J Dent Rehabil Appl Sci.  2020 Dec;36(4):211-221. 10.14368/jdras.2020.36.4.211.

Concept and application of implant connection systems: Part I. Placement and restoration of internal conical connection implant

• Ko KH
• Kang HG
• Huh YH
• Park CJ
• Cho LR

• KMID: 2512116
• DOI: http://doi.org/10.14368/jdras.2020.36.4.211

Abstract

The typical biomechanical properties of an internal conical connection (ICC) are axial displacement and loss of preload. The axial displacement of an ICC without a vertical stop can cause the loss of preload and a lowered occlusion. The stress of an ICC is concentrated on the contact interface of the abutment and not on the screw, and during placement, it is important to choose a wider coronal wall thickness as much as possible. The ICC should also be placed below the level of the bone crest. During the restoration of an ICC, care should be taken to ensure an appropriate abutment shape and an accurate connection. To get the best clinical results, it is important to select its wall thickness and place it in the appropriate position to restore it adequately.

Keyword

internal conical connection; axial displacement; preload; restoration; placement

Figure

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  Fig. 1 Three types of implant-abutment connection. (A) External butt joint connection (EXT), (B) Slip fit internal butt connection, tissue level (TL), (C) Internal conical connection (ICC).

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  Fig. 2 Lowered occlusion induced by axial displacement. (A) Right molar implant prosthesis using internal conical connection implant, (B) Left molar implant prosthesis using external implant, (C) Lowered occlusion was occurred in left molar restoration.

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  Fig. 3 Reverse torque value was lower in internal conical connection (ICC) comparing with external implant (EXT). In EXT, retightening (RT) did not affect the reverse torque value, while retightening of screws was effective in ICC implant.

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  Fig. 4 (A) Various screw fractures, (B) Various abutment fractures occurred in ICC implant.

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  Fig. 5 Implant fracture was happened after repetitive retightening of screw in ICC. Crack in implant coronal wall can be found in retrieved implant and radiographic image.

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  Fig. 6 Distribution of coronal wall thickness of commercially available ICC regular platform implant systems. The thinnest wall thicknesses ranged from 0.2 to 0.5 mm.

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  Fig. 7 Diameter expansion (μm; positive line graphs) and axial displacement (μm; negative line graphs) of experimental implant-abutment assembly after screw tightening and cyclic loadings. Experimental implants with coronal wall thickness (0.2 mm, 3.75 mm diameter; 0.3 mm, 3.95 mm; 0.4 mm, 4.15 mm; 0.5 mm, 4.35 mm). The diameter expansion was significantly small in the 4.35 mm implant larger (P < 0.001). The axial displacement of the 3.75 mm and 3.95 mm groups was significantly larger (P < 0.001).

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  Fig. 8 Single engagement feature (left) and double engagement feature (right).

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  Fig. 9 (A, B) Screw retained prosthesis splinting 2 ICC implants. Screw loosening and plaque accumulation under prosthesis. (C, D) Screw and cement retained prosthesis (SCRP) using CAD-CAM abutments (Courtesy of Dr. Park JH).

Reference

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