METROLOGY OF THE IMPLANT ABUTMENT CONNECTION
Julián Espinel Ramos1, Martha Sarmiento Delgado2, Christoph Ratka3
1. Private Practice and Department of Oral Health, Faculty of Dentistry, Universidad Nacional de Colombia,
Bogotá, Colombia; [email protected]
2. Private Practice and Department of Oral Health, Faculty of Dentistry, Universidad Nacional de Colombia,
Bogotá, Colombia; [email protected]
3. Department of Prosthodontics, Goethe University, 60590 Frankfurt am Main, Germany; [email protected]
frankfurt.de
Abstract
Introduction
Two components implant systems are widely used due to the multiple restorative
and treatment options. The presence of an interface between the implant and the
abutment can lead to mechanical complications such as screw loosening and
implant and abutment fractures. This mechanical issues are determined by the
connection stability and the stability depends on many factors such as the
connection type, gap presence, and mating zone length. The aim of the present
study is to measure and compare six different implant connection systems in terms
of the length of the mating zone, the gap on the internal connections and the angle
difference on the tapered connections.
Material and Methods
Six implant systems (three conical and three internal hexagonal connections) with a
total of twelve implants and a sample size of 2 implants per system, were analyzed
by a 3D microcoordinate measurement microscope to measure implant and
abutment of each system in terms of the gap between the components and the
resulting rotational freedom at the index, the angle difference and the mating zone
length of the conical connections. the results were analyzed using one and two way
ANOVA and Bonferroni tests
Results
The internal hexagon connections showed a gap at the index that can develop a
rotational freedom when the abutment is torqued. the internal hexagon connections
showed a bigger angle difference and a shorter mating zone than the conical
connections
Conclusion
The conical connections have better coupling between the surfaces at the implant
abutment interface than the internal hexagon connections.
Implant treatment is one of the most predictable procedures in dentistry with high
rate of success, however, the amount of failure cases still a matter of concern. This
success is evaluated on the esthetic, biological and mechanical perspectives, all
related with the bone health. To preserve this tissue around the implant, is necessary
to observe two main aspects: the biological and mechanical aspects.
For the biological aspect, it has been reported that the factors as bacterial
colonization and the host response can affect osseointegration, on the other hand,
the mechanical view is focused on occlusal loads and the supporting bone[16]
Implant design plays a major role on the achievement of a primary stability and the
maintenance of the fixation after the bone remodeling. This design can be divided in
macro and micro design. Micro design includes implant material, surface morphology
and surface coating. For the macro design, Includes implant body, thread design,
implant collar and implant connection.[16]
Two components implant systems consist of an abutment and an implant body that
are connected by a fixation screw which is tightened with a specific torque
determined by the screw material and the connection type.
Implant-abutment connection leaves an interlocking gap which permits micro
movement as well as fluids and bacterial leakage, hence, those leakage products
and micro motion of the connection can facilitate wear and corrosion of the
contacting surfaces. In the case of a wore or corroded surface, can increase the gap
between the components leading to a bigger micro-movement under masticatory
forces, affecting the stability of the fixation.[4]
There are different types of connection design that include external or internal
connection with a several index designs (like hexagon, octagon or three lobed
shapes) and the Morse taper interface. The contact between the components
determines the behavior of the implant- abutment joint where the mechanical
integrity is preserved and avoid the bacterial colonization. This contact varies by the
manufacture tolerances and the material properties. The poor fit on the connection
can lead to a higher displacement and preload loss. The first connection design was
the external interface which was created with an anti-rotational feature that worked
properly to a full arch restorations, but had many difficulties in single crown cases
where lateral forces are apply directly to the restauration.[4] [18]
To overcome those deficiencies the manufacturers changed the implants connection
design increasing the height, the precision of the mating surfaces and the contacting
surface. This is how the internal connection either hexagon and Morse taper was
developed.[18]
Implant abutment connection stability depends on many factors:
Presence of a gap
In contrast the presence of a gap has a negative influence on the connection stability.
This space between the components can lead to micro movement of the abutment
and in under masticatory forces can generate fretting and wear of the surface that
can show a bigger gap.
In the external and non-frictional internal connections, the gap is called clearance fit
and is necessary to allow the setting of the abutment over the implant, but can also
be present as a result of machining tolerances, that in the anti-rotational part can
permit a rotational displacement described as rotational freedom. Rotational misfit
can be shown as a result of the horizontal discrepancies at the connection at the
moment of the screw tightening. This displacement can change the repositioning of
the abutment, affecting the passive fit of the superstructure and allowing undesired
stress concentrations on the system (fig 1).[23]
Figure 1. Rotational freedom on a hexagon index of an internal connection. Semper et all 2009
On the conical connections, the gap can appear as result of a discrepancy between
the component cone angles. Aguirrebeitia in 2013 described two types of
discrepancies in the cone angle: Positive difference where the implant and the
abutment contact on the coronal portion leaving a gap in the apical part of the
connection. In this case, the joint has a sealing that avoid bacteria colonization, but
permits micro-motion and stress concentration on the top of the connection. If the
angle difference is higher than 0,25º, high peaks of stress can be developed at the
coronal area and undesired high stress transferring to the cortical bone.
In the negative difference, the components contact at the apical portion leading to
bacteria colonization on the top of the implant. Under masticatory forces, this gap
can increase even more after the loading.[2]
Vertical Length of the mating zone
The length of the mating zone is related to the area of the contacting surfaces.
Studies by Cho (2016) reported that increasing the length of the mating zone can
reduce the distribution and the values of the stress on the connection. These findings
support the statement of the relationship between the area of the mating zone and
the connection stability. [8]
Purpose of this study is to measure and compare six different implant connection
systems in terms of the length of the mating zone, the gap on the internal
connections and the angle difference on the tapered connections.
MATERIALS AND METHODS
Twelve implants and abutments split in six different implant systems, three internal
hexagon connections and three internal conical connection with a N=2 per system,
were scanned by a 3D micro coordinate measurement microscope (Alicona
InfiniteFocus) for metrological analysis in the metrological laboratory of the
mechanical engineering faculty of Universidad Nacional De Colombia.
The implant systems used on the study are listed below (table1)
IMPLANT SYSTEM DIAMETER CONNECTION ABUTMENT NUMBER
TYPE TYPE OF
SAMPLES
BIOHORIZONS 3,8mm Internal hexagon Straight stock 2
(BH) abutment
Tapered Internal
Implant
MIS (MS) 3,75mm Internal hexagon Straight stock 2
Seven internal hex abutment
ZIMMER (ZM) 3,7mm Internal hexagon Straight stock 2
TSV abutment
STRAUMANN (SM) 4,1mm Internal conical Straight stock 2
Bone level abutment
ANKYLOS (AN) 3,5mm Internal conical Straight stock 2
Dentsply firadent abutment
Meinheim
Germany
NEODENT(NE) 3,5mm Internal conical Straight stock 2
Drive CM abutment
Neodent-Curitiba
Table 1: Implant systems and abutments characteristics.
Internal connection gap measuring
For the gap measurement on the internal hexagon groups, the samples were
scanned 360 degrees by a 3D micro coordinate measurement microscope (Alicona
InfiniteFocus) with a 10X lens and an angulation of 50º for the implant body and 0º
for the abutment. For Both components was used a polarized filter due to the high
brightness of the material.
Implant Body
Implant body connection was measured in three points: on the most coronal (T1),
the mid-section (T2) and the most apical part of the hexagon internal socket of the
implant body(T3).
Each point a cross section of the socket was taken giving as a result, a hexagon
shape. The polygon width was taken in two points each face, due to the machining
curved area described in the mid-section of each side of the hexagon. Six distances
each section were taken. (fig 3)
a b c
Figure 2: implant's socket cross sections. a) Coronal Section. b) Mid-section c) Apical section
Abutment
The abutment was measured in three points: on the most coronal, the midsection
and the most apical area of the hexagon end of the component. Each point a cross
section was taken, giving as a result, a hexagon shape. The polygon width was
measure in the same areas than the ones taken on the implant body. Six distances
each section were taken.
Gap measurement
The abutment values (AD) were compared to the measurements on the
corresponding section in the implant body (ID). The clearance (C) is the result of the
difference of the distance in the abutment and the distance in the implant divided in
two G= (AD – ID)/2
Internal connection rotational freedom
Rotational freedom was theoretically measured using the semper method reported
in 2009 for a regular polygon pattern. The mathematical expression is described
below where a, is the rotational freedom, n is number of polygon’s sides, C is the
clearance fit and R is the radius:[22]
360º 180º 9
$= − 2 · /0123 4123 4 7+ 7
* * :
Conical angle measurement
For the cone angle measurement, the sides of resulting tapered images were
prolonged until a cone was completed. The angle among the sides of the cone is
called the opening angle (OA). The cone angle (CA) is the result of the opening angle
divided by 2. CA=OA/2
Internal hexagon joints, have a tapered area on the top end of the connection. The
same procedure was made to calculate the angle of the zone. [2]
Figure 3: Cone angle measurement. The sides of the tapered area are prolonged to create a cone.
The abutment cone angle (CAa) and implant cone angle (CAa) values were
compared to determine the conical angle difference (Da) according to the study
reported by Aguirrebeitia in 2013[2] Da = CAa – CAi
Vertical length of the mating zone
A longitudinal section was taken. A reference point was defined on coronal end of
the abutment (RP) and other at the most apical point of the tapered zone of the
abutment where the index begins (AE). The vertical length of the tapered zone is
measured by projecting the distance between these two points on the x axis of the
image. (fig5)
RP
AE
a b
Figure 4: a) 3D Scanning of the abutment. b) Distance of the vertical length between a reference point (RF)
and the end of the abutment´s tapered area(AE).
The implant and the abutment are connected and scanned under the same
conditions. A longitudinal section was taken. The mating point between the implant
platform and the abutment was located on the image and a distance was measured
with the top reference point in the abutment. This distance is projected over the x
axis. The vertical length of the mating zone is the result of the difference between
the distance of the abutment’s tapered area and the distance on the connected
components. (fig6)
RP
MP
a b
Figure 5: a) 3D scanning of the assembled implant to the abutment. b) Vertical length between the abutment's
reference point (RF) and the mating point of the abutment to the implant (MP).
Results
Gap Measuring and rotational freedom
In the internal hexagon connection implant systems, the group ZM and BH did not
show significant differences in gap and rotational freedom values. The MS group has
a significant difference in compare with the BH and ZM groups (P= 0,041). The BH
group showed the highest values (20,06µm gap and 3,375º of RF) followed by the
group ZS, and has the highest data dispersion (BH: max 20,06µm, min 8,52µm). The
lowest gap value showed in the MS group (4,37µm) and the data were more
consistent among the measures. There is not significant differences on the values
of the apical section (T3) in compare with the mid-section (T2) and the coronal areas
(T1). (chart1)
Chart 1: Gap values in the internal connection systems and sections.
There was no significant difference between the results of ZM and BH, but there was
a difference with the MS group. The highest value was found in the BH group (3,37º)
and the lowest value was found in the MS group (0,37º) (chart2)
BOX PLOT ROTATIONAL FREEDOM
Gráfico Caja y Bigotes
BH
BIOHORIZONT
SISTEMA
MSMIS
ZM
ZIMMER
0 1 2 3 4
RM
RF
Chart 2: Box plot of rotational freedom on the internal hexagon connection systems.
Cone angle difference
The following table shows the results of the cone angle of the implant and the
abutment and the respective difference among the systems analyzed.
SYSTEM IMPLANT’S ABUTMENT’S ANGLE
CONE ANGLE CONE ANGLE DIFFERENCE
BIOHORIZONS 42,979 43,799 0,819
MIS 44,838 46,141 1,303
ZIMMER 44,075 46,178 2,103
STRAUMANN 14,827 15,109 0,282
ANKYLOS 5,735 5,791 0,056
NEODENT 5,798 5,977 0,179
Table 2: Mean values of the implant and abutment cone angle and their respective angle differences on the
implant abutment connections
CONE ANGLE DIFFERENCE
DIFFERENCE
SYSTEM
Chart 3: Box plot of the implant - abutment cone angle difference
Mating zone length
The mating zone of the internal hexagon connections at the beveled area showed
the smallest results. The shortest value was found in the BH group (202,720µm), in
addition, there was no statistical difference with the ZM group (219,755µm). The MS
group showed the biggest dimensions among the internal hexagon connections
(453,204µm). On the other hand, among the conical connections, the NE group
showed the highest value (1945,54µm) followed by the AN group (1801,1µm) and
the SM group (664,259µm). (chart4)
MATING ZONE LENGTH DISTRIBUTION
LENGHT IN MICRONS
SYSTEM
Chart 4: Boxplot of the mating zone length.
DISCUSSION
Implant - abutment connection gives multiple restorative options in the two piece
implant systems, but can also be one of the factors that affects the implant stability
in the long term. The presence of a gap between the components can lead to micro
– motion, which is the cause of screw loosening and wear of the internal surfaces
of the assembly with particle releasing to the surrounding tissues. This particles can
activate inflammatory response by some cells types as the macrophages promoting
the activation of osteoclasts and bone loss.
It has been reported that the presence of a gap can produce a bigger space after
implant use, increasing micromotion as a progressive complication of the implant
abutment interface. [5]
Leakage to the internal chamber of the implant and bacteria pumping from the
implant may also be a consequence of a presence of a gap. The contamination of
the internal chamber of the implant body can produce pumping to the surrounding
tissues. This bacteria pumping to the bone and soft tissue can cause an
inflammatory process which can lead to mucositis and peri implantitis.
There are different measurement techniques to assess the assembly of the implant
components:
The destructive measurement methods such as scanning electron microscopy and
the cross section of the analyzed parts can disrupt the surface of the sample giving
altered outcomes. [25]
The use of non-invasive measurement instruments such non-contact 3D
microscopy, reduce the risk of surface and sample damage.[6]
Dispite of a low sample size (N=2), that can lead to a low statistical power, the high
repeatable and traceable of the metrology equipment used on this study, gives a
high relevance and trustworthy results.
In the present study the gap was measured by comparing the dimensions of the
components: implant and abutment at the polygonal area of the connection. The
results showed support the findings by Zipprich where there is a clearance fit
between de components on the internal hexagon connections. This gap size can
reach 20µm [26]. In the internal chamber of the implant systems analyzed, there is
a curved area in the mid-section of each side of the hexagon. The relation of this
curved area and the abutment produces a bigger gap in the section leading to an
increased receptacle for bacteria colonization but it is not considered to affect the
mechanical behavior of the connection due to the relation of the implant and the
abutment on the end of each side.[26]
The presence of a clearance fit allows the abutment setting into the implant,
however, can also permits micro-movement leading to wear, fatigue and leakage
under cycling loading. The friction caused by the micro-motion facilitates particle
debris release that act as active particles that can stimulate macrophages
proliferation. This cell stimulation releases cytokines that differentiate preosteoclasts
into osteoclasts leading to osteolysis of the peri-implant area, and also inhibits
osteoblastogenesis. [20] [13][10] .
Figure 6: Inflamatory cascade and osetolysis caused by wear debris.[20]
Rotational freedom is related to the clearance fit: the bigger the gap, a wider
rotational freedom can be generated. The rotation also depends on the radius and
the number of sides of the polygon index of the connection. A polygon with a higher
number of sides and a shorter radius allows more rotation of the system. This rotation
can lead to a stress and a set difficulties of the superstructure due to a different
position of the abutment.[23]
In the present study were analyzed straight abutments with an internal hexagon
connections. Rotational freedom of the abutments went from 0,37° on the MS group
to 3,37° on the BH group. According to the Semper study this rotation can develop
a misfit up to 183µ on the marginal area leading to bacterial leakage. This gap can
be diminished by pressure of the superstructure, but it can develop strains within the
components.
On the conical connections and the internal connections with a bevel on the cervical
area, there is a positive angle difference between the implant and the abutment that
acts as sealing feature of the connection and prevents bacterial leakage.[2] In the
study there was a great difference among the conical and internal hexagon
connections results. The conical connections showed a small angle difference that
means a complete coupling of the components. On the other hand, the internal
hexagon connections showed a big angle difference (>0.25º). An angle difference
greater than 0,25º provides a sealing on the top of the connection, but can also
develop stress on the contacting point, generating strains at the implant and affects
the surrounding bone. During loading the gap on the apical part of the beveled area
allows micromovement on the connection with a fulcrum on the top, leading to wear
and plastic deformation, that can increase the gap between the components. On the
other hand an small angle difference (<0,25º) reduces micromovement due to the
perfect coupling of the components and reduces the gap appearance during and
after loading.[2][5]
a b
Figure 7: Angle difference on the implant abutment connection: a)Internal hexagon connection with a coronal
bevel. b) Conical connection.
The mating zone plays a mayor role on the implant abutment connection stability.
Acording to Cho a longer mating zone diminish the ocurrance of micromovement
and decreases the maximun stress distribution on the connection due to the big
contacting surfaces. According to this study the strees distribution is located on the
upper area of the interface. A long contact between the inner surface of the implant
and the abutment can assure a lower peaks of stress and less micromovement. On
the present study the conical connections showed longer mating zones except for
the SM group where the length of the was shorter than rest of the conical groups.
For the internal hexagon conections, the contacting area is restricted to the bevel on
the top of the interface.
CONCLUSIONS
Six different implant systems were analyzed by a 3D micro coordinate
measurement microscope. Within the limitations of the present study, the following
conclusions can be drown:
1. There is a gap between the internal chamber of the implant and the abutment
at the hexagon index on the internal connections.
2. The rotational freedom is a phenomenon occurred when there is a gap
between the components.
3. There is a difference on the angle difference between the internal hexagon
and the conical connections.
4. There is a difference of the length of the mating zone between the internal
and conical connections
5. In the internal hexagon connections the contacting area is restricted to the top
of the beveled region.
6. The stability on the internal connections depends of the geometric design of
the index and the manufacturing tolerances
7. The optical high resolution microscope enable traceable and repeatable
measurements
It is advisable to increase the sample size and analyze more implant systems to
have a better statistical power.
It is necessary to perform this metrology study in the same implant systems after a
cycling loading to inspect the possible changes on the dimensions of the
components.
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