Effect of microthread presence and restoration design (screw versus cemented) in dental implant reliability and failure modes

Objectives: This study evaluated the reliability and failure modes of implants with a microthreaded or smooth design at the crestal region, restored with screwed or cemented crowns. The postulated null hypothesis was that the presence of microthreads in the implant cervical region would not result in different reliability and strength to failure than smooth design, regardless of fixation method, when subjected to step-stress accelerated life-testing (SSALT) in water. Materials and methods: Eighty four dental implants (3.3 × 10 mm) were divided into four groups (n = 21) according to implant macrogeometric design at the crestal region and crown fixation method: Microthreads Screwed (MS); Smooth Screwed (SS); Microthreads Cemented (MC), and Smooth Cemented (SC). The abutments were torqued to the implants and standardized maxillary central incisor metallic crowns were cemented (MC, SC) or screwed (MS, SS) and subjected to SSALT in water. The probability of failure versus cycles (90% 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% 2-sided confidence intervals) was calculated. Differences between final failure loads during fatigue for each group were assessed by Kruskal-Wallis along with Benferroni's post hoc tests. Polarized-light and scanning electron microscopes were used for failure analyses. Results: The Beta (β) value (confidence interval range) derived from use level probability Weibull calculation of 1.30 (0.76-2.22), 1.17 (0.70-1.96), 1.12 (0.71-1.76), and 0.52 (0.30-0.89) for groups MC, SC, MS, and SS respectively, indicated that fatigue was an accelerating factor for all groups, except for SS. The calculated reliability was higher for SC (99%) compared to MC (87%). No difference was observed between screwed restorations (MS - 29%, SS - 43%). Failure involved abutment screw fracture for all groups. The cemented groups (MC, SC) presented more abutment and implant fractures. Significantly higher load to fracture values were observed for SC and MC relative to MS and SS (P < 0.001). Conclusion: Since reliability and strength to failure was higher for SC than for MC, our postulated null hypothesis was rejected. © 2012 John Wiley & Sons A/S.

The effect of locked screw angulation on the biomechanical properties of the S.P.S. Free-Block plate

Objectives: Among the locked internal fixators is one denominated S.P.S. (Synthesis Pengo System) Free-Block, which was designed with a locking ring that allows the screw to be locked and positioned obliquely. Due to the paucity of biomechanical studies on this system, the present work aimed to evaluate the influence of locked screw angulation on the resistance of the S.P.S. Free--Block plate. Methods: Forty synthetic bone cylinders with 10 mm fracture gap were used. Forty seven-hole 3.5 mm stainless steel plates (two AO-like dynamic compression holes and five locked holes) were assembled according to the orientation of the locked screws: mono cortical screws were positioned at 90° to the long axis of the cylinder (Group 1), and monocortical screws were positioned at 70° to its cylinder long axis (Group 2). In both groups, AO-like dynamic compression hole screws were positioned bicortically and neutrally. For each group, six specimens were tested until failure, three in bending and three in compression, to determine the loads for fatigue testing. Subsequently, for each group, 14 specimens were tested for failure --seven by bending and seven in compression. Results: No significant failure differences were observed between Groups 1 and 2 under static-loading or fatigue test. Clinical significance: In a fracture gap model the orientation of the locked monocortical screws did not show any influence on the mechanical performance of the S.P.S. Free-Block to tests of axial compression and four-point bending. © Schattauer 2013.

Influence of Abutment Type and Esthetic Veneering on Preload Maintenance of Abutment Screw of Implant-Supported Crowns

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

Representações do feminino em Dom Casmurro e The Turn of the Screw

Pós-graduação em Letras - FCLAS

Effect of Abutment Screw Surface Treatment on Reliability of Implant-Supported Crowns

Purpose: To evaluate and compare the reliability of implant-supported single crowns cemented onto abutments retained with coated (C) or noncoated (NC) screws and onto platform-switched abutments with coated screws. Materials and Methods: Fifty-four implants (DT Implant 4-mm Standard Platform, Intra-Lock International) were divided into three groups (n = 18 each) as follows: matching-platform abutments secured with noncoated abutment screws (MNC); matching-platform abutments tightened with coated abutment screws (MC); and switched-platform abutments secured with coated abutment screws (SC). Screws were characterized by scanning electron microscopy and x-ray photoelectron spectroscopy (XPS). The specimens were subjected to step-stress accelerated life testing. Use-level probability Weibull curves and reliability for 100,000 cycles at 200 N and 300 N (90% two-sided confidence intervals) were calculated. Polarized light and scanning electron microscopes were used for fractographic analysis. Results: Scanning electron microscopy revealed differences in surface texture; noncoated screws presented the typical machining grooves texture, whereas coated screws presented a plastically deformed surface layer. XPS revealed the same base components for both screws, with the exception of higher degrees of silicon in the SiO2 form for the coated samples. For 100,000 cycles at 300 N, reliability values were 0.06 (0.01 to 0.16), 0.25 (0.09 to 0.45), and 0.25 (0.08 to 0.45), for MNC, MC, and SC, respectively. The most common failure mechanism for MNC was fracture of the abutment screw, followed by bending, or its fracture, along with fracture of the abutment or implant. Coated abutment screws most commonly fractured along with the abutment, irrespective of abutment type. Conclusion: Reliability was higher for both groups with the coated screw than with the uncoated screw. Failure modes differed between coated and uncoated groups.

A MICROSTRAIN COMPARISON OF PASSIVELY FITTING SCREW-RETAINED AND CEMENTED TITANIUM FRAMEWORKS

Statement of problem. An imprecise fit between frameworks and supporting dental implants in loaded protocols increases the strain transferred to the periimplant bone, which may impair healing or generate microgaps.Purpose. The purpose of this study was to investigate the microstrain between premachined 1-piece screw-retained frameworks (group STF) and screw-retained frameworks fabricated by cementing titanium cylinders to the prefabricated framework (group CTF). This procedure was developed to correct the misfit between frameworks and loaded implants.Material and methods. Four internal hexagon cylindrical implants were placed 10 mm apart in a polyurethane block by using the surgical guides of the corresponding implant system. Previously fabricated titanium frameworks (n=10) were divided into 2 groups. In group STF, prefabricated machined frameworks were used (n=5), and, in group CTF, the frameworks were fabricated by using a passive fit procedure, which was developed to correct the misfit between the cast titanium frameworks and supporting dental implants (n=5). Both groups were screw-retained under torque control (10 Ncm). Six strain gauges were placed on the upper surface of the polyurethane block, and 3 strain measurements were recorded for each framework. Data were analyzed with the Student t test (alpha=.05).Results. The mean microstrain values between the framework and the implants were significantly higher for group STF (2517 me) than for group CTF (844 me) (P<.05).Conclusions. Complete-arch implant frameworks designed for load application and fabricated by using the passive fit procedure decreased the strain between the frameworks and implants more than 1 piece prefabricated machined frameworks.

Carbon Film Coating of Abutment Surfaces: Effect on the Abutment Screw Removal Torque

Purpose: To evaluate the effect of diamond-like carbon (DLC) coating of prefabricated implant abutment on screw removal torque (RT) before and after mechanical cycling (MC).Materials and Methods: Fifty-four abutments for external-hex implants were divided among 6 groups (n = 9): S, straight abutment (control); SC, straight coated abutment; SCy, straight abutment and MC; SCCy, straight coated abutment and MC; ACy, angled abutment and MC; and ACCy, angled coated abutment and MC. The abutments were attached to the implants by a titanium screw. RT values were measured and registered. Data (in Newton centimeter) were analyzed with analysis of variance and Dunnet test (alpha = 0.05).Results: RT values were significantly affected by MC (P = 0.001) and the interaction between DLC coating and MC (P = 0.038). SCy and ACy showed the lowest RT values, statistically different from the control. The abutment coated groups had no statistical difference compared with the control. Scanning electron microscopy analysis showed DLC film with a thickness of 3 mm uniformly coating the hexagonal abutment.Conclusion: DLC film deposited on the abutment can be used as an alternative procedure to reduce abutment screw loosening.

Effect of mechanical cycling on screw torque in external hexagon implants with and without platform switching

This in vitro study evaluated the effect of mechanical cycling on the torque of retaining screw in external hexagon implants with platform switching (PS), regular platform (RP) and wide platform (WP). A total of 30 specimens were equally divided into 3 groups: PS, PR and WP. Each specimen was prepared with implants: 3.75 x 10 mm for RP group and 5.0x10 mm for PS and WP groups and its respective abutment with 32 Ncm torque. All groups were subjected to 106 cycles with 100 N (corresponding to about 40 months of chewing). The results were obtained with the reverse torque of each specimen and data were evaluated using ANOVA and Tukey test (p<0.05). The PS group showed statistically significant difference in screw removal torque (30.06±5.42) compared with RP (23.75±2.76) and WP (21.32±3.53) (p<0.05) groups; the RP and WP groups showed no statistically significant difference between them. It was concluded that the PS group showed higher reverse torque value, suggesting lower susceptibility of the abutment screw loosening.

TOMOGRAPHIC ANALYSIS FOR C2 SCREW PLACEMENT IN RHEUMATOID ARTHRITIS PATIENTS

Objective: A morphological analysis of the bone structure of 02 in patients with rheumatoid arthritis in order to enhance the security of the stabilization procedures for this vertebra. Methods: We retrospectively analyzed 20 CT scans of the cervical spine performed in patients with rheumatoid arthritis; the following parameters were measured: spinolaminar angle, thickness and length of C2 lamina. Results: The mean values are: 5.92mm and 5.87mm for thickness of right and left laminae retrospectively, 27.75mm for right lamina length and 27.94mm for left lamina length, and 44.7 degrees for spinolaminar angle. Conclusion: The values obtained are consistent with studies in normal subjects published by other groups, with no apparent need for change in the screw placement technique. Level of Evidence IV, Case Series.

Effect of a propeller duct on AUV maneuverability

A number of autonomous underwater vehicles, AUV, are equipped with commercial ducted propellers, most of them produced originally for the remote operated vehicle, ROV, industry. However, AUVs and ROVs are supposed to work quite differently since the ROV operates in almost the bollard pull condition, while the AUV works at larger cruising speeds. Moreover, they can have an influence in the maneuverability of AUV due to the lift the duct generates in the most distant place of the vehicle's center of mass. In this work, it is proposed the modeling of the hydrodynamic forces and moment on a duct propeller according to a numerical (CFD) simulation, and analytical and semi-empirical, ASE, approaches. Predicted values are compared to experimental results produced in a towing tank. Results confirm the advantages of the symbiosis between CFD and ASE methods for modeling the influence of the propeller duct in the AUV maneuverability. (C) 2012 Elsevier Ltd. All rights reserved.

Isokinetic muscle strength and knee function associated with double femoral pin fixation and fixation with interference screw in anterior cruciate ligament reconstruction

Intensive scheduling in sports requires athletes to resume physical activity shortly after injury. The purpose of this study was to investigate early isokinetic muscle strength and knee function on bone-patellar tendon-bone (BPTB) ACL reconstruction with double femoral pin fixation or interference screw technique. A prospective study was conducted from 2008 to 2009, with 48 athletes who received femoral BPTB fixation with interference screw (n = 26) or double pin (n = 22). Clinical (IKDC objective score and hop test) and isokinetic muscle strength (peak torque (PT), PT/body weight and flexion/extension rate (F/E) in 60 and 240A degrees/s) were analyzed at 6 months of follow-up. Analysis at baseline showed no differences between groups before surgery related to age, gender, associated injury, Tegner or Lysholm score; thus showing that groups were similar. During follow-up, however, there were significant differences between the two groups in some of the isokinetic muscle strength: PT/BW 60A degrees/s (Double Pin = 200% +/- A 13% vs. Interference Screw = 253% +/- A 16%*, *P = 0.01); F/E 60A degrees/s (Double Pin = 89% +/- A 29%* vs. Interference Screw = 74% +/- A 12%, *P = 0.04). No statistical differences between groups were observed on IKDC objective score, hop test and complications. The significant muscle strength outcome of the interference screw group found in this study gives initial evidence that this fixation technique is useful for athletes that may need accelerated rehabilitation. Early return to sports ability signaled by isokinetic muscle strength is of clinical relevance as it is one of the main goals for athletes' rehabilitation. III.

DensiProbe Spine: a novel instrument for intraoperative measurement of bone density in transpedicular screw fixation

STUDY DESIGN.: Cadaver study. OBJECTIVE.: To determine bone strength in vertebrae by measuring peak breakaway torque or indentation force using custom-made pedicle probes. SUMMARY OF BACKGROUND DATA.: Screw performance in dorsal spinal instrumentation is dependent on bone quality of the vertebral body. To date no intraoperative measuring device to validate bone strength is available. Destructive testing may predict bone strength in transpedicular instrumentations in osteoporotic vertebrae. Insertional torque measurements showed varying results. METHODS.: Ten human cadaveric vertebrae were evaluated for bone mineral density (BMD) measurements by quantitative computed tomography. Peak torque and indentation force of custom-made probes as a measure for mechanical bone strength were assessed via a transpedicular approach. The results were correlated to regional BMD and to biomechanical load testing after pedicle screw implementation. RESULTS.: Both methods generated a positive correlation to failure load of the respective vertebrae. The correlation of peak breakaway torque to failure load was r = 0.959 (P = 0.003), therewith distinctly higher than the correlation of indentation force to failure load, which was r = 0.690 (P = 0.040). In predicting regional BMD, measurement of peak torque also performed better than that of indentation force (r = 0.897 [P = 0.002] vs. r = 0.777 [P = 0.017]). CONCLUSION.: Transpedicular measurement of peak breakaway torque is technically feasible and predicts reliable local bone strength and implant failure for dorsal spinal instrumentations in this experimental setting.