Deformation of Implant Abutments After Framework Connection Using Strain Gauges

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

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.

Deformation of Implant Abutments After Framework Connection Using Strain Gauges

When a cylinder is connected to an abutment it is expected that abutment and cylinder will be subjected to compression forces throughout their periphery because of the clamping force exerted by the screw. The deformation resultant of this compression should be measurable and uniform along the periphery of the abutment. Considering that multiple retainers connected to each other can affect the fit of a framework, as well as the use of different alloys, it is expected that the abutments will present different levels of deformation as a result of framework connection. The aim of this study was to evaluate the deformation of implant abutments after frameworks, cast either in cobalt-chromium (CoCr) or silver-palladium (AgPd) alloys, were connected. Samples (n = 5) simulating a typical mandibular cantilevered implant-supported prosthesis framework were fabricated in cobalt-chromium and silver-palladium alloys and screwed onto standard abutments positioned on a master-cast containing 5 implant replicas. Two linear strain gauges were fixed on the mesial and distal aspects of each abutment to capture deformation as the retention screws were tightened. A combination of compressive and tensile forces was observed on the abutments for both CoCr and AgPd frameworks. There was no evidence of significant differences in median abutment deformation levels for 9 of the 10 abutment aspects. Visually well-fit frameworks do not necessarily transmit load uniformly to abutments. The use of CoCr alloy for implant-supported prostheses frameworks may be as clinically acceptable as AgPd alloy.

Avaliação da precisão das técnicas de moldagem para próteses implantossuportadas sobre implantes alinhados e implantes não-alinhados

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

An Alternative Section Method for Casting and Posterior Laser Welding of Metallic Frameworks for an Implant-Supported Prosthesis

Purpose: The aim of this study was to compare the accuracy of fit of three types of implant-supported frameworks cast in Ni-Cr alloy: specifically, a framework cast as one piece compared to frameworks cast separately in sections to the transverse or the diagonal axis, and later laser welded. Materials and Methods: Three sets of similar implant-supported frameworks were constructed. The first group of six 3-unit implant-supported frameworks were cast as one piece, the second group of six were sectioned in the transverse axis of the pontic region prior to casting, and the last group of six were sectioned in the diagonal axis of the pontic region prior to casting. The sectioned frameworks were positioned in the matrix (10 N(.)cm torque) and laser welded. To evaluate passive fit, readings were made with an optical microscope with both screws tightened and with only one-screw tightened. Data were submitted to ANOVA and Tukey-Kramer`s test (p < 0.05). Results: When both screws were tightened, no differences were found between the three groups (p > 0.05). In the single-screw-tightened test, with readings made opposite to the tightened side, the group cast as one piece (57.02 +/- 33.48 mu m) was significantly different (p < 0.05) from the group sectioned diagonally (18.92 +/- 4.75 mu m) but no different (p > 0.05) from the group transversally sectioned (31.42 +/- 20.68 mu m). On the tightened side, no significant differences were found between the groups (p > 0.05). Conclusions: Results of this study showed that casting diagonally sectioned frameworks lowers misfit levels of prosthetic implant-supported frameworks and also improves the levels of passivity to the same frameworks when compared to structures cast as one piece.

Comparative analysis of the fit of 3-unit implant-supported frameworks cast in nickel-chromium and cobalt-chromium alloys and commercially pure titanium after casting, laser welding, and simulated porcelain firings

This study compared the vertical misfit of 3-unit implant-supported nickel-chromium (Ni-Cr) and cobalt-chromium (Co-Cr) alloy and commercially pure titanium (cpTi) frameworks after casting as 1 piece, after sectioning and laser welding, and after simulated porcelain firings. The results on the tightened side showed no statistically significant differences. On the opposite side, statistically significant differences were found for Co-Cr alloy (118.64 mu m [SD: 91.48] to 39.90 mu m [SD: 27.13]) and cpTi (118.56 mu m [51.35] to 27.87 mu m [12.71]) when comparing 1-piece to laser-welded frameworks. With both sides tightened, only Co-Cr alloy showed statistically significant differences after laser welding. Ni-Cr alloy showed the lowest misfit values, though the differences were not statistically significantly different. Simulated porcelain firings revealed no significant differences.

Modified section method for laser-welding of ill-fitting cp Ti and Ni-Cr alloy one-piece cast implant-supported frameworks

P>This study aimed to verify the effect of modified section method and laser-welding on the accuracy of fit of ill-fitting commercially pure titanium (cp Ti) and Ni-Cr alloy one-piece cast frameworks. Two sets of similar implant-supported frameworks were constructed. Both groups of six 3-unit implant-supported fixed partial dentures were cast as one-piece [I: Ni-Cr (control) and II: cp Ti] and evaluated for passive fitting in an optical microscope with both screws tightened and with only one screw tightened. All frameworks were then sectioned in the diagonal axis at the pontic region (III: Ni-Cr and IV: cp Ti). Sectioned frameworks were positioned in the matrix (10-Ncm torque) and laser-welded. Passive fitting was evaluated for the second time. Data were submitted to anova and Tukey-Kramer honestly significant difference tests (P < 0 center dot 05). With both screws tightened, one-piece cp Ti group II showed significantly higher misfit values (27 center dot 57 +/- 5 center dot 06 mu m) than other groups (I: 11 center dot 19 +/- 2 center dot 54 mu m, III: 12 center dot 88 +/- 2 center dot 93 mu m, IV: 13 center dot 77 +/- 1 center dot 51 mu m) (P < 0 center dot 05). In the single-screw-tightened test, with readings on the opposite side to the tightened side, Ni-Cr cast as one-piece (I: 58 center dot 66 +/- 14 center dot 30 mu m) was significantly different from cp Ti group after diagonal section (IV: 27 center dot 51 +/- 8 center dot 28 mu m) (P < 0 center dot 05). On the tightened side, no significant differences were found between groups (P > 0 center dot 05). Results showed that diagonally sectioning ill-fitting cp Ti frameworks lowers misfit levels of prosthetic implant-supported frameworks and also improves passivity levels of the same frameworks when compared to one-piece cast structures.

Strain Gauge Analysis of the Effect of Porcelain Firing Simulation on the Prosthetic Misfit of Implant-Supported Frameworks

Objectives: This study investigated the effect of porcelain firing on the misfit of implant-supported frameworks and analyzed the influence of preheat treatment on the dimensional alterations.Materials and Methods: Four external-hex cylindrical implants were placed in polyurethane block. Ten frameworks of screw-retained implant-supported prostheses were cast in Pd-Ag using 2 procedures: (1) control group (CG, n = 5): cast in segments and laser welded; and test group (TG, n = 5): cast in segments, preheated, and laser welded. All samples were subjected to firing to simulate porcelain veneering firing. Strain gauges were bonded around the implants, and microstrain values (mu epsilon = 10(-6)epsilon) were recorded after welding (M1), oxidation cycle (M2), and glaze firing (M3). Data were statistically analyzed (2-way analysis of variance, Bonferroni, alpha = 0.05).Results: The microstrain value in the CG at M3 (475.2 mu epsilon) was significantly different from the values observed at M1 (355.6 mu epsilon) and M2 (413.9 mu epsilon). The values at M2 and M3 in the CG were not statistically different. Microstrain values recorded at different moments (M1: 361.6 mu epsilon/M2: 335.3 mu epsilon/M3: 307.2 mu epsilon) did not show significant difference.Conclusions: The framework misfit deteriorates during firing cycles of porcelain veneering. Metal distortion after porcelain veneering could be controlled by preheat treatment. (Implant Dent 2012;21:225-229)

An alternative technique for fabrication of frameworks in an immediate loading implant fixed mandibular prosthesis

The oral rehabilitation of edentulous patients with immediate loading has become a safe procedure with high predictability. The success is related to immediate fabrication of a passive fit framework to attach the implants. Based on these considerations, this case report shows an alternative technique for mandibular rehabilitation using implants immediately loaded, where the framework was fabricated using cylinders with internal reinforcement and precast pieces, electrowelding, and conventional welding providing esthetics and function to the patient in a short period of time.

Precision of fit of implant-supported screw-retained 10-unit computer-aided-designed and computer-aided-manufactured frameworks made from zirconium dioxide and titanium: an in vitro study

OBJECTIVE To analyze the precision of fit of implant-supported screw-retained computer-aided-designed and computer-aided-manufactured (CAD/CAM) zirconium dioxide (ZrO) frameworks. MATERIALS AND METHODS Computer-aided-designed and computer-aided-manufactured ZrO frameworks (NobelProcera) for a screw-retained 10-unit implant-supported reconstruction on six implants (FDI positions 15, 13, 11, 21, 23, 25) were fabricated using a laser (ZrO-L, N = 6) and a mechanical scanner (ZrO-M, N = 5) for digitizing the implant platform and the cuspid-supporting framework resin pattern. Laser-scanned CAD/CAM titanium (TIT-L, N = 6) and cast CoCrW-alloy frameworks (Cast, N = 5) fabricated on the same model and designed similar to the ZrO frameworks were the control. The one-screw test (implant 25 screw-retained) was applied to assess the vertical microgap between implant and framework platform with a scanning electron microscope. The mean microgap was calculated from approximal and buccal values. Statistical comparison was performed with non-parametric tests. RESULTS No statistically significant pairwise difference was observed between the relative effects of vertical microgap between ZrO-L (median 14 μm; 95% CI 10-26 μm), ZrO-M (18 μm; 12-27 μm) and TIT-L (15 μm; 6-18 μm), whereas the values of Cast (236 μm; 181-301 μm) were significantly higher (P < 0.001) than the three CAD/CAM groups. A monotonous trend of increasing values from implant 23 to 15 was observed in all groups (ZrO-L, ZrO-M and Cast P < 0.001, TIT-L P = 0.044). CONCLUSIONS Optical and tactile scanners with CAD/CAM technology allow for the fabrication of highly accurate long-span screw-retained ZrO implant-reconstructions. Titanium frameworks showed the most consistent precision. Fit of the cast alloy frameworks was clinically inacceptable.

Ceramic-veneered zirconia frameworks in full-arch implant rehabilitations: A 6-month to 5-year retrospective cohort study

Purpose: This was a retrospective cohort study designed to evaluate the clinical performance of ceramicveneered zirconia frameworks. Materials and Methods: Patients were recruited according to defined inclusion criteria. All patients were checked every 4 months from the time of definitive rehabilitation. At the end of 2013, all patients were rescheduled and rechecked for study purposes. The restorative procedures assessment was performed by previously established methods. The primary outcomes were the survival and success rates of the prosthesis. Descriptive statistics were used for the patient's demographics, implant distribution, and occurrence of complications. To study the survival and success of the prostheses, a Cox Regression analysis was used with a model constructed in a forward conditional stepwise mode. Predictive variables were included in the model, and adjusted survival curves were obtained for each outcome. Results: From 2008 to 2013, 75 patients were rehabilitated with 92 implant-supported, screw-retained, full-arch ceramic-veneered zirconia framework rehabilitations. The range of follow-up was between 6 months and 5 years. From the 92 full implant-supported screw-retained full-arch rehabilitations, Cox regression analysis indicated that within a 5-year time frame, the probability of framework fracture, major chipping, minor chipping, or any of the former combined to occur was 17.6%, 46.5%, 69.2%, and 90.5%, respectively. Conclusion: Results suggest zirconia as a suitable material for framework structure in implant-supported, full-arch rehabilitations. However, it experiences a high incidence of technical complications, mainly due to ceramic chipping. Further clinical studies should aim to ascertain the effects of clinical features and manufacturing procedures on the survival rates of these prostheses. © 2016 by Quintessence Publishing Co Inc.

Correlation between vertical misfits and stresses transmitted to implants from metal frameworks

An inappropriate prosthetic fit could cause stress over the interface implant/bone. The objective of this study was to compare stresses transmitted to implants from frameworks cast using different materials and to investigate a possible correlation between vertical misfits and these stresses. Fifteen one-piece cast frameworks simulating bars for fixed prosthesis in a model with five implants were fabricated and arranged into three different groups according to the material used for casting: CP Ti (commercially pure titanium), Co-Cr (cobalt-chromium) or Ni-Cr-Ti (nickel-chromium-titanium) alloys. Each framework was installed over the metal model with all screws tightened to a 10 N cm torque and then, vertical misfits were measured using an optical microscope. The stresses transmitted to implants were measured using quantitative photoelastic analysis in values of maximum shear stress (T), when each framework was tightened to the photoelastic model to a 10 N cm standardized torque. Stress data were statistically analyzed using one-way ANOVA and Tukey`s test and correlation tests were performed using Pearson`s rank correlation (alpha = 0.05). Mean and standard deviation values of vertical misfit are presented for CP Ti (22.40 +/- 9.05 mu m), Co-Cr (66.41 +/- 35.47 mu m) and Ni-Cr-Ti (32.20 +/- 24.47 mu m). Stresses generated by Co-Cr alloy (tau = 7.70 +/- 2.16 kPa) were significantly higher than those generated by CP Ti (tau = 5.86 +/- 1.55 kPa, p = 0.018) and Ni-Cr-Ti alloy (tau =5.74 +/- 3.05 kPa, p = 0.011), which were similar (p = 0.982). Correlations between vertical misfits and stresses around the implants were not significant as for any evaluated materials. (C) 2011 Elsevier Ltd. All rights reserved.

Effect of abutment's height and framework alloy on the load distribution of mandibular cantilevered implant-supported prosthesis

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Effect of cantilever length and framework alloy on the stress distribution of mandibular-cantilevered implant-supported prostheses

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Straight and Offset Implant Placement under Axial and Nonaxial Loads in Implant-Supported Prostheses: Strain Gauge Analysis

Purpose: The aim of this in vitro study was to quantify strain development during axial and nonaxial loading using strain gauge analysis for three-element implant-supported FPDs, varying the arrangement of implants: straight line (L) and offset (O). Materials and Methods: Three Morse taper implants arranged in a straight line and three implants arranged in an offset configuration were inserted into two polyurethane blocks. Microunit abutments were screwed onto the implants, applying a 20 Ncm torque. Plastic copings were screwed onto the abutments, which received standard wax patterns cast in Co-Cr alloy (n = 10). Four strain gauges were bonded onto the surface of each block tangential to the implants. The occlusal screws of the superstructure were tightened onto microunit abutments using 10 Ncm and then axial and nonaxial loading of 30 Kg was applied for 10 seconds on the center of each implant and at 1 and 2 mm from the implants, totaling nine load application points. The microdeformations determined at the nine points were recorded by four strain gauges, and the same procedure was performed for all of the frameworks. Three loadings were made per load application point. The magnitude of microstrain on each strain gauge was recorded in units of microstrain (mu). The data were analyzed statistically by two-way ANOVA and Tukey's test (p < 0.05). Results: The configuration factor was statistically significant (p= 0.0004), but the load factor (p= 0.2420) and the interaction between the two factors were not significant (p= 0.5494). Tukey's test revealed differences between axial offset (mu) (183.2 +/- 93.64) and axial straight line (285.3 +/- 61.04) and differences between nonaxial 1 mm offset (201.0 +/- 50.24) and nonaxial 1 mm straight line (315.8 +/- 59.28). Conclusion: There was evidence that offset placement is capable of reducing the strain around an implant. In addition, the type of loading, axial force or nonaxial, did not have an influence until 2 mm.