Biomechanical considerations for the screw of implant prosthesis: A literature review

So-Min Im; Dae-Gon Kim; Chan-Jin Park; Min-Sang Cha; Lee-Ra Cho

doi:10.4047/jkap.2010.48.1.61

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Im, Kim, Park, Cha, and Cho: Biomechanical considerations for the screw of implant prosthesis: A literature review

Review Article

J Korean Acad Prosthodont 2010;48(1):61-68.

Published online: 18 December 2010

DOI: https://doi.org/10.4047/jkap.2010.48.1.61

Biomechanical considerations for the screw of implant prosthesis: A literature review

So-Min Im, DDS¹, Dae-Gon Kim, DDS, MSD¹, Chan-Jin Park, DDS, PhD¹, Min-Sang Cha, DDS, MSD², Lee-Ra Cho, DDS, PhD^1,

^¹Department of Prosthodontics and Research Institute of Oral Science, College of Dentistry, Gangneung-Wonju National University

^²Gangneung Asan Hospital, Collge of Medicine, University of Ulsan, Gangneung, Korea

∗Corresponding Author: Lee-Ra Cho Department of Prosthodontics, College of Dentistry, Gangneung-Wonju National University, 1, GangneungDaehangno, Gangneung, Gangwon-Do, 210-702, Korea +82-33-640-3163: e-mail, lila@gwnu.ac.kr

Received 21 December 200914 January 2010 Accepted 15 January 2010

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This article attempted to determine the factors affecting the preload and screw loosening.

Methods

Available clinical studies from 1981 to 2008 from the PUBMED that presented screw loosening data and review articles regarding screw joint stability were evaluated. Eleven studies dealing the biomechanical principles of the screw mechanics were reviewed. Moreover, the results of our data were included.

Results

The frequency of screw loosening was consequently reduced due to the advancement in torque tightening with torque wrench, screw material, coating technique for reducing the frictional force, and thread design, etc. If preload in the screw falls below a critical level, joint stability may be compromised, and the screw joint may fail clinically. The types of fatigue failure of screw were divided to adhesive wear, plastic deformation, and screw fracture.

Conclusion

An optimum preload is essential to the success of the implant-abutment complex. To maintain optimum preload, using a torque wrench and re-tightening at recall time were needed. (J Korean Acad Prosthodont 2010;48:61-8)

Keywords: Preload, Screw, Screw loosening, Torque

REFERENCES

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19.Al Jabbari YS., Fournelle R., Ziebert G., Toth J., Iacopino AM. Mechanical behavior and failure analysis of prosthetic retaining screws after long-term use in vivo. Part 1: Characterization of adhesive wear and structure of retaining screws. J Prosthodont. 2008. 17:168–80.

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24.Al Jabbari YS., Fournelle R., Ziebert G., Toth J., Iacopino AM. Mechanical behavior and failure analysis of prosthetic retaining screws after long-term use in vivo. Part 1: Characterization of adhesive wear and structure of retaining screws. J Prosthodont. 2008. 17:168–80.

Fig. 1.

Clinical images and SEM images of fractured screws. Arrow indicates the starting point of crack line.

Fig. 2.

Marginal bone loss around the fractured abutment screw. From first fracture, the other fractures were consequently happened (Fig. 1).

Fig. 3.

Estimation of fatigue life of gold screw; theoretical failure and realistic failure.

Fig. 4.

A, Electronic torque controller; B, Torque limiting device; C, Torque indicating device; D, Contra-angle torque device.

Fig. 5.

Loosening torque of titanium screw at 20 Ncm and 30 Ncm tightening torques.

Fig. 6.

Mechanical tolerance of various implants. A, Implantium (Dentium, Seoul, Korea); B, Astra (Astratech, Mo ¨lndal, Sweden); C, GS (Osstem, Pusan, Korea); D, M implant (Shinhung, Seoul, Korea).

Fig. 7.

Spiralock system of Biohorizon (Detroit Tool Industries, Madison Heights, MI).

Fig. 8.

Schematic diagram of the mechanism of adhesive wear of screws in implant prostheses. (Upper thread indicates much milder state, while lower thread indicates much severe state of wear).

Table I.

Screw loosening in single implant prosthesis

Author	Observation time	Frequency (%)
Jemt et al. (1991)³	1 Y	27%	Cantilever
Jemt et al. (1993)⁴	3 Y	45%	CP Ti screw
Laney et al. (1994)⁵	3 Y	9.3%
Henry et al. (1996)⁶	5 Y	18.3%	old gold screw design
Priest G. (1999)⁷	10 Y	7.1%
Jung et al. (2008)²	5 Y	5.8%	1996 - 2006 Review

Table II.

Multiple factors for screw loosening

Extrinsic factors	Intrinsic factors
Mal-aligned implant position	Preload reduction by reduced tension
Off-axis occlusal force	Mechanical tolerance
Malocclusion	Screw material
Bruxism, Clenching	Fatigue resistance of metal
Cantilever
Insufficient tightening torque
Misfit between implant and abutment
Settling effect

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