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      The influence of implant–abutment connection on the screw loosening and microleakage

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          Abstract

          Background

          There are some spaces between abutment and implant body which can be a reservoir of toxic substance, and they can penetrate into subgingival space from microgap at the implant–abutment interface. This penetration may cause periimplantitis which is known to be one of the most important factors associated with late failure. In the present study, three kinds of abutment connection system, external parallel connection (EP), internal parallel connection (IP), and internal conical connection (CC), were studied from the viewpoint of microleakage from the gap between the implant and the abutment and in connection with the loosening of abutment screw.

          Methods

          We observed dye leakage from abutment screw hole to outside through microgap under the excessive compressive and tensile load and evaluated the anti-leakage characteristics of these connection systems.

          Results

          During the experiment, one abutment screw for EP and two screws for IP, out of seven samples in each group, were fractured. After the 2000 cycles of compressive tensile loadings, removal torque value (RTV) of abutment screw represented no statistical differences among three groups. Standard deviation was largest in the RTV of EP and smallest in that of CC. The results of microleakage of toluidine blue from implant–abutment connection indicated that microleakage generally increased as loading procedure progressed.

          The amount of microleakage was almost plateau at 2000 cycles in CC, but still increasing in other two groups. The value of microleakage greatly scattered in EP, but the deviation of that in CC is significantly smaller. At 500 cycles of loading, there were no significant differences in the amount of microleakage among the groups, but at 1000, 1500, and 2000 cycles of loading, the amount of microleakage in CC was significantly smaller than that in IP. Throughout the experiment, the amount of microleakage in EP was largest, but no statistical difference was indicated due to the high standard deviation.

          Conclusions

          Within the limitation of the present study, CC was stable even after the loading in the RTV of abutment screw and it prevented microleakage from the microgap between the implant body and the abutment, among the three tested connections.

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          Most cited references19

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          Biomechanics of locked plates and screws.

          To review the biomechanical principles that guide fracture fixation with plates and screws; specifically to compare and contrast the function and roles of conventional unlocked plates to locked plates in fracture fixation. We review basic plate and screw function, discuss the design rationale for the new implants, and examine the biomechanical evidence that supports the use of such implants. Systematic review of the per reviewed English language orthopaedic literature listed on PubMed (National Library of Medicine online service). Papers selected for this review were drawn from peer review orthopaedic journals. All selected papers specifically discussed plate and screw biomechanics with regard to fracture fixation. PubMed search terms were: plates and screws, biomechanics, locked plates, PC-Fix, LISS, LCP, MIPO, and fracture fixation. The following topics are discussed: plate and screw function-neutralization plates and buttress plates, bridge plates; fracture stability-specifically how this effects gap strain and fracture union, conventional plate biomechanics, and locking plate biomechanics. Locked plates and conventional plates rely on completely different mechanical principles to provide fracture fixation and in so doing they provide different biological environments for healing. Locked plates may increasingly be indicated for indirect fracture reduction, diaphyseal/metaphyseal fractures in osteoporotic bone, bridging severely comminuted fractures, and the plating of fractures where anatomical constraints prevent plating on the tension side of the bone. Conventional plates may continue to be the fixation method of choice for periarticular fractures which demand perfect anatomical reduction and to certain types of nonunions which require increased stability for union.
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            Factors associated with early and late failure of dental implants.

            Osseointegration is a good indication of the clinical success of titanium implants referring to the direct anchorage of such implants to the surrounding host bone. Despite the high success rate of endosseous dental implants, they do fail. A lack of primary stability, surgical trauma, and infection seem to be the most important causes of early implant failure. Early signs of infection may be an indication of a much more critical result than if the same complications occur later, because of disturbance of the primary bone healing process. Occlusal overload and periimplantitis seem to be the most important factors associated with late failure. Suboptimal implant design and improper prosthetic constructions are among those risk factors responsible for implant complications and failure. This concise review highlights the main causes associated with early and late implant failure, as thorough knowledge of this unavoidable clinical fact is essential in the field of oral implantology.
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              Performance of conical abutment (Morse Taper) connection implants: a systematic review.

              In this systematic review, we aimed to compare conical versus nonconical implant-abutment connection systems in terms of their in vitro and in vivo performances. An electronic search was performed using PubMed, Embase, and Medline databases with the logical operators: "dental implant" AND "dental abutment" AND ("conical" OR "taper" OR "cone"). Names of the most common conical implant-abutment connection systems were used as additional key words to detect further data. The search was limited to articles published up to November 2012. Recent publications were also searched manually in order to find any relevant studies that might have been missed using the search criteria noted above. Fifty-two studies met the inclusion criteria and were included in this systematic review. As the data and methods, as well as types of implants used was so heterogeneous, this mitigated against the performance of meta-analysis. In vitro studies indicated that conical and nonconical abutments showed sufficient resistance to maximal bending forces and fatigue loading. However, conical abutments showed superiority in terms of seal performance, microgap formation, torque maintenance, and abutment stability. In vivo studies (human and animal) indicated that conical and nonconical systems are comparable in terms of implant success and survival rates with less marginal bone loss around conical connection implants in most cases. This review indicates that implant systems using a conical implant-abutment connection, provides better results in terms of abutment fit, stability, and seal performance. These design features could lead to improvements over time versus nonconical connection systems.
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                Author and article information

                Contributors
                t-katsuhiro@dent.kyushu-u.ac.jp
                +81-92-642-6441 , ayukawa@dent.kyushu-u.ac.jp
                tmatsu@dent.kyushu-u.ac.jp
                kihara@dent.kyushu-u.ac.jp
                koyano@dent.kyushu-u.ac.jp
                Journal
                Int J Implant Dent
                Int J Implant Dent
                International Journal of Implant Dentistry
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                2198-4034
                9 April 2018
                9 April 2018
                December 2018
                : 4
                : 11
                Affiliations
                ISNI 0000 0001 2242 4849, GRID grid.177174.3, Section of Implant and Rehabilitative Dentistry, Division of Oral Rehabilitation, Faculty of Dental Science, , Kyushu University, ; 3-1-1 Maidashi, Higashi-ku, Fukuoka, 8128582 Japan
                Author information
                http://orcid.org/0000-0003-0039-716X
                Article
                121
                10.1186/s40729-018-0121-y
                5890007
                29629492
                1017ee1b-bb8e-40f1-82ac-756a6daa99e6
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 20 November 2017
                : 24 January 2018
                Categories
                Research
                Custom metadata
                © The Author(s) 2018

                implant–abutment connection,microleakage,microgap,screw loosening,toluidine blue,non-axial load

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