen YF, Ding YD, Yang F, Wang LH. Effect of the prosthetic index on stress distribution in Morse taper connection implant system and peri-implant bone: a 3D finite element analysis. BMC Oral Health 2022; 22:431. [PMID: 36180871 PMCID: PMC9523891 DOI: 10.1186/s12903-022-02465-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background The combination of a prosthetic index with Morse taper connection was developed, with the purpose of making prosthetic procedures more precise. However, the presence of the index may compromise the mechanical performance of the abutment. The aim of this study is to evaluate the effect of prosthetic index on stress distribution in implant–abutment-screw system and peri-implant bone by using the 3D finite element methodology. Methods Two commercial dental implant systems with different implant–abutment connections were used: the Morse taper connection with platform switching (MT-PS) implant system and the internal hex connection with platform matching (IH-PM) implant system. Meanwhile, there are two different designs of Morse taper connection abutment, namely, abutments with or without index. Consequently, three different models were developed and evaluated: (1) MT-PS indexed, (2) MT-PS non-indexed, and (3) IH-PM. These models were inserted into a bone block. Vertical and oblique forces of 100 N were applied to each abutment to simulate occlusal loadings. Results For the MT-PS implant system, the maximum stress was always concentrated in the abutment neck under both vertical and oblique loading. Moreover, the maximum von Mises stress in the neck of the MT-PS abutment with index even exceed the yield strength of titanium alloy under the oblique loading. For the IH-PM implant system, however, the maximum stress was always located at the implant. Additionally, the MT-PS implant system has a significantly higher stress level in the abutment neck and a lower stress level around the peri-implant bone compared to the IH-PM implant system. The combined average maximum stress from vertical and oblique loads is 2.04 times higher in the MT-PS indexed model, and 1.82 times for the MT-PS non-indexed model than that of the IH-PM model. Conclusions MT-PS with index will cause higher stress concentration on the abutment neck than that of without index, which is more prone to mechanical complications. Nevertheless, MT-PS decreases stress within cancellous bone and may contribute to limiting crestal bone resorption.
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Affiliation(s)
- Wen-Tao Zhang
- Center for Plastic and Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158 Shangtang Rd., Hangzhou, 310014, China
| | - Kang-Jie Cheng
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China.,Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China.,National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Yun-Feng Liu
- College of Mechanical Engineering, Zhejiang University of Technology, Hangzhou, 310023, China.,Key Laboratory of Special Purpose Equipment and Advanced Processing Technology, Ministry of Education and Zhejiang Province, Zhejiang University of Technology, Hangzhou, 310023, China.,National International Joint Research Center of Special Purpose Equipment and Advanced Processing Technology, Zhejiang University of Technology, Hangzhou, 310023, China
| | - Russell Wang
- Department of Comprehensive Care, Case Western Reserve University School of Dental Medicine, Cleveland, OH, 44106-4905, USA
| | - Yun-Fang Chen
- Center for Plastic and Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158 Shangtang Rd., Hangzhou, 310014, China
| | - Yu-de Ding
- Center for Plastic and Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158 Shangtang Rd., Hangzhou, 310014, China
| | - Fan Yang
- Center for Plastic and Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158 Shangtang Rd., Hangzhou, 310014, China.
| | - Lin-Hong Wang
- Center for Plastic and Reconstructive Surgery, Department of Stomatology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College), No. 158 Shangtang Rd., Hangzhou, 310014, China.
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Hsieh MC, Huang CH, Hsu ML. Influences of screw design features on initial stability in immediate implant placement and restoration. Clin Biomech (Bristol, Avon) 2021; 89:105453. [PMID: 34438334 DOI: 10.1016/j.clinbiomech.2021.105453] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Self-tapping screws have been extensively used for dental implants. Their biomechanical behavior is highly associated with their clinical success, particularly for screws used for immediate implant placement and restoration, because occlusal forces can directly affect the loading transfer at the bone-implant interface after implantation. The effect of implant design on the initial stability of self-tapping screws remains unclear. This study explored the biomechanical behaviors of implant stability in standardized implants with different design features. METHODS Six types of dental implants were designed using computer-aided design/computer-aided manufacturing technology, including three types of cutting flute shapes (spiral, straight, and non-self-tapping) combined with two types of screw features. Peak insertion torque values were first recorded; initial stability levels were subsequently evaluated in terms of the maximum force and resistance to lateral loads using an electrodynamic test system. FINDINGS The peak insertion torque values, maximum force, and resistance to lateral loads of the non-self-tapping groups were higher than those of the self-tapping groups by 17%-90% (p < 0.01). The peak insertion torque values of the Straumann implant with a spiral flute was higher than that of the original straight flute by 20% (p < 0.001). However, compared with the original spiral flute, the Nobel Biocare implant with straight flute had a 23% higher maximum force (p = 0.016) and 24.5% higher resistance (p = 0.012) under lateral loading. INTERPRETATION Changing the flute design would affect initial implant stability. Non-self-tapping implants exhibited superior initial stability than did self-tapping implants.
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Affiliation(s)
- Min-Chieh Hsieh
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Dentistry, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chang-Hung Huang
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medical Research, MacKay Memorial Hospital, New Taipei City, Taiwan
| | - Ming-Lun Hsu
- School of Dentistry, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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