Browsing by Subject "Dental Implants"

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    A Comparison Of Morse Taper And Sloped Shoulder Abutment Geometries Using Torque Angle Analysis
    (2024) Clark , Zane
    Abstract Background: Full arch fixed implant prostheses continue to become a popular treatment option for dentists when rehabilitating the completely edentulous patient as they can help to significantly restore function, esthetics and comfort paired with the well-documented predictability, success and longevity of dental implants. The connection of the prosthesis to the implant platform has also received much attention in the literature, however, many of these papers only report torque and de-torque values. Generally, torque values recommended by the manufacture are between 65-75% of that abutment screws yield potential, or in other words, the point at which the abutment screw will fracture. But a key concept to understand is that the implant-abutment connection maintains its stability through a mechanical force known as preload, which is a clamping force created from the elastic recovery of the abutment screw. But herein lies a well-documented issue that up to 90% of the torquing force applied to the abutment screw is lost to friction and other factors leaving only 10% available for conversion to preload. Although it has been reported that abutment geometry can aid in the stability of the connection, preload is the predominant force holding the implant, abutment and prosthesis together. If the preload can be maximized within the limits of the abutment screws yield potential, then a stronger implant abutment connection will be created. In a pilot study by Chow et al., they investigated whether abutment geometry contributes to preload of the abutment screw. Among their conclusions was a statistically significant difference between classical morse tapered engaging abutments and non-engaging abutments with the non-engaging abutments having higher preload values. This was because for the non-engaging abutments, much of the torque was lost to settling of the abutment into the morse taper. With the numerous dental implant companies a restorative dentist can choose from, it begs the question: are all implant-abutment connections created equal? More specifically, are some implant brands better suited for optimizing the implant-abutment connection and preload achieved in the abutment screw. Therefore, the purpose of this study is to investigate the effect of abutment geometry on preload with two widely used implant bodies and multiunit abutments. The hope of this pilot study is to report the data and utilize it for a larger future study that compares preload data between multiple implant brands. Purpose: This study aimed to evaluate preload on sloped shoulder and morse taper abutment geometries using torque angle signature analysis Materials and Methods: Three sloped shoulder (Straumann, BLX) implants were embedded into custom dies using Type V dental gypsum (Die-Keen Green). Two abutment designs were selected for this study, one having a morse taper geometry and the other with a morse taper and sloped shoulder component. Three morse tapered internal connection abutments and three sloped shoulder abutments were used in this study. An a priori power analysis was completed to determine sample size. Therefore, two experimental groups (n=3) were created. A custom fabricated device was milled out of aluminum to rigidly fixate both the imbedded implant and torque meter. A horizontal arm was also attached to the torque meter to allow for a consistent and controlled torque force to be applied. A torque driver was attached to the torque angle meter (HGTA-AMK Digital Torque Gauge with Angle Encoder, IMADA, PCB, Load &Torque, Inc.). Each abutment was torque to into the imbedded implants to 35 Ncm and a torque angle signature obtained. Upon reaching 35 Ncm, the torque meter was zeroed and samples were de-torqued producing a releasing curve. Analysis of the torque angle signatures allowed for extraction of insertion slope as well as insertion and releasing degree of rotation (torque angle). From these values, preload values were calculated using the preload formula outlined by Hagiwara and Ohashi (1994). Statistical analysis was conducted using non-paired student t-test. A p-value of 0.05 was used. Results: Morse Taper Abutments (blue) show an elongated rundown, alignment and elastic zone when compared to the sloped shoulder abutments. A mean insertion slope of 0.71 was calculated for sloped shoulder abutments (n=3, st. dev.= 0.102) with a 95% C.I. of ±0.115. A mean slope of 0.3 was calculated for morse taper abutments (n=3, st. dev.= 0.048) with a 95% C.I. of ±0.246. Non-paired student t-test produced a value of p=0.0039961. Analysis of the data shows a maximum mean insertion angle of 41.40° for sloped shoulder abutments (n=3, st. dev.= 3.176) and a 95% C.I. of ±3.59. Mean insertion angle for morse tapered abutments were 108.67° (n=3, st. dev. = 16.88) with a 95% C.I. of ±19.1. Non-paired student t-test produced a value of p=0.0105222. Similarly, upon releasing, releasing angles showed a maximum mean release angle of 31.6° for sloped shoulder abutments (n=3, st. dev. = 4.757) with a 95% C.I. of ±5.38°. Mean release angle for morse tapered abutments was 21.8° (n=3, st. dev. = 1.892) with a 95% C.I. of ± 2.14°. Non-paired student t-test produced a value of p=0.0222863. The mean preload for sloped shoulder abutments was 805.06N (n=3, st. dev. = 120.812) with a 95% C.I. of ±136.7. Mean preload for morse tapered abutments was 554.48N (n=3, st. dev. = 48.074) with a 95% C.I. of ±54.39. Non-paired student t-test produced a value of p=0.0.0222289. Conclusions: Higher preload levels were found in the sloped shoulder abutment than in the morse taper abutment. Longer rundown and alignment zones were found in the morse taper abutment than in the sloped shoulder abutment. The insertion slopes were less for the morse tapered abutment than for the non-engaging abutment. Additionally, insertion angles were greater and release angles shorter in morse tapered abutments. The lack of a positive stop and greater friction between components seen in the morse tapered abutment caused the torque limit to be reached before greater clamping force could be achieved. Although more studies are needed to take friction into account, this study demonstrates that the geometry of the implant-abutment connection does influence preload. With respect to multiple implant splinted prostheses, these factors can greatly impact the clinical outcome, longevity of the prosthesis, its various components, and underlying implants.
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    Immunomodulation of oral keratinocytes through titanium surface peptide coatings of cell adhesion oligopeptide motifs and IL-23 Receptor antagonist
    (2021-11) Pizarek, John
    Objectives: Peri-implantitis is the leading cause of implant failure with a prevalence of 8-34%. The dysbiotic bacterial invasion of the peri-implant surface leads to an inflammatory reaction of oral keratinocytes (OK) that attach to the implant surface via the junctional epithelium. During stages of inflammation, the attachment of keratinocytes to bound surfaces decreases. We evaluated OKs’ cytokine response to cell adhesion motif peptides, shown to increase hemidesmosomes (LamLG3 and Net1), bound to plasma activated glass (pGlass), compared to controls pGlass and activated pGlass (DIBO). Next, the innate inflammatory response of OKs through cytokine production, specifically the IL-17/IL-23 inflammatory axis, can induce activation of neutrophils and Th17 cells that are present in higher levels in peri-implantitis. We evaluated an IL-23 receptor antagonist (IL-23Ra) bound to etched titanium for cell proliferation of OKs, production of IL-17 and 23, and cytokine secretome regulation. By inducing cell adhesion or regulating the IL-17/23 pathway may reduce the induction and recruitment of aforementioned inflammatory cells, promoting integrity of the soft tissue interface of implants at sites of bacterial infection.Methods: Plasma disks were covalently functionalized with Net1 and LamLG3 and titanium disks were covalently functionalized with IL-23Ra using silanization. Disks in the cell adhesion studied had activated pGlass (DIBO), uncoated surface, and an antimicrobial peptide serving as controls, and the IL-23Ra study had disks with a randomized sequence peptide and non-coated disks serving as controls. IL-23Ra-coatings were physicochemically analyzed with water contact angle and X-ray photoelectron spectroscopy. Proliferation of OKs was measured. ELISAs were used to analyze levels of IL-23 and IL-17 in presence and absence of pro-inflammatory Porphyromonas gingivalis lipopolysaccharide (LPS). For both studies, supernatant and cell lysates were collected at 5 days and analyzed using a 20 and 36-target cytokine array. The IL-23Ra study assessed the cytokine array with a functional protein association network analysis (STRING). ANOVA and Tukey post-hoc tests assessed statistical significance (p<0.05) Results: Physicochemical analysis demonstrated the successful immobilization of the peptide coatings. The cell adhesion peptides showed a decrease in the production of pro-inflammatory cytokines compared to the three controls. On the other hand, the IL-23Ra-coated titanium significantly increased proliferation of OKs. Further, the IL-23Ra significantly decreased secretion of IL-17 and IL-23, both with and without LPS stimulation, compared to controls. Conclusions: Our results support the use of IL-23Ra-coatings for reduction of the keratinocyte IL17/23 pro-inflammatory pathway and the use of cell adhesion peptides for the reduction of pro-inflammatory cytokine secretion, and may inform immunomodulatory dental implant designs for soft tissue attachment to thereby reduce peri-implantitis rates.