• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.49 no.1
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• pp.43-48
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• 2023

The biocompatibility and durability of implant fixtures are major concerns for dentists and patients. Mechanical complications of the implant include abutment screw loosening, screw fracture, loss of implant prostheses, and implant fracture. This case report aims to describe management of a case of fixture damage that occurred after screw fracture in a tissue level, internal connection implant and microscopic evaluation of the fractured fixture. A trephine bur was used to remove the fixture, and the socket was grafted using allogeneic bone material. The failed implant was examined by scanning electron microscopy (SEM) and energy dispersive X-ray spectroscopy (EDS), which revealed a fractured fixture with both normal and irregular bone patterns. The SEM and EDS results give an enlightenment of the failed fixture surface micromorphology with microfracture and contaminated chemical compositions. Noticeably, the significantly high level of gold (Au) on the implant surface and the trace amounts of Au and titanium (Ti) in the bone tissue were recorded, which might have resulted from instability and micro-movement of the implant-abutment connection over an extended period of time. Further study with larger number of patient and different types of implants is needed for further conclusion.

• Journal of Periodontal and Implant Science
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• v.45 no.1
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• pp.23-29
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• 2015

Purpose: This study was conducted to compare the cumulative survival rates (CSRs) and the incidence of postloading complications (PLCs) between a bone-level internal connection system (ICS-BL) and an external connection system (ECS). Methods: The medical records of patients treated with either a ICS-BL or ECS between 2007 and 2010 at Asan Medical Center were reviewed. PLCs were divided into two categories: biological and technical. Biological complications included >4 mm of probing pocket depth, thread exposure in radiographs, and soft tissue complications, whereas technical complications included chipping of the veneering material, fracture of the implant, fracture of the crown, loosening or fracture of the abutment or screw, loss of retention, and loss of access hole filling material. CSRs were determined by a life-table analysis and compared using the log-rank chi-square test. The incidence of PLC was compared with the Pearson chi-squared test. Results: A total of 2,651 implants in 1,074 patients (1,167 ICS-BLs in 551 patients and 1,484 ECSs in 523 patients) were analyzed. The average observation periods were 3.4 years for the ICS-BLs and 3.1 years for the ECSs. The six-year CSR of all implants was 96.1% (94.9% for the ICS-BLs and 97.1% for the ECSs, P=0.619). Soft tissue complications were more frequent with the ECSs (P=0.005) and loosening or fracture of the abutment or screw occurred more frequently with the ICS-BLs (P<0.001). Conclusions: Within the limitations of this study, the ICS-BL was more prone to technical complications while the ECS was more vulnerable to biological complications.

• The Journal of the Korean dental association
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• v.55 no.7
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• pp.457-466
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• 2017

In the case of failed fixed implant prosthesis accompanied by abutment screw fracture, fractured screw fragment must be removed to use the existing implant fixtures. A 61-year-old male patient, who had a failed maxillary fixed implant prosthesis accompanied by three abutment screw fracture, hoped to reconstruct the maxillary implant prosthesis, while maintaining the existing implant fixtures. To use the existing implant fixtures, fractured screw fragments were removed. A maxillary implant overdenture using available existing implants was planned. Bar-attachment with Locator was used for implant splinting, denture stability, and retention. Final impression was taken after treatment of peri-implantitis. Jaw relation registration was taken to evaluate available interarch space for bar-attachment. After fabricating bar-attachment, centric relation was taken. Implant overdenture using bar-attachment with Locator was delivered after wax-denture evaluation. This case report showed that a satisfactory clinical result was achieved by implant overdenture using existing implant fixtures in a maxillary edentulous patient.

• The Journal of Advanced Prosthodontics
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• v.7 no.2
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• pp.160-165
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• 2015

PURPOSE. In this study, a temporal abutment fixation screw, designed to fracture in a controlled way upon application of an occlusal force sufficient to produce critical micromotion was developed. The purpose of the screw was to protect the osseointegration of immediate loaded single implants. MATERIALS AND METHODS. Seven different screw prototypes were examined by fixing titanium abutments to 112 Mozo-Grau external hexagon implants (MG Osseous$^{(R)}$; Mozo-Grau, S.A., Valladolid, Spain). Fracture strength was tested at $30^{\circ}$ in two subgroups per screw: one under dynamic loading and the other without prior dynamic loading. Dynamic loading was performed in a single-axis chewing simulator using 150,000 load cycles at 50 N. After normal distribution of obtained data was verified by Kolmogorov-Smirnov test, fracture resistance between samples submitted and not submitted to dynamic loading was compared by the use of Student's t-test. Comparison of fracture resistance among different screw designs was performed by the use of one-way analysis of variance. Confidence interval was set at 95%. RESULTS. Fractures occurred in all screws, allowing easy retrieval. Screw Prototypes 2, 5 and 6 failed during dynamic loading and exhibited statistically significant differences from the other prototypes. CONCLUSION. Prototypes 2, 5 and 6 may offer a useful protective mechanism during occlusal overload in immediate loaded implants.

• The Journal of Korean Academy of Prosthodontics
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• v.43 no.3
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• pp.338-351
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• 2005

Statement of problem. Accurate fit between the implant components is important because the misfit of the implant components results in frequent screw loosening, irreversible screw fracture, plaque accumulation, poor soft tissue reaction, and destruction of osseointegration. Purpose. This study is to evaluate the machining accuracy and consistency of the implant fixture/ abutment/screw interfaces of the internal connection system by using a Stereoscopic Zoom microscope and FE-SEM(field emission scanning electron microscope) Materials and methods. The implant systems selected in this study were internal connection type implants from AVANA(Osstem^{\circledR}), Bioplant(Cowell-Medi^{\circledR}), Dio(DIO^{\circledR}), Neoplant(Neobiotech 􀋓), Implantium(Dentium􀋓)systems. Each group was acquired 2 fixtures at random. Two piece type abutment and one piece type abutment for use with each implant system were acquired. Screw were respectively used to hold a two piece type abutment to a implant fixture. The implant fixtures were perpendiculary mounted in acrylic resin block. Each two piece abutment was secured to the implant fixture by screw and one piece abutment also secured to the implant fixture. Abutment/fixture assembly were mounted in liquid unsaturated polyester. All samples were cross-sectioned with grinder-polisher unit. Finally all specimens were analysed the fit between implant fixture/abutment/screw interfaces Results and conclusions. 1. Implant fixture/abutment/screw connection interfaces of internal connection systems made in Korea were in good condition. 2. The results of the above study showed that materials and mechanical properties and quality of milling differed depending on their manufacturing companies.

• Journal of Technologic Dentistry
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• v.40 no.1
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• pp.41-47
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• 2018

Purpose: The purpose of this study was to analyze the biomechanical properties of the dental implants on the supporting bone using three-dimensional finite element method when three different abutment materials were applied to the implant system. Methods: Three different dental implant models were fabricated by applying Ti, PEEK, and CRE-PEEK (60% carbon-reinforced PEEK) to abutment material. The abutment and connecting screw from the fixture was applied with a tightening torque of 20 Ncm. And then, total loads of 150 N were applied in an $30^{\circ}oblique$ direction (to the vertical). The structural stability of dental implants on the supporting bone was analyzed using Von Mises stress and principal stress values. Results: The maximum tensile stress of the cortical bone was highest at 12.6 MPa in the PEEK abutment (Model-B). Ti abutment (Model-A) and CRE-PEEK abutment (Model-C) showed similar stress distributions (10.6 and 10.3 MPa, respectively). And the maximum compressive principal stress was similar in all models. The Von Mises stress value delivered to the bone around the implant was highest at 16.5 MPa in Model-B. On the other hand, Model-A and C showed similar stress distributions (14.0 and 13.8 MPa, respectively). In addition, the maximum equivalent stress applied to the abutment was highest at 629.8 MPa in Model-A. The stress distribution in Model-C was 573.9 MPa. Whereas, Model-B showed the lowest value at 165.6 MPa. Conclusion : The dental implant supporting bone system using PEEK material seems to have the possibility of supporting bone fracture. It was found that the CRE-PEEK abutment can reduce the elastic deformation and reduce the stress value of the interfacial bone.

• The Journal of Advanced Prosthodontics
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• v.7 no.3
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• pp.183-190
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• 2015

PURPOSE. This study evaluated the fracture load of customized zirconia abutments with titanium insert according to preparation depths, with or without 5-year artificial aging. MATERIALS AND METHODS. Thirty-six identical lithium disilicate crowns (IPS e.max press) were fabricated to replace a maxillary right central incisor and cemented to the customized zirconia abutment with titanium insert on a $4.5{\times}10$ mm titanium fixture. Abutments were fabricated with 3 preparation depths (0.5 mm, 0.7 mm, and 0.9 mm). Half of the samples were then processed using thermocycling (temperature: $5-55^{\circ}C$, dwelling time: 120s) and chewing simulation (1,200,000 cycles, 49 N load). All specimens were classified into 6 groups depending on the preparation depth and artificial aging (non-artificial aging groups: N5, N7, N9; artificial aging groups: A5, A7, A9). Static load was applied at 135 degrees to the implant axis in a universal testing machine. Statistical analyses of the results were performed using 1-way ANOVA, 2-way ANOVA, independent t-test and multiple linear regression. RESULTS. The fracture loads were $539.28{\pm}63.11$ N (N5), $406.56{\pm}28.94$ N (N7), $366.66{\pm}30.19$ N (N9), $392.61{\pm}50.57$ N (A5), $317.94{\pm}30.05$ N (A7), and $292.74{\pm}37.15$ N (A9). The fracture load of group N5 was significantly higher than those of group N7 and N9 (P<.017). Consequently, the fracture load of group A5 was also significantly higher than those of group A7 and A9 (P<.05). After artificial aging, the fracture load was significantly decreased in all groups with various preparation depths (P<.05). CONCLUSION. The fracture load of a single anterior implant restored with lithium disilicate crown on zirconia abutment with titanium insert differed depending on the preparation depths. After 5-year artificial aging, the fracture loads of all preparation groups decreased significantly.

• Journal of Dental Rehabilitation and Applied Science
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• v.22 no.4
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• pp.329-340
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• 2006

Statement of problem: Damping of the peak force transmitted to implants has been reported by in vitro studies using impact forces on resin-veneered superstructures. Theoretical assumptions suggest that use of acrylic resin for the occlusal surfaces of a prosthesis would protect the connection between implant and bone. Therefore, the relationship between prosthesis materials and the force transmitted through the implant system also needs to be investigated under conditions that resemble the intraoral mechanical environment. Purpose: The purpose of this study was to analyze the fracture strength and modes of temporary prosthesis when a flange or occlusally extended structure were connected on the top of the abutment. Material and method: Modified abutments of winged and bulk design were made by casting the desired wax pattern which is made on the UCLA type plastic cylinder. Temporary crowns were made using templates on the modified abutments, and its fracture toughness and strain were compared to the traditional temporary prosthesis. To evaluate the effect of aging, 5.000 times of thermocycling were performed, and their result was compared to the 24hours specimen result. Results: The following conclusions were drawn from this study: 1. In the fracture toughness test, temporary crown's fracture line located next to the screw hole while modified designs with metal support showed fracture line on the metal and its propagation along the metal-resin interface. 2. Wing and bulk structure didn't show significant difference in the fracture toughness (p>0.05), but wing structure showed stress concentration on the screw hole area compared to bulk structure which showed even stress distribution. 3. In the fracture toughness test after thermocycling, wing and bulk structure showed increased or similar results in metal supported area while off-metal area and temporary crown showed decreased results. 4. In the strain measurement after thermocycling, its value increased in the temporary and bulk structure. However, wing structure showed decreased value in the loading point while increased value in the screw hole area. Conclusion: Wing type design showed compatible result to the bulk type that its application with composite resin prosthesis to the implant dentistry is considered promising.

• Journal of Dental Rehabilitation and Applied Science
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• v.27 no.2
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• pp.185-195
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• 2011

In this study, titanium abutments and zirconia abutments were connected to each implant in external type implants. After that they were loaded 10000 times with 20Kg as occlusal force. The surface changes of external hexgon part and platform were observed in FESEM image. Viker's hardness of an implant, a titanium abutment and a zirconia abutment were measured respectively. 1. Viker's hardness of an implants, a titanium abutment and a zirconia abutment was $309.80{\pm}11.78$ HV, $318.40{\pm}11.82$ HV, and $1495.30{\pm}16.21$ HV respectively. There was no statistical significance between an implant and a titanium abutment (P>0.05, Anova). However, there was statistical significance between an implant and a zirconia abutment(P<0.05, Anova). 2. The wear was observed at the joint of implant and abutment in both a titanium abutment group and a zirconia abutment group after loading 10,000 times. The zirconia abutment showed more remarkable wear than the titanium one. In conclusion, the wear of external hexagon and platform was much more notable in a zirconia abutment group than a titanium one. It was suggested that it could result from the difference of surface hardness between titanium and zirconia. The wear of junction between an implant and a zirconia abutment becomes more severe, the connection of an implant and an abutment is much more unfit. This is likely to cause loosening and fracture of the abutment screw. so it is considered that the possibility of implant supra-structure failure can be increased.

• The Journal of Advanced Prosthodontics
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• v.10 no.1
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• pp.65-72
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• 2018

PURPOSE. The aim of this in vitro study was to investigate the fracture resistance under chewing simulation of implant-supported posterior restorations (crowns cemented to hybrid-abutments) made of different all-ceramic materials. MATERIALS AND METHODS. Monolithic zirconia (MZr) and monolithic lithium disilicate (MLD) crowns for mandibular first molar were fabricated using computer-aided design/computer-aided manufacturing technology and then cemented to zirconia hybrid-abutments (Ti-based). Each group was divided into two subgroups (n=10): (A) control group, crowns were subjected to single load to fracture; (B) test group, crowns underwent chewing simulation using multiple loads for 1.2 million cycles at 1.2 Hz with simultaneous thermocycling between $5^{\circ}C$ and $55^{\circ}C$. Data was statistically analyzed with one-way ANOVA and a Post-Hoc test. RESULTS. All tested crowns survived chewing simulation resulting in 100% survival rate. However, wear facets were observed on all the crowns at the occlusal contact point. Fracture load of monolithic lithium disilicate crowns was statistically significantly lower than that of monolithic zirconia crowns. Also, fracture load was significantly reduced in both of the all-ceramic materials after exposure to chewing simulation and thermocycling. Crowns of all test groups exhibited cohesive fracture within the monolithic crown structure only, and no abutment fractures or screw loosening were observed. CONCLUSION. When supported by implants, monolithic zirconia restorations cemented to hybrid abutments withstand masticatory forces. Also, fatigue loading accompanied by simultaneous thermocycling significantly reduces the strength of both of the all-ceramic materials. Moreover, further research is needed to define potentials, limits, and long-term serviceability of the materials and hybrid abutments.