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Lowering The Chance Of Loosening Implant-Abutment Screws

Views: 289     Author: Kaylee     Publish Time: 2023-11-21      Origin: Site


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Lowering The Chance Of Loosening Implant-Abutment Screws

Screw joints are regarded as a "system" that have been used for hundreds of years to link materials together.This mechanism depends entirely on the screw and the alignment of the component elements, which are all necessary for a stable and well-performing joint. Failure is an issue, and the cure could be as simple as tightening the screw again or as complex as resolving catastrophic failure and joint component fracture.

Within the first five to six years after implantation and use, 5% to 12% of all single implant crowns have implant abutment screw-joint loosening.By using the right materials and tools, being aware of how the screw system operates, and routinely evaluating the implant repair so that doctors can lessen the adverse forces acting upon it, the chance of screw loosening can be significantly decreased.

This study will concentrate on managing the elements that lead to IA screw-joint failure, including mechanical mismatch, biological alterations in the patient's stomatological system, and operator error—which is the most frequent factor. First and foremost, one must comprehend the goals, supplies, and equipment utilized in the IA joint.

How Does The Screw Joint For An Implant Operate?

Dentists can lower the chance of failure in their screw joints by knowing how the joint functions and how to manage the stresses acting on it from both the inside and the outside.

Torque, or the rotating force on the screw, is the first force to take into account.The screw has a helical thread that, depending on which way it is spun, propels it vertically up or down within the implant. To prevent wear and tear from friction during use, the screw in implant dentistry is typically constructed of titanium, titanium alloy, or a material that is comparable to the implant body. When the screw threads engage the implant threads during tightening, friction prevents the threads from moving. For instance, ice on ice has a coefficient of kinetic friction of about 0.03; in contrast, titanium and its alloys have a relatively high coefficient of 0.8 to 0.9.When tightening the screw, high friction necessitates a large energy expenditure.

Ironically, friction not only keeps the screw from loosening but also allows for improved screw joint optimization by holding the screw position steady when the joint is under tension. This is why friction makes screw tightening more difficult. Put simply, friction draws the joint components together by holding the screw in place while it is stretched and put under strain, much like an elastic spring. This process, which is ultimately responsible for stabilizing the screw joint, is referred to as clamping force.

It's critical to understand that preload, which is a measure of the screw's stretch, has an ideal value.Like any elastic material, if the preload is too high, the screw is stretched too far and may break or deform. Conversely, if the preload is too low, the clamping force is too low. The implant maker determines the preload setting at a torque and efficiency point that maximizes performance.This tightening torque value that has been set must be properly followed, as it is an essential principle of implant dentistry.

IA screw joint stability is most challenged by non-axial occlusal stresses. Off-axial stresses can cause an implant screw joint, no matter how well tightened or how "perfect," to fail. Understanding this problem and the impact that bruxing and the chewing cycle's lateral forces have on a screw joint is crucial.

The degree to which the abutment and implant fit together is a significant factor influencing IA screw joints. Congruence is crucial, and the abutment should precisely fit where it is intended to seat, much like a piece of a jigsaw puzzle.10.

Manufacturer controls are very strict when it comes to component tolerance and design. Although there are many options available to doctors today when selecting abutments, it is recommended that they utilize components from the original equipment manufacturer because these have been demonstrated in numerous studies to be more effective at avoiding abutment screw loosening.

Delivering The Correct Tightening Torque

Osstem Multi Screw

The term "target torque value" refers to the recommended screw tightness. Only with the employment of specialized torque-limiting devices is this possible. It has been demonstrated that the torque values for hand-tightened IA screws in a simulated oral environment range from 4 to 21 Ncm.A final abutment screw torque of roughly 20 to 35 Ncm is needed for these tiny, frequently constructed of titanium alloy abutment screws. Torque-limiting devices are crucial instruments for creating IA screw preload, as mentioned. It has been demonstrated that manual tools, of which there are two fundamental designs: the friction wrench and cantilever beam wrench, are more accurate than electronic tools.Both have their limitations, yet they can both deliver precise and accurate torque.

Switch Wrenches

By pressing a ball bearing or other comparable object up against the wrench's head, an internal or external spring mechanism is typically used to create friction, which is how the toggle wrench operates. The head releases and a toggling effect occurs when the wrench is employed and the applied force is greater than the ball bearing's friction. Since inertia affects the wrench's internal operations when it is used, it must be triggered gradually. This is due to the wrench's tendency to under-deliver torque when twisted too quickly. Depending on the toggle device, two to four seconds is the appropriate activation time.

Maintenance is a second—and possibly more significant—factor to think about. Moisture will enter the internal spring/bearing system when it is used in the oral environment. If it is not cleaned and oiled after each usage, deterioration and problems may ensue. According to research by Gutierrez et al., an improperly maintained wrench may yield torque readings as high as 400% off, which would undoubtedly cause the IA screw to deform.

This emphasizes how important it is to calibrate and verify that the torque wrench is reading accurately. 94% of implant dentists, according to a recent survey, never calibrate their torque-limiting device, despite the International Organization for Standardization's ISO 6789 standard recommending this. Employees using these equipment in all industries are advised to inspect and calibrate the gadget at least once a year.

Beam Wrenches With Cantilevers

Some of the problems with toggle friction-type wrenches are solved by the cantilever beam torque wrench. It requires less maintenance because it doesn't have any moving parts. Furthermore, in contrast to other kinds of torque wrenches, it requires less calibration and is unaffected by the speed of activation.

However, the operator's proper viewing posture is crucial for accuracy. The device is susceptible to torque measurement read error and parallax, which are again taken into consideration in the engineering sector but are rarely done so in dentistry. These issues are included in the ISO 6789 standard.An inaccurate viewing angle can result in MREs, which can cause torque to deviate from the desired value by 20% to 30%. Because of this, physicians may under- or overtighten IA screws. The operator must adopt a viewing position that is as near to 90 degrees from the cantilever beam and the reader arm as feasible in order to combat this.

Tightening Technique For Screws

The dentistry literature has published and promoted a wide variety of screw tightening methods, some of which, regrettably, lack scientific backing. The idea that a screw can be repeatedly tightened to reduce friction and increase preload is specific to various screw types and is highly dependent on the surface coating.

For instance, the best way to tighten 23 Kt gold-coated screws is to tighten them to the preload target, then loosen, tighten again to the target torque, loosen again, and tighten again to the goal torque.Due to the gold coating's dry-lubricating effect when it smears into the implant screw threads, this causes the preload to increase. This aids in the screw's retention. Static friction is not time-dependent, therefore certain screw types only require one tightening and others require multiple tightenings. Nevertheless, there is no requirement to wait five or ten minutes between tightening events.Verifying that the abutment is well positioned and that the soft tissues are not being impinged upon is crucial. After confirmation, tighten the screw to get the desired torque. To ensure the abutment is correctly lodged within the implant at the conclusion of the tightening process, a well-made orthogonal radiograph of the IA site is necessary.

Reusing screws that have not broken can be taken into consideration; this is only valid if the screw's integrity is unharmed. Physicians should take great care to ensure that the screw has not been plastically distorted and that the surface has not been altered. since of this, gold screws cannot be used again since the gold ages. Furthermore, fresh screws must always be used to replace those that have come free while under strain.

Biochemical Aspects

Neodent Gm Premilled Abutment

It is also known that within a few weeks of implant placement, the stresses acting on the implant repair alter, despite the fact that many IA joints fail early, frequently due to operator mistake.Implant restorative occlusal surfaces should be built with the goal of transferring force across the long axis of the screw wherever possible. This is especially important for single restorations, where bracing from other related implants is absent. In addition to wear, erosion, and attrition, the cyclic function of chewing produces shifting occlusal stresses. Changes in occlusal force are also caused by mesial drift and facial dento-alveolar development. Because of this, occlusion is dynamic. Although teeth may shift and adapt to little changes, dental implants are unable to do the same; as a result, these changes directly affect how linearly forces are applied to them.

According to published research, up to 50% of implants next to natural teeth may become infraocclusal in five years, and interocclusal contacts may lighten in as little as three months, with many of these alterations leading to open contacts. Premature screw loosening events can also be caused by cantilevers, cyclic stress, and bruting, particularly in single-unit restorations.

It is noteworthy, though, because IA joints can sometimes malfunction years later, which is a little confusing from an engineering standpoint. While screws may eventually experience plastic distortion known as creep, it is more likely that the stresses acting on the implant repair have altered since the implant was first inserted.

According to research, dentoalveolar growth and development continue throughout life. Contrary to popular belief, males cease growing around the age of 21, and females cease growing around the age of 15. Research assessing tooth mobility near implants has revealed that alterations in adults between the ages of 40 and 55 are comparable to those in children between the ages of 15 and 21.These occlusion-related modifications will impact the occlusal force applied to the implant, frequently resulting in an increase in lateral loading that can be used to overcome any existing clamping pressures. Human head shape is also known to influence expected growth; people with brachycephaly typically expand laterally, whereas people with dolichocephaly typically grow more anteriorly and downwardly.

Mesial drift is another naturally occurring biological phenomenon that is associated with both interproximal wear and growth. Due to teeth's propensity to slide forward, gaps appear next to implants in around 50% of instances, resulting in lighter and occasionally open contacts.Once more, this kind of tooth movement will alter the stresses acting on the implant repair, perhaps resulting in the IA screw joint failing.

Clinicians may decide to provide patients a nighttime wear retainer to minimize tooth movement and lower the chance of IA screw loosening (much how orthodontists secure the occlusion and tooth position when cases are finished). Occlusions need to be routinely checked and rectified as needed. In the case that an open contact forms, it should be treated right away to avoid any subsequent biological problems, such as caries on a neighboring tooth or peri-implant disease.


IA screw loosening will probably always be a problem in implant dentistry, mostly because it is impossible to manage every natural force that exists within a person's stomatological system. However, the hazards can be minimized with enough knowledge and wise therapeutic treatment. By using this method, you can reduce difficulties, avoid material wear and fracture, create healthier implant sites, and increase the likelihood of positive long-term results.


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