Reverse Torque Values of Abutment Screws After Dynamic Loading: Effects of Sealant Agents and the Taper of Conical Connections

The effect of fabrication procedures and thermomechanical loading on the structural properties of screw-retained metal-ceramic implant restorations: An in vitro study

PURPOSE

Metal-ceramic screw-retained implant restorations persist as a fundamental choice in specific clinical scenarios. Little is known about the effects of fabrication steps and aging on their structural properties. This study aimed to investigate how laboratory fabrication procedures and thermomechanical loading affect the structural properties of screw-retained metal-ceramic implant restorations.

MATERIALS AND METHODS

Ten screw-retained metal-ceramic restorations were conventionally cast using UCLA chromium-cobalt overcast abutments. After 500 cycles of thermocycling and 500,000 cycles of mechanical loading, changes in connection dimensions and rotational freedom (RF) were measured and compared at various fabrication steps and post-thermomechanical loading. A generalized estimating equations (GEE) model was employed to analyze trends across the studied time points within the fabrication stage and after thermomechanical loading, with LSD post-hoc tests applied for pairwise comparisons. The level of significance was set at α = 0.05.

RESULTS

Significant changes were observed across the analyzed time points: the average hexagonal side length (L) decreased (p < 0.001), and the average hexagonal angle deformation (P) increased, with notable differences observed in most comparisons between different fabrication steps (p < 0.001). Short (T1) and long (T2) diagonals of the hexagon showed downward trends (p < 0.001), while concentricity (O) and RF increased (p < 0.001), except between porcelain firing and loading steps for RF (p = 0.637). Casting had the greatest impact on variations in O (93.33%), T1 (88.88%), and T2 (45%), while porcelain firing significantly affected L (71.42%), P (71.42%), with the greatest effect on RF (75.32%).

CONCLUSIONS

The fabrication processes and simulated clinical use adversely impacted the structural integrity and RF of abutments in screw-retained chromium-cobalt overcast implant restorations.

Coating Materials to Prevent Screw Loosening in Single Dental Implant Crowns: A Systematic Review

Oral rehabilitation with dental implants has resulted in high success rates. However, some complications have been described, such as the loss of the prosthetic screw. Some manufacturers sell screws with different coatings to avoid screw loosening, but even these types of screws can come loose. We aimed to investigate the screw coatings that can be applied during a dental appointment to avoid screw loosening. Following PRISMA Guidelines, we searched PubMed/Medline, Embase and Web of Science for studies published up to January 2024. All studies of single dental implant crowns, in which the prosthetic screw was coated with a lubricant and the preload and/or the removal torque value (RTV) was recorded, were analyzed. We excluded studies applying the finite element method (FEM) as well as studies without a control group. The risk of bias was assessed with a tool developed by our research group. Of the 1959 records identified, 19 were selected. Ten studies were considered to have a low risk of bias, and nine were considered to have a medium risk of bias. The coatings tested were adhesives, saliva, chlorhexidine, Vaseline, silicone gel, Polytetrafluoroethylene (PTFE) tape, blood, fluoride, Listerine® Mouthwash and normal saline. The preload, the RTV with and without cyclic loading and the percentage of RTV loss were recorded. Some coatings show promise, although there is no clear evidence that any option is superior in minimizing screw loosening.

An In Vitro Study of Fluid Contaminations Influences on Reverse Torque Values of Implant-Abutment Connections

Purpose

To examine the effects of fluid contamination on the reverse torque value (RTV) of abutment screws. 484 titanium fixtures were mounted into the stainless-steel holders.

Methods

11 groups (44 specimens in each group) of implants were mounted in acrylic resin. Ten groups of fixture screw holes were contaminated with chlorhexidine, saliva, blood, fluoride, or combination groups, and one group served as a control without contamination. To simulate the oral environment, samples were subjected to thermal cycling and cyclic loading.

Results

The RTV means were less than the initial torque in both control and contamination groups. The maximum RTV mean was observed in the fluoride group (26.00 ± 1.02 Ncm). In other groups, this rate for control, blood, saliva, and chlorhexidine groups were 18.00 ± 1.78 Ncm, 22.12 ± 1.56 Ncm, 21.56 ± 1.43 Ncm, and 21.89 ± 1.02 Ncm, respectively. In combination groups, the maximum RTV mean was observed in the saliva+CHX group (23.89 ± 1.92 Ncm). In other combination groups, this rate for the blood+CHX, blood+saliva, saliva+fluoride, fluoride+CHX, and fluoride+blood groups were 22.56 ± 1.73 Ncm, 22.00 ± 1.54 Ncm, 20.11 ± 1.58 Ncm, 23.51 ± 1.19 Ncm, 21.02 ± 1.38 Ncm, and 20.11 ± 1.58 Ncm, respectively. The RTV was statistically significant (p < 0.05) for the contamination groups (except saliva) and combination groups compared to the control group. There is no statistically significant difference (p > 0.05) between the reverse torque value mean of the blood and saliva groups and between that of the fluoride and chlorhexidine groups.

Conclusion

Implant-abutment specimens are suggested to be placed in a saliva environment and should be subjected to cyclic loading.