Effect of repeated torque/mechanical loading cycles on two different abutment types in implants with internal tapered connections: an in vitro study

Internal tapered connections were developed to improve biomechanical properties and to reduce mechanical problems found in other implant connection systems. The purpose of this study was to evaluate the effects of mechanical loading and repeated insertion/removal cycles on the torque loss of abutments with internal tapered connections. Sixty-eight conical implants and 68 abutments of two types were used. They were divided into four groups: groups 1 and 3 received solid abutments, and groups 2 and 4 received two-piece abutments. In groups 1 and 2, abutments were simply installed and uninstalled; torque-in and torque-out values were measured. In groups 3 and 4, abutments were installed, mechanically loaded and uninstalled; torque-in and torque-out values were measured. Under mechanical loading, two-piece abutments were frictionally locked into the implant; thus, data of group 4 were catalogued under two subgroups (4a: torque-out value necessary to loosen the fixation screw; 4b: torque-out value necessary to remove the abutment from the implant). Ten insertion/removal cycles were performed for every implant/abutment assembly. Data were analyzed with a mixed linear model (P <= 0.05). Torque loss was higher in groups 4a and 2 (over 30% loss), followed by group 1 (10.5% loss), group 3 (5.4% loss) and group 4b (39% torque gain). All the results were significantly different. As the number of insertion/removal cycles increased, removal torques tended to be lower. It was concluded that mechanical loading increased removal torque of loaded abutments in comparison with unloaded abutments, and removal torque values tended to decrease as the number of insertion/removal cycles increased. To cite this article:Ricciardi Coppede A, de Mattos MdaGC, Rodrigues RCS, Ribeiro RF. Effect of repeated torque/mechanical loading cycles on two different abutment types in implants with internal tapered connections: an in vitro study.Clin. Oral Impl. Res. 20, 2009; 624-632.doi: 10.1111/j.1600-0501.2008.01690.x.

Machined and plastic copings in three-element prostheses with different types of implant-abutment joints: a strain gauge comparative analysis

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Preload Evaluation of Different Screws in External Hexagon Joint

Purpose: This study compared the maintenance of tightening torque in different retention screw types of implant-supported crowns. Materials and Methods: Twelve metallic crowns in UCLA abutments cast with cobalt-chromium alloy were attached to external hexagon osseointegrated implants with different retention screws: group A: titanium alloy retention screw; group B: gold alloy retention screw with gold coating; group C: titanium alloy retention screw with diamond-like carbon film coating; and group D: titanium alloy retention screw with aluminum titanium nitride coating. Three detorque measurements were obtained after torque insertion in each replica. Data were evaluated by analysis of variance (ANOVA), Tukey's test (P < 0.05), and t test (P < 0.05). Results: Detorque value reduced in all groups (P < 0.05). Group A retained the highest percentage of torque in comparison with the other groups (P < 0.05). Groups B and D retained the lowest percentage of torque without statistically significant difference between them (P < 0.05). Conclusions: All screw types exhibited reduction in the detorque value. The titanium screw maintained the highest percentage of torque whereas the gold-coated screw and the titanium screw with aluminum titanium nitride coating retained the lowest percentage. (Implant Dent 2012;21:46-50)

The effect of insertion time on the axial pullout strength of anterior vertebral body screws

Top screw pullout occurs when the screw is under too much axial force to remain secure in the vertebral body. In vitro biomechanical pullout tests are commonly done to find the maximum fixation strength of anterior vertebral body screws. Typically, pullout tests are done instantaneously where the screw is inserted and then pulled out immediately after insertion. However, bone is a viscoelastic material so it shows a time dependent stress and strain response. Because of this property, it was hypothesised that creep occurs in the vertebral trabecular bone due to the stress caused by the screw. The objective of this study was therefore to determine whether the axial pullout strength of anterior vertebral body screws used for scoliosis correction surgery changes with time after insertion. This study found that there is a possible relationship between pullout strength and time; however more testing is required as the sample numbers were quite small. The design of the screw is made with the knowledge of the strength it must obtain. This is important to prevent such occurrences as top screw pullout. If the pullout strength is indeed decreased due to creep, the design of the screw may need to be changed to withstand greater forces.

Metal artifacts from titanium and steel screws in CT, 1.5T and 3T MR images of the tibial Pilon: A quantitative assessment in 3D

Radiographs are commonly used to assess articular reduction of the distal tibia (pilon) fractures postoperatively, but may reveal malreductions inaccurately. While Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) are potential 3D alternatives they generate metal-related artifacts. This study aims to quantify the artifact size from orthopaedic screws using CT, 1.5T and 3T MRI data. Three screws were inserted into one intact human cadaver ankle specimen proximal to and along the distal articular surface, then CT, 1.5T and 3T MRI scanned. Four types of screws were investigated: titanium alloy (TA), stainless steel (SS) (Ø = 3.5 mm), cannulated TA (CTA) and cannulated SS (CSS)(Ø = 4.0 mm, Ø empty core = 2.6 mm). 3D artifact models were reconstructed using adaptive thresholding. The artifact size was measured by calculating the perpendicular distance from the central screw axis to the boundary of the artifact in four anatomical directions with respect to the distal tibia. The artifact sizes (in the order of TA, SS, CTA and CSS) from CT were 2.0 mm, 2.6 mm, 1.6 mm and 2.0 mm; from 1.5T MRI they were 3.7 mm, 10.9 mm, 2.9 mm, and 9 mm; and 3T MRI they were 4.4 mm, 15.3 mm, 3.8 mm, and 11.6 mm respectively. Therefore, CT can be used as long as the screws are at a safe distance of about 2 mm from the articular surface. MRI can be used if the screws are at least 3 mm away from the articular surface except SS and CSS. Artifacts from steel screws were too large thus obstructed the pilon from being visualised in MRI. Significant differences (P < 0.05) were found in the size of artifacts between all imaging modalities, screw types and material types, except 1.5T versus 3T MRI for the SS screws (P = 0.063). CTA screws near the joint surface can improve postoperative assessment in CT and MRI. MRI presents a favourable non-ionising alternative when using titanium hardware. Since these factors may influence the quality of postoperative assessment, potential improvements in operative techniques should be considered.

The development of a component to improve the loading safety of bone-anchored prostheses

Use of socket prostheses Currently, for individuals with limb loss, the conventional method of attaching a prosthetic limb relies on a socket that fits over the residual limb. However, there are a number of issues concerning the use of a socket (e.g., blisters, irritation, and discomfort) that result in dissatisfaction with socket prostheses, and these lead ultimately a significant decrease in quality of life. Bone-anchored prosthesis Alternatively, the concept of attaching artificial limbs directly to the skeletal system has been developed (bone anchored prostheses), as it alleviates many of the issues surrounding the conventional socket interface.Bone anchored prostheses rely on two critical components: the implant, and the percutaneous abutment or adapter, which forms the connection for the external prosthetic system (Figure 1). To date, an implant that screws into the long bone of the residual limb has been the most common intervention. However, more recently, press-fit implants have been introduced and their use is increasing. Several other devices are currently at various stages of development, particularly in Europe and the United States. Benefits of bone-anchored prostheses Several key studies have demonstrated that bone-anchored prostheses have major clinical benefits when compared to socket prostheses (e.g., quality of life, prosthetic use, body image, hip range of motion, sitting comfort, ease of donning and doffing, osseoperception (proprioception), walking ability) and acceptable safety, in terms of implant stability and infection. Additionally, this method of attachment allows amputees to participate in a wide range of daily activities for a substantially longer duration. Overall, the system has demonstrated a significant enhancement to quality of life. Challenges of direct skeletal attachment However, due to the direct skeletal attachment, serious injury and damage can occur through excessive loading events such as during a fall (e.g., component damage, peri-prosthetic fracture, hip dislocation, and femoral head fracture). These incidents are costly (e.g., replacement of components) and could require further surgical interventions. Currently, these risks are limiting the acceptance of bone-anchored technology and the substantial improvement to quality of life that this treatment offers. An in-depth investigation into these risks highlighted a clear need to re-design and improve the componentry in the system (Figure 2), to improve the overall safety during excessive loading events. Aim and purposes The ultimate aim of this doctoral research is to improve the loading safety of bone-anchored prostheses, to reduce the incidence of injury and damage through the design of load restricting components, enabling individuals fitted with the system to partake in everyday activities, with increased security and self-assurance. The safety component will be designed to release or ‘fail’ external to the limb, in a way that protects the internal bone-implant interface, thus removing the need for restorative surgery and potential damage to the bone. This requires detailed knowledge of the loads typically experienced by the limb and an understanding of potential overload situations that might occur. Hence, a comprehensive review of the loading literature surrounding bone anchored prostheses will be conducted as part of this project, with the potential for additional experimental studies of the loads during normal activities to fill in gaps in the literature. This information will be pivotal in determining the specifications for the properties of the safety component, and the bone-implant system. The project will follow the Stanford Biodesign process for the development of the safety component.

Avaliação in vitro da variação do torque de remoção de parafusos para fixação de pilares protéticos submetidos a ciclos de parafusamento e desparafusamento

O afrouxamento dos parafusos protéticos é descrito na literatura como uma das complicações mais frequentes das próteses sobre implantes. Durante sua confecção, os profissionais sentem necessidade de remover várias vezes as próteses e/ou componentes protéticos, soltando e re-apertando os parafusos repetidamente. O principal objetivo deste trabalho foi avaliar a variação do torque de remoção de parafusos de fixação de pilares protéticos a implantes osteointegráveis após sucessivos ciclos de parafusamento e desparafusamento. Outro objetivo foi avaliar a influência do hexágono da base do pilar no torque de remoção dos parafusos. Para isso, foram utilizados 20 implantes de plataforma regular com hexágono externo e 20 pilares protéticos sextavados, que foram parafusados aos implantes com um parafuso de titânio, aplicando-se a este um torque de 32Ncm, por meio de um torquímetro digital. Os conjuntos implante/pilar/parafuso foram divididos em dois grupos: (1) pilares cujo hexágono da base foram removidos e (2) pilares convencionais, com hexágono na base. Cada conjunto recebeu uma restauração provisória e foi submetido a ciclagem mecânica por 15 minutos. Depois, os parafusos foram removidos, medindo-se o torque de remoção. Esta sequência foi repetida dez vezes e então o parafuso foi trocado por outro sem uso, e mais um ciclo foi realizado. Uma análise de regressão linear demonstrou nos dois grupos uma queda do torque de remoção do parafuso ao longo dos repetidos ciclos de inserção/remoção. A comparação entre os coeficientes da regressão nos dois grupos não revelou diferença entre eles. Também não houve diferença entre as médias das 5 últimas repetições e o 11 ciclo, com o parafuso novo. Concluiu-se que (1) repetidos parafusamentos e desparafusamentos promoveram a diminuição progressiva do torque de remoção dos parafusos, (2) a troca do parafuso por outro sem uso após dez ciclos de inserção/remoção não aumentou sua resistência ao afrouxamento, e (3) a remoção do hexágono da base do pilar protético não exerceu nenhum efeito sobre o torque de remoção do parafuso.

Lateral spreading-induced abutment rotation in the 2011 Christchurch earthquake: Observations and analysis

A series of strong earthquakes near Christchurch, New Zealand, occurred between September 2010 and December 2011, causing widespread liquefaction throughout the city's suburbs. Lateral spreading developed along the city's Avon River, damaging many of the bridges east of the city centre. The short-to medium-span bridges exhibited a similar pattern of deformation, involving back-rotation of their abutments and compression of their decks. By explicitly considering the rotational equilibrium of the abutments about their point of contact with the rigid bridge decks, it is shown that relatively small kinematic demands from the laterally spreading backfill soil are needed to initiate pile yielding, and that this mode of deformation should be taken into account in the design of the abutments and abutment piles.

Screws.

El objetivo de este recurso es llamar la atención de la importancia que tienen los objetos que nos rodean en los principios de la física básica y animar a explorar el entorno en busca de estos principios. Se ofrece a los alumnos de primaria una introducción breve y clara de los tornillos: lo que son, sus partes, cómo funcionan y cómo las usamos para aplicar las fuerzas. Contiene ejemplos conocidos de aplicaciones en el mundo que nos rodea, así como las ocultas en los objetos cotidianos. Las palabras nuevas de vocabulario se definen en un glosario.

Fracture Resistance of the Implant-Abutment Connection in Implants with Internal Hex and Internal Conical Connections Under Oblique Compressive Loading: An In Vitro Study

The objective of this study was to verify if differences in the design of internal hex (IH) and internal conical (IC) connection implant systems influence fracture resistance under oblique compressive forces. Twenty implant-abutment assemblies were utilized: 10 with IH connections and 10 with IC connections. Maximum deformation force for IC implants (90.58 +/- 6.72 kgf) was statistically higher than that for IH implants (83.73 +/- 4.94 kgf) (P = .0182). Fracture force for the IH implants was 79.86 +/- 4.77 kgf. None of the IC implants fractured. The friction-locking mechanics and the solid design of the IC abutments provided greater resistance to deformation and fracture under oblique compressive loading when compared to the IH abutments. Int J Prosthodont 2009;22:283-286.