1. 8 th International Conference and Exhibition on
Dentistry & Oral Care
D U B A I
µm?
Lecture:
Microgap, Micromovements and Bacterial Penetration on Different Implant - Abutment Connection System: A Litterature Review
April
Cesare D’Orsogna DDS

2. C e m e n t
&
S c r e w R e t a i n e d
M i c r o g a p
M i c r o m o v e m e n t s
B a c t e r i a l P e n e t r a t i o n

3. Implant - Abutment connection system
CEMENTED VERSUS SCREW RETAINED
IMPLANT PROSTHESES
Advantages
Easy access to the screw
No cement required
Disadvantages
Cosmetic appearance may not be ideal
Advantages
Looks like a natural tooth
Disadvantages
Cement can cause inflammation and bone loss

4. PROBLEM RELATED TO CEMENTED RETAINED

5. B I O L O G Y
Cementing crowns > 100 years on teeth without issue
Why is an implant more vulnerable?
WELL DEVELOPED WITH TRANSVERSAL FIBER BUNDLE INSERTION ATTACHMENT
“ STRONG ATTACHMENT “
SEAL
HEMIDESMOSOMAL ATTACHMENT ONLY. NO DIRECT INSERTION ATTACHMENT
CUFF

6. Implant - Abutment connection system
SCREW RETAINED
EXTERNAL
INTERNAL
CONE MORSE
Flat to Flat
Tube in Tube
- Flat to Flat
- Tube in Tube
Maurillo Sucena Pita; Rodollfo Bruniera Anchieta; Valentin Adelino Ricardo Barao; Idelmo Rangel Garcia Journal of Craniofacial Surgery & Volume 22, Number 6, November 2011 Prosthetic Platforms in Implant Dentistry

7. Mechanical Problems of Internal & External Connection
SEM imaging (longitudinal section) of a fixture - screw connection complex subjected to a non axial overloading
Maurillo Sucena Pita; Rodollfo Bruniera Anchieta; Valentin Adelino Ricardo Barao; Idelmo Rangel Garcia Journal of Craniofacial Surgery & Volume 22, Number 6, November 2011 Prosthetic Platforms in Implant Dentistry

8. Incidence of 12% after 5 years of follow-up
Screw Loosening
From a mechanical perspective it has been identified in a systematic review that the most common technical complication of a single-unit implant-supported reconstruction is abutment or occlusal screw loosening.
Incidence of 12% after 5 years of follow-up
Jung RE, Pjetursson BE, Glauser R, Zembic A, Zwahlen M, Lang NP. Oral Implants Res Feb;19(2): Epub 2007 Dec 7. A systematic review of the 5-year survival and complication rates of implant-supported single crowns.

9. Screw Loosening 76 implants 12 screw loosening (16%) 55 implants
Haas R, Mensdorff-Pouilly N, Mailath G, Watzek G.
Branemark single tooth implants: a preliminary report of 76 implants.
J. Prosthet Dent. 1995;73;274-9
76 implants
12 screw loosening
(16%)
55 implants
7 screw loosening
(10%)
Haas R, Polak C, Furhauser R, Mailath-Pokorny G, Dortbudak O, Watzek G.
A long-term follow-up of 76 Branemark’s single-tooth implants.
Clin Oral Implants Res 2002;13;38-43

10. - Wide diameter 5% screw loosening
- Standard diameter implants showed 14% screw loosening after insertion with only hand torquing.
Cho SC, Small PN, Elian N, Tarnow D. Screw loosening for Standard and Wide Diameter Implants in partially edentulous cases: 3 - to 7 - year longitudinal data. Implant Dent. 2004;13:

11. Screw Fracture
The rescrewing of a loosened screw should not be done because it can increase the risk of a fracture of the abutment
Scarano A, Quaranta M, Piattelli M, Piattelli A. J Immunopathol Pharmacol Jan-Mar;20(1 Suppl 1); SEM and fractography analysis of screw thread loosening in dental implants.

12. MICROGAP Holmes 1989 Between 1 to 5 µm in vitro
A) Vertical Discrepancy
B) Horizontal Discrepancy
MICROGAP
Between 1 to 5 µm in vitro
Takuma TSUGE, Yoshiyuki HAGIWARA and Hideo MATSUMURA Materials Journal 27(1):29-34, 2008
Marginal Fit and Microgaps of Implant-abutment Interface with Internal Anti-rotation Configuration

13. Size of Microgap Between 2 µm and 9 µm Between 3 µm and 7 µm
Callan DP, O’Mahony A, Cobb CM.
Loss of crystal bone around dental implants: A retrospective study
Implant Dent 1998;7:
Between 2 µm and 9 µm
Dellow AG, Driessen CH, Nel HJ.
Scanning electron microscopy evaluation of the interfacial
fit interchanged components of four dental implant system
Int J Prosthodontic 1997; 10:
Between 3 µm and 7 µm
Jansen VK, Conrads G, Richter EJ.
Microbial leakage and marginal fit of the implant-abutment interface
Int J Oral Maxillofac Implants 1997; 12:
Between 1µm and 10 µm

14. Micro or Macrogap?

15. Microgap: SRA vs CRA Research: Results: Conclusions:
Piattelli A, Scarano, Paoloantonio M, Assenza B, Leghissa GC, Di Bonaventura G, Catamo G, Piccolomini R.
Fluids and microbial penetration in the internal part of cement-retained versus screw-retained implant-abutment connections.
J. Periodontol Sep;72(9):
12 dental implants CRA
Research:
12 dental implants SRA
- Scanning electron microscopic (SEM)
- Fluid penetration analysis (FPA)
- Bacterial penetration analysis (BPA)
Results:
SRA
CRA
SEM
Microgap:
2 to 7µm
6 µm
FPA
Toloudine blue
No Toloudine blue
BPA
Yes No
Conclusions:
…CRA implants offer better results relating to fluid and bacterial permeability compared to SRA implants

16. Microgap & Bone Loss Conclusions:
Piattelli A, Vrespa G, Petrone G, Iezzi G, Annibali S, Scarano A.
Role of the microgap between implant and abutment: A retrospective histologic evaluation in monkeys
J. Periodontal Mar;74(3):346-52
Group 1
(15 Implants)
Group 2
(12 Implants)
Group 3
(13 Implants)
1 to 2 mm
above alveolar crest
Level of the alveolar crest
1 to 1.5 mm below the alveolar crest
Conclusions:
…if the microgap was moved coronally away from the alveolar crest, less bone loss would occur and if the microgap was moved apical to the alveolar crest, greater amounts of bone resorption were present.
Group 1
(15 Implants)
Group 2
(12 Implants)
Group 3
(13 Implants)
0.13 +/ mm bone increase in a coronal direction
2.1 +/ mm vertical bone loss was present
3.6 +/ mm vertical bone loss extending in an apical direction

17. Clereance fit: Between 0.8 to 1 µm
Micromovements
Fk: Masticatory force
Clereance fit: Between 0.8 to 1 µm
…the largest possible microgap will also be created during non-axial loading by the length of the parallel-wall connection, by the size of the clearance fit, and by elastic deformation of the implant components.
Holger Zipprich, Paul Weigl, Bodo Lange, Hans-Christoph Lauer
Micromovements at the Implant-Abutment Interface: Measurement, Causes, and Consequences
Implantologie 2007; 15(1): 31-46

18. Micromovements
…the static friction of the implant platform and the abutment floor would be the only factor counteracting rotation of the abutment.
However, this static friction is not enough to safely avoid rotation in the presence of masticatory forces.
Holger Zipprich, Paul Weigl, Bodo Lange, Hans-Christoph Lauer
Micromovements at the Implant-Abutment Interface: Measurement, Causes, and Consequences
Implantologie 2007; 15(1): 31-46

19. INFLAMATION / INFECTION
HEALTH

20. Tissue Reaction 1°
Micromovements between abutments and implants can be considered one of numerous causes of crestal bone resorption 2°
Cycling opening and closing of the microgap will exert a pumping effect on the liquid contained in the implant cavities
Holger Zipprich, Paul Weigl, Bodo Lange, Hans-Christoph Lauer Micromovements at the Implant-Abutment Interface: Measurement, Causes, and Consequences
Implantologie 2007; 15(1): 31-46

21. Tissue Reaction 3°
This liquid emanates a bad smell and contains endotoxins of bacterial origin. It may be assumed that the crestal bone is being contaminated with this liquid due to the pumping effect 4°
The extend of bone resorption is limited by the radius of the contaminated tissue
Holger Zipprich, Paul Weigl, Bodo Lange, Hans-Christoph Lauer Micromovements at the Implant-Abutment Interface: Measurement, Causes, and Consequences
Implantologie 2007; 15(1): 31-46

22. Cone Morse Connection
Mechanical friction between the external wall of the abutment and the internal wall of the implant
“Cold Welding”
No rotation of the abutment
Convergent angle from 8 to 11 degrees of the internal walls
The Journal of Craniofacial Surgery & Volume 22, Number 6, November 2011 Prosthetic Platforms in Implant Dentistry
Maurillo Sucena Pita; Rodollfo Bruniera Anchieta; Valentin Adelino Ricardo Barao; Idelmo Rangel Garcia

23. Cone Morse Connection May 2014 Results: Survival 97 %
Between January 1992 and December 2002
58 fixed reconstructions (15 single crowns, 29 partial prostheses, 14 full-arches)
49 patients
178 Morse-taper connection implants
10 years follow up
Results: Survival 97 %
Biological complication (3 %)
Mechanical complication (10 %)
Conclusion: … Morse Taper connection implants presents low incidence of biological complication and a very high cumulative implant survival rate

24. Conclusion
Implants materials, connection system, and surface properties have all relevant impact on the initial formation of biofilm and on the characteristics of the peri- and intra- implant microbiota.
The external hexagon is indicated for multiunit restoration. On the other hand, the internal hexagon
and the Morse cone are more favorable in single-unit restoration and aesthetic regions.
Cone Morse connection, is considered mechanically more stable and efficient in preventing
bacterial leakage (Merz et al.,2000)
Microbiological evaluation show that there is a more efficient bacterial sealing between
the Cone Morse connection implant and its abutment, revealed by lower bacterial counts
in comparison to other connection system (Pautke et al., 2009; Aloise et al., 2010)

25. T H A N K Y O U