In Vitro Evaluation of Manual Torque Values Applied to Implant-Abutment Complex by Different Clinicians and Abutment Screw Loosening
Identifieur interne : 000188 ( Pmc/Checkpoint ); précédent : 000187; suivant : 000189In Vitro Evaluation of Manual Torque Values Applied to Implant-Abutment Complex by Different Clinicians and Abutment Screw Loosening
Auteurs : Onur Dincer Kose [Turquie] ; Burcin Karatasl [Turquie] ; Sabit Demircan [Turquie] ; Taha Emre Kose [Turquie] ; Erhan Cene [Turquie] ; Serhan Ayd N Aya [Turquie] ; Mehmet Ali Erdem [Turquie] ; Abdulkadir Burak Cankaya [Turquie]Source :
- BioMed Research International [ 2314-6133 ] ; 2017.
Abstract
Preload is applied to screws manually or using a torque wrench in dental implant systems, and the preload applied must be appropriate for the purpose. The aim of this study was to assess screw loosening and bending/torsional moments applied by clinicians of various specialties following application of manual tightening torque to combinations of implants and abutments. Ten-millimeter implants of 3.7 and 4.1 mm diameters and standard or solid abutments were used. Each group contained five implant-abutment combinations. The control and experimental groups comprised 20 and 160 specimens, respectively. Implants in the experimental group were tightened by dentists of different specialties. Torsional and bending moments during tightening were measured using a strain gauge. Control group and implants with preload values close to the ideal preload were subjected to a dynamic loading test at 150 N, 15 Hz, and 85,000 cycles. The implants that deformed in this test were examined using an optical microscope to assess deformities. Manual tightening did not yield the manufacturer-recommended preload values. Dynamic loading testing suggested early screw loosening/fracture in samples with insufficient preload.
Url:
DOI: 10.1155/2017/7376261
PubMed: 28473988
PubMed Central: 5394346
Affiliations:
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<front><div type="abstract" xml:lang="en"><p>Preload is applied to screws manually or using a torque wrench in dental implant systems, and the preload applied must be appropriate for the purpose. The aim of this study was to assess screw loosening and bending/torsional moments applied by clinicians of various specialties following application of manual tightening torque to combinations of implants and abutments. Ten-millimeter implants of 3.7 and 4.1 mm diameters and standard or solid abutments were used. Each group contained five implant-abutment combinations. The control and experimental groups comprised 20 and 160 specimens, respectively. Implants in the experimental group were tightened by dentists of different specialties. Torsional and bending moments during tightening were measured using a strain gauge. Control group and implants with preload values close to the ideal preload were subjected to a dynamic loading test at 150 N, 15 Hz, and 85,000 cycles. The implants that deformed in this test were examined using an optical microscope to assess deformities. Manual tightening did not yield the manufacturer-recommended preload values. Dynamic loading testing suggested early screw loosening/fracture in samples with insufficient preload. </p>
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<article-meta><article-id pub-id-type="pmid">28473988</article-id>
<article-id pub-id-type="pmc">5394346</article-id>
<article-id pub-id-type="doi">10.1155/2017/7376261</article-id>
<article-categories><subj-group subj-group-type="heading"><subject>Research Article</subject>
</subj-group>
</article-categories>
<title-group><article-title>In Vitro Evaluation of Manual Torque Values Applied to Implant-Abutment Complex by Different Clinicians and Abutment Screw Loosening</article-title>
</title-group>
<contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-9153-5910</contrib-id>
<name><surname>Dincer Kose</surname>
<given-names>Onur</given-names>
</name>
<xref ref-type="aff" rid="I1"><sup>1</sup>
</xref>
<xref ref-type="corresp" rid="cor1"><sup>*</sup>
</xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0002-6178-0931</contrib-id>
<name><surname>Karataslı</surname>
<given-names>Burcin</given-names>
</name>
<xref ref-type="aff" rid="I2"><sup>2</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Demircan</surname>
<given-names>Sabit</given-names>
</name>
<xref ref-type="aff" rid="I1"><sup>1</sup>
</xref>
</contrib>
<contrib contrib-type="author"><contrib-id contrib-id-type="orcid" authenticated="false">http://orcid.org/0000-0003-3601-0393</contrib-id>
<name><surname>Kose</surname>
<given-names>Taha Emre</given-names>
</name>
<xref ref-type="aff" rid="I3"><sup>3</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cene</surname>
<given-names>Erhan</given-names>
</name>
<xref ref-type="aff" rid="I4"><sup>4</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Aya</surname>
<given-names>Serhan Aydın</given-names>
</name>
<xref ref-type="aff" rid="I5"><sup>5</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Erdem</surname>
<given-names>Mehmet Ali</given-names>
</name>
<xref ref-type="aff" rid="I6"><sup>6</sup>
</xref>
</contrib>
<contrib contrib-type="author"><name><surname>Cankaya</surname>
<given-names>Abdulkadir Burak</given-names>
</name>
<xref ref-type="aff" rid="I6"><sup>6</sup>
</xref>
</contrib>
</contrib-group>
<aff id="I1"><sup>1</sup>
Private Practice, Istanbul, Turkey</aff>
<aff id="I2"><sup>2</sup>
Department of Prosthodontics, Faculty of Dentistry, Istanbul University, Istanbul, Turkey</aff>
<aff id="I3"><sup>3</sup>
Department of Dentomaxillofacial Radiology, Faculty of Dentistry, Istanbul University, Istanbul, Turkey</aff>
<aff id="I4"><sup>4</sup>
Department of Statistics, Yıldız Technical University, Istanbul, Turkey</aff>
<aff id="I5"><sup>5</sup>
Department of Mechanical Engineering, Faculty of Mechanical Engineering, Istanbul Technical University, Istanbul, Turkey</aff>
<aff id="I6"><sup>6</sup>
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Istanbul University, Istanbul, Turkey</aff>
<author-notes><corresp id="cor1">*Onur Dincer Kose: <email>dt.onurdincer@hotmail.com</email>
</corresp>
<fn fn-type="other"><p>Academic Editor: Konstantinos Michalakis</p>
</fn>
</author-notes>
<pub-date pub-type="ppub"><year>2017</year>
</pub-date>
<pub-date pub-type="epub"><day>3</day>
<month>4</month>
<year>2017</year>
</pub-date>
<volume>2017</volume>
<elocation-id>7376261</elocation-id>
<history><date date-type="received"><day>2</day>
<month>11</month>
<year>2016</year>
</date>
<date date-type="rev-recd"><day>18</day>
<month>12</month>
<year>2016</year>
</date>
<date date-type="accepted"><day>16</day>
<month>3</month>
<year>2017</year>
</date>
</history>
<permissions><copyright-statement>Copyright © 2017 Onur Dincer Kose et al.</copyright-statement>
<copyright-year>2017</copyright-year>
<license xlink:href="https://creativecommons.org/licenses/by/4.0/"><license-p>This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</license-p>
</license>
</permissions>
<abstract><p>Preload is applied to screws manually or using a torque wrench in dental implant systems, and the preload applied must be appropriate for the purpose. The aim of this study was to assess screw loosening and bending/torsional moments applied by clinicians of various specialties following application of manual tightening torque to combinations of implants and abutments. Ten-millimeter implants of 3.7 and 4.1 mm diameters and standard or solid abutments were used. Each group contained five implant-abutment combinations. The control and experimental groups comprised 20 and 160 specimens, respectively. Implants in the experimental group were tightened by dentists of different specialties. Torsional and bending moments during tightening were measured using a strain gauge. Control group and implants with preload values close to the ideal preload were subjected to a dynamic loading test at 150 N, 15 Hz, and 85,000 cycles. The implants that deformed in this test were examined using an optical microscope to assess deformities. Manual tightening did not yield the manufacturer-recommended preload values. Dynamic loading testing suggested early screw loosening/fracture in samples with insufficient preload. </p>
</abstract>
</article-meta>
</front>
<floats-group><fig id="fig1" orientation="portrait" position="float"><label>Figure 1</label>
<caption><p>Experimental set-up.</p>
</caption>
<graphic xlink:href="BMRI2017-7376261.001"></graphic>
</fig>
<fig id="fig2" orientation="portrait" position="float"><label>Figure 2</label>
<caption><p>(A) Implant placement in the experimental set-up. (B) Handheld screwdriver placement in the experimental set-up.</p>
</caption>
<graphic xlink:href="BMRI2017-7376261.002"></graphic>
</fig>
<fig id="fig3" orientation="portrait" position="float"><label>Figure 3</label>
<caption><p>Measurement of loosening torque using a torque tester.</p>
</caption>
<graphic xlink:href="BMRI2017-7376261.003"></graphic>
</fig>
<table-wrap id="tab1" orientation="portrait" position="float"><label>Table 1</label>
<caption><p>ANOVA for bending and torsional moments according to specialty.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Moment type</th>
<th align="center" rowspan="1" colspan="1"><italic>F</italic>
</th>
<th align="center" rowspan="1" colspan="1">Sig.</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">Bending moment (Ch1)</td>
<td align="center" rowspan="1" colspan="1">2.230</td>
<td align="center" rowspan="1" colspan="1">0.067</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Bending moment (Ch2)</td>
<td align="center" rowspan="1" colspan="1">4.389</td>
<td align="center" rowspan="1" colspan="1">0.002<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Torsional moment (Ch3)</td>
<td align="center" rowspan="1" colspan="1">134.490</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p><italic>∗</italic>
refers to <0.05.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tab2" orientation="portrait" position="float"><label>Table 2</label>
<caption><p>Bonferroni test for bending and torsional moments according to specialty.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Moment <break></break>
type</th>
<th align="center" rowspan="1" colspan="1">(<italic>I</italic>
) Specialty</th>
<th align="center" rowspan="1" colspan="1">(<italic>J</italic>
) Specialty</th>
<th align="center" rowspan="1" colspan="1">Mean difference<break></break>
(<italic>I</italic>
− <italic>J</italic>
) (Ncm)</th>
<th align="center" rowspan="1" colspan="1">Std. error</th>
<th align="center" rowspan="1" colspan="1">Sig.</th>
</tr>
</thead>
<tbody><tr><td rowspan="15" align="left" colspan="1">Bending moment (Ch1) </td>
<td rowspan="3" align="center" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">−6.552</td>
<td align="center" rowspan="1" colspan="1">4.245</td>
<td align="center" rowspan="1" colspan="1">0.748</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">−0.207</td>
<td align="center" rowspan="1" colspan="1">4.245</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">5.322</td>
<td align="center" rowspan="1" colspan="1">4.245</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td rowspan="3" align="center" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">6.552</td>
<td align="center" rowspan="1" colspan="1">4.245</td>
<td align="center" rowspan="1" colspan="1">0.748</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">6.345</td>
<td align="center" rowspan="1" colspan="1">4.245</td>
<td align="center" rowspan="1" colspan="1">0.822</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">11.874<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">4.245</td>
<td align="center" rowspan="1" colspan="1">0.035<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td rowspan="3" align="center" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">0.207</td>
<td align="center" rowspan="1" colspan="1">4.245</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">−6.345</td>
<td align="center" rowspan="1" colspan="1">4.245</td>
<td align="center" rowspan="1" colspan="1">0.822</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">5.529</td>
<td align="center" rowspan="1" colspan="1">4.245</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td rowspan="3" align="center" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">−5.322</td>
<td align="center" rowspan="1" colspan="1">4.245</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">−11.874<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">4.245</td>
<td align="center" rowspan="1" colspan="1">0.035<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">−5.529</td>
<td align="center" rowspan="1" colspan="1">4.245</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td colspan="6" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td rowspan="15" align="left" colspan="1">Bending moment (Ch2) </td>
<td rowspan="3" align="center" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">2.181</td>
<td align="center" rowspan="1" colspan="1">3.585</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">8.525</td>
<td align="center" rowspan="1" colspan="1">3.585</td>
<td align="center" rowspan="1" colspan="1">0.112</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">10.440<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">3.585</td>
<td align="center" rowspan="1" colspan="1">0.025<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td rowspan="3" align="center" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">−2.181</td>
<td align="center" rowspan="1" colspan="1">3.585</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">6.344</td>
<td align="center" rowspan="1" colspan="1">3.585</td>
<td align="center" rowspan="1" colspan="1">0.473</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">8.259</td>
<td align="center" rowspan="1" colspan="1">3.585</td>
<td align="center" rowspan="1" colspan="1">0.135</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td rowspan="3" align="center" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">−8.525</td>
<td align="center" rowspan="1" colspan="1">3.585</td>
<td align="center" rowspan="1" colspan="1">0.112</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">−6.344</td>
<td align="center" rowspan="1" colspan="1">3.585</td>
<td align="center" rowspan="1" colspan="1">0.473</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">1.915</td>
<td align="center" rowspan="1" colspan="1">3.585</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td rowspan="3" align="center" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">−10.440<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">3.585</td>
<td align="center" rowspan="1" colspan="1">0.025<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">−8.259</td>
<td align="center" rowspan="1" colspan="1">3.585</td>
<td align="center" rowspan="1" colspan="1">0.135</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">−1.915</td>
<td align="center" rowspan="1" colspan="1">3.585</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td colspan="6" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td rowspan="24" align="left" colspan="1">Torsional moment (Ch3) </td>
<td rowspan="4" align="center" colspan="1">Control</td>
<td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">16.215<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">14.999<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">17.047<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">18.704<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td rowspan="4" align="center" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">Control</td>
<td align="center" rowspan="1" colspan="1">−16.215<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">−1.216</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">0.832</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">2.490</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1">0.079 </td>
</tr>
<tr><td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td rowspan="4" align="center" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">Control</td>
<td align="center" rowspan="1" colspan="1">−14.999<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">1.216</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">2.048</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1">0.285</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">3.705<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1">0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td rowspan="4" align="center" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">Control</td>
<td align="center" rowspan="1" colspan="1">−17.047<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">−0.832</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">−2.048</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1">0.285</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">1.658</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1">0.755</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td rowspan="4" align="center" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">Control</td>
<td align="center" rowspan="1" colspan="1">−18.704<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">−2.490</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1">0.079</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">−3.705<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">−1.658</td>
<td align="center" rowspan="1" colspan="1">0.928</td>
<td align="center" rowspan="1" colspan="1">0.755</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p><italic>∗</italic>
refers to <0.05.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tab3" orientation="portrait" position="float"><label>Table 3</label>
<caption><p>Mean bending and torsional moment values according to specialty.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Moment type</th>
<th align="center" rowspan="1" colspan="1">Specialty</th>
<th align="center" rowspan="1" colspan="1">Mean (Ncm)</th>
</tr>
</thead>
<tbody><tr><td rowspan="4" align="left" colspan="1">Bending moment (Ch1)</td>
<td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">22.868</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">29.420</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">23.075</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">17.546</td>
</tr>
<tr><td colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td rowspan="4" align="left" colspan="1">Bending moment (Ch1)</td>
<td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">22.917</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">20.736</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">14.392</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">12.476</td>
</tr>
<tr><td colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td rowspan="5" align="left" colspan="1">Torsional moment (Ch3)</td>
<td align="center" rowspan="1" colspan="1">Control</td>
<td align="center" rowspan="1" colspan="1">25.988</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Oral and maxillofacial surgeon</td>
<td align="center" rowspan="1" colspan="1">9.773</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Prosthodontist</td>
<td align="center" rowspan="1" colspan="1">10.989</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Periodontist</td>
<td align="center" rowspan="1" colspan="1">8.941</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Dentist</td>
<td align="center" rowspan="1" colspan="1">7.283</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tab4" orientation="portrait" position="float"><label>Table 4</label>
<caption><p><italic>t</italic>
-test for equality of means according to gender and bending moment.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Moment type</th>
<th align="center" rowspan="1" colspan="1"><italic>t</italic>
</th>
<th align="center" rowspan="1" colspan="1">Two-tailed (<italic>p</italic>
)</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">Bending moment (Ch1)</td>
<td align="center" rowspan="1" colspan="1">−2.336</td>
<td align="center" rowspan="1" colspan="1">0.021<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Bending moment (Ch2)</td>
<td align="center" rowspan="1" colspan="1">−1.494</td>
<td align="center" rowspan="1" colspan="1">0.137</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p><italic>∗</italic>
refers to <0.05.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tab5" orientation="portrait" position="float"><label>Table 5</label>
<caption><p>ANOVA for Ch3 torsional moment according to gender.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Moment type</th>
<th align="center" rowspan="1" colspan="1"><italic>F</italic>
</th>
<th align="center" rowspan="1" colspan="1">Sig.</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">Torsional moment (Ch3)</td>
<td align="center" rowspan="1" colspan="1">259.502</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p><italic>∗</italic>
refers to <0.05.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tab6" orientation="portrait" position="float"><label>Table 6</label>
<caption><p>Bonferroni test for Ch3 torsional moment according to gender.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Moment type</th>
<th align="center" rowspan="1" colspan="1">(<italic>I</italic>
) Gender</th>
<th align="center" rowspan="1" colspan="1">(<italic>J</italic>
) Specialty</th>
<th align="center" rowspan="1" colspan="1">Mean difference <break></break>
(<italic>I</italic>
− <italic>J</italic>
) (Ncm)</th>
<th align="center" rowspan="1" colspan="1">Std. error</th>
<th align="center" rowspan="1" colspan="1">Sig.</th>
</tr>
</thead>
<tbody><tr><td rowspan="8" align="left" colspan="1">Torsional moment (Ch3)</td>
<td rowspan="2" align="center" colspan="1">Female</td>
<td align="center" rowspan="1" colspan="1">Male</td>
<td align="center" rowspan="1" colspan="1">−2.096<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.664</td>
<td align="center" rowspan="1" colspan="1">0.006<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Control</td>
<td align="center" rowspan="1" colspan="1">−17.789<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.813</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td rowspan="2" align="center" colspan="1">Male</td>
<td align="center" rowspan="1" colspan="1">Female</td>
<td align="center" rowspan="1" colspan="1">2.096<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.664</td>
<td align="center" rowspan="1" colspan="1">0.006<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Control</td>
<td align="center" rowspan="1" colspan="1">−15.693<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.813</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td rowspan="2" align="center" colspan="1">Control</td>
<td align="center" rowspan="1" colspan="1">Female</td>
<td align="center" rowspan="1" colspan="1">17.789<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.664</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Male</td>
<td align="center" rowspan="1" colspan="1">15.693<sup><italic>∗</italic>
</sup>
</td>
<td align="center" rowspan="1" colspan="1">0.813</td>
<td align="center" rowspan="1" colspan="1"><0.001<sup><italic>∗</italic>
</sup>
</td>
</tr>
</tbody>
</table>
<table-wrap-foot><fn><p><italic>∗</italic>
refers to <0.05.</p>
</fn>
</table-wrap-foot>
</table-wrap>
<table-wrap id="tab7" orientation="portrait" position="float"><label>Table 7</label>
<caption><p>Mean bending and torsional moment values according to gender.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Moment type</th>
<th align="center" rowspan="1" colspan="1">Gender</th>
<th align="center" rowspan="1" colspan="1">Mean (Ncm)</th>
</tr>
</thead>
<tbody><tr><td rowspan="2" align="left" colspan="1">Bending moment (Ch1)</td>
<td align="center" rowspan="1" colspan="1">Female</td>
<td align="center" rowspan="1" colspan="1">19.718</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Male</td>
<td align="center" rowspan="1" colspan="1">26.737</td>
</tr>
<tr><td colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td rowspan="2" align="left" colspan="1">Bending moment (Ch2)</td>
<td align="center" rowspan="1" colspan="1">Female</td>
<td align="center" rowspan="1" colspan="1">15.693</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Male</td>
<td align="center" rowspan="1" colspan="1">19.567</td>
</tr>
<tr><td colspan="3" rowspan="1"><hr></hr>
</td>
</tr>
<tr><td rowspan="3" align="left" colspan="1">Torsional moment (Ch3)</td>
<td align="center" rowspan="1" colspan="1">Female</td>
<td align="center" rowspan="1" colspan="1">8.199</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Male</td>
<td align="center" rowspan="1" colspan="1">10.295</td>
</tr>
<tr><td align="center" rowspan="1" colspan="1">Control</td>
<td align="center" rowspan="1" colspan="1">25.988</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tab8" orientation="portrait" position="float"><label>Table 8</label>
<caption><p>Evaluation of the correlation between initial tightening torque and gap/fraction on the loading side using Spearman's rho test.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th align="left" rowspan="1" colspan="1">Correlation coefficient</th>
<th align="center" rowspan="1" colspan="1">Starting</th>
<th align="center" rowspan="1" colspan="1">Case</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">Spearman's Rho</td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"> Starting</td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"> Correlation coefficient</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
<td align="center" rowspan="1" colspan="1">−0.001</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"> Two-tailed (<italic>p</italic>
)</td>
<td align="center" rowspan="1" colspan="1">—</td>
<td align="center" rowspan="1" colspan="1">0.996</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"> <italic>N</italic>
</td>
<td align="center" rowspan="1" colspan="1">20</td>
<td align="center" rowspan="1" colspan="1">20</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"> Case</td>
<td align="center" rowspan="1" colspan="1"> </td>
<td align="center" rowspan="1" colspan="1"> </td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"> Correlation coefficient</td>
<td align="center" rowspan="1" colspan="1">−0.001</td>
<td align="center" rowspan="1" colspan="1">1.000</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"> Two-tailed (<italic>p</italic>
)</td>
<td align="center" rowspan="1" colspan="1">0.996</td>
<td align="center" rowspan="1" colspan="1">—</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1"> <italic>N</italic>
</td>
<td align="center" rowspan="1" colspan="1">20</td>
<td align="center" rowspan="1" colspan="1">20</td>
</tr>
</tbody>
</table>
</table-wrap>
<table-wrap id="tab9" orientation="portrait" position="float"><label>Table 9</label>
<caption><p>Complications of implants undergoing dynamic loading testing.</p>
</caption>
<table frame="hsides" rules="groups"><thead><tr><th rowspan="2" align="left" colspan="1">Implant </th>
<th colspan="3" align="center" rowspan="1">Experimental group</th>
<th colspan="2" align="center" rowspan="1">Control group</th>
</tr>
<tr><th align="center" rowspan="1" colspan="1">Fractures</th>
<th align="center" rowspan="1" colspan="1">Opening</th>
<th align="center" rowspan="1" colspan="1">Loosening</th>
<th align="center" rowspan="1" colspan="1">Fractures</th>
<th align="center" rowspan="1" colspan="1">Loosening</th>
</tr>
</thead>
<tbody><tr><td align="left" rowspan="1" colspan="1">3.7 mm + standard</td>
<td align="center" rowspan="1" colspan="1">3</td>
<td align="center" rowspan="1" colspan="1">2</td>
<td align="center" rowspan="1" colspan="1">0</td>
<td align="center" rowspan="1" colspan="1">1</td>
<td align="center" rowspan="1" colspan="1">4</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">3.7 mm + solid</td>
<td align="center" rowspan="1" colspan="1">4</td>
<td align="center" rowspan="1" colspan="1">1</td>
<td align="center" rowspan="1" colspan="1">0</td>
<td align="center" rowspan="1" colspan="1">1</td>
<td align="center" rowspan="1" colspan="1">4</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">4.1 mm + standard</td>
<td align="center" rowspan="1" colspan="1">2</td>
<td align="center" rowspan="1" colspan="1">1</td>
<td align="center" rowspan="1" colspan="1">2</td>
<td align="center" rowspan="1" colspan="1">1</td>
<td align="center" rowspan="1" colspan="1">4</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">4.1 mm + solid</td>
<td align="center" rowspan="1" colspan="1">0</td>
<td align="center" rowspan="1" colspan="1">4</td>
<td align="center" rowspan="1" colspan="1">1</td>
<td align="center" rowspan="1" colspan="1">0</td>
<td align="center" rowspan="1" colspan="1">5</td>
</tr>
<tr><td align="left" rowspan="1" colspan="1">Total</td>
<td align="center" rowspan="1" colspan="1">9</td>
<td align="center" rowspan="1" colspan="1">8</td>
<td align="center" rowspan="1" colspan="1">3</td>
<td align="center" rowspan="1" colspan="1">3</td>
<td align="center" rowspan="1" colspan="1">17</td>
</tr>
</tbody>
</table>
</table-wrap>
</floats-group>
</pmc>
<affiliations><list><country><li>Turquie</li>
</country>
</list>
<tree><country name="Turquie"><noRegion><name sortKey="Dincer Kose, Onur" sort="Dincer Kose, Onur" uniqKey="Dincer Kose O" first="Onur" last="Dincer Kose">Onur Dincer Kose</name>
</noRegion>
<name sortKey="Aya, Serhan Ayd N" sort="Aya, Serhan Ayd N" uniqKey="Aya S" first="Serhan Ayd N" last="Aya">Serhan Ayd N Aya</name>
<name sortKey="Cankaya, Abdulkadir Burak" sort="Cankaya, Abdulkadir Burak" uniqKey="Cankaya A" first="Abdulkadir Burak" last="Cankaya">Abdulkadir Burak Cankaya</name>
<name sortKey="Cene, Erhan" sort="Cene, Erhan" uniqKey="Cene E" first="Erhan" last="Cene">Erhan Cene</name>
<name sortKey="Demircan, Sabit" sort="Demircan, Sabit" uniqKey="Demircan S" first="Sabit" last="Demircan">Sabit Demircan</name>
<name sortKey="Erdem, Mehmet Ali" sort="Erdem, Mehmet Ali" uniqKey="Erdem M" first="Mehmet Ali" last="Erdem">Mehmet Ali Erdem</name>
<name sortKey="Karatasl, Burcin" sort="Karatasl, Burcin" uniqKey="Karatasl B" first="Burcin" last="Karatasl">Burcin Karatasl</name>
<name sortKey="Kose, Taha Emre" sort="Kose, Taha Emre" uniqKey="Kose T" first="Taha Emre" last="Kose">Taha Emre Kose</name>
</country>
</tree>
</affiliations>
</record>
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