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| Year : 2014 | Volume
: 25
| Issue : 1 | Page : 32-35 |
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| Analysis of the surface deformation of dental implants submitted to pullout and insertion test |
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Mariana Lima da Costa Valente1, Antonio Carlos Shimano2, Carla Rodrigues Mazzo1, César Penazzo Lepri3, Andréa Cândido dos Reis1
1 Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirao Preto, Sao Paulo, Brazil
2 Department of Biomechanics and Orthopaedics, School of Medicine of Ribeirao Preto, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
3 Teacher at the University of Uberaba, Uberaba, Minas Gerais, Brazil
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| Date of Submission | 14-Dec-2012 |
| Date of Decision | 23-Apr-2013 |
| Date of Acceptance | 19-Jan-2014 |
| Date of Web Publication | 21-Apr-2014 |
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 Abstract | | |
Objective: The aim of the present study was to evaluate the possible deformations in the surface of dental implants submitted to pullout and insertion test in polyurethane synthetic bone, using scanning electron microscopy.
Material and Methods: Four different types of implants were used: Master Screw, Master Porous, Master Conect AR and Master Conect Conical (n = 8). These implants were into the femoral head synthetic bone (Synbone) and removed through the pullout test, performed with a universal testing machine (EMIC MEM 2000). All the screws, before and after the mechanical tests, were micro structurally analyzed in a Scanning Electron Microscope (SEM - Zeiss EVO50), utilizing a magnification of 35 times. The results were subjected to ANOVA and Tukey tests (α =0.05).
Results: Only the Master Conect Conical and Master Porous implants presented statistically significant difference to pullout and maximum deformation (P = 0.014 and P = 0.009, respectively). The SEM images did not show morphological changes of the implants when compared before and after the mechanical tests.
Conclusion: We concluded that Master Porous presented higher pullout resistance, suggesting a greater primary stability. Keywords: Dental implants, osseointegration, scanning electron microscopy, torque, traction
How to cite this article:
da Costa Valente ML, Shimano AC, Mazzo CR, Lepri CP, dos Reis AC. Analysis of the surface deformation of dental implants submitted to pullout and insertion test. Indian J Dent Res 2014;25:32-5 |
How to cite this URL:
da Costa Valente ML, Shimano AC, Mazzo CR, Lepri CP, dos Reis AC. Analysis of the surface deformation of dental implants submitted to pullout and insertion test. Indian J Dent Res [serial online] 2014 [cited 2023 Jun 1];25:32-5. Available from: https://www.ijdr.in/text.asp?2014/25/1/32/131051 |
The clinical success of oral rehabilitation with dental implants depends mainly on the osseointegration, defined by Branemark in 1977 [1] as the direct microscopic contact of bone-implant interface without the interposition of fibrous tissue over a significant portion of it. However, for this to occur it is necessary to take into account biological factors, such as bone quantity and quality, and mechanical factors, such as the primary stability, responsible for preventing the micro movement of the implant in the bone site, promoting natural healing and effective bone formation. [2],[3],[4],[5]
Considering the primary stability as one of the pre-requisites for osseointegration, it is necessary to evaluate and control the factors that directly affect in this condition, as the surgical technique used, the bone type, the implant geometry and the surface treatment. [6],[7],[8],[9]
Despite the surface treatment be extensively studied by researchers, the implants geometry is still a underexplored factor in the literature and deserves special attention, since changes in the implant body design and on its surface can increase the treatments success, by the promotion of increased surface area and bone/implant contact, induction of bone growth and load distribution, thus allowing maximum surface anchorage, insertion with lower bone trauma and resistance to insertion and removal torques. [10],[11],[12]
The morphology involves several factors related to the implants such as shape, size, type, number, depth and screw-thread and the screws prosthetic connection. [13],[14] Thus, the dentist must be able to choose the best characteristics that a implant must have taking into consideration each specific clinical case.
There are surgical situations in which there occur the insertion of implants with unfavorable inclinations, due to bone quantity and quality, necessitating their removal and reinsertion in the same surgery. Considering that manufacturers do not recommend the reuse of dental implants, the purpose of this study was to evaluate the influence of insertion torque and pullout test in different implants and analyze the occurrence of possible macro and microstructure deformations on their surfaces, evaluated by using a scanning electron microscope.
| Materials and Methods | |  |
A total of thirty-two dental implants (Conexao®, Aruja, Sao Paulo, Brazil) were used in this study, divided in the following four groups with n = 8: Master Screw (11.5 × 3.75 mm) - cylindrical of machined surface, Master Porous (11.5 × 3.75 mm) - cylindrical with Porous double surface treatment, Master Conect AR (11.5 × 3.75 mm) - cylindrical with Porous single surface treatment and Conect Conical (11.5 × 3.5 mm) - conical with Porous surface treatment.
These implants were inserted into the femoral head of a polyurethane artificial human bone (Symbone®, Malans, Switzerland). Due to the difficulties in handling, acquisition and storage of the natural bone, we decided to use artificial bones, because there are similarities in relation to geometry, flexion and density when compared to natural bone, as well as greater standardization of the study utilizing few samples. [15],[16]
Before insertion, performed with standardized torque of 35 N.cm, the implants were analyzed morphologically using a scanning electron microscope (Zeiss - EVO50), under magnification of 35 times. After insertion, the implants were removed from the samples by using the pullout test, conducted with a universal testing machine (Emic - DL-10000) with load cell of 200 kgf and software Tesc 3.13. To perform the test, the screw head was fixed to the testing machine by connectors that allow multidirectional movements and application of axial tensile load without the application of torque. A preload of 5N was applied for 10 s to accommodate the system and then the axial tensile load was applied using 0.2 mm/min until the complete implant pullout. These variables were defined according to the need for implant adaptation to the Universal Machine. [17] Afterwards, these implants were subjected to a new SEM morphological analysis for comparison purposes.
Data were submitted to ANOVA and Tukey tests (α =0.05%) using SPSS Statistics 17.0 (SPSS, Chicago, USA). The images obtained using SEM were qualitatively evaluated, comparing the implants surface before insertion and after the pullout test.
| Results | | |
Comparing the types of implants with each variable [Table 1], it was observed that there was significant difference between the implants on the variables Maximum Force (P = 0.0120), Maximum EF (P = 0.024) and Relative Rigidity (P = 0.01). To the Maximum Deformation, it wasn't observed any significant difference between the implants (P = 0.440). It was observed that Master Porous dental implants presented higher values and statistically different (P < 0.05) from Master Conect Conical in relation to maximum pullout force (P = 0.009), maximum EF (P = 0.014) and relative rigidity (P = 0.006).
The comparison of photomicrographs SEM evaluation, before insertion and after pullout test, showed no surface morphological changes that may have been caused by mechanical tests. There was only substrate accumulation between the screw-threads due to artificial bone debris that remain adhered to the screws [Figure 1], [Figure 2], [Figure 3], [Figure 4].
| Discussion | | |
Many studies have evaluated the biomechanical characteristics of the different types of implants searching an ideal format for use in several clinical cases, however, there are many factors associated with failure of the implants such as the diameter and type, thickness of cortical bone, receiver bone site, insertion torque and inflammation of the peri-implant tissues, making this search difficult. [18]
Conical and cylindrical implants have different geometries, screw shapes and contact surface, which leads to differences in insertion torque results. Some studies [19] show that the conical implants have smaller screw-threads and, therefore, have greater surface area, which increases the friction between bone and implant and results in a greater insertion torque. In this study, we selected the mechanical pullout test for evaluating the screws, however, the results were different from those commonly found in the literature, because in this case the cylindrical implants and with double surface Porous treatment (Master Porous) demonstrated greater resistance when compared to the conical.
Given the difference in the surface treatment of the implants Master Porous and Conect Conical, the result suggests that the roughness plays great influence on the strength of them, because it increases the friction between the implant and the bone and modulates the cell behavior. [20],[21],[22] In addition, studies show that implants submitted to more than one treatment technique may show an enhanced bone apposition and higher values of removal torque in biomechanical testing. [23],[24] The best performance of the cylindrical implants may also have been influenced by the slightly smaller diameter of the conical implants.
There are several types of surface treatment available on the market. In the present study, the tested implants have the surface treated by acid attack, which produces micro depressions on the titanium surface, ranging from 0.5 to 2 μm of diameter. [22],[25] This acid treatment has been shown to improve the osseointegration, [26] a fact that could be confirmed with the results of the study, once that the implants with Porous-treated surface showed higher pullout strength when compared to the machined implants (Master Screw), suggesting a higher primary stability. The surface treatment, regardless of the type, causes a greater roughness on the titanium surface, favoring the osseointegration and the initial stability by promoting a greater mechanical imbrication between the substrate and the screw.
Despite that conical implants did not present the best results of pullout resistance, they demonstrated greater resistance than the cylindrical machined surface implants (Master Screw). Comparing the cylindrical implants with and without surface treatment, those treated (Master Porous and Master Conect AR) obtained better results than machined (Master Screw). These results demonstrate the positive influence of the roughness on the increase of resistance and primary stability. [16]
After performing the mechanical tests, all implants were evaluated in scanning electron microscope. A comparison was done by comparing the photomicrographs before and after those mechanical tests. The evaluation of the screw morphological structure showed no change in the surface that may have been caused by the realization of insertion torque and pullout test. The only difference found between the images was the accumulation of organic matter due to the debris of the polyurethane substrate that remained between the screw threads. The greatest deposition of organic matter was seen in the implants with double Porous surface treatment (Master Porous), probably due to the increased roughness of these screws, showing the imbrications effect caused by the surface treatment. In a clinical situation, this factor could increase the friction between bone-dental implant, promoting the primary stability.
This result suggests that an implant inserted in a specific surgical site can be reinserted into another one, on the same patient and on the same surgical procedure without causing damage to osseointegration. [27],[28]
Two aspects found in this study demonstrate the importance of the work: The first shows the positive influence of surface treatment on the pullout resistance of the tested implants, suggesting a higher primary stability. The second demonstrates the possibility of reuse of screws that were inserted in an incorrect inclination or improperly set.
| Conclusions | | |
The Master Porous cylindrical implants showed higher pullout resistance when compared to the other groups, suggesting a greater primary stability. The SEM evaluation did not identify any structural alteration after the mechanical tests.
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Correspondence Address:
Andréa Cândido dos Reis
Department of Dental Materials and Prosthesis, School of Dentistry of Ribeirao Preto, Sao Paulo
Brazil
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0970-9290.131051
[Figure 1], [Figure 2], [Figure 3], [Figure 4]
[Table 1] |
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