Clinical study on screw loosening in dental implant prostheses: a 6-year retrospective study

A Study on Screw Loosening in Dental Implant Abutment

Dental implants are integral in replacing missing teeth, providing durability and natural aesthetics through osseointegration-a process where the implant fuses with the jawbone to support a prosthesis. However, screw loosening presents significant challenges, potentially leading to implant failure, bone loss, and peri-implantitis. Contributing factors include micro-leakage, settling effects, loss of preload, abutment angulation, and inadequate torque application. Addressing these issues through proper torque management, anti-rotation features, and retightening protocols is crucial for implant longevity and success. This study outlines key causes and solutions for screw loosening in dental implants.

Acoustic resonance frequency analysis for evaluating prosthetic screw stability in splinted implant-supported fixed dental prostheses: An in vitro study

STATEMENT OF PROBLEM

Prosthetic screw loosening is a common mechanical complication of implant-supported fixed dental prostheses. Although techniques for detecting screw loosening in single implant-supported fixed dental prostheses have been reported, studies on the screw stability for splinted implant-supported fixed dental prostheses are lacking.

PURPOSE

The purpose of this in vitro study was to determine whether acoustic resonance frequency analysis using a newly developed system could detect prosthetic screw loosening in splinted implant-supported fixed dental prostheses.

MATERIAL AND METHODS

Maxillary and mandibular edentulous gypsum casts with screw-retained definitive fixed dental prostheses supported by 6 implants were used. A tapping simulation (0.2 N, 50 Hz) was directly applied to the buccal side of the tested screw, and a pickup device was used to collect the acoustic signals. The resonance peak frequencies of these signals were extracted by using time-frequency-domain analysis based on short-time Fourier transform. A 2-way mixed analysis of variance was performed to evaluate how jaw position and insertion torque affect resonance peak frequency. The Pearson correlation analysis was used to assess the relationship between the insertion torque and resonance peak frequency for each screw (α=.05).

RESULTS

Deviation from the insertion torque resulted in significant changes in the resonance peak frequency within 6 to 9 kHz. Additionally, significant positive correlation between the insertion torques and resonance peak frequencies was observed for all screws (P<.05). This correlation was affected by the position of the screw within the prosthesis. Specifically, screw loosening in the posterior and anterior regions had a greater influence on the resonance peak frequency than that in the central region.

CONCLUSIONS

The acoustic resonance peak frequency shifted leftward as the screw preload torque decreased, indicating a significant correlation with screw stability. These results suggest that acoustic resonance frequency analysis can be used to detect the stability status of a single prosthetic screw in a splinted implant-supported fixed dental prosthesis conveniently and with high sensitivity.

Mechanical effect of taper position in abutment hole and screw taper angles on implant system and peri-implant tissue: a finite element analysis

PURPOSE

The study aimed to investigate the mechanical effects of the taper position in the abutment hole and the screw taper angles on the implant system and peri-implant tissue using finite element analysis.

METHODS

Four taper positions (L1, L2, L3, L4) in the abutment hole were established using 3D software and five screw taper angles (30°, 60°, 90°, 120°, 180°) were set.

RESULT

Taper position significantly affects the stresses in the implant system. The 30° and 180° angles (L4 position) showed less stress than other angles.

CONCLUSION

Elevated taper position and reasonable taper angle are beneficial in reducing the stress in the implant system.

Influence of a mesial cantilever on stress, strain, and axial force in fixed partial dentures with a distally tilted implant in the atrophic posterior maxilla

PURPOSE

This study aimed to investigate whether the presence of a mesial cantilever influences the biomechanical behavior and screw loosening in fixed partial dentures (FPDs) with a distally tilted implant in the atrophic posterior maxilla and where to best place the distal implant.

METHODS

Two configurations of implant-supported four-unit FPDs were modelled using finite element analysis. Five interabutment distances were considered. The stress and strain distributions in the implants, abutments, and prosthetic screws were verified under occlusal loading. The development of the axial force on the abutments and screws was also examined. Two-sample t-tests were used to identify differences (P < 0.05).

RESULTS

The von Mises stress distributions of the components in the two configurations were similar, as were the maximum plastic strains of the distal prosthetic screws, distal implants, and 30° abutments. The difference in the maximum plastic strains of the straight abutments was statistically significant. The preload of the 30° abutment screws was significantly reduced after the initial loading. In the absence of a mesial cantilever, the axial force on the straight abutments increased. However, when a mesial cantilever was used, the preload of the straight abutments was maintained, and the axial force on the prosthetic screws fluctuated less. The axial force fluctuation of the abutments gradually decreased as the interabutment distance increased.

CONCLUSIONS

Mesial cantilever usage had minimal effect on stress or strain distribution in FPD implants, abutments, or prostheses. However, it helped resist screw loosening. The distal screw access hole was preferably positioned close to the prosthetic end.

Could various angulated implant depths affect the positional accuracy of digital impressions? An in vitro study

PURPOSE

The purpose of this in vitro investigation was to assess how implant depth could affect the three-dimensional positional accuracy of digital impressions made from angulated implants.

MATERIALS AND METHODS

Four modified maxillary models were printed and divided into four study groups. In each model, two angulated implant analogs were placed at the sites of the first premolar and first molar at four different depths of 1 (G1), 2 (G2), 3 (G3), and 4 (G4) mm from the models' edentate area. Scan bodies were connected to the analogs, and one operator made 10 full-arch scans for each master model using an intraoral scanner. Afterward, the marginal gingival part of all models was removed, and digital scans were performed for each model using a laboratory scanner to achieve a reference STL file as the control group. One-way ANOVA and Leven's tests were used to measure and compare the 3D distance deviations across research groups after the superimposing test and control scans.

RESULTS

A significant difference between research groups was revealed by trueness and precision analysis (p < 0.001). The trueness and precision results obtained for G1 and G4 were significantly better than those for G2 and G3 (p < 0.05).

CONCLUSION

This study demonstrated that implant depth could affect the digital implant impressions' 3D positional accuracy.

Influence of Trabecular Bone Presence on Osseodensification Instrumentation: An In Vivo Study in Sheep

Osseodensification enhances the stability of endosteal implants. However, pre-clinical studies utilizing osseodensification instrumentation do not account for the limited presence of trabeculae seen clinically. This study aimed to evaluate the effect of osseodensification instrumentation on osteotomy healing in scenarios with and without the presence of trabecular bone. A ~10 cm incision was made over the hip of twelve sheep. Trabecular bone was surgically removed from twelve sites (one site/animal; negative control (Neg. Ctrl)) and left intact at twelve sites (one site/animal; experimental group (Exp.)). All osteotomies were created using the osseodensification drilling protocol. Each osteotomy received an endosteal implant and was evaluated after 3 or 12 weeks of healing (n = 6 animals/time). Histology revealed increased woven and lamellar bone surrounding the implants in the Exp. group relative to the Neg. Ctrl group. The Exp. group demonstrated the presence of bone fragments, which acted as nucleating sites, thereby enhancing the bone formation and remodeling processes. Bone-to-implant contact (%BIC) and bone area fractional occupancy (%BAFO) were significantly higher in the Exp. group relative to the Neg. Ctrl group both at 3 weeks (p = 0.009 and p = 0.043) and 12 weeks (p = 0.010 and p = 0.008). Osseodensification instrumentation in the presence of trabecular bone significantly improved osseointegration. However, no negative influences such as necrosis, inflammation, microfractures, or dehiscence were observed in the absence/limited presence of trabeculae.

Accuracy of mechanical torque-limiting devices for implant screw tightening: A systematic review and meta-analysis

STATEMENT OF PROBLEM

A consensus is lacking on the accuracy of torque value on different types of mechanical torque-limiting devices.

PURPOSE

The purpose of this systematic review and meta-analysis was to determine the accuracy of unused mechanical torque-limiting devices.

MATERIAL AND METHODS

Electronic searches were conducted until October 2021 in 6 electronic databases. Relevant articles were manually screened in 5 journals from January 2000 to October 2021. Two reviewers screened titles, abstracts, and full texts and extracted the data independently. A meta-analysis was conducted to evaluate the weighted mean difference in torque value deviation from target torque between spring-style and friction-style devices as a primary outcome. Deviations of output torque value from target value in spring-style or friction-style devices were also analyzed as a secondary outcome.

RESULTS

A total of 11 595 articles were identified, and 16 articles were included for final statistical analysis. Meta-analysis of the included articles showed that torque value deviation in the spring-style was significantly lower than in the friction-style devices (-0.99 Ncm, 95% confidence interval [CI]: [-1.89, -0.09], P=.030). Deviations of output torque value from target value was -0.54 Ncm in the spring-style group (CI: [-1.23, 0.15], P=.122) and -0.18 Ncm in the friction-style group (95% CI: [-1.40, 1.04], P=.770). Meta-regression analysis indicated that target value was significantly associated with the mean deviation from target value only in the spring-style group. High heterogeneity was found, suggesting more studies with standardized research design are required.

CONCLUSIONS

Both spring- and friction-style mechanical torque-limiting devices can produce relatively accurate torque values; however, unused spring-type devices tend to have lower deviation from target torque value than unused friction-type devices.

Prosthetic Complications of Single Screw-Retained Implant-Supported Metal-Ceramic Fixed Prostheses: A Retrospective Observational Study

Purpose

To analyze prosthetic complications of single screw-retained implant-supported metal-ceramic fixed prostheses (SSIMCFPs).

Materials and Methods

A total of 457 medical records of patients treated with implants at the University Dental Clinic of the European University of Valencia from 2016 to 2022 were reviewed. Of the 335 SSIMCFPs evaluated, 222 were included. The following data were collected from medical records: age, sex, prosthesis location, implant diameter, type of antagonist, date of prosthesis placement, type of prosthetic complications, and the date of the occurrence of complications. Statistical analysis was estimated at the patient level with a simple binary logistic regression and at the prosthesis level, a simple logistic regression with generalized estimating equation models (p  < 0.05).

Results

A total of 222 SSIMCFPs were placed in 159 patients. The prevalence of complications was 23.3% at the patient level, equivalent to 21.6% of SSIMCFPs. A total of 48 complications were collected; screw loosening was the most frequent complication (16.2%), followed by ceramic fracture (3.1%), screw fracture (1.8%), and implant fracture (0.5%). There were no cases of abutment fracture. The mean time of the loosening of the screw was 10.5 months and ceramic fractures at 6.9 months. The factors that most influenced the occurrence of prosthetic complications were posterior position (p  < 0.001), implant diameter from 3.5 to 4.8 mm (p  < 0.01), and lower arch position (p  < 0.05).

Conclusions

The most frequent complication of SSIMCFP was loosening of the screw followed by ceramic fracture. The appearance of these complications usually occurred during the first year after SSIMCFP placement. Factors related to the occurrence of complications were mandibular posterior location and implant diameter from 3.5 to 4.8 mm.

Implant-supported crowns with locking taper implant-abutment connection: A systematic review and meta-analysis

STATEMENT OF PROBLEM

Implant-supported single crowns are more prone to screw loosening than splinted prostheses. Therefore, the locking taper system, which has a screwless abutment, may perform better when associated with this type of rehabilitation. However, systematic reviews on this system are lacking.

PURPOSE

The purpose of this systematic review was to evaluate the clinical performance and complications of single crowns retained by the locking taper system.

MATERIAL AND METHODS

This systematic review was registered at the International Prospective Register of Systematic Reviews (PROSPERO) under CRD42020189921. An electronic search was made in 5 databases and 3 other sources up to February 2021 to select prospective clinical studies evaluating the performance of single crowns retained by the locking taper system by using the outcomes implant survival, success rate, complications, marginal bone loss (MBL), and prosthesis success rate. Four meta-analyses grouped according to the follow-up intervals were performed. The risk of bias of the selected studies was evaluated by using the RoB 2 checklist for randomized controlled trials (RCTs) and Downs and Black for uncontrolled studies.

RESULTS

Twelve studies were included: 9 prospective cohort studies and 3 RCTs. A survival rate of 99% (98% to 99%) and a success rate of 97% (92% to 99%) after 5 years were found. Of the total, 2.6% biological and 2.9% prosthetic complications were described. The prosthesis success rate was 97% (96% to 98%) after 5 years. An average of -0.73 mm (-0.93 to -0.52) was found for the MBL after 5 years. The risk-of-bias assessment showed 2 RCTs with high risk and 1 RCT with low risk of bias. Among uncontrolled studies, 2 were classified as poor and 7 as fair.

CONCLUSIONS

Single crowns retained by locking taper implants can be safely indicated based on the high survival and success rates achieved in the long term, the maintenance of bone level stability over time, and the low incidence of complications.

The innovative double or triple dental abutment-implant: Case study with a 3-to-12-year follow-up

BACKGROUND

The aim of this case study is to present the rationality and scientific evidence of a new design for a double (DA) and triple (TA) dental abutment-implant with their specific new concept of biodynamic optimized peri-implant tissue (BOPiT).

METHODS

The innovative design of these abutments with a paraboloid geometry was based on BOPiT, simultaneously involving the principles of mechanobiology, biotensegrity, and mechanotransduction. Thus, 37 consecutive individuals/43 cases rehabilitated with single dental implant using the innovative DA (n = 28) and TA (n = 15) on 43 implants were included in this case study. The DA and TA support 2 or 3 dental crowns on a single implant, respectively. Clinic and radiographic examinations were presented at T1 (loading after 4 months) and T2 [final examination with an average follow-up time of 7.2 years (>3 to 12 years)].

RESULTS

At T2, mean scores for plaque index, peri-implant bleeding on probing, and peri-implant probing depth were low, depicting healthy peri-implant conditions. All radiographic images showed insignificant annual marginal bone loss (0.022 ± 0.05 mm) when compared to T1, reflecting great bone stability.

CONCLUSION

DA and TA, based on the BOPiT concept, represent an advantageous, simple and non-invasive mechanism for the longevity and healthy regulation of the peri-implant tissues.

The effect of different implant-abutment types and heights on screw loosening in cases with increased crown height space

OBJECTIVES

The stability of the abutment screw is pivotal for successful implant-supported restorations, yet screw loosening remains a common complication, leading to compromised function and potential implant failure. This study aims to evaluate the effect of different implant-abutment types and heights on screw loosening in cases with increased crown height space (CHS).

MATERIALS AND METHODS

In this in vitro study, a total of 64 abutments in eight distinct groups based on their type and height were evaluated. These groups included stock, cast, and milled abutments with heights of 4 mm (groups S4, C4, and M4), 7 mm (groups S7, C7, and M7), and 10 mm (groups C10 and M10). Removal torque loss (RTL) was assessed both before and after subjecting the abutments to dynamic cyclic loading. Additionally, the differences between initial RTL and RTL following cyclic loading were analyzed for each group (p < .05).

RESULTS

The C10 group demonstrated the highest RTL, whereas the S4 group exhibited the lowest initial RTL percentage (p < .05). Furthermore, the study established significant variations in RTL percentages and the discrepancies between initial and postcyclic loading RTL across different abutment groups (p < .05). Additionally, both abutment types and heights were found to significantly influence the RTL percentage (p < .05).

CONCLUSION

The type and height of the implant abutment affected screw loosening, and in an increased CHS of 12 mm, using a stock abutment with a postheight of 4 mm can be effective in minimizing screw loosening.

Dental Implant Abutment Screw Loss: Presentation of 10 Cases

Re-tightening the loosened dental implant abutment screw is an accepted procedure, however the evidence that such screw will hold sufficiently is weak. The purpose of this study was material analysis of lost dental implant abutment screws made of the TiAlV alloy from various manufacturers, which became lost due to unscrewing or damaged when checking if unscrewed; undamaged screws could be safely re-tightened. Among 13 failed screws retrieved from 10 cases, 10 screws were removed due to untightening and 3 were broken but without mechanical damage at the threads. Advanced corrosion was found on nine screws after 2 years of working time on all surfaces, also not mechanically loaded. Sediments observed especially in the thread area did not affect the corrosion process because of no pit densification around sediments. Pitting corrosion visible in all long-used screws raises the question of whether the screws should be replaced after a certain period during service, even if they are well-tightened. This requires further research on the influence of the degree of corrosion on the loss of the load-bearing ability of the screw.

Proposal regarding potential causes related to certain complications with dental implants and adjacent natural teeth: Physics applied to prosthodontics

PURPOSE

Complications can and do occur with implants and their restorations with causes having been proposed for some single implant complications but not for others.

METHODS

A review of pertinent literature was conducted. A PubMed search of vibration, movement, and dentistry had 175 citations, while stress waves, movement, and dentistry had zero citations as did stress waves, movement. This paper discusses the physics of vibration, elastic and inelastic collision, and stress waves as potentially causative factors related to clinical complications.

RESULTS

Multiple potential causes for interproximal contact loss have been presented, but it has not been fully understood. Likewise, theories have been suggested regarding the intrusion of natural teeth when they are connected to an implant as part of a fixed partial denture as well as intrusion when a tooth is located between adjacent implants, but the process of intrusion, and resultant extrusion, is not fully understood. A third complication with single implants and their crowns is abutment screw loosening with several of the clinical characteristics having been discussed but without determining the underlying process(es).

CONCLUSIONS

Interproximal contact loss, natural tooth intrusion, and abutment screw loosening are common complications that occur with implant retained restorations. Occlusion is a significant confounding variable. The hypothesis is that vibration, or possibly stress waves, generated from occlusal impact forces on implant crowns and transmitted to adjacent teeth, are the causative factors in these events. Since occlusion appears to play a role in these complications, it is recommended that occlusal contacts provide centralized stability on implant crowns and not be located on any inclined surfaces that transmit lateral forces that could be transmitted to an adjacent tooth and cause interproximal contact loss or intrusion. The intensity, form, and location of proximal contacts between a natural tooth located between adjacent single implant crowns seem to play a role in the intrusion of the natural tooth. Currently, there is a lack of information about the underlying mechanisms related to these occurrences and research is needed to define any confounding variables.

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.

Removal of broken abutment screws using ultrasonic tip - a heat development in-vitro study

BACKGROUND

Dental implants can cause complications, including the loosening of the abutment screw or fracture. However, there is no standardized technique for removing broken abutment screws. This necessitates further research.

OBJECTIVE

This study aimed to measure heat generation during screw removal to better understand its implications for dental implant procedures.

MATERIAL AND METHODS

The experimental setup involved using synthetic bone blocks and titanium implants. An ultrasonically operated instrument tip was utilized for screw removal. Infrared thermometry was employed for accurate temperature measurement, considering factors such as emissivity and distance. Statistical analysis using linear regression and ANOVA was conducted.

RESULTS

The findings revealed an initial rapid temperature increase during the removal process, followed by a gradual decrease. The regression model demonstrated a strong correlation between time and temperature, indicating the heat generation pattern.

CONCLUSION

Heat generation during screw removal poses risks such as tissue damage and integration issues. Clinicians should minimize heat risks through an intermittent approach. The lack of a standardized technique requires further research and caution. Understanding the generated heat optimizes implant procedures.

Survival and complication rates of two dental implant systems supporting fixed restorations: 10-year data of a randomized controlled clinical study

OBJECTIVES

To compare clinical, radiographic, biological and technical long-term outcomes of two types of dental implants over a period of 10 years.

MATERIALS AND METHODS

Ninety-eight implants were placed in 64 patients, randomly allocated to one of two manufacturers (AST and STM). All implants were loaded with fixed restorations. Outcome measures were assessed at implant insertion (Ti), at baseline examination (TL), at 1, 3, 5, 8 and 10 (T10) years. Data analysis included survival, bone level changes, complications and clinical measures.

RESULTS

Re-examination was performed in 43 patients (23 AST and 20 STM) at 10 years. The implant level analysis was based on 37 (AST) and 32 (STM) implants. Survival rates of 100% were obtained for both groups. The median changes of the marginal bone levels between baseline and T10 (the primary endpoint) amounted to a loss of 0.07 mm for group AST and a gain of 0.37 mm for group STM (intergroup p = 0.008). Technical complications occurred in 27.0% of the implants in group AST and in 15.6% in group STM. The prevalence of peri-implant mucositis was 29.7% (AST) and 50.1% (STM). The prevalence of peri-implantitis amounted to 0% (AST) and 6.3% (STM).

CONCLUSIONS

Irrespective of the implant system used, the survival rates after 10 years were high. Minimal bone level changes were observed, statistically significant but clinically negligible in favor of STM. Technical complications were more frequently encountered in group AST, while group STM had a higher prevalence of peri-implant mucositis.

Classification of dental implant systems using cloud-based deep learning algorithm: an experimental study

BACKGROUND

This study aimed to evaluate the accuracy and clinical usability of implant system classification using automated machine learning on a Google Cloud platform.

METHODS

Four dental implant systems were selected: Osstem TSIII, Osstem USII, Biomet 3i Os-seotite External, and Dentsply Sirona Xive. A total of 4,800 periapical radiographs (1,200 for each implant system) were collected and labeled based on electronic medical records. Regions of interest were manually cropped to 400×800 pixels, and all images were uploaded to Google Cloud storage. Approximately 80% of the images were used for training, 10% for validation, and 10% for testing. Google automated machine learning (AutoML) Vision automatically executed a neural architecture search technology to apply an appropriate algorithm to the uploaded data. A single-label image classification model was trained using AutoML. The performance of the mod-el was evaluated in terms of accuracy, precision, recall, specificity, and F1 score.

RESULTS

The accuracy, precision, recall, specificity, and F1 score of the AutoML Vision model were 0.981, 0.963, 0.961, 0.985, and 0.962, respectively. Osstem TSIII had an accuracy of 100%. Osstem USII and 3i Osseotite External were most often confused in the confusion matrix.

CONCLUSION

Deep learning-based AutoML on a cloud platform showed high accuracy in the classification of dental implant systems as a fine-tuned convolutional neural network. Higher-quality images from various implant systems will be required to improve the performance and clinical usability of the model.

The preliminary in vitro study and application of deep learning algorithm in cone beam computed tomography image implant recognition

To properly repair and maintain implants, which are bone tissue implants that replace natural tooth roots, it is crucial to accurately identify their brand and specification. Deep learning has demonstrated outstanding capabilities in analysis, such as image identification and classification, by learning the inherent rules and degrees of representation of data models. The purpose of this study is to evaluate deep learning algorithms and their supporting application software for their ability to recognize and categorize three dimensional (3D) Cone Beam Computed Tomography (CBCT) images of dental implants. By using CBCT technology, the 3D imaging data of 27 implants of various sizes and brands were obtained. Following manual processing, the data were transformed into a data set that had 13,500 two-dimensional data. Nine deep learning algorithms including GoogleNet, InceptionResNetV2, InceptionV3, ResNet50, ResNet50V2, ResNet101, ResNet101V2, ResNet152 and ResNet152V2 were used to perform the data. Accuracy rates, confusion matrix, ROC curve, AUC, number of model parameters and training times were used to assess the efficacy of these algorithms. These 9 deep learning algorithms achieved training accuracy rates of 100%, 99.3%, 89.3%, 99.2%, 99.1%, 99.5%, 99.4%, 99.5%, 98.9%, test accuracy rates of 98.3%, 97.5%, 94.8%, 85.4%, 92.5%, 80.7%, 93.6%, 93.2%, 99.3%, area under the curve (AUC) values of 1.00, 1.00, 1.00, 1.00, 1.00, 1.00, 1.00, 1.00, 1.00. When used to identify implants, all nine algorithms perform satisfactorily, with ResNet152V2 achieving the highest test accuracy, classification accuracy, confusion matrix area under the curve, and receiver operating characteristic curve area under the curve area. The results showed that the ResNet152V2 has the best classification effect on identifying implants. The artificial intelligence identification system and application software based on this algorithm can efficiently and accurately identify the brands and specifications of 27 classified implants through processed 3D CBCT images in vitro, with high stability and low recognition cost.

Effects of the internal contact surfaces of dental implants on screw loosening: A 3-dimensional finite element analysis

STATEMENT OF PROBLEM

The effects of the internal contact surfaces of dental implants on screw loosening have yet to be investigated.

PURPOSE

The purpose of this 3-dimensional finite element analysis (FEA) study was to evaluate and compare the mechanical effects of the abutment implant angle (θ), the abutment screw head diameter (D), and the abutment screw length (L) on screw loosening.

MATERIAL AND METHODS

A total of 27 models presenting various mechanical scenarios were built by using combinations of 3 different θ (30 degrees, 45 degrees, and 60 degrees), D (2.65 mm, 2.75 mm, and 2.85 mm), and L (4 mm, 5 mm, and 6 mm). In FEA, a static test with a 200-N force inclined 30 degrees in the implant axial direction was applied to the upper surface of the abutment to evaluate and compare the maximum von Mises stresses of the implant components and the maximum total deformation in all models. In addition, modal analysis was applied to identify the natural frequencies in all models under free (unforced) vibration, and a Kruskal-Wallis statistical test (α=.05) was performed, followed by multiple pairwise comparisons by using the Dunn test.

RESULTS

The Kruskal-Wallis test found a significant influence of the θ on implant stress, total deformation, and natural frequency (P<.001). For example, increasing the θ from 30 degrees to 45 degrees and 60 degrees can considerably reduce the model's natural frequencies to 18% and 26%, respectively. Similarly, the test underscored the significant impact of the D on both abutment screw stress and abutment stress (P=.010 and P=.002, respectively). However, the L appeared to have no significant effect on any of the dependent variables (P>.05).

CONCLUSIONS

The θ and the D significantly influenced the stresses of dental implant components, total deformation, and natural frequency of the model, which may impact the mechanical stability of the screw joint. However, the L does not appear to affect these values significantly.

Long-Term Efficacy of Chlorhexidine Gel in Single-Crown Implant Rehabilitation: A Five-Year Follow-Up Study

Chlorhexidine digluconate (CHX) has shown the ability to significantly reduce inflammation and marginal bone loss (MBL) at the 1-year follow-up but limited data exist regarding its long-term efficacy in peri-implant stability. The objective was to compare the long-term effects (5 years of follow-up) of a placebo gel (16 patients in Group A) or a 0.20% CHX gel (15 patients in Group B) used at each previous surgical and prosthetic stage. Control visits were conducted in 2022, investigating the long-term effects by biological, radiological, and clinical evaluation. The data were statistically analyzed. The research achieved a 96.7% implant success rate over five years, but 41.9% of patients did not attend annual oral hygiene check-ups. The average MBL was 1.04 ± 0.39 mm, with no significant differences between the two groups. Notably, patients who attended regular periodontal check-ups experienced significantly less MBL than those who did not (p < 0.05). At five years, direct effects of CHX were absent, with both groups showing moderate bone loss. However, the results suggest that early disinfection could enhance both short- and long-term outcomes. In fact, patients with initial minor MBL due to use of CHX, preserve this advantage also after 5 years of follow-up. Additionally, the data underscore the importance of annual check-ups in early detection and management of biological complications.

Anaerobic adhesives effect on counter-torque of abutment screws on implants with external hexagon and conical connections: An in vitro study

BACKGROUND

Abutment screw loosening is a common complication of implant supported prostheses, especially for single crowns. In engineering, anaerobic adhesives (AA) are used to provide chemical locking between screw surfaces, but their application in implantology remains unclear.

PURPOSE

The purpose of this article is to evaluate, in vitro, the effect of AA on counter-torque of abutment screws for cemented prosthesis on dental implants with external hexagon connection (EHC) and conical connection (CC).

MATERIALS AND METHODS

Sample was composed by 60 specimens, 30 dental implants with EHC and 30 with CC. Abutments (transmucosal 3 mm straight universal abutment) were installed without AA (control group) or with application of AA with two different adhesive strength: medium strength (LOCTITE® 242) and high strength (LOCTITE® 277). The specimens were subjected to mechanical cycling at 37°C, with a load setting of 133 N, a 1.3 Hz frequency, and 1 200 000 cycles. The abutments were removed, and the counter-torque values were registered. Screws and implants were inspected using a stereomicroscope to verify the presence of residual adhesive and damage the internal structures. The data were analyzed using descriptive statistics and comparison tests (p < 0.05).

RESULTS

Comparing to the torque of installation, the medium strength AA kept the counter-torque values for CC implants and the high strength AA kept the counter-torque for EHC implants and increased for CC implants. In the intergroup comparisons, control group presented significantly lower counter-torque values than other groups, both for EHC and CC implants. High strength AA presented similar results to medium strength AA in the EHC implants, but in the CC implants presented higher counter-torque values. Damage in threads was more frequent in the groups that received high strength AA.

CONCLUSION

The use of AA increased the counter-torque of abutment screws, both in implants with EHC and CC.

Clinical performance of implant supported mandibular overdentures with cantilever bar and stud attachments: A retrospective study

BACKGROUND

Treatment of edentulous patients with implant-supported over-dentures improves denture's retention and stability. Published data concerning implant-supported overdenture with cantilever bars that claimed that can affect the survival and bone loss of implants are scarce.

PURPOSE

The purpose of this study was to evaluate 5-year clinical performance of mandibular implant-supported over-dentures with different attachment systems.

MATERIALS AND METHODS

In this retrospective study, 103 patients who had received mandibular over-dentures supported by two implants were evaluated in a 5-year follow up. Studied groups were patients with Spherblock ball attachment (58 patients), Dolder bar with cantilever (36 patients), and Locator attachment (9 patients). Marginal bone-loss around implants, prosthetic complications, soft tissue status of the implants (gingival index, plaque index, pocket depth, and bleeding on probing) were used to compare studied groups. Visual Analogue Scale (VAS) criteria was used to assay patient's satisfaction. One-way ANOVA, Scheffe, Kruskal-Wallis, Mann-Whitney, and Fisher's exact tests, were used for the data analysis (α = 0.05).

RESULTS

One hundred and three patients (46 male, 57 female, mean age 64.7 ± 8.6) with 206 implants (Strauman) were studied. The implant survival rate was 100% with mean bone loss of 0.22 mm around implants in 5 years. Prosthetic complications including attachment wear and denture fracture occurred more often with ball attachments. The number of attachment replacement, and post insertion appointments were significantly less in patients with bar attachments (p < 0.05). Pocket depth and gingival index were less in the ball attachment (p < 0.05).

CONCLUSION

Mandibular overdenture supported by two implants can be considered a successful treatment in edentulous patients. The frequency of prosthetic complication is higher in unsplinted than splinted superstructures.

Mandibular Fracture in a Hemifacial Microsomia Patient following Implant Failure and Hardware Infection: A Case Report

Hemifacial microsomia (HFM) is a complex congenital condition with heterogeneous malformations of the facial skeleton that almost always involves mandibular hypoplasia. Here we introduce a unique case in which a patient with HFM had initially successful optimization of facial symmetry using a polyetheretherketone implant for mandibular augmentation. However, multiple factors associated with the intraoperative and postoperative course, including hardware failure and infection, led to diminished mechanical strength of the mandible, ultimately resulting in a mandibular fracture. In this unique case presentation of HFM, we discuss the various factors that contributed to mandibular weakness and increased susceptibility to fracture.

The effect of the digital manufacturing technique of cantilevered implant-supported frameworks on abutment screw preload

PURPOSE

The purpose of this study was to investigate the misfit and screw preload at the implant abutment connection of implant supported fixed dental prosthesis with cantilever (ICFDP) manufactured using different digital manufacturing techniques and to compare the screw preload before and after cyclic loading.

MATERIALS AND METHODS

Mandibular jaw model with four intra-foraminal implants was scanned using digital scanner. Stereolithography file was used to design a framework with nonengaging (NE) abutments and 10 mm cantilever distal to one terminal implant. Five frameworks were constructed using combined digital-conventional techniques (CAD-cast), and five frameworks were constructed using three-dimensional printing (3DP). Additional CAD-cast framework was constructed in a way that ensures passive fit (PF) to use as control. Scanning electron microscope (SEM) measured the implant abutment connection misfit. Sixty screws were used on the corresponding frameworks. Screws were torqued and pre-cyclic loading reverse torque value (RTV) was recorded. Frameworks were subjected to 200,000 loading cycles with a loading point 9 mm from the center of terminal implants adjacent to the cantilever and post-cyclic loading RTVs were recorded.

RESULTS

Microscopic readings showed significant differences between frameworks. PF demonstrated the lowest measurements of 16.04 (2.6) µm while CAD-cast demonstrated the highest measurements of 29.2 (3.1) µm. In all groups, RTVs were significantly lower than the applied torque. Post-cyclic loading RTV was significantly lower than pre-cyclic loading RTV in PF and 3DP frameworks. Differences in RTVs between the three manufacturing techniques were insignificant.

CONCLUSION

Although CAD-cast and three-dimensionally printed (3DP) both produce frameworks with clinically acceptable misfit, 3DP might not be the technique of choice for maintaining screw’s preload stability under an aggressive loading situation.

Management of perishing implants with abutment screw fracture - A systematic review

Aim:

To systematically review the reported techniques, for evaluating the risk and difficulty encountered in the management of fractured abutment screw in accordance with the location of fracture, and to develop a logical sequence in managing an implant abutment screw fracture.

Settings and Design:

Systematic review following PRISMA guidelines.

Materials and Methods:

A systematic search of the PubMed/MEDLINE database for articles published between January 2000 and March 2020 was performed by 2 independent reviewers. Case reports and case series that described the management of fractured implant abutment screw were included. Published articles were qualitatively analyzed employing CARE guidelines and were classified according to the location of screw fracture with respect to implant platform, risk of damage to the implant, and intervention for managing the fractured screw.

Statistical Analysis Used:

Qualitative analyisis.

Results:

A total of 28 articles were included in the review. Two of them explained the management of screw fracture at or above the implant platform and required only mild approach with low risk while the others explained the management of screw fracture below the level of implant platform. Among them, 6 were considered mild approach with low risk, 13 moderate approach with moderate risk, and 8 of them severe approach with high risk.

Conclusion:

Irrespective of the technique, any attempt to retrieve abutment screw fragment poses some risk to the implant which is varying from mild to severe. As the location of fracture is more gingival to the implant platform, difficulty of retrieval as well as risk to the implant increases. The proposed decisionmaking tree will be a useful tool in helping clinicians to manage abutment screw fracture.

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

The purpose of this in vitro study was to evaluate the influence of taper angle in internal conical connections of implant systems and the application of chlorhexidine gel as an antibacterial agent or polyvinyl siloxane sealant on reverse torque values of abutment screws after dynamic loading. Four implant systems having different taper angles (5.4°, 12°, 45°, 60°) were tested in this study. Test specimens were divided into 3 groups: control (neither chlorhexidine gel filled nor silicone sealed), 2% chlorhexidine gel filled, and silicone sealed. The samples were subjected to a dynamic load of 50 N at 1 Hz for 500 000 cycles before reverse torque measurements. The taper angle of conical connections presented a quantitative positive correlation between the degree of the taper angle and the percentage of tightening torque loss. However, it was significant only between 60° angled connection and others except for the sealant applied groups (P = .013 for control groups and P = .007 for chlorhexidine groups). The percentages of decrease in torque values of silicon sealant-applied specimens were significantly higher than both the control and chlorhexidine groups (P values are .001, .002, .001, and .002, respectively, according to increasing taper angles), but the percentage of decrease in torque values due to chlorhexidine application was not statistically significant when compared with control groups. Gel form chlorhexidine application as an antibacterial agent does not significantly affect the implant-abutment connection stability under dynamic loads. Polyvinyl siloxane sealant may cause screw loosening under functional loads.

Abutment screw loosening in implants: A literature review

This review was intended on major factors contributing to abutment screw loosening. A search of Pubmed and Google Scholar, as well as a manual search, was conducted. Publications and articles accepted for publication up to February 2020 were included. Out of 150 studies retrieved, a total of 57 were selected for this review. Dental implants are associated with a complexity of abutment screw loosening. Implantologists and prosthodontists should be aware of factors that contribute to this problem. In this review previously identified factors were collected, the consideration of which can help to reduce the frequency of abutment screw loosening.

Deep Neural Networks for Dental Implant System Classification

In this study, we used panoramic X-ray images to classify and clarify the accuracy of different dental implant brands via deep convolutional neural networks (CNNs) with transfer-learning strategies. For objective labeling, 8859 implant images of 11 implant systems were used from digital panoramic radiographs obtained from patients who underwent dental implant treatment at Kagawa Prefectural Central Hospital, Japan, between 2005 and 2019. Five deep CNN models (specifically, a basic CNN with three convolutional layers, VGG16 and VGG19 transfer-learning models, and finely tuned VGG16 and VGG19) were evaluated for implant classification. Among the five models, the finely tuned VGG16 model exhibited the highest implant classification performance. The finely tuned VGG19 was second best, followed by the normal transfer-learning VGG16. We confirmed that the finely tuned VGG16 and VGG19 CNNs could accurately classify dental implant systems from 11 types of panoramic X-ray images.