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 Table of Contents  
REVIEW ARTICLE
Year : 2018  |  Volume : 10  |  Issue : 3  |  Page : 180-183

Comparison of biomechanical properties of different implant-abutment connections


Department of Prosthodontics, Dayananda Sagar College of Dental Sciences and Hospital, Bengaluru, Karnataka, India

Date of Web Publication12-Sep-2018

Correspondence Address:
Dr Joel Koshy Joseph
Department of Prosthodontics, Dayananda Sagar College of Dental Sciences and Hospital, Kumaraswamy Layout, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJDS.IJDS_28_18

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  Abstract 


Implant abutment connection has proven to have a significant impact on the success of the prosthetic rehabilitation for an implant-supported restoration. This connection not only provides the base on which the restoration is supported but also maintains the integrity of the hard and the soft tissues surrounding the implant. In this review, we describe the performances of different implant-abutment connections that are the external implant connections, internal implant connections, and the Morse taper connections in terms of their mechanical properties, biological properties, and its biomechanical effects.

Keywords: Abutment connection, implant, Morse taper, systematic review


How to cite this article:
Devaraju K, Rao SJ, Joseph JK, Kurapati SK. Comparison of biomechanical properties of different implant-abutment connections. Indian J Dent Sci 2018;10:180-3

How to cite this URL:
Devaraju K, Rao SJ, Joseph JK, Kurapati SK. Comparison of biomechanical properties of different implant-abutment connections. Indian J Dent Sci [serial online] 2018 [cited 2018 Dec 9];10:180-3. Available from: http://www.ijds.in/text.asp?2018/10/3/180/241053




  Introduction Top


In the late 1970s, we saw the advent of modern implantology with the accidental discovery of osseointegration of titanium within the bone by Professor Per-Ingvar Branemark. Since then, prosthodontic rehabilitation with osseointegrated implant turned out to be the therapeutic solution of choice for treating partially or completely edentulous arches. However, for a long time, “osseointegration” was the only criteria taken into account for the evaluation of implant success. This has changed with time and technology. Now, esthetics and functional results also serve as important criteria to be fulfilled for a successful implant treatment.[1]

Even with a successful placement of implant, if it fails to serve the very purpose of esthetics, the treatment is a failure. Similarly, an osseointegrated implant if not able to withstand occlusal forces and maintain its stability and rigidity, the treatment is again considered to be a failure.[2]

Under these circumstances, the implant abutment connection plays the crucial role to maintain the biomechanical criteria. The strength of the implant connections determines whether it can withstand the occlusal loads, whereas the rigidity of the implant connections aims to minimize the micromovements. Implant abutment connections could be external or internal depending on the distinct projection; external or recessed into the implant body.[3]

Branemark's original implant-abutment connection was an external hexagon [Figure 1], which later on underwent manymodifications to counter the demerits of the former, for example, tapered hexagon, external octagon, and spline [4] dental implant.[5]
Figure 1: External hex implants and internal hex implants

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Internal implant-abutment connections were introduced to overcome the clinical complications associated with external connections. They are further subdivided depending on the type of joint which is passive fit or frictional fit. These connections also underwent several modifications which gave them specific clinical advantages such as, 12-point internal hex connections, internal tripod connections, and internal octagon.[3]

In 1864, Stephen A. Morse an enterprising mechanic invented the Morse taper connection which was used to connect two rotating machine components in drilling machines. This connection was later used by the orthopedic industry under the generic name of “Morse tapers” as means of reliably joining modular components of total joints directly for hip arthroplasty.[6]

The principle of Morse taper is that, of the cone in the cone [Figure 2], where the trunnion (the male portion) and the bore (the female portion) both are uniformly tapered. The bone is tapped into the trunnion as they come in intimate contact; thus, the stresses inside the materials keep both components fixed together.[6]
Figure 2: Morse taper implants

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In the recent decade, the biomechanics of this connection favored the requirements of implant abutment connections not only in the physical terms but also at microscopic levels, as they were able to counter the demerits of traditionally used abutment connections.[7]


  Mechanical Strength Top


Generally, internal connections initially showed increased fragility compared to the external connections, especially for the small diameters. This fragility is due to the recess in the body of the implant destined to provide space for the implant abutment.[8]

This thinned the walls of the implant and decreased its strength. However, in vitro studies suggest that internal connections showed greater resistance than external connections under heavy torque stresses.[9]

Chun et al., 2006, demonstrated that internal hexagon connections distributed stress better within the implant and further redistributed within bone. This was possible due to larger implant abutment contact area. In external hexagon connection, highest strain concentration was found between the implant platform and the abutment which indirectly led to compromised biological width.[10]


  Stress/load Performance Top


Implant abutment designs show different degrees of peri-implant crestal bone remodeling after subjected to functional loading.[11]

In a histological and histomorphological evaluation of marginal bone resorption around implants in dogs, Resende et al. demonstrated the smaller amount of bone loss for Morse taper implants, both on the buccal and lingual sides, whereas external hex implants showed a larger bone loss.[12]

Quaresma et al. in 2008 showed that the stress is better distributed at the alveolar bone but more concentrated at the abutment itself in Morse taper implant. Whereas internal hex abutments produce greater stresses on the alveolar bone and the prosthesis but lower stresses on the abutment system.[13]


  Load Fatigue Performance/resistance Top


Failure of the abutments was system dependent and occurred primarily in the region of the weakest point, the screws, respectively, the threaded parts, or between the threaded or unthreaded parts of the abutment. Khraisat et al. reported a significant difference between the Morse taper and external hexagonal connection systems; in that no fractures were noted for the Morse taper group, while the mean fractures' rate for the external hexagonal groups was between 1733 and 1778 cycles.[14]


  Bending Moment/Maximal Load Resistance Top


Higher maximal load resistance values were seen for the internal conical implant abutment as compared to the internal hexagonal connections with a two-piece abutment. Fractures only occurred in the internal hexagonal group at the weakest point; the threaded part of the screw. Internal conical implant-abutment connections' systems showed higher resistance to bending forces than other internal connections.[15]


  Microgap Top


Microgap within external and internal implant-abutment connections was always evident. In addition, the micro-movements act like a pumping effect, which draws in intraoral fluids within the spaces making them a harbor site for the bacterial growth. Numerous studies demonstrated the presence of bacterial growth within these spaces which directly affect the continuity of the biological width and may lead to marginal bone loss and peri-implantitis.[16]

Within Morse taper abutment connection, a cold-welded interface is seen between the implant and the abutment, which considerably reduced the presence of any microgaps and micromovements between the fixtures.[17]

A comparative study conducted by Jaworski et al., 2012, demonstrated significant lower bacterial penetration within Morse taper (30% of cases) against external connections (60%).[18]

When compared between Morse tapers and internal connections, Tripodi et al. in 2012 demonstrated that 2 out of the 10 Morse taper implants were contaminated against 5 of the internal hexagon connection implants.[19]


  Platform Switching Top


The concept of platform switching was introduced by Lazzara and Porter based on the hypothesis that a narrower abutment can increase the distance between the implant-abutment microgap contamination and the crestal bone and may allow the establishment of an adequately dimensioned biological width, thus reducing bone resorption [Figure 3].[20]
Figure 3: Illustration of bone morphology in Morse taper implant with platform switching

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Siffert and Etienne et al. in 2011 stated in a review that platform-switched implants showed biological and biomechanical consequences which led to decreased bone resorption.[21] Biologically, they observed horizontal repositioning of the biologic width toward the implant abutment junction which repositioned the inflammatory infiltrates and created a mucosal joint. Under biomechanical consequence, they observed that forces were concentrated more toward the center of the implant which was further redistributed harmoniously into the bone. Thus, the tissues at the junction-abutment are in less stress.[22]

Since internal connections are often associated to platform switching which gives them an added benefit against external connections. Zipprich et al. in 2007 showed that the Morse taper connections did not show microgap opening during micromovements in relation to other internal connections (without platform switching).[23]


  Biological Width Top


The periodontal tissue around an implant ought to acts as a barrier against the oral environment, which prevents the bacterial infiltrates contaminating the implant surfaces [Figure 4].
Figure 4: Peri-implant biological width

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Tomasi et al. in 2013 conducted an experimental study on humans for morphogenesis of peri-implant mucosa. It was seen among 21 patients receiving implant-supported single tooth that the presence of connective tissue and epithelial attachment on to the implant surface about 8 weeks.[24]

Although obtaining biological width depends on many other factors such as the presence of parafunctional habits such as bruxism, gingival biotype, and position of the implant, but the type of implant abutment connection also plays a crucial role. The presence of microgap, bacterial infiltrated, and existence of abutment micromovement all predisposes to bacterial contamination and hampers the biological width. If the biological width is invaded and is reduced to < 3 mm, there would be pocket formation or gingival recession depending on the gingival biotype and ultimately lead to implant failure.[25]

When compared with external abutment connections, internal connections show superior performance in terms of mechanical strength, stress distribution, microgap, and bacterial penetration; thus implants supported with internal abutment connections preserve biological width better than external connections.[26]

When compared between other internal abutment connections, Morse tapered connections distributed stress better at the alveolar bone level and better resistance to bacterial leakage. Morse taper connections with platform switching showed reduced inflammation and bone loss. Hence, Morse taper connection preserves the biological width better than other internal connections.[22]


  Conclusion Top


Within the limitations, this review concludes that, biomechanically, Morse taper connections showed better performance against external and internal connections, this was possible because of their geometry, as they were able to redistribute the forces and stresses evenly through the implant body, thereby ensuring reduced deleterious forces to the surrounding bone.[27]

In terms of mechanical and structural integrity, conical abutment connection systems are more resistant to micromovements and microgaps.[28]

They have better torque resistance and higher resistance to fatigue loading and maximum bending. No connections have absolute perfect bacterial seal; however, conical connection systems proved themselves to be better when compared with internal hex and external connections.[29]

Clinically, Morse taper connections produced lower stress over the surrounding bone resulting to reduced marginal bone loss and therefor the vital biological width.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Chiche FA, Leriche MA. Multidisciplinary implant dentistry for improved aesthetics and function. Pract Periodontics Aesthet Dent 1998;10:177-86.  Back to cited text no. 1
    
2.
Odo CH, Pimentel MJ, Consani RL, Mesquita MF, Nóbilo MA. Stress on external hexagon and Morse taper implants submitted to immediate loading. J Oral Biol Craniofac Res 2015;5:173-9.  Back to cited text no. 2
    
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Prithviraj DR. The evolution of external and internal implant-abutment connections: A review. Int Dent Res 2012;2920:37-42.  Back to cited text no. 3
    
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Binon PP. The spline implant: Design, engineering, and evaluation. Int J Prosthodont 1996;9:419-33.  Back to cited text no. 4
    
5.
Niznick G. The implant abutment connection: The key to prosthetic success. Compendium 1991;12:932, 934-8.  Back to cited text no. 5
    
6.
Hernigou P, Queinnec S, Flouzat Lachaniette CH. One hundred and fifty years of history of the Morse taper: From Stephen A. Morse in 1864 to complications related to modularity in hip arthroplasty. Int Orthop 2013;37:2081-8.  Back to cited text no. 6
    
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Annibali S, Bignozzi I, Cristalli MP, Graziani F, La Monaca G, Polimeni A, et al. Peri-implant marginal bone level: A systematic review and meta-analysis of studies comparing platform switching versus conventionally restored implants. J Clin Periodontol 2012;39:1097-113.  Back to cited text no. 7
    
8.
Steinebrunner L, Wolfart S, Ludwig K, Kern M. Implant-abutment interface design affects fatigue and fracture strength of implants. Clin Oral Implants Res 2008;19:1276-84.  Back to cited text no. 8
    
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Schmitt CM, Nogueira-Filho G, Tenenbaum HC, Lai JY, Brito C, Döring H, et al. Performance of conical abutment (Morse taper) connection implants: A systematic review. J Biomed Mater Res A 2014;102:552-74.  Back to cited text no. 9
    
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Chun HJ, Shin HS, Han CH, Lee SH. Influence of implant abutment type on stress distribution in bone under various loading conditions using finite element analysis. Int J Oral Maxillofac Implants 2006;21:195-202.  Back to cited text no. 10
    
11.
Toniollo MB, Macedo AP, Rodrigues RC, Ribeiro RF, Mattos Mda G. Three-dimensional finite element analysis of the stress distribution on Morse taper implants surface. J Prosthodont Res 2013;57:206-12.  Back to cited text no. 11
    
12.
Resende CC, Castro CG, Pereira LM, Prudente MS, Zancopé K, Davi LR, et al. Influence of the prosthetic index into Morse taper implants on bacterial microleakage. Implant Dent 2015;24:547-51.  Back to cited text no. 12
    
13.
Quaresma SET, Cury PR, Sendyk WR, Sendyk C. A finite element analysis of two different dental implants: stress distribution in the prosthesis, abutment, implant, and supporting bone. J Oral Implantol 2008;34:1-6.  Back to cited text no. 13
    
14.
Khraisat A, Stegaroiu R, Nomura S, Miyakawa O. Fatigue resistance of two implant/abutment joint designs. J Prosthet Dent 2002;88:604-10.  Back to cited text no. 14
    
15.
Coppedê AR, Bersani E, de Mattos Mda G, Rodrigues RC, Sartori IA, Ribeiro RF, et al. Fracture resistance of the implant-abutment connection in implants with internal hex and internal conical connections under oblique compressive loading: An in vitro study. Int J Prosthodont 2009;22:283-6.  Back to cited text no. 15
    
16.
Saidin S, Abdul Kadir MR, Sulaiman E, Abu Kasim NH. Effects of different implant-abutment connections on micromotion and stress distribution: Prediction of microgap formation. J Dent 2012;40:467-74.  Back to cited text no. 16
    
17.
Norton MR. Assessment of cold welding properties of the internal conical interface of two commercially available implant systems. J Prosthet Dent 1999;81:159-66.  Back to cited text no. 17
    
18.
Jaworski ME, Melo AC, Picheth CM. Analysis of the bacterial seal at the implant-abutment interface in external-hexagon and Morse taper connection implants: An in vitro study using a new methodology. Int J Maxillofac Implants 2012;27:1091-5.  Back to cited text no. 18
    
19.
Tripodi D, D'Ercole S, Iaculli F, Piattelli A, Perrotti V, Iezzi G. Degree of bacterial microleakage at the implant-abutment junction in Cone Morse tapered implants under loaded and unloaded conditions. Journal of Applied Biomaterials & Functional Materials 2015;13:e367-e71. doi: 10.5301/jabfm.5000247.  Back to cited text no. 19
    
20.
Cassetta M, Driver A, Brandetti G, Calasso S. Peri-implant bone loss around platform-switched Morse taper connection implants: A prospective 60-month follow-up study. Int J Oral Maxillofac Surg 2016;45:1577-85.  Back to cited text no. 20
    
21.
Siffert F, Etienne O. Le concept de plateform-switching : analyse de la littérature. Titane 2011;8:260-7.  Back to cited text no. 21
    
22.
Macedo JP, Pereira J, Vahey BR, Henriques B, Benfatti CA, Magini RS, et al. Morse taper dental implants and platform switching: The new paradigm in oral implantology. Eur J Dent 2016;10:148-54.  Back to cited text no. 22
[PUBMED]  [Full text]  
23.
Zipprich H, Miatke S, Hmaidouch R, Lauer HC. Micromovements at the implant-abutment interface: Measurement, causes, and consequences. Implantologie 2007;15:31-46.  Back to cited text no. 23
    
24.
Tomasi C, Tessarolo F, Caola I, Wennström J, Nollo G, Berglundh T, et al. Morphogenesis of peri-implant mucosa revisited: An experimental study in humans. Clin Oral Implants Res 2014;25:997-1003.  Back to cited text no. 24
    
25.
Cochran DL, Hermann JS, Schenk RK, Higginbottom FL, Buser D. Biologic width around titanium implants. A histometric analysis of the implanto-gingival junction around unloaded and loaded nonsubmerged implants in the canine mandible. J Periodontol 1997;68:186-98.  Back to cited text no. 25
    
26.
Brägger U, Aeschlimann S, Bürgin W, Hämmerle CH, Lang NP. Biological and technical complications and failures with fixed partial dentures (FPD) on implants and teeth after four to five years of function. Clin Oral Implants Res 2001;12:26-34.  Back to cited text no. 26
    
27.
de Medeiros RA, Pellizzer EP, Vechiato Filho AJ, Dos Santos DM, da Silva EV, Goiato MC, et al. Evaluation of marginal bone loss of dental implants with internal or external connections and its association with other variables: A systematic review. J Prosthet Dent 2016;116:501-6.e5.  Back to cited text no. 27
    
28.
Balik A, Karatas MO, Keskin H. Effects of different abutment connection designs on the stress distribution around five different implants: A 3-dimensional finite element analysis. J Oral Implantol 2012;38:491-6.  Back to cited text no. 28
    
29.
Raoofi S, Khademi M, Amid R, Kadkhodazadeh M, Movahhedi MR. Comparison of the effect of three abutment-implant connections on stress distribution at the internal surface of dental implants: A finite element analysis. J Dent Res Dent Clin Dent Prospects 2013;7:132-9.  Back to cited text no. 29
    


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Abstract
Introduction
Mechanical Strength
Stress/load Perf...
Load Fatigue Per...
Bending Moment/M...
Microgap
Platform Switching
Biological Width
Conclusion
References
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