In Vitro Evaluation of Retentive Characteristic of Friction Fit Implant Supported Prosthesis

Related to Different Taper Angles

Abstract
Statement of problem: Conventionally, for securing prosthesis (fixed or removable) two type of
connections between implant and prosthesis have been mainly used, namely screw retained and
cement retained connection. Though, both systems (Screw and cement retained) have been good
and predictable, they do inherently show some drawbacks.
Purpose: The objective of the present study was to correlate retentive characteristic of friction fit
implant supported prostheses with different taper angles. To compare retentive strength of
abutment-coping interface at 2 degree, 4 degrees and 6 degrees taper angles.
Material and method: Abase assembly and superstructure were designed and milled simulating a
three-unit FDP. The 3D CAD software STL files were generated with the help of SOLIDWORKS
for the required dimensions of each block assembly. The five axis milling machine (Arum) was
used to mill polymethyl meth acrylate (PMMA) and it was scanned by Extraoral scanner. Universal
Testing machine was used for testing retentive strengths of friction fit implant supported prosthesis
with different taper angles. The force values were gradually increased till the superstructure
dislodged from the base assembly. This value was noted as the retentive strength.
Results : Results exhibited that the minimum retentive force was 148.97 N and maximum was
152.34 for group I with 2 degrees taper of abutment.
Conclusion : It can be concluded that the present study stands a fair chance in contributing to
standardisation of protocol for CAD/CAM fabricated friction fit prosthesis with taper and will aid in
determining the cone angle needed to attain given strength target.
Introduction

Implant dentistry has gained much importance and acceptance over past few years.

The friction fit implant supported prostheses is one of the most popular new approaches to implant
dentistry.

Dental implant–abutment systems can be used as anchors for supporting multiple or single-unit
protheses to edentulous patients. Abutment can be clamped onto the implant using screw and then
dental prostheses fabricated over the abutment.

However, the success of the treatment is dependent on several factor including interface between
abutment-prosthesis, implant-abutment and bone-implant.

Two types of connection methods involving (a) a screw, and (b) a tapered interference fit (also
called Morse taper) are commonly used for securing the abutment to the implant. For the systems
using a screw, the connection between the implant and the abutment depends on the screw-preload,
which is generated by applying a predetermined amount of torque during installation. Designs in
which the screw has a large tapered end essentially work like a tapered interference fit, and the
screw threads do not appear to contribute to the connection (Schwarz, 2000; Binon et al., 1994;
Sutter et al., 1993). The tapered interference fit relies on the large contact pressure and resulting
frictional resistance, in the mating region of the implant–abutment interface, to provide a secure
connection.

In-screw type implant–abutment connection mechanism, mechanical complications such as screw

loosening when occlusal loads exceed the preload, or creep deformation in the screw–implant
interface can lead to clinical complications (Schwarz, 2000). When the tapered-interference fits are
used, the abutment loosening seems to be less of a problem (Müftü and Chapman, 1998; Morgan
and Chapman, 1999; Keating, 2001; Sutter et al., 1993).
Material and methods

Softwares: SOLIDWORKS® 3D CAD solution (STL file generation for base assembly), Auto-
CAD and Exo CAD (STL file generation for Super structure).

Equipments : Arum 5 axis dental milling machine, HAAS milling machine, laboratory scanner,
Universal Testing machine.

Materials: Titanium grade 5 alloy, poly methyl meth acrylate resin.

Methodology
Dimension of Abutment assembly: Height – 5mm, Width – 4.5mm.
Dimension of super-structure (coping) as follows
The super-structure consisted of 2 copings connected by 10 mm long Bar. All dimensions (height,
thickness) were standardized for all specimens, except taper angle. Height- 5mm, Thickness –
0.3mm (uniform all around), ConnectorThickness – 2.5mm.

The study was designed to correlate retentive characteristic of friction fit implant supported
Prosthesis with different taper angles. Abase assembly and superstructure were designed and milled
simulating a three-unit FDP.
The samples were categorized into 3 groups and subsequently tested for retentive strength using
Universal Testing Machine.
GROUP-I: abutments with taper angle of 2 degrees
GROUP-II: abutments with taper angle of 4 degrees
GROUP-III: abutments with taper angle of 6 degrees.

Laboratory Procedures:
Fabrication of Base assembly: With the help of SOLIDWORKS 3D CAD software STL files were
generated with the above-mentioned dimensions for each block assembly. These STL files for each
degree taper (2 degree, 4 degrees and 6 degrees) acted as template for Milling machine.
STL is a file format native to the stereolithography CAD software created by 3D Systems.
Computer Aided Manufacturing (CAM): 5 axis milling machine (Arum) was used to mill
polymethyl meth acrylate (PMMA), once the design was found to be satisfactory for (2, 4, 6 degree
taper angle) and overall functionality was assured, Titanium (grade 5 alloy) base assembly blocks
were milled using subtractive machining process.

Scanning: The three base assembly blocks in PMMA were digitally scanned by Extraoral scanner
(Open Technologies 3D Scanner). Scan spray was sprayed on the PMMA model to mitigate
reflection from the surface. The scanner used the data acquisition system that records the 3D
geometry of the infrastructure that is of the abutment on base assembly and converted the actual
dental model into virtual dental model.

Fabrication of Super Structure: Once again STL files were designed using EXO-CAD Dental
CAD from the scanned images for fabrication of super structure with above stated dimensions. The
copings (superstructure) just as abutments (base assembly) were allowed a uniform with 2-, 4- and
6-degree axial tapers to allow for complete seating and yet provide sufficient resistance form. the
custom abutments are perfectly parallel and have the desired subgingival emergence profiles and
heights. Customised CAD/ CAM Conical titanium abutments permit a maximum abutment angle
correction of 25 degrees.

CAM of Super structure: The CAM system (Haas 3 Axis CNC Milling Machine) produced the
actual superstructures according to the virtual design. It was ensured that to achieve friction fit, zero
cement space was left after milling (The outer diameter of abutment was same as the internal
diameter of superstructure).

Evaluation of Retentive Strength

After milling, the models were tested for retentive strengths of friction fit implant supported
prosthesis with different taper angles using Universal Testing machine. The force values were
gradually increased till the superstructure dislodged from the base assembly. This value was noted
as the retentive strength. Mean value was obtained after repeating the test for 5 times with each
degree sample.

Statistical analysis
Computer aided designed base assembly and super structure were milled as per specifications. The
super structure was seated with a preload of 100 N and the retentive strengths of three groups with
taper angles (2, 4 and6 degrees) on abutment and superstructure were recorded and analysed.
Data was analysed using Statistical Package for Social Sciences (SPSS) version 21, IBM Inc.
Descriptive data is reported for each variable. Summarized data was presented using Tables and
Graphs. Data was not normally distributed as tested using the Shaperio-Wilk W test (p-value was
less than 0.05). Kruskal Wallis test for comparison of two or more groups. Mann Whitney U test
was used of unpaired data and Wilcoxon paired t test for paired data. A level of p<0.05 was
considered statistically significant.

Results
After the Super structure was seated with a 100N preload and the retention was measured for all
samples, it was observed that:
For Group I with 2 degrees taper of abutment the minimum retentive force was 148.97 N and
maximum was 152.34. The mean and standard deviation 150.3633 and 1.75 respectively.
The RETENTIVE STREGTH was compared using Kruskal Wallis test. It was found to be
Statistically significant at P < 0.05.
The PAIR WISE test showed a STATISTICALLY SIGNIFICANT DIFFERENCES at p < .05 for
all pairs.
When the taper angles were corelated to the retentive force, the linear correlation was such that the
taper angle increased retentive force decreased. Taper angle explains 96.6% of variation in retentive
force.
96.6% variance in the value of retentive strength can be explained through this model
The p = 0.0001, overall, the regression model statistically significantly predicts the outcome
variable (i.e., it is a good fit for the data).
GRAPH 3: The P-P plot compared the observed cumulative distribution function (CDF) of the
standardized residual to the expected CDF of the normal distribution and showed that the diagonal
line (which is passing through the lower and upper quartiles of the theoretical distribution) is
providing a visual aid that the relationship between (TAPER ANGLE AND RETENTIVE
SRENGTH is linear. The normal probability plot of the residuals suggests that the error terms are
indeed normally distributed.
Discussion

The long-term success of a dental implant, is influenced by the bone-implant, implant-abutment and
abutment-prosthesis interfaces (Geng et al., 2001). The abutment prosthesis interface is critical as in
screw type implant-abutment connection mechanism, mechanical complications such as screw
loosening and screw fracture are observed when occlusal loads exceed the preload. In the cement
retained implant prostheses peri-implant disease are seen in the majority (81%) of the cases, due to
residual excess cement after placement of prostheses. The excess dental cement is associated with
signs of periimplantitis. Friction fit abutment prosthesis is a prosthesis designed to overcome the
aforementioned shortcomings of screw or cement retained implant prosthesis.

The tapered interference fit relies on the large contact surface and resulting frictional resistance, in
the mating region of the prosthesis-abutment interface, to provide a secure connection.
Friction fit is dependent on accuracy of fit of the prosthesis abutment interface and increases as the
area of contact increases. Friction is maximum when the coping is fully seated on the abutment.
Retentive forces over 150 N were identified, greater than the values found in
cemented systems. It follows that the connection between abutment and coping can be considered
fixed when seated.