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crew loosening is a common Purpose: To analyze the torque Results: The mean and standard
design factors (the thread pitch and of friction, which is reduced as the The results of this in vitro study
implant complex dimensions), the mate- quantity of lubricant is increased.26 This demonstrated that torque maintenance
rial properties of the components, and in vitro study estimated the torque for 10, 20, and 30 seconds are better
environmental conditions such as the state required to loosen the screws when con- options when compared with instant
of lubrication at mating surfaces should sidering a condition without humidity. torque application, promoting higher
be also be taken into consideration. None- Therefore, it is assumed that the removal torque values 10 minutes after
theless, in this study, minimal variables removal torque values found in this torque application. The torque of 30
were included to investigate the effect study would be different than expected N$cm applied for 20 seconds seemed
of torque maintenance time on removal in clinical conditions. to be the best option when considering
torque values. When working with The torque loss observed, in this the higher removal torque values com-
machined components, some errors may study, occurred in an in vitro situation, pared with the torque application for 10
be introduced in each abutment screw or without the application of any external seconds and was similar to the value
implant during fabrication. However, this force, different from the clinical environ- observed for torque application for 30
study used an adequate sample size of ment, in which the implant and prosthe- seconds, with the advantage of reducing
new components (implants, abutments, ses are subjected to dynamical forces. A the time of torque maintenance by 10
and titanium screws) to minimize these previous study36 demonstrated that a sin- seconds.
variables. This study also did not aim to gle application of a physiological load This simple, accessible, and low-
compare the removal torque values after on a cantilever prosthesis may cause loss cost procedure reduces preload loss on
repeated cycles of screw tightening and of preload on the prosthetic screw. the prosthetic screws, enhancing the
loosening. Another study37 revealed that the reten- torque required for screw loosening.
A single operator conducted the tion mechanism of implant screws is sig- Therefore, the current results encourage
experiment. Despite this, the rate of nificantly affected in vivo by functional the recommendation of applying and
torque application, time to reach the and parafunctional forces. Thus, the cur- maintaining torque for 20 seconds on
maximum torque,35 and torque value rent results probably underestimate the the prosthetic screws.
applied may alter the removal torque torque loss that occurs clinically. Even There are some limitations of this
value, which may not be identically re- though plastic deformation is unavoid- study. No comparisons were made
produced for all specimens. To avoid able during tightening of prosthetic between the removal torque values of
these factors and standardize the torque screws, the search for the highest preload torque application after repeated screw
applied, an electrical device (Torque possible is fundamental for the stability tightening procedures and a single
handpiece Controller; Nobel Biocare and success of implant-supported tightening procedure with torque appli-
AB, Karlskoga, Sweden) may be prostheses. cation using different torque mainte-
used.34 When this device is used, there Accurate materials and procedures nance times. Further studies are needed
may be a slight variation in the torque are recommended to achieve the best on this context using scanning electron
applied, which may be influenced by preload possible on implant-supported microscopy for the evaluation of screw
the axial load during application. How- prostheses, minimizing the deformation surfaces for better interpretation of the
ever, this electrical device interrupts the caused by surface irregularities. This effects of each procedure to the surface
torque application when the pro- highlights the importance of investigat- texture of the screws. In addition,
grammed torque is reached, which pre- ing mechanisms to control the defor- a study set up using eccentric cyclic
cluded its use in this study, because the mation of implant-supported metallic loading in preferably simulated body
desired torque should be maintained for frameworks, in an attempt to enhance fluid is needed to test the effects of
10, 20, and 30 seconds in groups 2, 3, the preload and prosthetic stability. The different variables to each procedure in
and 4, respectively. recommended tightening torque values external hexagonal implant-abutment-
A previous study34 mentioned the of abutment screws are different in screw complex.
occurrence of large variations in the tor- different implant-abutment systems. In
que value when a mechanical torque the study of Tsuge and Hagiwara13 20
wrench was used, because of the corro- N$cm tightening torque was applied for CONCLUSIONS
sion caused by the sterilization process. tightening Ti Screws of external hexag- According to the results achieved
However, a new mechanical torque onal implants and abutments, whereas, and within the experimental conditions
wrench and a digital torque measuring Khraisat et al38 used the CeraOne abut- investigated, it was concluded that the
device were used in this study ments in their experiment and the rec- application of a torque of 30 N$cm for
to minimize the variations that might ommended tightening torque was 32 10, 20, or 30 seconds are better options
occur on torque application, allowing N$cm. Asvanund and Morgano29 used when compared with the instant torque
the desired torque maintenance for 10, 35 N$cm tightening torque for connect- application in external hexagon im-
20, and 30 seconds in groups 2, 3, and 4, ing external hexagon abutments in their plants. The torque of 30 N$cm applied
respectively. study model. It must be highlighted that for 20 seconds seemed to be the best
The presence and quantity of lubri- differences in abutment screw type, option when considering the higher
cant (saliva or blood) between the material, and the tightening torque removal torque values compared with
components may affect the coefficient greatly influence preload. the instant torque application and with
IMPLANT DENTISTRY / VOLUME 22, NUMBER 5 2013 539
torque application for 10 seconds and by 2 or 3 implants: A retrospective study 25. Cardoso M, Torres MF, Lourenço
considering the similar value observed up to 18 years. Int J Oral Maxillofac Im- EJ, et al. Torque removal evaluation of
for torque application for 30 seconds. plants. 2006;21:567–574. prosthetic screws after tightening and
11. Barbosa GA, Bernardes SR, das loosening cycles: an in vitro study. Clin Or-
Neves FD, et al. Relation between implant/ al Implants Res. 2012;23:475–480.
DISCLOSURE abutment vertical misfit and torque loss 26. Burguete RI, Johns RB, King T,
of abutment screws. Braz Dent J. et al. Tightening characteristics for screw
The authors claim to have no 2008;19:358–363. joints in osseointegrated dental implants.
financial interest, either directly or 12. Schmitt J, Holst S, Eitner S, et al. J Prosthet Dent. 1994;71:592–599.
indirectly, in the products or informa- Prosthetic screw torque removal values in 27. Haack JE, Sakaguchi RL, Sun T,
tion listed in the article. implants retained as cast bar superstruc- et al. Elongation and preload stress in den-
tures or bars modified by the Cresco Ti tal implant abutment screws. Int J Oral
Precision technique–a comparative in vivo Maxillofac Implants. 1995;10:529–536.
ACKNOWLEDGMENTS study. Int J Prosthodont. 2009;22:193–200. 28. Saboury A, Neshandar Asli H, Vaziri
13. Tsuge T, Hagiwara Y. Influence of S. The effect of repeated torque in small
The authors gratefully acknowl- lateral-oblique cyclic loading on abutment diameter implants with machined and
edge the support of Conexão Sistemas screw loosening of internal and external premachined abutments. Clin Implant Dent
de Prótese for supplying the test com- hexagon implants. Dent Mater J. 2009; Relat Res. 2012;14(suppl 1):e224–e230.
ponents used in this study. 28:373–381. 29. Asvanund P, Morgano SM. Pho-
14. Guzaitis KL, Knoernschild KL, toelastic stress analysis of external versus
Viana MA. Effect of repeated screw joint internal implant-abutment connections.
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