Fracture Resistance of Zirconia Abutments with or without a Titanium Base: An In Vitro Study for Tapered Conical Connection Implants

Dental implants with tapered conical connections are often combined with zirconia abutments for esthetics; however, the effect of the titanium base on the implant components remains unclear. This study evaluated the effects of a titanium base on the fracture resistance of zirconia abutments and damage to the tapered conical connection implants. Zirconia (Z) and titanium base zirconia (ZT) abutments were fastened to Nobel Biocare (NB) implants and Straumann (ST) implants and subjected to static load testing according to ISO 14801:2016. The experiments were performed with 3 mm of the platform exposed (P3) and no platform exposed (P0). The fracture loads were statistically greater in the titanium base abutments than the zirconia abutments for the NB and ST specimens in the P0 condition. In the P3 condition of the ST specimens, the deformation volume of the ZT group was significantly greater than the Z group. The titanium base increased the fracture resistance of the zirconia abutments. Additionally, the titanium base caused more deformation in the P3 condition. The implant joint design may also affect the amount of damage to the implants when under a load. The mechanical properties of the abutment should be considered when selecting a clinical design.

Implant-abutment screw removal torque values between customized titanium abutment, straight titanium abutment, and hybrid zirconia abutment after a million cyclic loading: an in vitro comparative study

Purpose The aim of this study was to compare removal torque values after mechanical cyclic loading and bending moment after the static compression testing of customized titanium abutment compared with prefabricated and hybrid abutments. Materials and methods The study was developed according to ISO 14801:2016. Sixty implants were divided into three groups equally: Straight titanium abutment group, Customized titanium abutment group, and Hybrid zirconia abutment group. Abutments were fabricated with zirconia restoration. Forty five implants underwent for cyclic loading. The removal torque values were measured after a fatigue test was conducted at 0 cycles (control), 50,000 cycles and 1,000,000 cycles. In the second experiment, 15 implants were divided into the same groups. Then, bending moments were investigated. Results The mean initial removal torque value was significantly higher than 50,000 cycles and 1,000,000 cycles (P < 0.001). The comparison of mean removal torque value between types of abutments was not significantly different (P > 0.05), and the bending moments of all abutments were not significantly different (P > 0.05). Conclusions From the boundary of this in-vitro study, it could be concluded that customized titanium abutment and hybrid abutment were not significantly different in terms of removal torque values after the fatigue test. The bending moment between types of abutment were not significantly different. Thus, it could be concluded that abutment type does not significantly influence abutment stability or fracture strength.

A Novel Zirconia-Based Composite Presents an Aging Resistant Material for Narrow-Diameter Ceramic Implants

A novel ceria-stabilized zirconia-alumina-aluminate composite (Ce-TZP-comp) that is not prone to aging presents a potential alternative to yttrium-stabilized zirconia for ceramic oral implants. The objective of this study was to evaluate the long-term stability of a one-piece narrow-diameter implant made of Ce-TZP-comp. Implant prototypes with a narrow (3.4 mm) and regular (4.0 mm) diameter were embedded according to ISO 14801, and subgroups (n = 8) were subsequently exposed to dynamic loading (107 cycles, 98N) and/or hydrothermal treatment (aging, 85 °C). Loading/aging was only applied as a combined protocol for the 4.0 mm diameter implants. One subgroup of each diameter remained untreated. One sample was cross-sectioned from each subgroup and evaluated with a scanning electron microscope for phase-transformation of the lattice. Finally, the remaining samples were loaded to fracture. A multivariate linear regression model was applied for statistical analyses (significance at p < 0.05). All samples withstood the different loading/aging protocols and no transformation propagation was observed. The narrow diameter implants showed the lowest fracture load after combined loading/aging (628 ± 56 N; p < 0.01), whereas all other subgroups exhibited no significantly reduced fracture resistance (between 762 ± 62 and 806 ± 73 N; p > 0.05). Therefore, fracture load values of Ce-TZP-comp implants suggest a reliable intraoral clinical application in the anterior jaw regions.

NUMERICAL COMPARISON OF TRANSGINGIVAL AND SUBGINGIVAL DENTAL IMPLANTS IN REGARD TO THEIR STRESS DISTRIBUTIONS

Most modern dental implants differentiate in regard to the fixation of the abutment into two main categories - the external or internal hexagon or octagon. We performed mechanical tests according to the ČSN EN ISO 14801 standard on a dental implant variant using the external hex. We found that failure of all implant specimens occured below the screw head. To improve the current geometry, we performed numerical analysis of an alternative variant (internal hex) and compared it with analysis of the current geometry (external hex). It was found that the stress distribution of the variant with internal hex is preferable to the old variant. Although extreme values of shear stress in the corresponding plane of loading are higher, they do not concentrate below the screw head, where the screw itself is thinner and more prone to breaking. Therefore, it seems that the new variant of the dental implant is stronger, which is still to be proven by mechanical tests.

Experimental and numerical investigations of fracture and fatigue behaviour of implant-supported bars with distal extension made of three different materials

The aim of this study was to investigate experimentally the fatigue and stability of three bar materials with distal extension at the molar region and to numerically analyse the biomechanical properties of the bar materials connected to overdentures in a patient individual model. A milled bar was designed for the mandible on four implants in the canine and second premolar region. Three bar materials were investigated: titanium (Ti), cobalt chromium (CoCr), and polyetherketonketon (PEKK). Firstly, static and fatigue tests were performed based on EN ISO 14801 in a commercial permanent loading set-up. Unilateral axial force was applied on the distal extension of the bars. Secondly, numerical models were created. Different bar materials and loading scenarios were analysed. The static fracture limit of the three materials was 1,750 N, 780 N, 310 N for Ti, CoCr, and PEKK, respectively. The Wöhler curves showed comparable fatigue limits of 200 N, 160 N, and 150 N for titanium, CoCr, and PEKK, respectively. The stress at the distal extension was 2,600 MPa (Ti), 1,000 MPa (CoCr), and 270 MPa (PEKK). All loading simulations with the PEKK bar showed higher stresses in the implants and in the bone bed as well as higher displacements of the over denture in comparison to metal bars. PEKK showed different mechanical behaviour compared to Ti and CoCr. The distribution of stresses within the PEKK bar was wider than the area of loading which probably leads to fatigue of the whole bar and not only the part under load.

Fatigue Evaluation of a New Two-Piece Dental Implant, Having a Replaceable Titanium Sleeve

A new two-piece dental implant, having a replaceable thin titanium sleeve in its 5mm crestal part was designed. The use of a sleeve of near 0.2mm thickness reduces implant diameter by 0.4mm. Narrower diameter implants may increase the likelihood of component fracture in dental implant systems. 14 two-piece dental implants, with 25° abutment angle were subjected to a dynamic fatigue test according to DIN EN ISO 14801. The highest load at which a runout (non-failure) occurred at 5x106 cycles, amounted to 575 N. According to DIN EN ISO 14801, this load level was confirmed with n=3 samples. The Wöhler curve was determined. Accordingly, the runout at 106 cycles can be anticipated as 625N. The new two-piece Implant B™ design using a 0.2 mm sleeve is compatible with the DIN EN ISO 14801 standard for dimensions of 4.2mm diameter and 13mm length. It withstands dynamic fatigue test at least as good as any other standard endosseous implant.

Optimized Planning and Evaluation of Dental Implant Fatigue Testing: A Specific Software Application

Mechanical complications in implant-supported fixed dental prostheses are often related to implant and prosthetic design. Although the current ISO 14801 provides a framework for the evaluation of dental implant mechanical reliability, strict adherence to it may be difficult to achieve due to the large number of test specimens which it requires as well as the fact that it does not offer any probabilistic reference for determining the endurance limit. In order to address these issues, a new software program called ProFatigue is presented as a potentially powerful tool to optimize fatigue testing of implant-supported prostheses. The present work provides a brief description of some concepts such as load, fatigue and stress-number of cycles to failure curves (S-N curves), before subsequently describing the current regulatory situation. After analyzing the two most recent versions of the ISO recommendation (from 2008 and 2016), some limitations inherent to the experimental methods which they propose are highlighted. Finally, the main advantages and instructions for the correct implementation of the ProFatigue free software are given. This software will contribute to improving the performance of fatigue testing in a more accurate and optimized way, helping researchers to gain a better understanding of the behavior of dental implants in this type of mechanical test.

Fatigue Design of Dental Implant Assemblies: A Nominal Stress Approach

Fatigue is the most common mechanical failure type in dental implants. ISO 14801 standardizes fatigue testing of dental implants, providing the load-life curve which is most useful for comparing the fatigue behavior of different dental implant designs. Based on it, many works were published in the dental implant literature, comparing different materials, component geometries, connection types, surface treatments, etc. These works are useful for clinicians in order to identify the best options available in the market. The present work is intended not for clinicians but for dental implant manufacturers, developing a design tool that combines Finite Element Analysis, fatigue formulation and ISO 14801 experimental tests. For that purpose, 46 experimental tests were performed on BTI INTERNA® IIPSCA4513 implants joined with INPPTU44 abutments by means of INTTUH prosthetic screws under three different tightening torque magnitudes. Then, the load case was reproduced in a FE model from where the nominal stress state in the fatigue critical section was worked out. Finally, Walker criterion was used to represent accurately the effects of mean stress and predict fatigue life of the studied dental implant assembly, which can be extended to most of the products of BTI manufacturer. By means of this tool, dental implant manufacturers will be able to identify the critical design and assembly parameters in terms of fatigue behavior, evaluate their influence in preliminary design stages and consequently design dental implants with significantly better fatigue response which in turn will reduce future clinical incidences.

Mechanical Assessment of Fatigue Characteristics between Single- and Multi-Directional Cyclic Loading Modes on a Dental Implant System

Mechanical testing based on ISO 14801 standard is generally used to evaluate the performance of the dental implant system according to material and design changes. However, the test method is difficult to reflect on the clinical environment because the ISO 14801 standard does not take into account the various loads from different directions during chewing motion. In addition, the fracture pattern of the implant system can occur both in the horizontal and the vertical directions. Therefore, the purpose of this study was to compare fatigue characteristics and fracture patterns between single directional loading conditions based on the ISO 14801 standard and multi-directional loading condition. Firstly, the static test was performed on five specimens to derive the fatigue load, and the fatigue load was chosen as 40% of the maximum load measured in the static test. Subsequently, the fatigue test was performed considering the single axial/occlusal (AO), AO with facial/lingual (AOFL) and AO with mesial/distal (AOMD) directions, and five specimens were used for each fatigue loading modes. In order to analyze the fatigue characteristics, the fatigue cycle at the time of specimen fracture and displacement change of the specimen every 500 cycles were measured. Field emission scanning electron microscopy (FE-SEM) was used to analyze the fracture patterns and the fracture surface. Compared to the AO group, the fatigue cycle of the AOFL and AOMD groups showed lower about five times, while the displacement gradually increased with every 500 cycles. From FE-SEM results, there were no different surface morphology characteristics among three groups. However, the AOMD group showed a vertical slip band. Therefore, our results suggest that the multi-directional loading mode under the worst-case environment can reproduce the vertical fracture pattern in the clinical situation and may be essential to reflect on the dental implant design including connection types and surface treatments.