Machined and plastic copings in three-element prostheses with different types of implantabutment joints: a strain gauge comparative analysis
Identifieur interne : 003017 ( Pmc/Corpus ); précédent : 003016; suivant : 003018Machined and plastic copings in three-element prostheses with different types of implantabutment joints: a strain gauge comparative analysis
Auteurs : Renato Sussumu Nishioka ; Lea Nogueira Braulino De Melo Nishioka ; Celina Wanderley Abreu ; Luis Gustavo Oliveira De Vasconcellos ; Ivan BalducciSource :
- Journal of Applied Oral Science [ 1678-7757 ] ; 2010.
Abstract
Using strain gauge (SG) analysis, the aim of this
Three dental implants with external (EH) and internal (IH) hexagonal configurations were inserted into two polyurethane blocks. Microunit abutments were screwed onto their respective implant groups, applying a torque of 20 Ncm. Machined Co-Cr copings (M) and plastic prosthetic copings (P) were screwed onto the abutments, which received standard wax patterns. The wax patterns were cast in Co-Cr alloy (n=5), forming four groups: G1) EH/M; G2) EH/P; G3) IH/M and G4) IH/P. Four SGs were bonded onto the surface of the block tangentially to the implants, SG 1 mesially to implant 1, SG 2 and SG 3 mesially and distally to implant 2, respectively, and SG 4 distally to implant 3. The superstructure’s occlusal screws were tightened onto microunit abutments with 10 Ncm torque using a manual torque driver. The magnitude of microstrain on each SG was recorded in units of microstrain (µε). The data were analyzed statistically by ANOVA and Tukey’s test (p<0.05).
Microstrain values of each group were: G1= 338.1±223.0 µε; G2= 363.9±190.9 µε; G3= 415.1±53.5 µε; G4= 363.9±190.9 µε. No statistically significant difference was found between EH and IH, regardless of the type of copings (p>0.05). The hypotheses were partially accepted.
It was concluded that the type of hexagonal connection and coping presented similar mechanical behavior under tightening conditions.
Url:
DOI: 10.1590/S1678-77572010000300005
PubMed: 20856998
PubMed Central: 5349059
Links to Exploration step
PMC:5349059Le document en format XML
<record><TEI><teiHeader><fileDesc><titleStmt><title xml:lang="en">Machined and plastic copings in three-element prostheses with different
types of implantabutment joints: a strain gauge comparative analysis</title><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="aff01"> DDS, MSc, PhD, Professor, 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, 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="aff02"> Eng, MSc, Professor of Department of Mechanical Engineering-CETEC, São José dos Campos, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Abreu, Celina Wanderley" sort="Abreu, Celina Wanderley" uniqKey="Abreu C" first="Celina Wanderley" last="Abreu">Celina Wanderley Abreu</name><affiliation><nlm:aff id="aff03"> DDS, MSc, Graduate student, 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, 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="aff03"> DDS, MSc, Graduate student, 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="Balducci, Ivan" sort="Balducci, Ivan" uniqKey="Balducci I" first="Ivan" last="Balducci">Ivan Balducci</name><affiliation><nlm:aff id="aff04"> Eng, MSc, Professor of Department of Community Dentistry and Pediatric Clinic, São José dos Campos Dental School, São Paulo State University, São José dos Campos, SP, Brazil.</nlm:aff></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">PMC</idno><idno type="pmid">20856998</idno><idno type="pmc">5349059</idno><idno type="url">http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349059</idno><idno type="RBID">PMC:5349059</idno><idno type="doi">10.1590/S1678-77572010000300005</idno><date when="2010">2010</date><idno type="wicri:Area/Pmc/Corpus">003017</idno><idno type="wicri:explorRef" wicri:stream="Pmc" wicri:step="Corpus" wicri:corpus="PMC">003017</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a" type="main">Machined and plastic copings in three-element prostheses with different
types of implantabutment joints: a strain gauge comparative analysis</title><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="aff01"> DDS, MSc, PhD, Professor, 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, 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="aff02"> Eng, MSc, Professor of Department of Mechanical Engineering-CETEC, São José dos Campos, Brazil.</nlm:aff></affiliation></author><author><name sortKey="Abreu, Celina Wanderley" sort="Abreu, Celina Wanderley" uniqKey="Abreu C" first="Celina Wanderley" last="Abreu">Celina Wanderley Abreu</name><affiliation><nlm:aff id="aff03"> DDS, MSc, Graduate student, 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, 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="aff03"> DDS, MSc, Graduate student, 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="Balducci, Ivan" sort="Balducci, Ivan" uniqKey="Balducci I" first="Ivan" last="Balducci">Ivan Balducci</name><affiliation><nlm:aff id="aff04"> Eng, MSc, Professor of Department of Community Dentistry and Pediatric Clinic, São José dos Campos Dental School, São Paulo State University, 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="2010">2010</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><sec><title>Objective</title><p>Using strain gauge (SG) analysis, the aim of this <italic>in vitro</italic> study
was quantify the strain development during the fixation of three-unit screw
implant-supported fixed partial dentures, varying the types of implant-abutment
joints and the type of prosthetic coping. The hypotheses were that the type of
hexagonal connection would generate different microstrains and the type of copings
would produce similar microstrains after prosthetic screws had been tightened onto
microunit abutments.</p></sec><sec><title>Materials and methods</title><p>Three dental implants with external (EH) and internal (IH) hexagonal
configurations were inserted into two polyurethane blocks. Microunit abutments
were screwed onto their respective implant groups, applying a torque of 20 Ncm.
Machined Co-Cr copings (M) and plastic prosthetic copings (P) were screwed onto
the abutments, which received standard wax patterns. The wax patterns were cast in
Co-Cr alloy (n=5), forming four groups: G1) EH/M; G2) EH/P; G3) IH/M and G4) IH/P.
Four SGs were bonded onto the surface of the block tangentially to the implants,
SG 1 mesially to implant 1, SG 2 and SG 3 mesially and distally to implant 2,
respectively, and SG 4 distally to implant 3. The superstructure’s occlusal screws
were tightened onto microunit abutments with 10 Ncm torque using a manual torque
driver. The magnitude of microstrain on each SG was recorded in units of
microstrain (µε). The data were analyzed statistically by ANOVA and Tukey’s
test (p<0.05).</p></sec><sec><title>Results</title><p>Microstrain values of each group were: G1= 338.1±223.0 µε; G2=
363.9±190.9 µε; G3= 415.1±53.5 µε; G4=
363.9±190.9 µε. No statistically significant difference was found
between EH and IH, regardless of the type of copings (p>0.05). The hypotheses
were partially accepted.</p></sec><sec><title>Conclusions</title><p>It was concluded that the type of hexagonal connection and coping presented
similar mechanical behavior under tightening conditions.</p></sec></div></front><back><div1 type="bibliography"><listBibl><biblStruct><analytic><author><name sortKey="Assif, D" uniqKey="Assif D">D Assif</name></author><author><name sortKey="Marshak, B" uniqKey="Marshak B">B Marshak</name></author><author><name sortKey="Schmidt, A" uniqKey="Schmidt A">A Schmidt</name></author></analytic></biblStruct><biblStruct><analytic><author><name sortKey="Byrne, D" uniqKey="Byrne D">D Byrne</name></author><author><name sortKey="Houston, F" uniqKey="Houston F">F Houston</name></author><author><name sortKey="Cleary, R" uniqKey="Cleary R">R Cleary</name></author><author><name sortKey="Claffey, N" uniqKey="Claffey N">N Claffey</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 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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-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">20856998</article-id><article-id pub-id-type="pmc">5349059</article-id><article-id pub-id-type="doi">10.1590/S1678-77572010000300005</article-id><article-categories><subj-group subj-group-type="heading"><subject>Original Articles</subject></subj-group></article-categories><title-group><article-title>Machined and plastic copings in three-element prostheses with different
types of implantabutment joints: a strain gauge comparative analysis</article-title></title-group><contrib-group><contrib contrib-type="author"><name><surname>NISHIOKA</surname><given-names>Renato Sussumu</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>Lea Nogueira Braulino de Melo</given-names></name><xref ref-type="aff" rid="aff02">2</xref></contrib><contrib contrib-type="author"><name><surname>ABREU</surname><given-names>Celina Wanderley</given-names></name><xref ref-type="aff" rid="aff03">3</xref></contrib><contrib contrib-type="author"><name><surname>de VASCONCELLOS</surname><given-names>Luis Gustavo Oliveira</given-names></name><xref ref-type="aff" rid="aff03">3</xref></contrib><contrib contrib-type="author"><name><surname>BALDUCCI</surname><given-names>Ivan</given-names></name><xref ref-type="aff" rid="aff04">4</xref></contrib></contrib-group><aff id="aff01"><label>1</label> DDS, MSc, PhD, Professor, 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> Eng, MSc, Professor of Department of Mechanical Engineering-CETEC, São José dos Campos, Brazil.</aff><aff id="aff03"><label>3</label> DDS, MSc, Graduate student, 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="aff04"><label>4</label> Eng, MSc, Professor of Department of Community Dentistry and Pediatric Clinic, São José dos Campos Dental School, São Paulo State University, São José dos Campos, SP, Brazil.</aff><author-notes><corresp id="c01"><bold>Corresponding address:</bold> Prof. Adj. Renato S. Nishioka -
Departamento de Materiais Odontológicos e Prótese - Faculdade de
Odontologia de São José dos Campos, UNESP - Av. Francisco José
Longo, 777 - 12245-000 - São José dos Campos, SP - Brasil - Phone:
+55-12-39479056 - Fax: +55-12-39479010 - email:
<email>nishioka@fosjc.unesp.br</email></corresp></author-notes><pub-date pub-type="epub-ppub"><season>May-Jun</season><year>2010</year></pub-date><pmc-comment>Fake ppub date generated by PMC from publisher
pub-date/@pub-type='epub-ppub' </pmc-comment>
<pub-date pub-type="ppub"><season>May-Jun</season><year>2010</year></pub-date><volume>18</volume><issue>3</issue><fpage>225</fpage><lpage>230</lpage><history><date date-type="received"><day>23</day><month>9</month><year>2008</year></date><date date-type="rev-recd"><day>16</day><month>2</month><year>2010</year></date><date date-type="accepted"><day>02</day><month>3</month><year>2010</year></date></history><permissions><license license-type="open-access" xlink:href="http://creativecommons.org/licenses/by/4.0/"><license-p>This is an Open Access article distributed under the terms of 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><sec><title>Objective</title><p>Using strain gauge (SG) analysis, the aim of this <italic>in vitro</italic> study
was quantify the strain development during the fixation of three-unit screw
implant-supported fixed partial dentures, varying the types of implant-abutment
joints and the type of prosthetic coping. The hypotheses were that the type of
hexagonal connection would generate different microstrains and the type of copings
would produce similar microstrains after prosthetic screws had been tightened onto
microunit abutments.</p></sec><sec><title>Materials and methods</title><p>Three dental implants with external (EH) and internal (IH) hexagonal
configurations were inserted into two polyurethane blocks. Microunit abutments
were screwed onto their respective implant groups, applying a torque of 20 Ncm.
Machined Co-Cr copings (M) and plastic prosthetic copings (P) were screwed onto
the abutments, which received standard wax patterns. The wax patterns were cast in
Co-Cr alloy (n=5), forming four groups: G1) EH/M; G2) EH/P; G3) IH/M and G4) IH/P.
Four SGs were bonded onto the surface of the block tangentially to the implants,
SG 1 mesially to implant 1, SG 2 and SG 3 mesially and distally to implant 2,
respectively, and SG 4 distally to implant 3. The superstructure’s occlusal screws
were tightened onto microunit abutments with 10 Ncm torque using a manual torque
driver. The magnitude of microstrain on each SG was recorded in units of
microstrain (µε). The data were analyzed statistically by ANOVA and Tukey’s
test (p<0.05).</p></sec><sec><title>Results</title><p>Microstrain values of each group were: G1= 338.1±223.0 µε; G2=
363.9±190.9 µε; G3= 415.1±53.5 µε; G4=
363.9±190.9 µε. No statistically significant difference was found
between EH and IH, regardless of the type of copings (p>0.05). The hypotheses
were partially accepted.</p></sec><sec><title>Conclusions</title><p>It was concluded that the type of hexagonal connection and coping presented
similar mechanical behavior under tightening conditions.</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 sec-type="intro"><title>INTRODUCTION</title><p>Osseointegrated dental implants have been a well-accepted and predictable treatment
modality for rehabilitation of partially and completely edentulous patients. An
implant-supported prosthesis may be under the influence of external (functional or
parafunctional) and/or internal (preload) forces. The magnitude of this forces affects
the amount of induced strains and stresses in all components of bone-implant-prosthesis
complex<sup><xref rid="r06" ref-type="bibr">6</xref>,<xref rid="r08" ref-type="bibr">8</xref>-<xref rid="r10" ref-type="bibr">10</xref>,<xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r19" ref-type="bibr">19</xref>,<xref rid="r22" ref-type="bibr">22</xref>,<xref rid="r23" ref-type="bibr">23</xref>,<xref rid="r25" ref-type="bibr">25</xref>,<xref rid="r26" ref-type="bibr">26</xref></sup>.</p><p>On tightening, the abutment screw exerts a compressive force to maintain the contact
between the abutment and the implant surface. Due to the characteristics inherent to
superstructure castings, component fit is not perfect but clinically acceptable. Torque
of the prosthesis-abutment set induces stresses which are transmitted to the supporting
bone.</p><p>Strain is defined as the ratio between the length of an object under stress and its
original dimension; it is a dimensionless entity. Strain gauge (SG) is considered an
indirect measurement that analyzes a physical effect, mechanical deformation, based on
electrical measurements taken with a device called transducer. In short, it can be
stated that deformations are normally imperceptible to the naked eye, so it is necessary
a SG to measure them. SG is an electric sensor that quantifies a superficial
deformation. Its working principle is based on the variation of the electrical
resistance transformed into deformation levels.</p><p>The aim of this <italic>in vitro</italic> study was quantify the strain development
during the fixation of three-unit screw implant-supported fixed partial dentures (FPDs),
using SG analysis. The influence of types of implant-abutment joints (external and
internal hexagon) and type of prosthetic coping (machined and plastic) was
investigated.</p><p>The hypotheses were that type of hexagonal connection would generate different
microstrains and type of copings would produce similar microstrains after prosthetic
screws were tightened onto microunit abutments.</p></sec><sec sec-type="materials|methods"><title>MATERIALS AND METHODS</title><sec><title>Preparation of the test specimens</title><p>To simulate clinical conditions in a real-life arrangement, three external hexagon
(3.75 mm diameter, 13 mm length; Master screw, Conexão Sistemas de
Prótese, Arujá, SP, Brazil) and three internal hexagon type implants
from mesial to distal: labeled A, B, and C (3.75 mm diameter, 13-mm depth; Conect AR;
Conexão Sistemas de Prótese,) were arranged in the middle of two
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).</p><p>A set of aluminum index consisting of three components was used to standardize in a
straight line the implant placement into the polyurethane blocks and also to
standardize the wax-up of superstructures (<xref ref-type="fig" rid="f01">Figure
1</xref>). The implants were placed in the polyurethane block excluding strict
asepsis.</p><fig id="f01" orientation="portrait" position="float"><label>Figure 1</label><caption><p>Aluminum matrix used to standardize in a straight line the implant placement in
the polyurethane blocks and also to standardize the wax up of the
superstructures. This matrix has lateral screws to keep the three components
stable. A- component 1 (base); B- component 2; Ccomponent 3</p></caption><graphic xlink:href="jaos-18-03-0225-g01"></graphic></fig><p>Component 3 (the upper one), which determined the standardization of the distance and
locations for implant placement, was fixed onto the polyurethane block with
horizontal screws. Color-coded rings were screwed alternately into the three holes in
component 3. The rings had progressively larger internal diameters compatible with
standard twist drill used for implant placement (Drill guides; Conexão
Sistemas de Prótese). The white ring was locations for implant placement
compatible with the 2 mm, the yellow one with the 3 mm, and the blue one with the
3.15 mm twist drills. A handpiece with 16:1 reduction (16:1 handpiece; Kavo do
Brasil, Joinville, SC, Brazil) was used to make the holes and insert the implants
(<xref ref-type="fig" rid="f02">Figure 2</xref>).</p><fig id="f02" orientation="portrait" position="float"><label>Figure 2</label><caption><p>Component 3 with color-coded rings fixed onto the polyurethane block with
horizontal screws to standardize locations for implant placement</p></caption><graphic xlink:href="jaos-18-03-0225-g02"></graphic></fig><p>Three external hexagon (eH) (Master Screw, Conexão Sistemas de Prótese)
and internal hexagon (IH) (Conect AR) implants measuring 3.75 mm in diameter and
13.00 mm in length were installed into the first and second polyurethane blocks,
respectively. Microunit abutment types (Micro unit; Conexão Sistemas de
Prótese) were screwed onto the implants to 20 Ncm torque using a manual torque
driver (Torque driver, Conexão Sistemas de Prótese).</p></sec><sec><title>Fabrication of metallic superstructures</title><p>All wax-up procedures (Kronen Wachs; Bego Bremer Goldschalgerei, Bremen, Germany) was
standardized using component 1 (base) and component 2, which resulted in a
rectangular compartment that allowed for the systematic reproduction of the wax-up of
all the test specimens, especially in terms of thickness.</p><p>Each specific polyurethane block also served as the base for the abutment and wax-up
procedures. Both plastic copings with metallic pre-machined Co-Cr collars (machined
copings) and plastic copings were initially positioned directly on the abutment and
the wax-up was adapted under slight pressure (<xref ref-type="fig" rid="f03">Figure
3a</xref> and <xref ref-type="fig" rid="f03">b</xref>).</p><fig id="f03" orientation="portrait" position="float"><label>Figure 3a and 3b</label><caption><p>Component 1 and component 2 used for reproduction of the wax-up and wax
patterns under polyurethane block</p></caption><graphic xlink:href="jaos-18-03-0225-g03"></graphic></fig><p>The wax patterns with dimensions of 35x16x2 mm<sup>3</sup> were sprued, invested and
one-piece cast in a induction oven with cobalt-chromium alloy<sup><xref rid="r05" ref-type="bibr">5</xref></sup> (Wirobond SG, Bego Bremer
Goldschalgerei). To avoid bias resulting from manufacturing conditions, random sets
comprising superstructures of different types were put together and cast. After
removal from the investment material, the sprues were eliminated with the aid of
carbide discs at low speed. The castings were airborne particle abraded with 110-μm
particle aluminum oxide (Korox, Bego Bremer Goldschalgerei), under 60 psi pressure,
care was taken not to damage the surface of coping and inspected under a binocular
microscope for casting imperfections in the interior of each coping. The castings
were then ultrasonically cleaned in isopropyl alcohol (Vitasonic II, Vita
Zahnfabrick, Bad Säckingen, Germany) for 10 min and dried at room
temperature.</p><p>The superstructures were fit individually to their respective abutments and
polyurethane blocks: stability of the set was checked without torque tightening.
Superstructures showing signs of instability were excluded (<xref ref-type="fig" rid="f04">Figure 4</xref>).</p><fig id="f04" orientation="portrait" position="float"><label>Figure 4</label><caption><p>Fit and passivity of the superstructures</p></caption><graphic xlink:href="jaos-18-03-0225-g04"></graphic></fig><p>Each metallic structure was numbered and labeled according to its corresponding
group. The whole sample was constituted of 20 superstructures distributed randomly
and equally among the eH and IH groups. These were differentiated by casting of
machined (M) and plastic (P) copings.</p></sec><sec><title>SG analysis</title><p>For the exact determination of the sites for bonding the four SGs
(KFG-02-120-c1-11N30C2, Kyowa electronic Instruments Co., Ltd, Tokyo, Japan), a line
was drawn with a rule and a 0.7 mm pencil lead. The four SGs were centered along this
line tangential to abutment. A thin film of methyl-2-cyanoacrylate resin (M-Bond 200;
Vishay Measurements Group, Raleigh, NC, USA) was used to fix each SG, which was
carefully positioned and held in place under slight pressure for three minutes. each
gauge was wired separately and the four SGs were connected to a multichannel bridge
amplifier to form one leg of the bridge.</p><p>All SGs were set to zero and then the superstructure was placed on the abutments. The
superstructure’s occlusal screws were tightened onto the Microunit abutments using a
hand-operated screwdriver, until the screws started to engage based on tactile
sensation and with a torque of 10 Ncm using the manufacture’s manual
torque-controlling device. each of the superstructures was screw tightened according
the torque sequences with abutments: I) first screw: implant B (center), second:
implant A and third screw: implant C and the sequence. The strains occurring were
measured for the same duration (5 min). The screws were removed and the procedure was
repeated other four times. A new set occlusal screw was used for each superstructure.
The same investigator tightened all screws (<xref ref-type="fig" rid="f05">Figure
5a</xref> and <xref ref-type="fig" rid="f05">b</xref>).</p><fig id="f05" orientation="portrait" position="float"><label>Figure 5</label><caption><p>Strain gauges locations and the tightening sequence: first screw: implant B;
second screw: implant A and third screw: implant C</p></caption><graphic xlink:href="jaos-18-03-0225-g05"></graphic></fig><p>The signals were interpreted, modified and processed using a computer program (Strain
smart, Vishay Measurements Group). The data acquisition hardware (System 5000 Model
5100B; Vishay Measurements Group), which is an integrated system comprising an
analog-digital converter, was used to condition the signals and the converter control
and the connection to the computer.</p><p>The electrical variations were transformed arithmetically into microstrain units (με)
by the data acquisition software installed in a microcomputer.</p></sec><sec><title>Statistical analysis</title><p>The absolute values of strains were compared by two-way ANOVA followed by a post-hoc
Tukey’s HSD test at 95 % confidence level (α=0.05). The absolute values of
the four SGs were compared for this study, as the SGs are only capable of detecting
stresses in a limited segment around the implants and do not clear statements as to
whether compressive or tensile forces are present in a polyurethane area of a given
magnitude.</p></sec></sec><sec sec-type="results"><title>RESULTS</title><p><xref ref-type="fig" rid="f06">Figure 6</xref> shows the microdeformation values (με)
obtained after analysis of the mean microstrain values obtained by the four SGs
positioned around the implant, for two types of prosthetic connection (EH and IH), as
well as the type of coping (plastic and machined).</p><fig id="f06" orientation="portrait" position="float"><label>Figure 6</label><caption><p>Dot plot for microdeformation (με) values obtained under the different
experimental conditions</p></caption><graphic xlink:href="jaos-18-03-0225-g06"></graphic></fig><p>To evaluate the influence of tightening in relation to the type of prosthetic connection
on the type of coping, in terms of microstrains, the data were subjected to two-way
ANOVA after considering the distribution of the residuals. No statistically significant
difference (p>0.05) was found between eH and IH, regardless of the type of copings.
The hypotheses were partially accepted.</p></sec><sec sec-type="discussion"><title>DISCUSSION</title><p>To ensure the success of a surgical intervention, a factor that must be taken into
account is the transfer of stresses and strains occurs around bone<sup><xref rid="r03" ref-type="bibr">3</xref>,<xref rid="r08" ref-type="bibr">8</xref>,<xref rid="r09" ref-type="bibr">9</xref>,<xref rid="r10" ref-type="bibr">10</xref>,<xref rid="r25" ref-type="bibr">25</xref>,<xref rid="r26" ref-type="bibr">26</xref></sup>. The reason for studying strains around implants is an attempt to
define levels of safety, since there are studies reporting that an excessive load at the
interface between the implant and the bone may be one of the causes of marginal bone
loss<sup><xref rid="r15" ref-type="bibr">15</xref></sup>. The precise mechanism is
not yet fully understood. Undoubtedly, there is a remodeling response around the bone
under a given stress, or even in situations with absence of activity<sup><xref rid="r11" ref-type="bibr">11</xref>,<xref rid="r27" ref-type="bibr">27</xref></sup>. The use of SG, a well-suited design tool for analysis of the
complex strain’s field around fixtures, is becoming more widespread<sup><xref rid="r04" ref-type="bibr">4</xref>,<xref rid="r06" ref-type="bibr">6</xref>,<xref rid="r15" ref-type="bibr">15</xref>,<xref rid="r21" ref-type="bibr">21</xref>,<xref rid="r23" ref-type="bibr">23</xref></sup>.</p><p>The present study used the SG analysis to quantify the strain development during the
fixation of three-unit screw implant-supported FPDs, varying the types of
implant-abutment joints (external and internal hexagon) and the type of prosthetic
coping (plastic and machined).</p><p>The popularization of the use of plastic copings (without metallic collar) is directly
attributable to a national trend for reducing costs. In the present study, the mean
microstrain values recorded for eH and IH systems were similar, regardless of the type
of coping used. This independence in the use of copings is consistent with the results
reported by Karl, et al.<sup><xref rid="r20" ref-type="bibr">20</xref></sup> (2005), who
performed a study using the same number of fixations, although their prosthesis was
built with five elements. Heckmann, et al.<sup><xref rid="r13" ref-type="bibr">13</xref></sup> (2004) found no difference between these two types of copings.
Previous SG studies have reported similar results<sup><xref rid="r13" ref-type="bibr">13</xref>,<xref rid="r14" ref-type="bibr">14</xref>,<xref rid="r20" ref-type="bibr">20</xref></sup> , with fixed partial prostheses screwed onto implants,
made from plastic or machined copings, producing the same magnitude of microdeformation
during tightening of the retention screws, without any statistically significant
difference between plastic and prefabricated copings before<sup><xref rid="r13" ref-type="bibr">13</xref>,<xref rid="r14" ref-type="bibr">14</xref></sup> and
after<sup><xref rid="r20" ref-type="bibr">20</xref></sup> the application of a
dental ceramic. Moreover, it should be noted that the care involved in handling
multiple-element prostheses is very different from that involved in handling
single-element ones, and the complexity of the laboratory procedures increases
proportionally to the number of fixations involved. This may explain the results for
single-element prosthesis reported by Carr, et al.<sup><xref rid="r03" ref-type="bibr">3</xref></sup> (1991) and Byrne, et al.<sup><xref rid="r02" ref-type="bibr">2</xref></sup> (1998), which evaluated gold machined copings.</p><p>The implant-abutment joint designs should have such junctions that reduce the peak bone
interface stresses and strains<sup><xref rid="r07" ref-type="bibr">7</xref></sup>. In
designs such as EH and IH, a compressive force is generated during the abutment screw
tightening, which maintains the contact between the fixture-bearing surface and the
bearing surface of the abutment. In EH, the abutment screw is the only element that
keeps the fixture and the abutment assembled. Otherwise, in the IH, friction plays a
crucial role in the maintenance of screw-joint in addition to the torque applied during
abutment tightening. These fundamental differences in design affect the mechanical
behaviors of implants<sup><xref rid="r07" ref-type="bibr">7</xref>,<xref rid="r24" ref-type="bibr">24</xref></sup>. From a prosthetic point of view, it would be important
to assess bone deformation, more specifically bone strains near the
bone/abutment/implant. In the present study, each specimen was screwed to the abutment
using a same torque sequence. The values obtained with EH and IH showed no statistically
significant differences. This finding suggests that the type of implant-abutment joint
does not affect the magnitude of microdeformation in the fixation of three-unit screw
implant-supported FPDs.</p><p>The one-piece casting method was chosen in order to eliminate several variables that
would otherwise influence the analysis of the results, such as the material and transfer
impression techniques<sup><xref rid="r01" ref-type="bibr">1</xref>,<xref rid="r12" ref-type="bibr">12</xref></sup> , positioning of the analog to obtain a functional model
and the welding techniques (standard or laser welding). The fabrication of one-piece
casting method avoids the high risks of distortion when compared to structures that have
to be cut and then welded. Welding may not improve the adaptation of three-element
prostheses<sup><xref rid="r28" ref-type="bibr">28</xref></sup>.</p><p>However, one concern here is the misfit between the abutment and the prosthesis. The
accuracy of metallic superstructures that adapt to the abutment has received undue
attention and a rather unmerited concern, probably because it has always been dictated
by the adaptation of conventional prostheses, and has been transferred incorrectly to
implant-supported prostheses.</p><p>The cast structures showed satisfactory adaptation, which was confirmed by direct
visualization together with tactile sensation using an explorer<sup><xref rid="r18" ref-type="bibr">18</xref></sup>. Çehreli, et al.<sup><xref rid="r06" ref-type="bibr">6</xref></sup> (2004) reported a similar behavior in
their evaluation. In the present study, it was not concerned with the occurrence of a
gap, but with the seating of the test specimens on the abutment. Jemt and Book<sup><xref rid="r16" ref-type="bibr">16</xref></sup> (1996) reported the extreme difficulty
of visually checking for discrepancies of around 30 µm with the naked eye.
Conventional laboratory procedures with the most diverse possibilities for the use of
screwed or cemented copings are unable to produce metallic structures with passive
adaptation<sup><xref rid="r19" ref-type="bibr">19</xref></sup>. Independently of
the variables studied here, there was no occurrence of passivity during the tightening
of the structures. This corroborates the studies of Assif, et al.<sup><xref rid="r01" ref-type="bibr">1</xref></sup> (1996), who did not find a metallic
structure with a design that could provide a passive adaptation, and is also consistent
with the results of Jemt and Lie<sup><xref rid="r17" ref-type="bibr">17</xref></sup>(1995), who reported the impossibility of connecting a multiple-element prosthesis on
implants with a completely passive adaptation in a clinical situation.</p></sec><sec sec-type="conclusions"><title>CONCLUSIONS</title><p>The SGs indicated that machined and plastic copings did not determine significant
microstrains on three-element implant-supported prostheses. The external hexagon
configuration showed similar values as those of the internal hexagon connection
design.</p></sec></body><back><ack><title>ACKNOWLEDGEMENTS</title><p>The authors wish to thank FAPESP (The State of São Paulo Research Foundation,
process #07/53293-4) for supporting this study, and Conexão Sistemas de
Prótese for providing some equipment and materials. They also express their
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