Professional Documents
Culture Documents
Mechanical Testing of Implant-Supported Anterior Crowns With Different Implant/Abutment Connections
Mechanical Testing of Implant-Supported Anterior Crowns With Different Implant/Abutment Connections
net/publication/235397301
Article in The International journal of oral & maxillofacial implants · February 2013
DOI: 10.11607/jomi.2443 · Source: PubMed
CITATIONS READS
60 600
6 authors, including:
Paulo Coelho
New York University College of Dentistry; New York University Langone Medical Center
585 PUBLICATIONS 14,030 CITATIONS
SEE PROFILE
All content following this page was uploaded by Paulo Coelho on 19 May 2014.
Purpose: This study evaluated the reliability and failure modes of anterior implants with internal-hexagon (IH),
external-hexagon (EH), or Morse taper (MT) implant-abutment interface designs. The postulated hypothesis
was that the different implant-abutment connections would result in different reliability and failure modes
when subjected to step-stress accelerated life testing (SSALT) in water. Materials and Methods: Sixty-three
dental implants (4 × 10 mm) were divided into three groups (n = 21 each) according to connection type: EH,
IH, or MT. Commercially pure titanium abutments were screwed to the implants, and standardized maxillary
central incisor metallic crowns were cemented and subjected to SSALT in water. The probability of failure
versus number of cycles (95% two-sided confidence intervals) was calculated and plotted using a power-law
relationship for damage accumulation. Reliability for a mission of 50,000 cycles at 150 N (90% two-sided
confidence intervals) was calculated. Polarized-light and scanning electron microscopes were used for failure
analyses. Results: The beta values (confidence intervals) derived from use-level probability Weibull calculation
were 3.34 (2.22 to 5.00), 1.72 (1.14 to 2.58), and 1.05 (0.60 to 1.83) for groups EH, IH, and MT, respectively,
indicating that fatigue was an accelerating factor for all groups. Reliability was significantly different between
groups: 99% for MT, 96% for IH, and 31% for EH. Failure modes differed; EH presented abutment screw
fracture, IH showed abutment screw and implant fractures, and MT displayed abutment and abutment screw
bending or fracture. Conclusions: The postulated hypothesis that different implant-abutment connections to
support anterior single-unit replacements would result in different reliability and failure modes when subjected
to SSALT was accepted. INT J ORAL MAXILLOFAC IMPLANTS 2013;28:103–108. doi: 10.11607/jomi.2443
Key words: cementation, dental implants, fractography, implant-supported prostheses, reliability, step-stress
accelerated life testing
a b c
Fig 1 Implant connection configurations tested. (a) EH, (b) IH, (c) MT.
stable, since the load is distributed deep within the The aim of this study was to evaluate the reliabil-
implant, where engagement with a long internal wall ity and failure modes of implant-supported anterior
shields the abutment screw.10–12 High rates of mechan- crowns restored with different implant connections
ical complications (6% to 48%) have been reported for (IH, EH, and MT). The postulated hypothesis was that
EH implants,13–15 whereas fewer episodes of abutment different implant connections used as anterior single-
loosening (3.6% to 5.3%) seem to occur in Morse taper unit replacements would show different rates of reli-
(MT) connections.16 ability and different failure modes when subjected to
The maintenance and stability of screw-type con- step-stress accelerated life testing (SSALT).
nections are challenged by forces exceeding that of
the torqued abutment/crown system.17 However,
lower physiologic forces, applied repeatedly, although MATERIALS AND METHODS
they do not necessarily surpass the failure threshold of
the assembly, may potentially lead to gradual loosen- Sample Preparation
ing of the implant-abutment connection and/or fail- Sixty-three commercially pure titanium dental im-
ure as a result of fatigue.5,18,19 The ensuing misfit of a plants (4 mm in diameter, 10 mm in length, Emfils, Co-
loose abutment connected to an implant may not only losso Evolution System) were divided into three groups
impose taxing stresses in the crestal bone, potentially (n = 21) according to the implant/abutment connec-
leading to resorption,20,21 but it may also serve as a tion design: EH (HEE Evolution; Fig 1a), IH (ECI Evolution;
bacterial reservoir, contributing to peri-implant tissue Fig 1b), and MT (Fig 1c). All implants were vertically em-
inflammation.22 bedded in acrylic resin (Orthoresin, Degudent) that had
Laboratory fatigue studies have shown improved been poured into a 25-mm-diameter plastic tube. The
mechanical behavior for prostheses supported by top platform was left at the level of the resin surface.
implants with an internal connection versus implants A maxillary central incisor crown was waxed into an
with external connections.5,23 A specific evaluation anatomical shape and cast in cobalt-chromium alloy
comparing EH and IH connections to MT connections (BEGO). To reproduce the anatomy of the crowns, an
was performed in a finite element investigation; the impression was taken from the first waxed pattern and
results showed the lowest stress concentration in the used by the technician as a guide during waxing of the
abutment screw of the MT connection.10 Whereas that remaining crowns. The respective prefabricated abut-
study provided insight about the stress concentrations ments (commercially pure titanium; Emfils, Colosso
of different implant/abutment configurations, the Evolution System) were tightened with a torque gauge
clinical significance of the presence of stresses per se according to the manufacturer’s instructions (30 Ncm)
requires further validation by mechanical testing, such using titanium alloy abutment screws (titanium-alu-
as fatigue. Because comparisons have frequently been minum-vanadium). Following connection of the corre-
made between different implant systems comprising sponding abutments to the implants, the cementation
different implant geometry, an evaluation of the me- surface of the crowns was blasted with aluminum oxide
chanical behavior and failure patterns of EH, IH, and (particle size ≤ 40 µm; 276 KPa of compressed air pres-
MT connections within the same implant system is sure), cleaned with ethanol, dried with air free of water
warranted. and oil, and then cemented (RelyX Unicem, 3M ESPE).
Mechanical Testing and Reliability Analysis identify fractographic markings and characterize the
For mechanical testing, the specimens were subjected origin of failure and direction of propagation, the
to 30-degree off-axis loading. Three specimens of each most representative failed samples of each group were
group underwent single-load-to-failure (SLF) testing at a inspected first under a polarized light microscope
crosshead speed of 1 mm/min in a universal testing ma- (MZ-APO stereomicroscope, Carl Zeiss MicroImaging)
chine (INSTRON 5666); a flat tungsten carbide indenter and then by scanning electron microscopy (SEM)
was used to apply the load at the incisal edge of the (Model S-3500N, Hitachi).26
crown. Based upon the mean values from SLF testing,
three SSALT profiles were determined for the remain-
ing 18 specimens of each group, which were assigned RESULTS
to mild (n = 9), moderate (n = 6), or aggressive (n = 3)
fatigue profiles (ratio 3:2:1, respectively).24–26 These pro- SLF and Reliability
files were named based on the stepwise load increase by The SLF values (means ± standard deviations) were
which they were fatigued along the cycles. Hence, in the 468 ± 97 N for IH, 486 ± 51 N for EH, and 759 ± 52 N
mild profile, a specimen was cycled longer to reach the for MT.
same load level as that allocated in the moderate pro- The beta value means (confidence intervals) and
file and even longer in the aggressive profile. The data associated upper and lower bounds derived from use-
collected during testing at different stress profile levels level probability Weibull calculation (probability of fail-
were used to estimate the parameter that best fit the ure vs number of cycles) were 3.34 (2.22 to 5.00), 1.72
data by means of commonly used life distributions, such (1.14 to 2.58), and 1.05 (0.60 to 1.83) for groups EH, IH,
as log normal, exponential, or Weibull. and MT, respectively. These indicate that fatigue was
The prescribed fatigue method was SSALT under an accelerating factor in all groups (Table 1).
water at 9 Hz with a servo–all-electric system (Test- The step-stress–derived probability Weibull plots
Resources 800L); the indenter contacted the incisal and summary statistics at a 150-N load are presented
edge, applied the prescribed load within the step in Fig 2 and Table 1, respectively. The SSALT permitted
profile, and lifted off the incisal edge. Fatigue testing estimates of reliability at a given load level (Table 1).
was performed until failure (bending or fracture of the The calculated reliability with 90% confidence intervals
fixation screw and/or bending, partial fracture, or total for a mission of 50,000 cycles at 150 N showed that the
fracture of the abutment) or survival (no failure at the cumulative damage from loads reaching 150 N would
end of step-stress profiles, where maximum loads were lead to implant-supported restoration survival of only
up to 600 N).27–29 31% of EH assemblies, whereas 96% of the IH group
Use-level probability Weibull curves (probability of specimens and 99% of the MT specimens would sur-
failure versus number of cycles) with a power law re- vive. The lack of overlap between the upper and lower
lationship for damage accumulation were calculated limits of reliability values emphasizes the statistically
(Alta Pro 7, Reliasoft).30 Reliability (the probability of an significant differences between groups; the MT group
item functioning for a given amount of time without presented the highest reliability, the EH the lowest, and
failure) for completion of a mission of 50,000 cycles at a IH was positioned intermediate to the other groups.
load of 150 N (90% two-sided confidence bounds) was
calculated for group comparisons. Failure Modes
All specimens failed after SSALT. When component
Failure Analysis failures were evaluated together, failures comprised a
The failed samples were visually inspected and classi- combination of abutment screw bending or fracture,
fied according to the proposed failure criteria (bend- abutment bending or fracture, and implant fracture.
ing, fracture) for comparisons between groups. To Observed failure modes are described in Table 2.
50 IH*
Data points
Probability of failure
1
100 10,000 1.000E+6 1.000E+8 1.000E+10
1,000 100,000 1.000E+7 1.000E+9
No. of cycles
a b c
Fig 3 SEM images of the fractured surfaces of the abutments and abutment screws together (a) EH, (b) IH, (c) MT. The white
arrows indicate compression curls, which indicate the direction of crack propagation (black arrow) and evidence of fracture origin at
the opposing tensile side (yellow arrows).
For the EH group, most failures involved abutment fracture were the main failure modes. All abutments and
screw fractures, whereas the abutments and implants re- their screws fractured or bent, whereas the implants re-
mained intact after mechanical testing. For the IH group, mained intact in this group (Fig 3, Table 2).
abutment screw and implant fractures were the chief Observation of the polarized-light and SEM images
failure modes. This group was the only one that showed of the fractured surfaces of the abutment screws al-
longitudinal fractures in the implant neck area. Similarly lowed the consistent identification of fractographic
to the EH group, the abutments were also intact. In the markings (eg, compression curl), fracture origins, and
MT group, abutment and abutment screw bending or the direction of crack propagation (Fig 3).
7. Rangert B, Krogh PH, Langer B, Van Roekel N. Bending overload and 25. Reliasoft. The Weibull Distribution and Beta. Tucson: Reliasoft, 2010.
implant fracture: A retrospective clinical analysis. Int J Oral Maxil- 26. Manda MG, Psyllaki PP, Tsipas DN, Koidis PT. Observations on an in-
lofac Implants 1995;10:326–334. vivo failure of a titanium dental implant/abutment screw system: A
8. Cardoso Lde C, Luvizuto ER, Trevisan CL, Garcia IR Jr, Panzarini SR, case report. J Biomed Mater Res B Appl Biomater 2009;89:264–273.
Poi WR. Resolution of a titanium implant fracture after a recurrent 27. Nelson W. Accelerated Testing: Statistical Models, Test Plans and
trauma. Dent Traumatol 2010;26:512–515. Data Analysis. New York: John Wiley & Sons, 1990.
9. Akca K, Cehreli MC, Iplikcioglu H. Evaluation of the mechanical char- 28. Coelho PG, Silva NR, Bonfante EA, Guess PC, Rekow ED, Thompson
acteristics of the implant-abutment complex of a reduced-diameter VP. Fatigue testing of two porcelain-zirconia all-ceramic crown
Morse-taper implant. A nonlinear finite element stress analysis. Clin systems. Dent Mater 2009;25:1122–1127.
Oral Implants Res 2003;14:444–454. 29. Silva NR, Coelho PG, Fernandes CA, Navarro JM, Dias RA, Thompson
10. Pessoa RS, Muraru L, Marcantonio E Jr, et al. Influence of implant VP. Reliability of one-piece ceramic implant. J Biomed Mater Res B
connection type on the biomechanical environment of immedi- Appl Biomater 2009;88:419–426.
ately placed implants: CT-based nonlinear, three-dimensional finite 30. Zhao WE, Elsayed E. A general accelerated life model for step-stress
element analysis. Clin Implant Dent Relat Res 2010;12:219–234. testing. IEEE Trans Reliabil 2005;37:1059–1069.
11. Binon PP. Implants and components: Entering the new millennium. 31. Silva NR, Bonfante EA, Zavanelli RA, Thompson VP, Ferencz JL,
Int J Oral Maxillofac Implants 2000;15:76–94. Coelho PG. Reliability of metalloceramic and zirconia-based ce-
12. Finger IM, Castellon P, Block M, Elian N. The evolution of external ramic crowns. J Dent Res 2010;89:1051–1056.
and internal implant/abutment connections. Pract Proced Aesthet 32. Coelho PG, Bonfante EA, Silva NR, Rekow ED, Thompson VP. Labora-
Dent 2003;15:625–632. tory simulation of Y-TZP all-ceramic crown clinical failures. J Dent
13. Jemt T, Laney WR, Harris D, et al. Osseointegrated implants for Res 2009;88:382–386.
single tooth replacement: A 1-year report from a multicenter pro- 33. Bonfante EA, Coelho PG, Navarro JM Jr, et al. Reliability and failure
spective study. Int J Oral Maxillofac Implants 1991;6:29–36. modes of implant-supported Y-TZP and MCR three-unit bridges.
14. Morgan MJ, James DF, Pilliar RM. Fractures of the fixture compo- Clin Implant Dent Relat Res 2010;12:235–243.
nent of an osseointegrated implant. Int J Oral Maxillofac Implants 34. Guess PC, Zavanelli RA, Silva NR, Bonfante EA, Coelho PG, Thomp-
1993;8:409–414. son VP. Monolithic CAD/CAM lithium disilicate versus veneered
15. Belser UC, Mericske-Stern R, Bernard JP, Taylor TD. Prosthetic Y-TZP crowns: Comparison of failure modes and reliability after
management of the partially dentate patient with fixed implant fatigue. Int J Prosthodont 2010;23:434–442.
restorations. Clin Oral Implants Res 2000;11(suppl 1):126–145. 35. Freitas AC Jr, Bonfante EA, Rocha EP, Silva NR, Marotta L, Coelho PG.
16. Levine RA, Clem DS III, Wilson TG Jr, Higginbottom F, Solnit G. Effect of implant connection and restoration design (screwed vs.
Multicenter retrospective analysis of the ITI implant system used for cemented) in reliability and failure modes of anterior crowns. Eur J
single-tooth replacements: Results of loading for 2 or more years. Oral Sci 2011;119:323–330.
Int J Oral Maxillofac Implants 1999;14:516–520. 36. Freitas AC Jr, Bonfante EA, Silva NR, Marotta L, Coelho PG. Effect
17. McGlumphy EA, Mendel DA, Holloway JA. Implant screw mechan- of implant-abutment connection design on reliability of crowns:
ics. Dent Clin North Am 1998;42:71–89. Regular vs. horizontal mismatched platform. Clin Oral Implants Res
18. Merz BR, Hunenbart S, Belser UC. Mechanics of the implant- 2012;23:1123-1126.
abutment connection: An 8-degree taper compared to a butt joint 37. Freitas AC Jr, Bonfante EA, Martins LM, Silva NR, Marotta L, Coelho
connection. Int J Oral Maxillofac Implants 2000;15:519–526. PG. Effect of implant diameter on reliability and failure modes of
19. Haack JE, Sakaguchi RL, Sun T, Coffey JP. Elongation and preload molar crowns. Int J Prosthodont 2011;24:557–561.
stress in dental implant abutment screws. Int J Oral Maxillofac 38. Martins LM, Bonfante EA, Zavanelli RA, et al. Fatigue reliability of 3
Implants 1995;10:529–536. single-unit implant-abutment designs. Implant Dent 2012;21:67–71.
20. Alkan I, Sertgoz A, Ekici B. Influence of occlusal forces on stress 39. Jung RE, Pjetursson BE, Glauser R, Zembic A, Zwahlen M, Lang NP.
distribution in preloaded dental implant screws. J Prosthet Dent A systematic review of the 5-year survival and complication rates of
2004;91:319–325. implant-supported single crowns. Clin Oral Implants Res 2008;19:1
21. Hecker DM, Eckert SE. Cyclic loading of implant-supported 19–130.
prostheses: Changes in component fit over time. J Prosthet Dent 40. Mangano C, Mangano F, Shibli JA, et al. Prospective evaluation of
2003;89:346–351. 2,549 Morse taper connection implants: 1- to 6-year data. J Peri-
22. Broggini N, McManus LM, Hermann JS, et al. Peri-implant inflamma- odontol 2011;82:52–61.
tion defined by the implant-abutment interface. J Dent Res 2006; 41. de Jesus Tavarez RR, Bonachela WC, Xible AA. Effect of cyclic load
85:473–478. on vertical misfit of prefabricated and cast implant single abut-
23. Khraisat A, Stegaroiu R, Nomura S, Miyakawa O. Fatigue resistance ment. J Appl Oral Sci 2011;19:16–21.
of two implant/abutment joint designs. J Prosthet Dent 2002;88: 42. Parrington RJ. Fractography of Metals and Plastics. Practical Failure
604–610. Analysis. Materials Park: ASM International, 2002:16–46.
24. Hellsing G. On the regulation of interincisor bite force in man. J Oral
Rehabil 1980;7:403–411.