|Year : 2018 | Volume
| Issue : 2 | Page : 154-160
Effect of surface treatments on the retention of implant-supported cement-retained bridge with short abutments: An in vitro comparative evaluation
Department of Prosthodontics and Crown and Bridge, Mahatma Gandhi Dental College and Hospital, Jaipur, Rajasthan, India
|Date of Submission||23-Sep-2017|
|Date of Acceptance||05-Mar-2018|
|Date of Web Publication||06-Apr-2018|
Dr. Monica Shrivastav
Shanti Nagar B Block Opposite R.S.E.B Grid Station, Jalore, Rajasthan
Source of Support: None, Conflict of Interest: None
Statement of Problem: In clinical situations, short implant abutments create lack of retention with overlying cemented prosthesis.
Aims: The aim of this study is to evaluate the impact of different surface treatments on the retention of implant-supported cement-retained bridge with short implant abutments.
Materials and Methods: Six straight Adin implant abutments of similar sizes (3 mm diameter × 3 mm height) were selected. All were divided into three groups (n = 2): with circumferential grooves and sandblasting (G + SB), with a circumferential groove and bur modification (G + B) and third one taken as control. The framework simulating three-unit bridge was casted in each group. A total of 30 such frameworks (10 for each group) were fabricated. Each casting was cemented with a zinc phosphate cement (Dentsply). The cemented frameworks were then being stored in 100% humidity at 37°C for 24 h. Retention tests were conducted with a universal testing machine (5 mm/min), and retentive forces were recorded. Data were subjected to one-way analysis of variance, Tukey's honestly significant difference test, (α = 0.05).
Results: For the first group, retentive value increased by 619.30 N, the second group increased the retention by approximately 749.80 N (P < 0.001). The null hypothesis was rejected, the abutments with G + B showed significantly higher retention, than the G + SB and control group (F = 15.95, df = 29, P < 0.001).
Conclusion: The addition of G + B to implant abutments significantly increased the retention of cement-retained frameworks. For long-term prognosis of the prosthesis; G + B modification can be a better option as compared to G + SB.
Keywords: Groove + bur modification (G + B), groove + sandblasting modification (G + SB), implant supported cement-retained bridge, retention, short abutments
|How to cite this article:|
Shrivastav M. Effect of surface treatments on the retention of implant-supported cement-retained bridge with short abutments: An in vitro comparative evaluation. J Indian Prosthodont Soc 2018;18:154-60
|How to cite this URL:|
Shrivastav M. Effect of surface treatments on the retention of implant-supported cement-retained bridge with short abutments: An in vitro comparative evaluation. J Indian Prosthodont Soc [serial online] 2018 [cited 2018 May 26];18:154-60. Available from: http://www.j-ips.org/text.asp?2018/18/2/154/229462
| Introduction|| |
In clinical situations, reduced inter-arch space  create lack of retention problem in the cemented prosthesis. The use of implant-supported cement-retained restorations has increased, due in part to the ability to optimize occlusal inter-digitation, enhance esthetics and provide a passive fit. In such clinical situations, the use of cement-retained prosthesis become a mandatory option over screw-retained., To enhance the retention; airborne-particle abrasion , bur modifications,, addition of retentive grooves,, and minimal angle of convergence  are to be used. Studies on implant-supported cement-retained bridge (ISCRB) in short abutment  condition is still not known. That is why this study was designed.
| Materials and Methods|| |
A total of six straight narrow diameter implant abutments (Adin Rs Slim Titanium Abutment, Adin Dental Implant System Ltd Israeli), 3 mm in diameter and 3 mm in height were selected [Figure 1]. Along with this, six Adin implant analogs (Adin Rs Internal Hex Implant Analog, Adin Dental Implant System Ltd., Israeli) were also selected [Figure 2], two analogs were aligned vertically in the center of a plastic ring using dental surveyor with a distance of 10 mm (measured from the center of screw channel).
Chemically cured acrylic resin (RR Cold-Cure DPI, India) was poured between and surrounded the analogs, the assembly was maintained until the acrylic resin set. The abutments were then screwed on to the implant analogs with Universal Torque Ratchet and Hex Drive and torqued to 25 Ncm. Three such similar assemblies were formed (n = 2). A framework simulating three-unit bridge was casted over the assemblies using non-Precious Dental Alloy Nickel–Chromium (Ndn, Dfs-Diamon, Germany). For that purpose, tin platinum foil of 0.001 inches (0.025 mm) thickness was closely adapted and burnish onto the abutment surface as a die spacer. The assembly was then duplicated using silicon material and micro stone.
Wax patterns for copings had been formed using blue inlay wax with a thickness of approximately 1 and 8 mm diameter occlusal surface on the stone replica. All samples are waxed to this identical size using the split mold technique with silicon material. A 5 mm diameter ring was being waxed on the center of the occlusal surface of each pattern to facilitate the connection of the crown to the universal testing machine.
The wax patterns were then sprued with 2 mm diameter (12 gauges) wax sprues, and invested in phosphate bonded investment. The investment had been mixed according to the manufacturer's instructions and then poured using a vibrator to spaced metal rings. The rings was then being kept overnight in a dry environment and then casted with a Co-Cr base metal alloy.
The fit of metal copings was being examined utilizing Fit-Checker disclosing media and the internal surface of each casting was inspected with a microscope and minute nodules were removed with a half round bur in the straight handpiece. Stability was assessed by applying finger pressure vertically to the crown while seating on the abutment and considered acceptable if the crown does not have any rotational movement on the abutment.
The investment, burnout, and casting techniques were standardized. Patterns were sprued and invested individually in a phosphate-bonded investment with the casting technique described by white. Devesting had been completed in the usual manner with the minimum use of aluminum oxide air abrasives on critical interfaces. Further internal adjustments had been made by painting a thin layer of die lubricant on the abutments and removing any wet, shiny areas on the lightly air-abraded internal surfaces of the castings.
A total of 30 such frameworks, ten for each group were fabricated. Metal loops [Figure 3] were mounted over the frameworks for pull-off movements.
|Figure 3: Metal frameworks with loop attachment with mounted implant abutments|
Click here to view
Each assembly was randomly selected and assigned to modification as follows [Table 1]:
- Group I (G + SB): The abutments were subjected to surface modification; by milling one circumferential groove [Figure 4] in the middle of each abutment. The circumferential groove was 0.5 mm wide and 0.3 mm deep with an inter-wall angle of approximately 60° [Figure 5]. The abutments were then [Figure 6] roughened by sandblasting (50 μm aluminum oxide)
- Group II (G + B): The abutments were subjected to surface modification by adding one circumferential groove that was milled in the similar manner followed by bur modification by creating punches of size whole bur diameter 5 per axial surfaces of abutments [Figure 7]
- Group III: [Figure 8] control; having no any surface modifications.
The frameworks were seated and checked with the fit-checker to check for fitting and any visible problems. The Frameworks were then cemented with zinc phosphate  (Adhesor Fine, Shofa Dental, Kerr Company) on each assembly. This resulted in a simulation of ISCRB with short abutments.
The cemented frameworks were taken under a 4.5 kg load for 1 min followed by a 0.9 kg load for 2 min and then allowed to bench set. Before testing the specimens, the size of the acrylic blocks was reduced according to the dimensions of the clamp for holding the specimens. A universal load testing machine [Figure 9] was used to apply vertical tensile forces at a crosshead speed of 5 mm/min, to dislodge the framework from the abutments. The peak load to dislodge was documented (N) and used to indicate the retentive values. All frameworks were tested for retentive strength in a similar manner.
The data were analyzed statistically using one-way analysis of variance (ANOVA) and Tukey honestly significant difference (HSD) test for further comparison.
| Results|| |
The analysis revealed a statistically significant difference in retention among the three groups based on one-way ANOVA test in [Table 2] and according to Tukey's HSD test in [Table 3], the amount of force required to remove the metal bridge from implant abutments after cementation was higher for bur modification when comparing Group II with Group III as compared to other groups.
The comparative retentive forces to remove the cemented bridge from the abutments were always as follows Group II > Group I > Group III except with ninth sample testing.
| Discussion|| |
Currently, dental implants are restored with two types of crowns, i.e. cement-retained and screw-retained. The screw-retained prosthesis was developed in response to the need for retrievability of restorations. Later, the use of implant-supported cement-retained restorations has increased, due in part to the ability to optimize occlusal inter-digitation, enhance esthetics and provide a passive fit.
In certain clinical situations, reduction of the abutment height due to limited inter-occlusal space which can compromise retention of the cemented prosthesis, methods to enhance the retention of cement-retained prosthesis are advocated. A few factors can be controlled by the clinician to increase retention is surface roughness which is the most important factor that a clinician has control over it. Moreover, cemented prosthesis is the need when considering the anterior quadrant region, majority of them were fixed partial denture (FPD) type of cases, and hence by considering the situation like three-unit bridge overlying implants, we tried to judge the splinting effects along with surface modification on retention of the prosthesis because previous studies are done on single crowns only and splinted prosthesis are studied for stress distribution effects on bone. No study till done on FPD to analyze retention of overlying implant prosthesis.
Hence, this study was conducted to evaluate the effect of retention of ISCRB on short abutments with different surface treatments G + B and G + SB.
The result of this study showed G + B modification showed significant influence on retention of ISCRB over short abutments as compared to no modification.
Cement-retained prosthesis have gained popularity due to several advantages such as loading along a linear axis, better passive fit, small occlusal table, lower fracture of porcelain due to lack of screw accessibility hole, and better comfort to cemented restoration in posterior regions. Minimum abutment height may lack to provide adequate retention for an implant supported cement-retained restorations as quoted in the study of Saleh Saber et al.
However, there could be situations where a three-unit bridge has to be fabricated on implant abutments having reduced crown height space. This may compromise the retention of the prosthesis. Many procedures have been suggested to modify the surfaces of short abutments to improve retention. Among them sandblasting, bur modification, the addition of circumferential grooves, and alloy primers  are practically achievable at chairside. Roughening the surface of abutment by a bur increases the retention of cemented crowns in comparison with sandblast and control assemblies as showed in a study of Ganbarzadeh et al. On the metal surfaces sandblasting creates irregularities, the surface area increases, and removes debris mechanically, thus increasing the bond strength of cements.,,, Circumferential grooves added to implant abutments was also found to increase the retention of cemented restorations. Circumferential groove creates a local lock, and this may increase the length of the fracture line (plane) and have a greater effect on cements with a high modulus of elasticity such as zinc phosphate cements.
Zinc phosphate cement provides casting retention by micromechanical interlocking into the casting and the abutment surface irregularities. For zinc phosphate cement, 1 groove was as effective as several, as quoted in the study of Lewinstein et al., thus in the present study only one circumferential groove was milled on the center of each abutment that underwent modifications.
Group II had a significantly higher mean peak forces of dislodgment than all other groups, which correlated to the study of Ganbarzadeh et al. Group II showed the highest tensile strength values followed by Group I and control group.
Studies done by Clayton et al. and Sheets et al. have shown that dislodging loads in natural tooth and implant abutment intraorally range between 207 and 509 N. From this study, it is evident that the control group showed retentive bond strength values within the range, whereas the Group I and II showed higher values than the dislodging forces encountered intraorally. The inter-group comparison revealed group II and I that showed the statistically significant difference from that of Group III. Although, both have significantly greater value as compared to intraoral dislodging forces, for long-term prognosis of the prosthesis; G + B modification may be better as compared to G + SB.
The repeated dislodgement of restoration on short abutments can always be a problem when implant-supported restorations are luted with temporary cement. Thus, in such cases, the choice of cement is a permanent cement., However, many clinicians are of the opinion that retrievability of crowns is more important than retention in implant crowns, in such clinical situations, simulating the present study, using temporary/semi-permanent cement would compromise retention to a higher level.
Inside the mouth, implant-supported restorations are under the influence of various forces such as shear, tensile, and compressive and the combination of these forces can create different dynamic forces resulting in the dislodgement of restoration. Creating in vitro dynamic conditions similar to those in the mouth is difficult.
It has been revealed that bond strength could be significantly different based on cement type , and surface roughness.,, Sandblasting the surface of abutment can increase resistance to dynamic lateral loading , and the amount of this increase is different in various cements.
The results of this study indicated that the retention of metal crowns on titanium abutments noticeably increases with factors such as roughening the surface of abutment with a diamond bur. This matter is very practical in clinics because it is very important to access a method which enables clinicians to cement crowns on titanium abutments with a long-term durability in spite of temporary cement.
Here, in the present study, our main focus is on mechanical modifications rather chemical changes or different cements types because in many different studies expensive methods were used for it. The main goal is to provide almost same services to patients without any extra expense to him/her. Second, by doing this study on the bridge, we indirectly splint the implants to compensate for increased crown to implant ration.
So considering the retrievability ,,, and functionality of prosthesis Group II modification sounds good. The effect of surface modifications on short abutments when cemented with temporary cement needs further study.
Strength of this study
Modifications are made to allow retrieval when necessary and at the same time it should have sufficient retention during function and should not dislodge off the abutment frequently.
Modifications can be done clinical side only, no need for extra laboratory time consumption and also economical for patient benefits.
Limitation of this study
- Creating in vitro dynamic conditions similar to those in the mouth is difficult, and hence, the present study was done in a static condition
- In this study, only one type of abutment and cement were used. It has been demonstrated that bond strength can be significantly different based on cement type and surface roughness need to be further investigated.
| Conclusion|| |
Within the limitations of this study, the following conclusions can be drawn:
- Retention of the ISCRB with short implant abutments is improved by surface treatments of the abutments, namely, G + SB and G + B
- Surface modification done by G + B showed to have the greatest influence on increasing the retention of ISCRB
- For long-term prognosis of the prosthesis; G + B modification may be better as compared to G + SB.
G + B modification may be recommended as a good practical chairside option to improve retention of a bridge cemented on shorted implant abutments when zinc phosphate cement is used.
With exaltation and gratitude, first, I thankful to almighty and my dear parents for their constant support, I express my gratefulness to my esteemed teacher and great mentor Dr. Narendra Padiyar U, Professor and Head, Department of Prosthodontics and Crown and Bridge, Mahatma Gandhi Dental College and Hospital and my guide Dr. Pragati Kaurani, Professor of the Department, for their expert opinion, constant encouragement and support during the preparation of this study. I also grateful to all my colleagues, teaching and nonteaching staff for their support.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Hebel KS, Gajjar RC. Cement-retained versus screw-retained implant restorations: Achieving optimal occlusion and esthetics in implant dentistry. J Prosthet Dent 1997;77:28-35.
Tuna T, Knops A, Jungwirth F, Fischer H, Wolfart S. Retrievability of Implant-Retained Splinted or Non-Splinted Crowns following Semipermanent Cementation. 5th
International Camlog Congress. Valencia, Spain; 26-28 June, 2014.
Chee W, Felton DA, Johnson PF, Sullivan DY. Cemented versus screw-retained implant prostheses: Which is better? Int J Oral Maxillofac Implants 1999;14:137-41.
Michalakis K, Pissiotis AL, Kang K, Hirayama H, Garefis PD, Petridis H, et al.
The effect of thermal cycling and air abrasion on cement failure loads of 4 provisional luting agents used for the cementation of implant-supported fixed partial dentures. Int J Oral Maxillofac Implants 2007;22:569-74.
Felton DA, Kanoy BE, White JT. The effect of surface roughness of crown preparations on retention of cemented castings. J Prosthet Dent 1987;58:292-6.
Kunt GE. Effect of surface treatments on implant crown retention. J Dent Sci 2010;5:131-5.
Maydan L, Lewinstein I, Lehr Z. Effect of Circumferential Grooves on Retention of Implant-Cemented Crowns. Implantology Research, Scientific Program. Crowne Plaza Hotel AVSA I; 27 August, 2004.
Lewinstein I, Block L, Lehr Z, Ormianer Z, Matalon S. An in vitro
assessment of circumferential grooves on the retention of cement-retained implant-supported crowns. J Prosthet Dent 2011;106:367-72.
Jørgensen KD. The relationship between retention and convergence angle in cemented veneer crowns. Acta Odontol Scand 1955;13:35-40.
Covey DA, Kent DK, St. Germain HA Jr., Koka S. Effects of abutment size and luting cement type on the uniaxial retention force of implant-supported crowns. J Prosthet Dent 2000;83:344-8.
Uludamar A, Ozkan YK. Cement selection of cemented implant supported restorations. Cumhuriyet Dent J 2012;15:166-74.
Ganbarzadeh J, Nakhaei MR, Shiezadeh F, Abrisham SM. The effect of abutment surface roughness on the retention of implant-supported crowns cemented with provisional luting cement. J Dent Mater Techn 2012;1:6-10.
Saleh Saber F, Abolfazli N, Nuroloyuni S, Khodabakhsh S, Bahrami M, Nahidi R, et al.
Effect of abutment height on retention of single cement-retained, wide- and narrow-platform implant-supported restorations. J Dent Res Dent Clin Dent Prospects 2012;6:98-102.
Naik S, Tredwin CJ, Nesbit M, Setchell DJ, Moles DR. The effect of engaging the screw access channel of an implant abutment with a cement-retained restoration. J Prosthodont 2009;18:245-8.
Clayton GH, Driscoll CF, Hondrum SO. The effect of luting agents on the retention and marginal adaptation of the CeraOne implant system. Int J Oral Maxillofac Implants 1997;12:660-5.
Sheets JL, Wilcox C, Wilwerding T. Cement selection for cement-retained crown technique with dental implants. J Prosthodont 2008;17:92-6.
Akça K, Iplikçioǧlu H, Cehreli MC. Comparison of uniaxial resistance forces of cements used with implant-supported crowns. Int J Oral Maxillofac Implants 2002;17:536-42.
Darveniza M, Basford KE, Meek J, Stevens L. The effects of surface roughness and surface area on the retention of crowns luted with zinc phosphate cement. Aust Dent J 1987;32:446-57.
Al Hamad KQ, Al Rashdan BA, Abu-Sitta EH. The effects of height and surface roughness of abutments and the type of cement on bond strength of cement-retained implant restorations. Clin Oral Implants Res 2011;22:638-44.
Goldman H, Cohen DW. Periodontal Therapy. 5th
ed. St. Louis, MO: Mosby; 1973. p. 977-1013.
Emms M, Tredwin CJ, Setchell DJ, Moles DR. The effects of abutment wall height, platform size, and screw access channel filling method on resistance to dislodgement of cement-retained, implant-supported restorations. J Prosthodont 2007;16:3-9.
Mehl C, Harder S, Wolfart M, Kern M, Wolfart S. Retrievability of implant-retained crowns following cementation. Clin Oral Implants Res 2008;19:1304-11.
Michalakis KX, Hirayama H, Pavlos D, Garefis PD. Cement-retained versus screw-retained implant restorations: A critical review. J Oral Maxillofac Implants 2003;18:719-28.
Misch CE. Contemporary Implant Dentistry. St. Louis: Mosby-Year Book Inc.; 1993. p. 651-85.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6], [Figure 7], [Figure 8], [Figure 9]
[Table 1], [Table 2], [Table 3]