• The Journal of the Korean dental association
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• v.54 no.3
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• pp.184-190
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• 2016

The osseointegration of titanium implants has been examined over the past 50 years. Many implant systems have been introduced and have become popular to the implant dentistry. The designs of the connection between implant fixture and abutment are divided into external vs internal connection. From beginning, the $Br{\aa}nemark$ system was characterized by an external hexagon. Internal connection has been developed to reduce stress transferred to the bone. These differences may have impact on the clinical procedures and protocols, laboratory and components costs, and incidence of complications. Therefore, the clinician has to know the different biomechanical features and understand their implications to produce successful implant-supported prosthesis with an external or an internal connection system.

• The Journal of Korean Academy of Prosthodontics
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• v.41 no.4
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• pp.393-404
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• 2003

Statement of problem. Higher incidence of prosthetic complications such as screw loosening, screw fracture has been reported for posterior single tooth implant. So, there is ongoing research regarding stability of implant-abutment interface. One of those research is increasing the implant diameter and prosthetic table width to improve joint stability. In another part of this research, internal conical type implant-abutment interface was developed and reported joint strength is higher than traditional external hex interface. Purpose. The purpose of this study is to compare stress distribution in single molar implant between external hex butt joint implant and internal conical joint implant when increasing the implant diameter and prosthetic table width : 4mm diameter, 5mm diameter, 5mm diameter/6mm prosthetic table width. Material and method. Non-linear finite element models were created and the 3-dimensional finite element analysis was performed to see the distribution of stress when 300N static loading was applied to model at $0^{\circ},\;15^{\circ},\;30^{\circ}$ off-axis angle. Results. The following results were obtained : 1. Internal conical joint showed lower tensile stress value than that of external hex butt joint. 2. When off-axis loading was applied, internal conical joint showed more effective stress distribution than external hex butt joint. 3. External hex butt joint showed lower tensile stress value when the implant diameter was increased. 4. Internal conical joint showed lower tensile stress value than external hex butt joint when the implant diameter was increased. 5. Both of these joint mechanism showed lower tensile stress value when the prosthetic table width was increased. Conclusion. Internal conical joint showed more effective stress distribution than external hex joint. Increasing implant diameter showed more effective stress distribution than increasing prosthetic table width.

• Tribology and Lubricants
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• v.37 no.4
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• pp.136-143
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• 2021

This paper presents the loosening behavior that occurs after the application of an external load to internal and external connection types of dental implants using the finite element method. We use fastening force between an abutment and a fixture to clamp the dental implant system; however, loosening and breakage may occur owing to cyclic external loads. In this study, we considered the initial fastening condition in the pre-load analysis and then investigated the change in stress and contact surface status when applying external loads. After the application of the initial fastening load, we verified that the internal connection-type model exhibited a relatively lower stress distribution than that of the external connection-type one. Moreover, we found that the former model showed a lower stress concentration after the application of the external load. In addition, after the application of this load, we found that the higher the shear load acting on the implant system, the higher the possibility of loosening. The study results showed the change in stress distribution and contact surface according to the connection type of the dental implants and the phenomenon of loosening by cyclic loads. We expect that the results of this study will be useful for the study of reliability and design of dental implant systems.

• Journal of Periodontal and Implant Science
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• v.52 no.6
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• pp.496-508
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• 2022

Purpose: This study aimed to compare the long-term survival rate and peri-implant marginal bone loss between different types of dental implant-abutment connections. Methods: Implants with external or internal abutment connections, which were fitted at Gangneung-Wonju National University Dental Hospital from November 2011 to December 2015 and followed up for >5 years, were retrospectively investigated. Cumulative survival rates were evaluated for >5 years, and peri-implant marginal bone loss was evaluated at 1- and 5-year follow-up examinations after functional loading. Results: The 8-year cumulative survival rates were 93.3% and 90.7% in the external and internal connection types, respectively (P=0.353). The mean values of marginal bone loss were 1.23 mm (external) and 0.72 mm (internal) (P<0.001) after 1 year of loading, and 1.20 mm and 1.00 mm for external and internal abutment connections, respectively (P=0.137) after 5 years. Implant length (longer, P=0.018), smoking status (heavy, P=0.001), and prosthetic type (bridge, P=0.004) were associated with significantly greater marginal bone loss, and the use of screw-cement-retained prosthesis was significantly associated (P=0.027) with less marginal bone loss. Conclusions: There was no significant difference in the cumulative survival rate between implants with external and internal abutment connections. After 1 year of loading, marginal bone loss was greater around the implants with an external abutment connection. However, no significant difference between the external and internal connection groups was found after 5 years. Both types of abutment connections are viable treatment options for the reconstruction of partially edentulous ridges.

• The Journal of Korean Academy of Prosthodontics
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• v.44 no.2
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• pp.174-184
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• 2006

Purpose: Current trend in implant dentistry is changing from external connection to internal connection. To evaluate the splinting of external and internal connection implant on screw loosening, 2-units prosthesis was fabricated with BioPlant $System^(R)$ of external connection type and Lifecore STAGE-1 Single Stage Implant $System^(R)$ of internal connection type. Material and Method: Experimental group is classified into three groups. 1) $G_1-EE$: 2-units prosthesis was fabricated with two Bioplant $System^(R)$ of external connection type. 2) $G_1-EI$: 2-units prosthesis was fabricated with one BioPlant $System^(R)$ of external connection type and one Lifecore STAGE-1 Single Stage Implant $System^(R)$ of internal connection type. 3) $G_1-II$: 2-units prosthesis was fabricated with two Lifecore STAGE-1 Single Stage Implant $System^(R)$ of internal connection type. In fabricating 2-units prosthesis, two hexed abutments are recommended when two implants are installed parallel, otherwise one hexed abutment is used on major occlusal force area and one nonhexed abutment is used on the other area. Since it is rare to find two implants being parallel, it is hard to fabricate prosthesis with passive adaptation using two hexed abutments. It is much more difficult to acquire passive adaptation when using hex abutment compared to nonhex abutment. To evaluate the influence of hexed and nonhexed abutment on screw loosening, 2-units prosthesis was fabricated with hexed and nonhexed abutment. Experimental group is classified into three groups. 1) $G_2-HH$: 2-units prosthesis was fabricated with two hexed abutments. 2) $G_2-HN$: 2-units prosthesis was fabricated with one hexed abutment and one nonhexed abutment. 3) $G_2-NN$: 2-units prosthesis was fabricated with two nonhexed abutments. Result: The results of comparing the detorque value after loading on a each prosthesis periodically are as follows. 1. In splinting group of external and internal connection implant, $G_1-II$ group demonstrated the biggest detorque value, followed by $G_1-EI$ group and $G_1-EE$ group. 2. There is no notable significance between external connection implant of $G_1-EI$ group and $G_1-EE$ group and also no significance between internal connection implant of $G_1-EI$ group and $G_1-II$ group. 3. $G_2-HH$ group showed higher detorque value than $G_2-HN\;and\;G_2-NN$ group. From the results, we can concluded that using both external connection and internal connection implant together is clinically acceptable and in order to acquire a good passive adaptation in fabricating 2-units implant prosthesis we can use two nonhexed abutments.

• The Journal of Advanced Prosthodontics
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• v.8 no.6
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• pp.465-471
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• 2016

PURPOSE. The purpose of this study is to evaluate the stability of interface between Co-Cr-Mo (CCM) UCLA abutment and external hex implant. MATERIALS AND METHODS. Sixteen external hex implant fixtures were assigned to two groups (CCM and Gold group) and were embedded in molds using clear acrylic resin. Screw-retained prostheses were constructed using CCM UCLA abutment and Gold UCLA abutment. The external implant fixture and screw-retained prostheses were connected using abutment screws. After the abutments were tightened to 30 Ncm torque, 5 kg thermocyclic functional loading was applied by chewing simulator. A target of $1.0{\times}10^6$cycles was applied. After cyclic loading, removal torque values were recorded using a driving torque tester, and the interface between implant fixture and abutment was evaluated by scanning electronic microscope (SEM). The means and standard deviations (SD) between the CCM and Gold groups were analyzed with independent t-test at the significance level of 0.05. RESULTS. Fractures of crowns, abutments, abutment screws, and fixtures and loosening of abutment screws were not observed after thermocyclic loading. There were no statistically significant differences at the recorded removal torque values between CCM and Gold groups (P>.05). SEM analysis revealed that remarkable wear patterns were observed at the abutment interface only for Gold UCLA abutments. Those patterns were not observed for other specimens. CONCLUSION. Within the limit of this study, CCM UCLA abutment has no statistically significant difference in the stability of interface with external hex implant, compared with Gold UCLA abutment.

• Journal of Dental Rehabilitation and Applied Science
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• v.18 no.2
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• pp.81-91
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• 2002

Dental implant systems have shown many post-surgical problems and One of the most frequent problem is screw loosening. To reduce screw loosening, a number of methods have been tried and recently fundamental modification of fixture-abutment connection structure was developed and used the most frequently. Former implant system structure, such as Br${\aa}$nemark, had external hex with the height of 0.7 mm and later, fixture with external hex of 1.0 mm height and internal hex structure were developed. In addition, the method of morse taper application was introduced to reduce screw loosening. In this study, the level of screw loosening of each implant systems was compared based on the vibration loosening measurement of abutment screw of each implant systems. Analysis of measured value was performed using 3 kinds of methods, (i) Percentage of average of initial 3 times loosening-torque value(initial loosening value) to tightening-torque of 30 Ncm, (ii) Percentage of loosening-torque value after 200 N strength loaded(experimental value) to initial loosening value and (iii) Percentage of experimental value to 30 Ncm of tightening-torque. Each result of analyses shows the value of initial loosening, loosening by repetitive load and final loosening level. The results of this study were as follows. (1) Percentage of initial loosening value to tightening-torque was increased in order of 0.7 mm external hex, 1.0 mm external hex, internal hex and internal taper and all values between each groups showed statistical significance (p<0.05). (2) Percentage of experimental value to initial loosening value was increased in order of internal hex, 0.7 mm external hex, 1.0 mm external hex and internal taper. Value of internal taper showed significant difference with that of 0.7 mm external hex and internal hex (p<0.05). (3) Percentage of experimental value to tightening torque was increased in order of 0.7 mm external hex, 1.0 mm external hex, internal hex and internal taper. Values of all groups showed statistical significance (p<0.05) except between the groups of 1.0 mm external hex and internal hex. Based on those results, there was no significant difference of loosening-torque by repetitive loading except internal taper. It is supposed that implant system with high resistant capability against initial loosening could be recommended for clinical use. In addition, in case of single implant restoration, 1.0 mm external hex or internal hex could be recommended rather than 0.7 mm external hex, and the use of internal taper would be the most useful way to reduce screw loosening.

• The Journal of Korean Academy of Prosthodontics
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• v.55 no.1
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• pp.9-17
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• 2017

Purpose: The purpose of this study was to evaluate the fracture strength of straight and angled zirconia abutments for internal hex and external hex implants. Materials and methods: Twenty internal hex implants and 20 external hex implants were prepared. The prefabricated straight zirconia abutments and 17-degree-angled zirconia abutments were connected to those 40 implants. The specimens were classified into 4 groups depending on the connection type and abutment angulation; internal hex implant/straight abutment, group INS; internal hex implant/angled abutment, group INA; external hex implant/straight abutment, group EXS; external hex implant/angled abutment, group EXA. All specimens were loaded at a 30-degree angle with a crosshead speed of 1 mm/min using universal testing machine. The fracture loads were analyzed using 2-way ANOVA and independent t-test (${\alpha}=.05$). Results: The mean fracture load for INS was 955.91 N, 933.65 N for INA, 1267.20 N for EXS, and 1405.93 N for EXA. External hex implant showed a significantly higher fracture load, as compared to internal hex implant (P < .001). No significant differences in fracture loads were observed between the straight and angled abutment in internal hex implants (P = .747) and external hex implants (P = .222). Internal hexes of abutments were fractured horizontally in internal connection implants, while lingual cervical neck portions were fractured in external connection implants. Conclusion: The zirconia abutments with external hex implants showed significantly higher fracture strength than those with internal hex implants. However there was no difference in fracture strength between the straight and 17-degree-angled zirconia abutment connected to both implant systems.

• The Journal of Advanced Prosthodontics
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• v.10 no.2
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• pp.155-162
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• 2018

PURPOSE. The aim of this study was to compare the fracture of implant component behavior of external and internal type of implants to suggest directions for successful implant treatment. MATERIALS AND METHODS. Data were collected from the clinical records of all patients who received WARANTEC implants at Seoul National University Dental Hospital from February 2002 to January 2014 for 12 years. Total number of implants was 1,289 and an average of 3.2 implants was installed per patient. Information about abutment connection type, implant locations, platform sizes was collected with presence of implant component fractures and their managements. SPSS statistics software (version 24.0, IBM) was used for the statistical analysis. RESULTS. Overall fracture was significantly more frequent in internal type. The most frequently fractured component was abutment in internal type implants, and screw fracture occurred most frequently in external type. Analyzing by fractured components, screw fracture was the most frequent in the maxillary anterior region and the most abutment fracture occurred in the maxillary posterior region and screw fractures occurred more frequently in NP (narrow platform) and abutment fractures occurred more frequently in RP (regular platform). CONCLUSION. In external type, screw fracture occurred most frequently, especially in the maxillary anterior region, and in internal type, abutment fracture occurred frequently in the posterior region. placement of an external type implant rather than an internal type is recommended for the posterior region where abutment fractures frequently occur.

• The Journal of Advanced Prosthodontics
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• v.9 no.4
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• pp.271-277
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• 2017

PURPOSE. This in vitro study aimed to evaluate the effect of implant connection design (external vs. internal) on the fit discrepancy and torque loss of zirconia and titanium abutments. MATERIALS AND METHODS. Two regular platform dental implants, one with external connection ($Br{\aa}nemark$, Nobel Biocare AB) and the other with internal connection (Noble Replace, Nobel Biocare AB), were selected. Seven titanium and seven customized zirconia abutments were used for each connection design. Measurements of geometry, marginal discrepancy, and rotational freedom were done using video measuring machine. To measure the torque loss, each abutment was torqued to 35 Ncm and then opened by means of a digital torque wrench. Data were analyzed with two-way ANOVA and t-test at ${\alpha}=0.05$ of significance. RESULTS. There were significant differences in the geometrical measurements and rotational freedom between abutments of two connection groups (P<.001). Also, the results showed significant differences between titanium abutments of internal and external connection implants in terms of rotational freedom (P<.001). Not only customized internal abutments but also customized external abutments did not have the exact geometry of prefabricated abutments (P<.001). However, neither connection type (P=.15) nor abutment material (P=.38) affected torque loss. CONCLUSION. Abutments with internal connection showed less rotational freedom. However, better marginal fit was observed in externally connected abutments. Also, customized abutments with either connection could not duplicate the exact geometry of their corresponding prefabricated abutment. However, neither abutment connection nor material affected torque loss values.