Effect of axial loads on implant-supported partial fixed prostheses by strain gauge analysis
Identifieur interne : 000602 ( Pmc/Corpus ); précédent : 000601; suivant : 000603Effect of axial loads on implant-supported partial fixed prostheses by strain gauge analysis
Auteurs : Luis Gustavo Oliveira De Vasconcellos ; Renato Sussumu Nishioka ; Luana Marotta Reis De Vasconcellos ; Lea Nogueira Braulino De Melo NishiokaSource :
- Journal of Applied Oral Science [ 1678-7757 ] ; 2011.
Abstract
The present study used strain gauge analysis to perform an
Three internal hexagon implants were linearly embedded in a polyurethane block. Microunit abutments were connected to the implants applying a torque of 20 Ncm, and prefabricated Co-Cr cylinders and plastic prosthetic cylinders were screwed onto the abutments, which received standard patterns cast in Co-Cr alloy (n=5). Four strain gauges (SG) were bonded onto the surface of the block tangentially to the implants, SG 01 mesially to implant 1, SG 02 and SG 03 mesially and distally to implant 2, respectively, and SG 04 distally to implant 3. Each metallic structure was screwed onto the abutments with a 10 Ncm torque and an axial load of 30 kg was applied at five predetermined points (A, B, C, D, E). The data obtained from the strain gauge analyses were analyzed statistically by RM ANOVA and Tukey's test, with a level of significance of p<0.05.
There was a significant difference for the loading point (p=0.0001), with point B generating the smallest microdeformation (239.49 με) and point D the highest (442.77 με). No significant difference was found for the cylinder type (p=0.748).
It was concluded that the type of cylinder did not affect in the magnitude of microdeformation, but the axial loading location influenced this magnitude.
Url:
DOI: 10.1590/S1678-77572011000600011
PubMed: 22230995
PubMed Central: 3973462
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<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Effect of axial loads on implant-supported partial fixed prostheses by
strain gauge analysis</title><author><name sortKey="De Vasconcellos, Luis Gustavo Oliveira" sort="De Vasconcellos, Luis Gustavo Oliveira" uniqKey="De Vasconcellos L" first="Luis Gustavo Oliveira" last="De Vasconcellos">Luis Gustavo Oliveira De Vasconcellos</name><affiliation><nlm:aff id="aff01"> DDS, MS, Department of Dental Materials and Prosthodontics, São José dos Campos Dental School, São Paulo State University, São José dos Campos, SP, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Nishioka, Renato Sussumu" sort="Nishioka, Renato Sussumu" uniqKey="Nishioka R" first="Renato Sussumu" last="Nishioka">Renato Sussumu Nishioka</name><affiliation><nlm:aff id="aff02"> DDS, MS, PhD, Department of Dental Materials and Prosthodontics, São José dos Campos Dental School, São Paulo State University, São José dos Campos, SP, Brazil.</nlm:aff></affiliation></author><author><name sortKey="De Vasconcellos, Luana Marotta Reis" sort="De Vasconcellos, Luana Marotta Reis" uniqKey="De Vasconcellos L" first="Luana Marotta Reis" last="De Vasconcellos">Luana Marotta Reis De Vasconcellos</name><affiliation><nlm:aff id="aff03"> DDS, MS, PhD, Department of Bioscience and Buccal Diagnosis, São José dos Campos Dental School, São Paulo State University, São José dos Campos, SP, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Nishioka, Lea Nogueira Braulino De Melo" sort="Nishioka, Lea Nogueira Braulino De Melo" uniqKey="Nishioka L" first="Lea Nogueira Braulino De Melo" last="Nishioka">Lea Nogueira Braulino De Melo Nishioka</name><affiliation><nlm:aff id="aff04"> Mech Eng, MS, Department of Mechanical Engineering, Institute of Science Technology - CETEC, São José dos Campos, SP, Brazil.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">22230995</idno><idno type="pmc">3973462</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3973462</idno><idno type="RBID">PMC:3973462</idno><idno type="doi">10.1590/S1678-77572011000600011</idno><date when="2011">2011</date><idno type="wicri:Area/Pmc/Corpus">000602</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">000602</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Effect of axial loads on implant-supported partial fixed prostheses by
strain gauge analysis</title><author><name sortKey="De Vasconcellos, Luis Gustavo Oliveira" sort="De Vasconcellos, Luis Gustavo Oliveira" uniqKey="De Vasconcellos L" first="Luis Gustavo Oliveira" last="De Vasconcellos">Luis Gustavo Oliveira De Vasconcellos</name><affiliation><nlm:aff id="aff01"> DDS, MS, Department of Dental Materials and Prosthodontics, São José dos Campos Dental School, São Paulo State University, São José dos Campos, SP, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Nishioka, Renato Sussumu" sort="Nishioka, Renato Sussumu" uniqKey="Nishioka R" first="Renato Sussumu" last="Nishioka">Renato Sussumu Nishioka</name><affiliation><nlm:aff id="aff02"> DDS, MS, PhD, Department of Dental Materials and Prosthodontics, São José dos Campos Dental School, São Paulo State University, São José dos Campos, SP, Brazil.</nlm:aff></affiliation></author><author><name sortKey="De Vasconcellos, Luana Marotta Reis" sort="De Vasconcellos, Luana Marotta Reis" uniqKey="De Vasconcellos L" first="Luana Marotta Reis" last="De Vasconcellos">Luana Marotta Reis De Vasconcellos</name><affiliation><nlm:aff id="aff03"> DDS, MS, PhD, Department of Bioscience and Buccal Diagnosis, São José dos Campos Dental School, São Paulo State University, São José dos Campos, SP, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Nishioka, Lea Nogueira Braulino De Melo" sort="Nishioka, Lea Nogueira Braulino De Melo" uniqKey="Nishioka L" first="Lea Nogueira Braulino De Melo" last="Nishioka">Lea Nogueira Braulino De Melo Nishioka</name><affiliation><nlm:aff id="aff04"> Mech Eng, MS, Department of Mechanical Engineering, Institute of Science Technology - CETEC, São José dos Campos, SP, Brazil.</nlm:aff></affiliation></author></analytic><series><title level="j">Journal of Applied Oral Science</title><idno type="ISSN">1678-7757</idno><idno type="eISSN">1678-7765</idno><imprint><date when="2011">2011</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objectives</title><p>The present study used strain gauge analysis to perform an <italic>in vitro
</italic>evaluation of the effect of axial loading on 3 elements of
implant-supported partial fixed prostheses, varying the type of prosthetic
cylinder and the loading points. </p></sec><sec><title>Material and methods</title><p>Three internal hexagon implants were linearly embedded in a polyurethane block.
Microunit abutments were connected to the implants applying a torque of 20 Ncm,
and prefabricated Co-Cr cylinders and plastic prosthetic cylinders were screwed
onto the abutments, which received standard patterns cast in Co-Cr alloy (n=5).
Four strain gauges (SG) were bonded onto the surface of the block tangentially to
the implants, SG 01 mesially to implant 1, SG 02 and SG 03 mesially and distally
to implant 2, respectively, and SG 04 distally to implant 3. Each metallic
structure was screwed onto the abutments with a 10 Ncm torque and an axial load of
30 kg was applied at five predetermined points (A, B, C, D, E). The data obtained
from the strain gauge analyses were analyzed statistically by RM ANOVA and Tukey's
test, with a level of significance of p<0.05. </p></sec><sec><title>Results</title><p>There was a significant difference for the loading point (p=0.0001), with point B
generating the smallest microdeformation (239.49 με) and point D the highest
(442.77 με). No significant difference was found for the cylinder type (p=0.748).
</p></sec><sec><title>Conclusions</title><p>It was concluded that the type of cylinder did not affect in the magnitude of
microdeformation, but the axial loading location influenced this magnitude.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Akca, K" uniqKey="Akca K">K Akça</name></author><author><name sortKey="Cehreli, Mc" uniqKey="Cehreli M">MC Çehreli</name></author><author><name sortKey="Iplikcioglu, H" uniqKey="Iplikcioglu H">H Iplikçioglu</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Carr, Ab" uniqKey="Carr A">AB Carr</name></author><author><name sortKey="Brunski, Jb" uniqKey="Brunski J">JB Brunski</name></author><author><name sortKey="Hurley, E" uniqKey="Hurley E">E Hurley</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Castilho, Aa" uniqKey="Castilho A">AA Castilho</name></author><author><name sortKey="Kojima, An" uniqKey="Kojima A">AN Kojima</name></author><author><name sortKey="Pereira, Sm" uniqKey="Pereira S">SM Pereira</name></author><author><name 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<front><journal-meta><journal-id journal-id-type="nlm-ta">J Appl Oral Sci</journal-id><journal-id journal-id-type="iso-abbrev">J Appl Oral Sci</journal-id><journal-id journal-id-type="publisher-id">J. Appl. Oral. Sci.</journal-id><journal-title-group><journal-title>Journal of Applied Oral Science</journal-title></journal-title-group><issn pub-type="ppub">1678-7757</issn><issn pub-type="epub">1678-7765</issn><publisher><publisher-name>Faculdade de Odontologia de Bauru da Universidade de São
Paulo</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="pmid">22230995</article-id><article-id pub-id-type="pmc">3973462</article-id><article-id pub-id-type="doi">10.1590/S1678-77572011000600011</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>Effect of axial loads on implant-supported partial fixed prostheses by
strain gauge analysis</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>de VASCONCELLOS</surname><given-names>Luis Gustavo Oliveira</given-names></name><xref ref-type="aff" rid="aff01">1</xref><xref ref-type="corresp" rid="c01"></xref></contrib><contrib contrib-type="author"><name><surname>NISHIOKA</surname><given-names>Renato Sussumu</given-names></name><xref ref-type="aff" rid="aff02">2</xref></contrib><contrib contrib-type="author"><name><surname>de VASCONCELLOS</surname><given-names>Luana Marotta Reis</given-names></name><xref ref-type="aff" rid="aff03">3</xref></contrib><contrib contrib-type="author"><name><surname>NISHIOKA</surname><given-names>Lea Nogueira Braulino de Melo</given-names></name><xref ref-type="aff" rid="aff04">4</xref></contrib></contrib-group><aff id="aff01"><label>1</label> DDS, MS, Department of Dental Materials and Prosthodontics, São José dos Campos Dental School, São Paulo State University, São José dos Campos, SP, Brazil.</aff><aff id="aff02"><label>2</label> DDS, MS, PhD, Department of Dental Materials and Prosthodontics, São José dos Campos Dental School, São Paulo State University, São José dos Campos, SP, Brazil.</aff><aff id="aff03"><label>3</label> DDS, MS, PhD, Department of Bioscience and Buccal Diagnosis, São José dos Campos Dental School, São Paulo State University, São José dos Campos, SP, Brazil.</aff><aff id="aff04"><label>4</label> Mech Eng, MS, Department of Mechanical Engineering, Institute of Science Technology - CETEC, São José dos Campos, SP, Brazil.</aff><author-notes><corresp id="c01"><bold>Corresponding address:</bold> Luis Gustavo Oliveira de Vasconcellos - Alameda
Harvey C. Weeks, 14 - sala 09 - Vista Verde - São José dos Campos - SP - Brasil -
12223-830 - Phone: +55-12-3912 2342 - Fax: +55-12-3947 9010 - e-mail:
<email>lgovasconcellos11@terra.com.br</email> or
<email>luis.vasconcellos@alunos.fosjc.unesp.br</email></corresp></author-notes><pub-date pub-type="ppub"><season>Nov-Dec</season><year>2011</year></pub-date><volume>19</volume><issue>6</issue><fpage>610</fpage><lpage>615</lpage><history><date date-type="received"><day>15</day><month>10</month><year>2009</year></date><date date-type="rev-recd"><day>02</day><month>5</month><year>2010</year></date><date date-type="accepted"><day>30</day><month>5</month><year>2010</year></date></history><permissions><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by-nc/3.0/"><license-p>This is an Open Access article distributed under the terms of the Creative
Commons Attribution Non-Commercial License which permits unrestricted
non-commercial use, distribution, and reproduction in any medium, provided the
original work is properly cited. </license-p></license></permissions><abstract><sec><title>Objectives</title><p>The present study used strain gauge analysis to perform an <italic>in vitro
</italic>evaluation of the effect of axial loading on 3 elements of
implant-supported partial fixed prostheses, varying the type of prosthetic
cylinder and the loading points. </p></sec><sec><title>Material and methods</title><p>Three internal hexagon implants were linearly embedded in a polyurethane block.
Microunit abutments were connected to the implants applying a torque of 20 Ncm,
and prefabricated Co-Cr cylinders and plastic prosthetic cylinders were screwed
onto the abutments, which received standard patterns cast in Co-Cr alloy (n=5).
Four strain gauges (SG) were bonded onto the surface of the block tangentially to
the implants, SG 01 mesially to implant 1, SG 02 and SG 03 mesially and distally
to implant 2, respectively, and SG 04 distally to implant 3. Each metallic
structure was screwed onto the abutments with a 10 Ncm torque and an axial load of
30 kg was applied at five predetermined points (A, B, C, D, E). The data obtained
from the strain gauge analyses were analyzed statistically by RM ANOVA and Tukey's
test, with a level of significance of p<0.05. </p></sec><sec><title>Results</title><p>There was a significant difference for the loading point (p=0.0001), with point B
generating the smallest microdeformation (239.49 με) and point D the highest
(442.77 με). No significant difference was found for the cylinder type (p=0.748).
</p></sec><sec><title>Conclusions</title><p>It was concluded that the type of cylinder did not affect in the magnitude of
microdeformation, but the axial loading location influenced this magnitude.</p></sec></abstract><kwd-group><kwd>Biomechanics</kwd><kwd>Dental implants</kwd><kwd>Dental prosthesis</kwd><kwd>Implant-supported dental prosthesis</kwd></kwd-group></article-meta></front><body><sec><title>INTRODUCTION</title><p>Occlusal overload has been given as the primary factor for peri-implant bone loss, as
well as loss of implants and of implant-supported prostheses<sup><xref rid="r10" ref-type="bibr">10</xref>,<xref rid="r12" ref-type="bibr">12</xref></sup>. The transfer
of occlusal load is related with several factors such as: a) geometry - position and
number of implants<sup><xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r18" ref-type="bibr">18</xref>,<xref rid="r24" ref-type="bibr">24</xref>,<xref rid="r26" ref-type="bibr">26</xref>,<xref rid="r27" ref-type="bibr">27</xref>,<xref rid="r29" ref-type="bibr">29</xref></sup>, linear or off-set
arrangement of the implants<sup><xref rid="r22" ref-type="bibr">22</xref>,<xref rid="r24" ref-type="bibr">24</xref></sup>, <italic>cantilever</italic>extension<sup><xref rid="r18" ref-type="bibr">18</xref>,<xref rid="r24" ref-type="bibr">24</xref></sup>, a displaced occlusal plane<sup><xref rid="r24" ref-type="bibr">24</xref></sup>, size of the occlusal table<sup><xref rid="r18" ref-type="bibr">18</xref>,<xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r24" ref-type="bibr">24</xref></sup>, excessive height of the abutment/crown
set<sup><xref rid="r24" ref-type="bibr">24</xref></sup>; b) occlusion -
parafunctional habits<sup><xref rid="r18" ref-type="bibr">18</xref></sup>, bite
force<sup><xref rid="r18" ref-type="bibr">18</xref>,<xref rid="r23" ref-type="bibr">23</xref></sup>, occlusal contacts<sup><xref rid="r06" ref-type="bibr">6</xref>,<xref rid="r27" ref-type="bibr">27</xref></sup>; c) load-bearing
capacity of bone - bone density and quality<sup><xref rid="r28" ref-type="bibr">28</xref></sup>, primary mechanical stability<sup><xref rid="r24" ref-type="bibr">24</xref></sup>, healing time<sup><xref rid="r24" ref-type="bibr">24</xref></sup>; and d) technological - precision of the implant/abutment and
abutment/prosthesis interfaces<sup><xref rid="r08" ref-type="bibr">8</xref>,<xref rid="r20" ref-type="bibr">20</xref>,<xref rid="r24" ref-type="bibr">24</xref></sup>, amount of preload<sup><xref rid="r24" ref-type="bibr">24</xref></sup>, and type of prosthetic retention<sup><xref rid="r08" ref-type="bibr">8</xref>,<xref rid="r09" ref-type="bibr">9</xref>,<xref rid="r24" ref-type="bibr">24</xref></sup>.</p><p>Occlusal loads are first introduced to the prosthesis, and are delivered to the
bone/implant interface<sup><xref rid="r25" ref-type="bibr">25</xref></sup>; hence, the
development and maintenance of the bone/implant interface is particularly dependent on
the control of biomechanical loads. Bones carrying mechanical loads adapt their strength
to the load applied on them by bone modeling/remodeling. The response to an increased
mechanical stress below a certain threshold will be a strengthening of the bone by
increasing the bone density or apposition of bone. On the other hand, fatigue
micro-damage resulting in bone resorption may be the result of mechanical stress beyond
this threshold<sup><xref rid="r07" ref-type="bibr">7</xref>,<xref rid="r12" ref-type="bibr">12</xref>,<xref rid="r30" ref-type="bibr">30</xref></sup>.</p><p>Compared to implant-supported total fixed prostheses, implant-supported partial fixed
prostheses are more susceptible to the moment generated by occlusal loads, since they
lack the benefit of cross-arch stabilization<sup><xref rid="r24" ref-type="bibr">24</xref></sup>. Moreover, the posterior region of the oral cavity presents
higher occlusal loading and lower bone quality than the anterior region; additionally,
bone height is limited by the maxillary sinus or the mandibular nerve. In a
retrospective clinical analysis of the relation between the fracture of implants and
occlusal overload, Rangert, et al.<sup><xref rid="r24" ref-type="bibr">24</xref></sup>(1997) found that 90% of implant fractures occurred in the posterior segment, supported
by one or more implants, in association with cantilever, bruxism or high occlusal
loads.</p><p>Recent studies have investigated the stresses caused by implant-supported prosthesis
fabrication methods, by varying the type of cylinder<sup><xref rid="r08" ref-type="bibr">8</xref>,<xref rid="r09" ref-type="bibr">9</xref>,<xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r16" ref-type="bibr">16</xref></sup>. However, these studies
observed stresses only during the fixation of implant-supported fixed partial
prostheses.</p><p>Strain gauge analysis has been used to evaluate stresses in implant-supported
prostheses, both <italic>in vitro</italic><sup><xref rid="r03" ref-type="bibr">3</xref>,<xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r22" ref-type="bibr">22</xref></sup> and <italic>in vivo</italic><sup><xref rid="r09" ref-type="bibr">9</xref>,<xref rid="r16" ref-type="bibr">16</xref></sup>, under
static<sup><xref rid="r01" ref-type="bibr">1</xref>,<xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r26" ref-type="bibr">26</xref></sup> and/or dynamic
loads<sup><xref rid="r05" ref-type="bibr">5</xref></sup>. Depending on the site to
be evaluated, strain gauges can be bonded close to implants<sup><xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r09" ref-type="bibr">9</xref>,<xref rid="r22" ref-type="bibr">22</xref></sup>, on the implants<sup><xref rid="r01" ref-type="bibr">1</xref>,<xref rid="r19" ref-type="bibr">19</xref></sup>, on the
abutments<sup><xref rid="r19" ref-type="bibr">19</xref>,<xref rid="r26" ref-type="bibr">26</xref></sup>, and on the metal structures of the prosthesis<sup><xref rid="r03" ref-type="bibr">3</xref>,<xref rid="r09" ref-type="bibr">9</xref>,<xref rid="r17" ref-type="bibr">17</xref></sup>.</p><p>The objective of the present study was to compare the magnitude of peri-implant
microdeformation of three-element fixed partial prostheses obtained from prefabricated
and plastic cylinders subjected to axial loads.</p></sec><sec sec-type="materials|methods"><title>MATERIAL AND METHODS</title><p>To simulate clinical conditions in a real-life arrangement, three internal hexagon type
implants from mesial to distal: labeled 1, 2, and 3 (Conect AR; 3.75-mm diameter, 13-mm
depth; Conexão Sistemas de Prótese, Arujá, SP, Brazil) were arranged in the middle of a
measurement model consisting of a 70x40x30 mm<sup>3</sup> rectangular polyurethane block
(Polyurethane F16, Axson, Cergy, France) with known mechanical properties (Young's
modulus of 3.6 GPa). One matrix that could generate a constant implant placement was
custom-built. The implants were embedded in a straight line in the polyurethane block.
The distance between the centers of the implants was set at 7 mm, leaving sufficient
space for the strain gauge (SG) (<xref ref-type="fig" rid="f01">Figure 1</xref>).</p><fig id="f01" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Positioning of the internal hexagon implants, showing the equidistance and linear
configuration</p></caption><graphic xlink:href="jaos-19-06-0610-g01"></graphic></fig><p>Microunit abutments (Micro unit; Conexão Sistemas de Prótese) were screwed onto the
implants with a 20 Ncm torque using the implant manufacturer's manual torque driver
(Torque driver; Conexão Sistemas de Prótese).</p><p>The patterns were fabricated using a pattern resin (GC Pattern Resin; GC Europe N.V.,
Leuven, Belgium) and wax (Kronen wachs; Bego Bremer Goldschalgerei, Bremen, Germany).
The 10 superstructures were made on the polyurethane blocks. The components were
connected to the Microunit abutment to eliminate the inevitable dimensional changes
originating from impression procedures<sup><xref rid="r08" ref-type="bibr">8</xref></sup>. The superstructures were fabricated using plastic cylinders (Plastic
coping; Conexão Sistemas de Prótese) and pre-machined cobalt-chromium cylinders
(Machined coping; Conexão Sistemas de Prótese). The superstructures were sprued,
invested, and cast using a cobalt-chromium alloy (Wirobond SG, Bego Bremer
Goldschalgerei, Bremen, Germany). To avoid bias resulting from manufacturing conditions,
random sets comprising frameworks of different types were put together and cast. The
superstructures were fabricated using the 1-piece method. The castings were cleaned,
finished, and polished, and care was taken not to damage the internal surface of the
copings, whose interiors were inspected under a binocular microscope to check for
casting imperfections. The abutments received three-unit superstructures, and each group
consisted of five superstructures. The fit and passivity of the superstructures were
checked without torque tightening. The superstructures showed satisfactory adaptation
which was confirmed by direct vision in conjunction with tactile sensation through an
explorer<sup><xref rid="r13" ref-type="bibr">13</xref></sup>. Superstructures
showing signs of instability were excluded.</p><p>Four strain gauges (SGs) (KFG-02-120-c1-11N30C2, Kyowa Electronic Instruments Co., Ltd,
Tokyo, Japan) were bonded onto the surface of each polyurethane block using a thin film
of methyl-2-cyanoacrylate adhesive (M-Bond 200; Vishay Measurements Group, Raleigh, NC,
USA). SG 01 was placed mesially adjacent to implant 1, SG 02 and SG 03 were placed
mesially and distally adjacent to implant 2, respectively, and SG 04 was placed distally
adjacent to implant 3. Each gauge was wired separately, and the 4 strain gauges were
arranged in series to form a full Wheatstone bridge. The leads from the strain gauges
were connected to a multichannel bridge amplifier to form one leg of the bridge. A
computer (Intel 775P Pentium 4 Q6600) was interfaced with the bridge amplifier to record
the output signal of polyurethane surface. Data-acquisition system software (System 5000
Model 5100B; Vishay Measurements Group, Raleigh, NC, USA) was used to record the
data.</p><p>The superstructure's occlusal screws were tightened onto the Microunit abutments with a
hand-operated screwdriver until the screws started to engage, based on tactile
sensation, while applying a torque of 10 Ncm using the manufacture's manual
torque-controlling device.</p><p>Five loading points were selected to apply a static vertical load on the metallic
superstructures. Point A was located on the hole of the retention screw of implant 1,
point B was located centrally between the holes of the retention screws of implants 1
and 2, point C was located on the hole of the retention screw of implant 2, point D was
located centrally between the hole of the retention screws of implants 2 and 3, and
point E was located on the hole of the retention screw of implant 3.</p><p>All of the strain gauges were zeroed and calibrated prior to each loading and a vertical
load of 30 kg<sup><xref rid="r21" ref-type="bibr">21</xref></sup> was applied for 10 s,
using a universal load-testing machine (DL-1000; EMIC, São José dos Pinhais, PR,
Brazil). The magnitude of microdeformation on each strain gauge was recorded in units of
microdeformation (με). This procedure was repeated two more times, making a total of 3
loads <italic>per </italic>loading point (<xref ref-type="fig" rid="f02">Figure
2</xref>).</p><fig id="f02" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Detail of static vertical loading on loading point A</p></caption><graphic xlink:href="jaos-19-06-0610-g02"></graphic></fig><p>In order to compare the magnitude of microdeformation resulting from the type of
cylinder and the loading point, the positive and negative strains recorded in the strain
gauge analysis were transformed into absolute values<sup><xref rid="r08" ref-type="bibr">8</xref>,<xref rid="r16" ref-type="bibr">16</xref>,<xref rid="r17" ref-type="bibr">17</xref>,<xref rid="r26" ref-type="bibr">26</xref></sup>, which were
used to calculate the mean values of microdeformation of each strain gauge.</p><p>This experiment followed a factorial scheme of the 2x5 type. The experimental variables
under study were cylinder (plastic and pre-fabricated) and loading point (A, B, C, D,
E). The variable response was the micro-deformation value obtained in the strain-gauge
analysis. The experimental unit was the prosthetic superstructure. The test specimens
were randomly assigned to the loading point conditions.</p><p>Fifty (50) data obtained were submitted to statistical analysis using the following
statistical softwares: GraphPad Prism version 4.00, 2003 (GraphPad Software, Inc., La
Jolla, CA, USA), Minitab version 14.12, 2004 (Minitab Corporation, State College, PA,
USA) and Statix version 8.0, 2003 (Analytical Software Inc., version 8.0, 2003;
Tallahassee, FL, USA). The descriptive statistics consisted of the calculation of the
means and standard deviations. The inferential statistics consisted of analysis of
variance of repeated measurements of two factors (cylinder and loading point), in which
the variable loading point was considered as a repeated factor. The study of the
interaction effect was conducted by graph means. Multiple comparisons among the means
for the five experimental conditions were made by the Tukey's multiple-comparison test.
Significance level was set at 5%.</p></sec><sec sec-type="results"><title>RESULTS</title><p><xref ref-type="table" rid="t01">Table 1</xref> lists the descriptive statistical data,
analyzing the mean values of microdeformation obtained with each strain gauge (SG) and
mean of 4 strain gauges for the plastic prosthetic cylinders and the prefabricated Co-Cr
cylinders at each loading point.</p><table-wrap id="t01" orientation="portrait" position="float"><label>Table 1</label><caption><p>Mean values and standard deviations of microdeformation (µε) measured by each
strain gauge and mean of 4 strain gauges at each loading point for the plastic and
prefabricated cylinders</p></caption><table frame="hsides" rules="groups"><thead><tr style="background-color:#dcddde"><th align="center" rowspan="1" colspan="1"><bold>Cylinder</bold></th><th align="center" rowspan="1" colspan="1"><bold>Loading point</bold></th><th align="center" rowspan="1" colspan="1"><bold>SG 01</bold></th><th align="center" rowspan="1" colspan="1"><bold>SG 02</bold></th><th align="center" rowspan="1" colspan="1"><bold>SG 03</bold></th><th align="center" rowspan="1" colspan="1"><bold>SG 04</bold></th><th align="center" rowspan="1" colspan="1"><bold>Mean of 4SG </bold></th></tr></thead><tbody><tr><td align="center" rowspan="1" colspan="1">Plastic (n=5)</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">568.8±133.0</td><td align="center" rowspan="1" colspan="1">306.2±138.3</td><td align="center" rowspan="1" colspan="1">55.4±39.2</td><td align="center" rowspan="1" colspan="1">256.8±130.6</td><td align="center" rowspan="1" colspan="1">296.6±77.68</td></tr><tr style="background-color:#dcddde"><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">B</td><td align="center" rowspan="1" colspan="1">605.3±64.4</td><td align="center" rowspan="1" colspan="1">156.4±123.4</td><td align="center" rowspan="1" colspan="1">34.4±39.6</td><td align="center" rowspan="1" colspan="1">167.1±93.3</td><td align="center" rowspan="1" colspan="1">240.8±42.41</td></tr><tr><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">C</td><td align="center" rowspan="1" colspan="1">463.9±40.4</td><td align="center" rowspan="1" colspan="1">175.3±124.9</td><td align="center" rowspan="1" colspan="1">67.1±44.4</td><td align="center" rowspan="1" colspan="1">535.0±184.8</td><td align="center" rowspan="1" colspan="1">310.3±19.92</td></tr><tr style="background-color:#dcddde"><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">D</td><td align="center" rowspan="1" colspan="1">349.8±45.4</td><td align="center" rowspan="1" colspan="1">369.4±152.5</td><td align="center" rowspan="1" colspan="1">190.2±65.8</td><td align="center" rowspan="1" colspan="1">937.0±112.8</td><td align="center" rowspan="1" colspan="1">461.6±59.46</td></tr><tr><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">E</td><td align="center" rowspan="1" colspan="1">156.6±69.4</td><td align="center" rowspan="1" colspan="1">444.6±128.4</td><td align="center" rowspan="1" colspan="1">115.1±91.9</td><td align="center" rowspan="1" colspan="1">1044.6±127.7</td><td align="center" rowspan="1" colspan="1">440.2±43.18</td></tr><tr style="background-color:#dcddde"><td align="center" rowspan="1" colspan="1">Pre-fabricated (n=5)</td><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">617.4±100.7</td><td align="center" rowspan="1" colspan="1">205.0±148.8</td><td align="center" rowspan="1" colspan="1">31.83±20.49</td><td align="center" rowspan="1" colspan="1">319.2±32.0</td><td align="center" rowspan="1" colspan="1">293.4±64.0</td></tr><tr><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">B</td><td align="center" rowspan="1" colspan="1">634.1±104.3</td><td align="center" rowspan="1" colspan="1">118.9±57.0</td><td align="center" rowspan="1" colspan="1">39.88±16.45</td><td align="center" rowspan="1" colspan="1">150.9±140.3</td><td align="center" rowspan="1" colspan="1">238.2±51.77</td></tr><tr style="background-color:#dcddde"><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">C</td><td align="center" rowspan="1" colspan="1">563.5±46.5</td><td align="center" rowspan="1" colspan="1">145.8±121.9</td><td align="center" rowspan="1" colspan="1">83.3±67.4</td><td align="center" rowspan="1" colspan="1">451.1±170.8</td><td align="center" rowspan="1" colspan="1">310.9±56.08</td></tr><tr><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">D</td><td align="center" rowspan="1" colspan="1">389.5±56.3</td><td align="center" rowspan="1" colspan="1">267.8±108.9</td><td align="center" rowspan="1" colspan="1">154.3±46.1</td><td align="center" rowspan="1" colspan="1">884.1±140.1</td><td align="center" rowspan="1" colspan="1">423.9±55.44</td></tr><tr style="background-color:#dcddde"><td align="center" rowspan="1" colspan="1"> </td><td align="center" rowspan="1" colspan="1">E</td><td align="center" rowspan="1" colspan="1">246.4±46.6</td><td align="center" rowspan="1" colspan="1">358.4±130.6</td><td align="center" rowspan="1" colspan="1">81.4±38.5</td><td align="center" rowspan="1" colspan="1">1067.1±114.6</td><td align="center" rowspan="1" colspan="1">438.3±42.80</td></tr></tbody></table></table-wrap><p><xref ref-type="table" rid="t01">Table 1</xref> shows the microdeformation values (με)
obtained, analyzing the mean values of microstrain obtained by the four strain gauges
(SG) positioned around the implant, for five loading point (A, B, C, D, E), as well as
the type of cylinders (plastic and prefabricated).</p><p>The statistical RM ANOVA indicated that the loading point effect was statistically
significant (p=0.0001), while the interaction effect was not statistically significant,
demonstrating that the cylinder effect was the same for each loading point.</p><p>Tukey's multiple-comparison test was then applied to compare the mean values of the 5
levels of the loading point factor (<xref ref-type="table" rid="t02">Table
2</xref>).</p><table-wrap id="t02" orientation="portrait" position="float"><label>Table 2</label><caption><p>Mean values of the 5 levels of the loading point factor</p></caption><table frame="hsides" rules="groups"><thead><tr style="background-color:#dcddde"><th align="center" rowspan="1" colspan="1"><bold>Loading point</bold></th><th align="center" rowspan="1" colspan="1"><bold>Mean (µε)</bold></th></tr></thead><tbody><tr><td align="center" rowspan="1" colspan="1">D</td><td align="center" rowspan="1" colspan="1">442.77<sup>A</sup></td></tr><tr style="background-color:#dcddde"><td align="center" rowspan="1" colspan="1">E</td><td align="center" rowspan="1" colspan="1">439.28<sup>A</sup></td></tr><tr><td align="center" rowspan="1" colspan="1">C</td><td align="center" rowspan="1" colspan="1">310.63<sup>B</sup></td></tr><tr style="background-color:#dcddde"><td align="center" rowspan="1" colspan="1">A</td><td align="center" rowspan="1" colspan="1">295.00<sup>B</sup></td></tr><tr><td align="center" rowspan="1" colspan="1">B</td><td align="center" rowspan="1" colspan="1">239.49<sup>C</sup></td></tr></tbody></table><table-wrap-foot><fn><p>*Same superscript letters mean no significant difference at 5% (Tukey’s
test).</p></fn></table-wrap-foot></table-wrap></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>When an occlusal load is applied upon an implant, the load is partially transferred to
the bone, with the highest stresses occurring in the implant's most cervical region.
This phenomenon is due to one of the principles of engineering, i.e., when two materials
are in contact with each other and one of them is loaded, the stresses will be higher at
the materials' initial point of contact<sup><xref rid="r11" ref-type="bibr">11</xref></sup>. Therefore, the cervical region of the implant is the site where the
greatest microdeformations occur<sup><xref rid="r17" ref-type="bibr">17</xref>,<xref rid="r18" ref-type="bibr">18</xref></sup>, independently of the type of bone and
the design of the implant<sup><xref rid="r28" ref-type="bibr">28</xref></sup>, the
configuration of the prosthesis and the load<sup><xref rid="r27" ref-type="bibr">27</xref></sup>. In the present study, strain gauges were strategically bonded on
the polyurethane block, tangentially to the implant platform, to observe the region with
the highest concentration of stresses during the application of loads, to correlate it
with clinical practice<sup><xref rid="r17" ref-type="bibr">17</xref></sup>. This
positioning of the strain gauges has also been used in previous studies<sup><xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r08" ref-type="bibr">8</xref>,<xref rid="r09" ref-type="bibr">9</xref>,<xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r17" ref-type="bibr">17</xref>,<xref rid="r22" ref-type="bibr">22</xref></sup>. The flat surface of the polyurethane block made the positioning and
bonding of the stain gauges simpler and more precise than in other studies, which opted
for bonding on the implants<sup><xref rid="r01" ref-type="bibr">1</xref>,<xref rid="r19" ref-type="bibr">19</xref></sup>, on the abutments<sup><xref rid="r19" ref-type="bibr">19</xref>,<xref rid="r26" ref-type="bibr">26</xref></sup>, and on the metal structures of the prosthesis<sup><xref rid="r09" ref-type="bibr">9</xref>,<xref rid="r17" ref-type="bibr">17</xref></sup>.</p><p>According to Frost<sup><xref rid="r07" ref-type="bibr">7</xref></sup> (1994) and Wiskott
and Belser<sup><xref rid="r30" ref-type="bibr">30</xref></sup> (1999), bone homeostasis
occurs when the level of microdeformation remains within the range of 100 to 2000 με and
50 to 1500 uε, respectively. In <xref ref-type="table" rid="t01">Table 1</xref>, most of
the microdeformation values obtained for both the plastic and the prefabricated
cylinders remained within the level of bone homeostasis, or normal load. However, this
ideal clinical situation of occlusal contacts is difficult to achieve with an
implant-supported partial fixed prosthesis because the hole of the retention screw makes
it impossible to position the occlusal contacts in the center of the implant.
Nevertheless, based on the results of the current work, it can be inferred that, when a
3-element partial fixed prosthesis supported by 3 implants is loaded axially, with
occlusal contacts positioned between the implants and as close as possible to the
latter, bone resorption around the implants and occlusal overload can be minimized. If
the load were applied around the center of the implants, the torque or moment would be
greater, since the torque is directly proportional to the distance between the loading
point and the center of the implant<sup><xref rid="r24" ref-type="bibr">24</xref></sup>.</p><p>In the present study, it was found that when loads were applied on loading points A, B,
D and E, which were positioned on and close to the implants at the extremities, the
largest microdeformations occurred in the closest strain gauges, indicating that the
amount of load transmitted to the implant and the stresses generated in the bone depend
on the location where the load is applied on the prosthesis. In contrast, when loads
were applied on loading point C, which was positioned on the central implant, the
greatest microdeformations occurred in the most distant strain gauges, indicating that
the implants at the extremities were more loaded (<xref ref-type="table" rid="t01">Table
1</xref>). These results suggest that the stresses generated by occlusal contacts
located close to the central implant of the screwed fixed partial prosthesis supported
on three implants are distributed to the implants at the extremities, while the stresses
generated by occlusal contacts positioned close to the implants at the extremities
concentrate in those implants.</p><p>Misfit at the abutment/prosthesis interface may lead to significant instability of the
implant-supported prosthesis, which increases linearly as a function of the degree of
misfit<sup><xref rid="r20" ref-type="bibr">20</xref></sup>. The precision of the
interfaces may also negatively affect the load-bearing ability of the implant-supported
prosthesis<sup><xref rid="r24" ref-type="bibr">24</xref></sup>, affecting the
magnitude of the forces in the peri-implantar region<sup><xref rid="r25" ref-type="bibr">25</xref></sup>. The inaccurate fit of the superstructures can attribute to the
impression technique, the control of laboratory analogues, or soldering method. The
procedure that attempts to compensate for shrinkage or deformation, the one-piece
casting method, waxing was performed directly on the abutment in polyurethane
block<sup><xref rid="r08" ref-type="bibr">8</xref></sup>. Studies to evaluate the
fit of the abutment/prosthesis interface have demonstrated that the precision of unitary
metallic structures obtained with prefabricated cylinders is better than that obtained
with plastic cylinders<sup><xref rid="r02" ref-type="bibr">2</xref>,<xref rid="r14" ref-type="bibr">14</xref></sup>. However, it should be noted that the
care involved in handling multiple prostheses is very different from that involved in
handling single ones, and the complexity of the laboratory procedures increases
proportionally to the number of fixations involved.</p><p>In this present study, the cylinder effect and the cylinder/loading point interaction
showed no statistically significant difference. This finding suggests that the type of
cylinder, plastic or prefabricated, does not affect the magnitude of microdeformation
when an implant-supported fixed prosthesis is axially loaded, and that the behavior of
both cylinders followed the same pattern at all of the loading points, showing no
significant difference. Previous strain gauge studies have reported similar
results<sup><xref rid="r08" ref-type="bibr">8</xref>,<xref rid="r09" ref-type="bibr">9</xref>,<xref rid="r15" ref-type="bibr">15</xref></sup>, with fixed
partial prostheses screwed onto implants, made from plastic or prefabricated cylinders,
producing the same magnitude of microdeformation during tightening of the retention
screws, without significant difference between plastic and prefabricated cylinders
before<sup><xref rid="r08" ref-type="bibr">8</xref>,<xref rid="r09" ref-type="bibr">9</xref></sup> and after<sup><xref rid="r15" ref-type="bibr">15</xref></sup> the application of a dental ceramic.</p><p>With regard to the loading point effect, a significant difference was found (p=0.0001),
suggesting that symmetrical loading points, A versus E and B versus D, did not produce
similar magnitudes of microdeformation. The superstructures showed satisfactory
adaptation which was confirmed by direct vision in conjunction with tactile sensation
through an explorer. Therefore, the method used is not able to detect slight distortions
of the prosthesis on the implant<sup><xref rid="r13" ref-type="bibr">13</xref></sup>,
probably caused by casting procedures of the implant-supported fixed partial prosthesis.
This finding suggests that the fit of the cast metal rods was not homogeneous, i.e., the
fit attained by the cast metal rods in implant 3 may have differed from that found in
implant 1, which in turn may also have differed from the fit obtained in implant 2.
Thus, the nonhomogeneous fit may have influenced the distribution of stresses, producing
different magnitudes of microdeformation, even when the load was applied on equidistant
and symmetrical points.</p><p>Limitations of the present model must be taken into account when interpreting the
results of this investigation. This is an <italic>in vitro</italic> study based on a
homogenous model with known mechanical properties instead of bone, which allowed not
only proper strain measurements, but also 100% implant-model material contact.
<italic>In vivo</italic>, additional variables like bone density, implant stability,
and bone-to-implant contact would have to be considered. The interimplant relationships
represented a straight-line configuration of the implants, which seems to be also a
simplified situation compared to a curved distribution with a longer segment splinted.
The flat occlusal surface of the superstructures did not represent the "real clinical
situation", variables such as cusp inclination, occlusal table and location, direction
and magnitude of applied occlusal forces on the superstructures could change the results
of this study.</p></sec><sec sec-type="conclusions"><title>CONCLUSION</title><p>Based on the obtained results, type of cylinder, plastic or prefabricated, did not
affect in the magnitude of microdeformation under axial loading and the location of the
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