CLINICAL REPORT

Implant-supported fixed dental prosthesis with a microlocking

implant prosthetic system: A clinical report
Jae-Won Choi, MSD, PhD,a Jin-Ju Lee, BSPH,b Eun-Bin Bae, MSD,c and Jung-Bo Huh, DDS, MSD, PhDd

Since the introduction of os- ABSTRACT

seointegration, longitudinal
A microlocking implant prosthetic system has recently been developed to address the limitations of
studies have demonstrated the conventional screw- and cement-retained implant-supported fixed dental prostheses. This
long-term success of osseointe- prosthesis system consists of a precision-machined abutment and an attachment that includes
grated implants.1 Implants have zirconia balls and a nickel-titanium spring, thus providing retrievability and constant retention of
been reported to treat patients the prosthesis. In addition, screw-related complications are avoided because there is no retention
with partial edentulism suc- screw. The occlusal access hole is of a smaller diameter than that of conventional screw-retained
cessfully, and implants and prostheses, which is beneficial for esthetics and occlusion. It also prevents common
implant-supported restorations complications of cement-retained prostheses because residual cement around the prosthesis can
be removed extraorally. This article presents a clinical treatment with this new prosthetic system.
have high success and survival (J Prosthet Dent 2019;-:---)
rates. Implant-supported fixed
2

dental prostheses (FDPs) may

be retained either using a screw or cement.3
Screw-retained FDPs have advantages including
predictable retrievability, a minimal amount of inter-
occlusal space needed, easy hygiene management, and
easy removal upon repair or surgical intervention.4,5
However, screw-retained FDPs may be contraindicated
and may require increased production time and cost.4 In
addition, screw-retained FDPs require a high degree of
accuracy to achieve a passive fit,6 and residual stress from
screw tightening can occur between the multiunit FDPs
and the implant if passive fit is not achieved.5 The most
common complications to occur with screw-retained
prostheses are prosthetic screw loosening, fracture, and
prosthesis breakage.7
Cement-retained FDPs also have advantages
including compensation for inappropriately inclined im-
plants, easier achievement of passive fit, the presence of
an intact occlusal surface due to the absence of an
occlusal access hole, and easier control of occlusion.4,5
However, cement-retained FDPs can be associated with
retained cement, which may precipitate peri-implant
diseases such as peri-implant mucositis and peri-
implantitis.8,9 As early as 1997, Agar et al10 reported that
an abutment may be scratched during the removal of
excess cement from subgingival margins and that cement
removal may be incomplete. Other authors have reported
that the amount of undiscovered cement increases with
margin depth.11

This research was supported by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the
Ministry of Health and Welfare, Republic of Korea (grant number: HI18C0594). Also, this study was financially supported by the 2018 Postdoctoral Development Program of
Pusan National University.
a
Postdoctoral Researcher, Department of Prosthodontics, Dental Research Institute, Institute of Translational Dental Sciences, School of Dentistry, Pusan National Uni-
versity, Yangsan, Republic of Korea.
b
Graduate student, Department of Prosthodontics, Dental Research Institute, Institute of Translational Dental Sciences, BK21 PLUS Project, School of Dentistry, Pusan
National University, Yangsan, Republic of Korea.
c
Doctoral student, Department of Prosthodontics, Dental Research Institute, Institute of Translational Dental Sciences, BK21 PLUS Project, School of Dentistry, Pusan
National University, Yangsan, Republic of Korea.
d
Associate Professor, Department of Prosthodontics, Dental Research Institute, Institute of Translational Dental Sciences, School of Dentistry, Pusan National University,
Yangsan, Republic of Korea.

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To solve these complications, a microlocking implant

prosthetic system has been developed to combine
the advantages of predictable retrievability, good occlu-
sion, and esthetics without complications associated
with residual cement. Microlocking implant prosthetic
systems consist of an assembly-type attachment and a
precision-machined abutment to accommodate this
attachment (EZ crown; Samwon DMP Co) (Fig. 1).
Retention of the microlocking implant prosthetic system
is controlled by a ball and spring, which are the sub-
components of the attachment, and the retention groove
in the abutment cylinder. The ball is composed of
zirconia (ZrO2), which has excellent biocompatibility,
flexural strength, fracture strength, and wear resistance,12
and is a perfect sphere, with a 0.7-mm diameter. The
springs located outside the zirconia balls are made of a
nickel-titanium alloy. Nickel-titanium alloys can be Figure 1. Microlocking implant prosthetic system. A, Overall concept. B,
subdivided into 3 types: nonsuperelastic or martensitic- Components.
stabilized, austenitic-active, and martensitic-active.13-15
The springs used in this system are martensitic-
stabilized alloys, similar to the Nitinol (Unitek) prod-
uct.15-17 Unlike austenitic-active and martensitic-active
alloys, which exhibit a superelasticity effect or shape
memory effects due to phase transformation caused by
induced stress or temperature changes,13,16 martensitic-
stabilized alloys do not undergo phase transformation
because of their stable martensite structure.16 Thus, they
do not have a superelasticity effect or shape memory
effects13 but have a large working range and low
modulus of elasticity.17 They are also much more elastic
than other alloys such as stainless steel, cobalt-
chromium, or beta-titanium, thus exhibiting excellent
spring-back capacity.13,17
Therefore, after the attachment is engaged in the
Figure 2. Abutment tightened on implant.
abutment, the spring is able to provide a continuous and
constant force on the ball, which is seated in the reten-
CLINICAL REPORT
tion groove of the abutment. The stability of the micro-
locking implant prosthetic system is controlled by the This treatment was conducted in patients who had a
abutment shape. The abutment cylinder has a height of single osseointegrated implant in the posterior region
3.2 mm, which can indirectly resist lateral forces, and the and who agreed to a clinical feasibility study with
upper hexagonal structure in the cylinder directly pre- the approval of the Pusan National University Dental
vents rotation of the attachment. Also, the cylinder has a Hospital Institutional Review Board (IRB no.: PNUDH-
tapered external hexagon connection with a 25-degree 2017-035-MD).
convergence angle and compensates for the angle of Before impression making, the abutment was tight-
the implant even when the implant is not positioned ened to 35 Ncm according to the manufacturer’s protocol
parallel. To fabricate the restoration, the overall protocol (Fig. 2). Then, the attachment was inserted to the abut-
is similar to that of the combination screweretained and ment by using a dedicated tool (Fig. 3). Impressions were
cement-retained prostheses,18 but an occlusal access hole made with the closed mouth technique by using a sili-
is not necessary in this new prosthetic system. If an cone impression material (Imprint II VPS Impression
occlusal access hole is formed according to the operator’s Material; 3M ESPE).
preference, the prosthesis can be easily removed using a A zirconia single crown fabricated with a computer-
dedicated removal driver. aided design and computer-aided manufacturing
This clinical report describes the restoration of an (CAD-CAM) system (exocad DentalCAD; exocad
implant-supported single crown by using a microlocking GmbH/Trione Z; DIO) was placed seated on the
implant prosthetic system. attachment. Interproximal contact areas, marginal fit,

THE JOURNAL OF PROSTHETIC DENTISTRY Choi et al

- 2019 3

Figure 3. A, Insertion of attachment using dedicated tool. B, Attachment seated on abutment.

Figure 4. Removal of definitive prosthesis using removal driver. Figure 5. Removal of residual cement around prosthesis extraorally.

esthetics, and accessibility for oral hygiene were evalu-

ated. The hole at the top of the attachment was sealed
with Teflon tape, and the crown was cemented using
self-adhesive resin luting cement (G-CEM LinkAce; GC
America). Excess cement from the occlusal access hole
was cleaned, and the crown was removed by using a
removal driver (Fig. 4). After removing excess cement
around the cervical margin of the crown (Fig. 5), the
crown was reinserted on the abutment. The occlusal
access hole was filled with a flowable composite resin
(Filtek Z350 XT; 3M ESPE) (Fig. 6).
A periapical radiograph was made to confirm that the
crown was properly seated on the abutment (Fig. 7). The
probing pocket depth and bleeding index were measured
by using a periodontal probe (Merritt B; Hu-Friedy) on Figure 6. Filling occlusal access hole.
the peri-implant mesiodistal and labiolingual sides.19,20
The plaque index was measured according to the The patient was instructed on appropriate oral hygiene.
criteria of Mombelli et al,20 and the presence of calculus After an observation period of 6 months, the crown was
was evaluated. Occlusal stability was assessed by using removed. To remove the crown, the flowable composite
an occlusal analysis system (T-Scan Evolution System; resin was removed, and the removal driver was tightened
Tekscan Inc), which is a computerized device capable of along the screw thread of the attachment through the
evaluating occlusal loads.21 occlusal access hole. Finally, the crown was removed as the

Choi et al THE JOURNAL OF PROSTHETIC DENTISTRY

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Figure 7. Radiograph of abutment and prosthesis.
removal driver tip pushed the top of the abutment. The
patient did not complain of any discomfort or pain, and
there was no change in the periodontal index when
compared with that at the initial installation of the crown.
In terms of prosthodontic maintenance, the crown showed
no mobility or fracture and maintained a stable occlusal
contact, and no fracture was presented in the implant or
abutment. The removed crown, attachment, and abutment
all showed a clean surface. The soft tissue was healthy, and
clinical symptoms such as peri-implant inflammation,
edema, or ulceration were not observed.
DISCUSSION
The microlocking implant prosthetic system has no
retention screw. Therefore, there is no inherent me-
chanical complication such as screw loosening and frac-
ture of screw-retained prostheses. In addition, when
forming an occlusal access hole in the crown, the new
prosthetic system has advantages in occlusion and es-
thetics because it requires a smaller diameter (1.5 mm)
than conventional screw-retained prostheses (3 mm).
Also, the cement gap between the crown and the
attachment not only provides a passive fit of the pros-
thesis but also compensates for implant angulation.
Above all, the new prosthetic system can be easily
retrieved, which is advantageous for maintenance or
repair. A previous study has reported the mechanical
properties of the microlocking implant prosthetic sys-
tem.22 The authors reported that the load-bearing ca-
pacity of the new prosthetic system was not significantly
different from other commercially available systems.22
Because the new prosthetic system has an internal
conical connection interface, it has close contact between
the implant and the abutment.23 Also, the stability and
resistance of this system are determined not by screws
but by the frictional resistance caused by the contact
between the conical connection of the abutment and the
implant.23,24 This connection enhances the mechanical
THE JOURNAL OF PROSTHETIC DENTISTRY
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stability of the abutment, such as high resistance to
bending forces at the implant-abutment interface, and
prevents rotation and abutment loosening.25,26 There-
fore, the new prosthetic system is assumed to show
sufficient mechanical strength for restoration with an
implant-supported posterior crown. A decrease in
retention has been reported during the initial 1 000 000
cycles.22 Long-term clinical studies with an adequate
sample size are needed to determine whether this
microlocking implant prosthetic system will be successful
in clinical applications.
SUMMARY
The microlocking implant prosthetic system combines
the retrievability of screw-retained FDPs with the ad-
vantages of cement-retained FDPs such as esthetics,
occlusal stability, and passive fit. Attachment compo-
nents consisting of zirconia balls and nickel-titanium
springs prevent complications from subgingival residual
cement.
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Corresponding author:
Dr Jung-Bo Huh
Department of Prosthodontics
Institute for Dental Research, Institute of translation dental science
School of Dentistry, Pusan National University
20 Geumo-ro, Mulgeum-eup, Yangsan 50612
REPUBLIC OF KOREA
Email: huhjb@pusan.ac.kr
Copyright © 2019 by the Editorial Council for The Journal of Prosthetic Dentistry.
https://doi.org/10.1016/j.prosdent.2018.11.021
THE JOURNAL OF PROSTHETIC DENTISTRY