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

Multiaxial fatigue life assessment of dental implants

As screwed joints, dental restorations may suffer mechanical failures such as screw loosening and implant or prosthetic screw failure due to fatigue. This work is focused on the failure of the implant and develops a numerical methodology to predict its fatigue life under cyclic loading conditions. This methodology is based on the combination of Critical Plane Methods and the Theory of Critical Distances to account for stress multiaxiality and notch effects. The obtained predictions were validated experimentally, which can be used to identify the main geometrical, assembly and operational factors affecting the fatigue behavior of dental implants. As a result, a powerful and efficient design tool for fatigue life prediction of dental implants is presented. This methodology complements a previously presented one focused on the fatigue life prediction of the prosthetic screw, thereby, offering now a complete design tool package regardless the critical component of the dental restoration, predicting accurately the fatigue response of the restoration, with no need for long-term fatigue test campaigns. This is a pioneering work since no other fatigue design methodology for dental implants with such a solid foundation and experimental validation has been published to date.

Silver coating on dental implant-abutment connection screws as potential strategy to prevent loosening and minimizing bacteria adhesion

Introduction: One of the main problems for the long-term behavior of dental implants are loosening of the implant-abutment connection screws and bacterial infiltration. The aim of this work is to increase the screw fixation by silver coating, providing superior mechanical retaining and antibacterial effect. Methods: Eighty dental implants with their abutments and screws have been studied. Twenty screws were not coated and were used as a control while the rest of screws were silver coated by sputtering, with three different thickness: 10, 20 and 40 μm and 20 screws per each thickness. Coating morphology and thickness were determined by scanning electron microscopy using image analysis systems. The screws were tightened for each of the thicknesses and the control with two torques 15 Ncm and 20 Ncm and tested under mechanical fatigue simulating oral stresses up to a maximum of 500,000 cycles. The remaining torques at different cycles were determined with a high-sensitivity torquemeter. Cell viability assays were performed with SaOs-2 osteoblasts and microbiological studies were performed against Streptococcus gordonii and Enterococcus faecalis bacteria strains, determining their metabolic activity and viability using live/dead staining. Results: It was observed a decrease in torque as cycles increase. For a preload of 15 Ncm at 100,000 cycles, the loosening was complete and, for 20 Ncm at 500,000 cycles, 85% of torque was lost. The silver coatings retained the torque, especially the one with a thickness of 40 μm, retaining 90% of the initial torque at 500,000 cycles. It was observed that osteoblastic viability values did not reach 70%, which could indicate a slight cytotoxic effect in contact with cells or tissues; however, the screw should not be in direct contact with tissue or living cells. Silver coating induced a significant reduction of the bacteria metabolic activity for Streptococcus gordonii and Enterococcus faecalis, around 90% and 85% respectively. Discussion: Therefore, this coating may be of interest to prevent loosening of implant systems with a worthy antibacterial response.

On the fatigue life of dental implants: Numerical and experimental investigation on configuration effect

Dental implants have seen widespread and successful use in recent years. Given their long-term application and the critical role of geometry in determining fracture and fatigue characteristics, fatigue assessments are of utmost importance for implant systems. In this study, nine dental implant system samples were subjected to testing in accordance with ISO 14801 standards. The tests included static evaluations to assess ultimate loads and fatigue tests conducted under loads of 270 N and 230 N at a frequency of 15 Hz, aimed at identifying fatigue failure locations and fatigue life. Fatigue life predictions and related calculations were carried out using Fe-safe software. The initial model featured a 22° angle for both the fixture and abutment. Subsequently, variations in abutment angles at 21° and 23° were considered while keeping the fixture angle at 22°. In the next phase, the fixture and abutment angles were set as identical, at 21° and 23°. The results unveiled that when the angles of the abutment and fixture matched, stress values decreased, and fatigue life increased. Conversely, models featuring abutment angles of 21° and 23°, with a 22° angle for the fixture, led to a 49.1 % increase in stress and a 36.9 % decrease in fatigue life compared to the primary model. Notably, in the case of the implant with a 23° angle for both abutment and fixture, the fatigue life reached its highest value at 10 million cycles. Conversely, the worst-case scenario was observed in the implant with a 21° abutment angle and a 23° fixture angle, with a fatigue life of 5.49 million cycles.

Strains in the implant collars supporting a cantilevered cross-arch bar prosthesis. An in vitro study

PURPOSE

To examine the strains in the collar area of implants supporting a cantilevered cross-arch bar prosthesis during vertical load application.

MATERIALS AND METHODS

A milled cross-arch metal framework supported by four implants in a trapezoidal design was supported in polymethylmethacrylate. T-strain gage rosettes were attached to the crestal areas of the implants with two grids, one recording circumference strain of the crestal area of the implant and the second recording vertical strain, torquing strains of the implant. The framework was subject to vertical loading from an MTS 810 mechanical system. Loading sites were directly on anterior and posterior implants, and on a cantilever at 7.5, 15, 22.5, and 30 mm (0.5, 1.0, 1.5, and 2.0 of the anterior-posterior spread) distal from the posterior implant on the right side. The anterior-posterior (A-P) spread from anterior to posterior implants was 15 mm. Sites were loaded individually with 50 and 100 N. The data from the rosettes were transferred to a desktop computer and processed using StrainSmart 5000 software.

RESULTS

Means and standard deviations were calculated for the 10 trials at each of the loading sites. Two-way ANOVAs were done separately for each dependent variable, the vertical grid, and the circumferential grid. The independent variables were the load magnitude and the load site. Tukey's test was used to compare groups post hoc. When directly loading the implants, loading the anterior implant resulted initially in compression followed by increasing tensile strain with 100 N loads. Loading the implant adjacent to cantilever (the posterior implant) resulted in greater strain at the collar than that observed with anterior implant with minimal bending strains. When loading the cantilever, anterior implant showed increasing bending strain at greater cantilever length, whereas the circumferential strains were greater for the supporting implant adjacent to the cantilever, particularly at 100 N loads, p ≤ 0.001.

CONCLUSIONS

Limiting cantilever lengths to A-P spread ratios of 0.5 are preferred. Ratios greater than 1.0 should be avoided as flexing of the collar may occur. The dimensions of the implant, particularly wall thickness, adjacent to the cantilever should be carefully considered when planning the cantilevered implant-supported prosthesis.

Stability of implant-abutment connection in three different systems after fatigue test

Aim

Abutment screw loosening of implant-supported prosthesis causes a mismatch between the abutment and the implant. This screw loosening is influenced by the implant-abutment connection type, however, with contradictory results reported in different studies. The present study evaluates the stability of abutment-implant connections in three different systems before and after the fatigue test.

Settings and Design

Thirty implants (4.3 mm in diameter and 12 mm in length) were divided into three groups of 10: Implantium, Zimmer, and straight internal hexagonal connection (SIC) implants.

Materials and Methods

Two torques of 35 Ncm with an interval of 10 min were applied, followed by measuring removal torque value (RTV). The samples were re-torqued and then underwent a simulation of 1-year chewing clinical performance of dental implant under axial force of 400 N, with a frequency of 8 Hz (one million cycles). After fatigue test, the RTV was calculated and recorded.

Statistical Analysis

The mean RTVs obtained before and after cyclic load were analyzed by SPSS version 22 software using multivariate analysis.

Results

Significant differences in RTV and role of cyclic loading were found between SIC and Implantium groups (P = 0.006 and 0.021, respectively), as well as between Zimmer and SIC groups (P = 0.032 and 0.006, respectively), but not between Zimmer and Implantium groups (P = 0.771 and 0.248, respectively).

Conclusion

The type of connection could affect the screw loosening, the preload loss, and the implant component stability. SIC group revealed the highest RTVs before and after cyclic loading.

Long-Term Treatment Outcomes of Implant Prostheses in Partially and Totally Edentulous Patients

Implant dental therapy is a clinical procedure used for treating patients with tooth loss with known clinical success. This clinical study aimed to evaluate the long-term clinical outcomes of dental implants in partially and totally edentulous patients. A total of 544 Microdent (Microdent SU, Implant Microdent System®, Santa Eulàlia de Ronçana Barcelona, Spain) screw implants were placed in 111 patients using a two-stage surgical technique and a conventional loading protocol (lasting 3 months). Implant and prosthetic clinical findings were evaluated during a 15-year follow-up. A total of 6 implants were lost during the healing period, and 124 prostheses were placed over the 538 implants that remained: 20 single crowns, 52 partially fixed bridges, 45 full-arch fixed restorations, and 7 overdentures. A total of 20 of these were lost during the follow-up period. The cumulative survival rate for all implants was 96.4%. The data underwent statistical analysis (significance level: p < 0.05). The mean marginal bone loss was 1.82 ± 0.54 mm, ranging from 1.2 to 3.1 mm. The most frequent complications were mechanical prosthodontic complications (16.2%). In all, 11.8% of implants showed periimplantitis as the primary biological complication. Dental implants inserted in both the maxillary and mandibular areas produce long-term favorable outcomes and stable tissue conditions when a delayed loading protocol is followed.

Evaluation of the Fatigue Strength of a CAD-CAM Nanoceramic Resin Crown on Titanium and Zirconia-Titanium Abutments

A computer-aided design/computer-aided manufacturing (CAD/CAM) resin block material for restoration of single-implant abutments can be milled and cemented on an optimized standard titanium abutment as a cheaper solution or, alternatively, individualization of the crown–abutment connection is required to fulfill the same mechanical requirements. The aim of this study was to evaluate how different structural and geometric configurations of the abutment influence the resistance of a nano ceramic resin crown (NCRC). During the test, 30 implants with an internal conical tapered configuration were considered. Each implant received a standard titanium abutment: in group 1, NCRCs were directly bonded to the titanium abutments; in group 2, NCRCs were cemented on a customized zirconia framework and then cemented on a standardized titanium abutment. Three crowns of each group were submitted to a static load test until failure. The remaining crowns were submitted to a fatigue test protocol with a dynamic load. The static and dynamic test showed earlier failure for group 1. In group 1, complete breaking of NCRCs was observed for all samples, with an almost total titanium abutment exposition. In the static tests, group 2 showed a mode of failure that involved only the crown, which partially debonded from the zirconia abutment. Within the limitations of the present preliminary study, it was possible to conclude that the shape of the abutment mainly influences the fatigue strength compared to the static tensile strength. The results of the performed test show that NCRC bonded to the customized zirconia abutments, and presented a 75% survival rate when compared to the same material bonded directly to a standard titanium abutment.

Factors Influencing Marginal Bone Loss around Dental Implants: A Narrative Review

Implant supported dental prostheses are increasingly used in dental practice. The aim of this narrative review is to present the influence of transmucosal surface of prosthetic abutment and implant on peri-implant tissue. The article describes causes of bone loss around the dental implant. Moreover, properties of different materials are compared and discussed. The advantages, disadvantages, and biomechanical concept of different implant-abutment connections are presented. The location of connections in relation to the bone level and the influence of microgap between the abutment and implant are described. Additionally, the implant abutments for cemented and screwed prosthetic restorations are compared. The influence of implant and abutment surface at the transmucosal level on peri-implant soft tissue is discussed. Finally, the biological aspect of abutment-implant connection is analyzed.