The development of modern Oral

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1 RESEARCH In Vitro Evaluation of the Removal Force of Abutments in Frictional Dental Implants João César Zielak, DDS, MSc, PhD* Murilo Rorbacker, DDS Rodrigo Gomes, DDS Celso Yamashita, DDS, MSc, PhD Carla Castiglia Gonzaga, DDS, MSc, PhD Allan Fernando Giovanni, DDS, MSc, PhD The objective of the present work was to determine some force parameters for removal of an abutment from a dental implant in a frictional system (locking taper, 1.23 degrees). Ten implants of the same length (11 mm) and different diameters were selected, along with 10 straight abutments (13 mm length) with different diameters. Abutments were attached to implants without application of force. Fixation of the implant-abutment mount (IA) (repeated 1 5 times) was performed through the impact of a body weight (compression force, tapping) left from a known height. After each group of tappings, IA mounts were coupled with a tensile strength tester. The lowest removal value was found after the first tapping of mount #2 (83 N, implant diameter 3.3 mm/4.5 mm abutment diameter), and the highest removal value happened with mount #8 after the fifth tapping (420 N, 5.0 mm/5.5 mm). The force to remove IA mounts increased with the number of tappings and with the increase in abutment mass. Three activations (tappings) of the abutment were considered necessary to yield optimal stability, demonstrated by the large increase in removal force. Key Words: dental implants, frictional system, locking taper, abutment removal, tensile strength INTRODUCTION The development of modern Oral Implantology is the result of concepts added to original ideas proposed by Brånemark, but the main definition of osseointegration has been preserved. 1 A great challenge of Implantology is the connection between the implant and the prosthesis (abutment). Screw-retained abutments are widely used in Faculty of Dentistry, Positivo University, Curitiba, Paraná, Brazil. *Corresponding author, jzielak@up.edu.br DOI: /AAID-JOI-D commercial implant systems; however, they are known to present technical complications, such as smallness of screws and the need for repeated torques due to screw loosening. In addition, the formation of a gap between implant and abutment may allow the infiltration of fluids and bacteria through the implant-abutment interface. 2 Alternatives to screw-retained abutments are currently available. In a screwless implant system, the abutment is retained by means of friction force. Some examples use taper angle values from 1 to 10 degrees. 3 Intimate contact between the components Journal of Oral Implantology 519

2 Evaluation of Abutments in Frictional Dental Implants FIGURES 1 2. FIGURE 1. Schematic drawing of frictional implant used here. Threads are used for cover screws and temporary plugs, not for the implant abutment. FIGURE 2. The instrument used to tap the abutment against the implant, the first one being supported by its proper base. provides great frictional force and retention. Frictional systems present some advantages, starting with ease of handling (no tiny parts and screws), ease of abutment preparation in intraoral adjustments, and hermetic sealing. 3 6 In screw-retained systems, connection of the components is achieved by means of known rotational force (torque) during installation. 7 Although long-time clinical effectiveness has been demonstrated, 4,7 doubts have been raised regarding quantification of forces applied during installation of frictional systems. The importance of this matter becomes more evident with consideration that in some cases, it may be necessary to reverse the applied connection. Thus, the objective of this in vitro study was to determine some force parameters for removal of the union of an abutment and an implant in a locking taper system with a 1.23 degree angle. MATERIALS AND METHODS Ten Ti implants of 11 mm in length and different diameters and 10 straight abutments of 13 mm in length and different diameters (Kopp, Curitiba, Brazil) were selected (Figure 1). The implants and the abutments were made of titanium alloys (ASTM F67 and ASTM F136, respectively), with hardness values of 20 HRC and 29 HRC. According to the manufacturer, all surfaces of the implants and abutments were machined in a Swiss lathe using hard metal inserts. The internal calibration was verified by standards for Morse cone confirmation. One by one, abutments and implants, available in separate packages, were passively mounted together by a single operator prior to the application of force, with rounding up to a total of 10 implantabutment mounts (IA), as described in Table 1. After attachment, the IA mounts were placed on an adapted support base for compression. The instrument used for delivery of compression force (BCP, Kopp, Curitiba, Brazil), shown in Figure 2, was placed on another support base (7011SN, Mitutoyo, Sao Paulo, Brazil) following the long axis of the IA mounts. Fixation of IA was performed by the impact of a body weight (m kg), left from a known height (h m), limited by the instrument. The potential energy (Ep) provided by each 520 Vol. XXXVII/No. Five/2011

3 Zielak et al TABLE 1 General specifications of the implantabutment (IA) mounts used here Implant Abutment (IA) Mount External Diameter of 11-mm-Long Implant tapping was calculated by equation 1, where g is the gravitational force. Ep ~ m : g : h ð1þ The weights of the abutments were determined by a semianalytical scale (Mark 500, Bel, Denver, Colo). The resultant potential energy was J (N.m). The removal (separation of abutment from implant) force was determined after 1, 2, 3, 4, and 5 tappings performed for each IA mount. Force values were determined with the aid of a universal testing machine (DL 30000, EMIC, Sao Jose dos Pinhais, Brazil) at a cross-head speed of 3 mm/min. RESULTS ExternalDiameter of 13-mm-Long Abutment Figure 3 shows removal force values as a function of the number of tappings. It can be seen that the higher the number of tappings, the greater the removal force, although a few exceptions were found, such as mounts #7 and #10. Figure 4 shows a positive correlation between removal forces and the increasing masses of the abutments. Table 2 presents minimum, mean, and maximum removal forces as a function of the number of tappings. For all groups, the lowest removal force was found for mount #2 after a single tapping only, while the highest value occurred in mount #8, after the fifth tapping. Removal forces tended to increase as the number of tappings increased. DISCUSSION Removal of the abutment in frictional implants may be of greater concern in esthetic areas, where the clinician tends to verify the position of the IA mount visually. In this implant system, the abutment itself is used as transfer for the laboratory, which means that it has to be at the right level during the impression. It has been demonstrated that tapping can intrude abutment as far as 0.1 mm. 3 Nevertheless, until occlusal balance is achieved, it is possible to have the IA disconnected. The present study confirmed a positive correlation between the number of tappings and the removal forces. Figure 3 and Table 2 show that for almost all groups, the removal force increased as tappings increased. Removal mean values were increased after 1 (111.4 N) and up to 5 tappings (294.6 N). FIGURES 3 AND 4. FIGURE 3. Removal force values (N) as a function of the number of tappings. FIGURE 4. Removal force values (N) as a function of the mass (g) of the abutment. Journal of Oral Implantology 521

Evaluation of Abutments in Frictional Dental Implants TABLE 2 Minimum, mean, and maximum removal forces (Newtons) as a function of the number of tappings Number of Tappings Minimum Mean Maximum 1 83

4 Evaluation of Abutments in Frictional Dental Implants TABLE 2 Minimum, mean, and maximum removal forces (Newtons) as a function of the number of tappings Number of Tappings Minimum Mean Maximum 1 83 (#2) (#9) (#10) (#6) (#7) (#10) (#7) (#8) (#2) (#8) # indicates number of IA mount. After the second tapping, the mean removal force value increased by 53.2%; the same can be seen in subsequent tappings, but after the third tapping, removal force values increased by 40%. The fourth and fifth tappings increased the removal force value, but with less intensity, respectively, at 8.4% and 14.3%. This can be explained by increasing applied forces on the abutment, as follows: the higher the applied forces (higher number of tappings), the greater will be the intrusion of the abutment in the implant. This intimate contact created by the intrusion can make the 2 separate parts work physically as a unit, as a single body. Thus, this created unity can be interesting in many clinical situations, particularly during the stress distribution of masticatory forces (Figures 5 and 6). This study showed some coincident data points, whereby removal force values after subsequent tappings demonstrated little difference (8 in total of 50 tests) for the same implant-abutment mount, and for a specimen (IA mount #10) in which the third tapping generated a larger force than the fourth and fifth an unexpected result. This fact can be related to some possible alterations at the moment of application of the compression force, caused by (1) little variation in IA mount positioning during tapping, which might have generated small distortions of parallelism, and/or (2) adaptation of contacts among the internal surfaces of the implant (well) and the external surfaces of the abutment. In addition, the possibility of small irregularities in such surfaces cannot be discarded. Continuing studies with increased repetitions are necessary to clarify this issue. Although a small number of specimens were tested, thus impairing statistical analysis, a strong tendency of correlation between mass of the abutment and removal force can be seen in Figure 4, because during activation, the mass of the abutment was incorporated to the inward movement, thereby increasing potential energy provided by the system. Regarding actual forces applied during mastication, it is known that variations occur among individuals, but the dental literature reports high values for men (between 536 FIGURES 5 AND 6. FIGURE 5. Separated implant and abutment. FIGURE 6. Implant and abutment union. 522 Vol. XXXVII/No. Five/2011

5 Zielak et al and 644 N) and lower values for women (between 358 and 449 N). 8 It is important to note that these values disregard parafunctional habits, such as bruxism. Regular masticatory movements are characterized by higher compressive forces, responsible for trituration of foods, when compared with tensile forces, produced by the retention of food on the occlusal surface of the teeth and by the presence of lateral excursive movements. Within the limitations of this study, it can be concluded that the higher the number of tappings, the greater is the force needed to separate the implant-abutment mount. In the present work design, 3 activations (tappings) of the abutment were considered necessary to attain optimal stability, demonstrated by the large increase in removal force. REFERENCES 1. Jokstad A. Oral implants the future. Aust Dent J. 2008;53(1 suppl):s89 S Bozkaya D, Muftu S. Efficiency considerations for the purely tapered interface fit (TIF) abutments used in dental implants. J Biomech Eng. 2004;126: Chapman RJ, Grippo W. The locking taper attachment for implant abutments: use and reliability. Implant Dent. 1996;5: Dibart S, Warbington M, Su MF, Skobe Z. In vitro evaluation of the implant-abutment bacterial seal: the locking taper system. Int J Oral Maxillofac Implant. 2005;20: Urdaneta RA, Marincola M. The integrated abutment crown, a screwless and cementless restoration for single-tooth implants: a report on a new technique. J Prosthodont. 2007;16: Jaarda MJ, Razzoog ME, Gratton DG. Providing optimum torque to implant prostheses: a pilot study. Implant Dent. 1993;2: Morgan KM, Chapman RJ. Retrospective analysis of an implant system. Compend Contin Educ Dent. 1999;20: Okeson JP. Management of Temporomandibular Disorders and Occlusion. 6th ed. St Louis, Mo: Mosby; 2007:640. Journal of Oral Implantology 523

Hex-Lock Abutment System. Restorative Manual

Hex-Lock Abutment System. Restorative Manual System Restorative Manual 32 Restorative options with s s are manufactured from titanium alloy and used as the support foundation for single- or multiple-unit cement-retained, partially edentulous fixed