Misfit simulation on implant prostheses with different combinations of engaging and nonengaging titanium bases. Part 1: Stereomicroscopic assessment of the active and passive fit

Statement of problem. Little is known about whether the misfit level of implant-supported screw-retained prostheses can be tolerated when different combinations of engaging and nonengaging titanium bases are used.Purpose. The purpose of this in vitro study was to simulate prosthetic workflow distortions (horizontal and vertical) and to evaluate the fit (passive and active) of 2-implant-supported screw-retained zirconia frameworks with 3 different combinations of abutments: both engaging, engaging and nonengaging, and both nonengaging.Material and methods. The fit of both engaging (n=10), engaging and nonengaging (n=10), and both nonengaging (n=10) 2-implant-supported zirconia frameworks was evaluated on control and definitive casts simulating 50-, 100-, and 150-mu m vertical and 35-, 70-, 100-mu m horizontal misfit levels. Stereomicroscopy was used to assess the passive fit (1 screw tightened) and active fit (both screws tightened) of the zirconia frameworks. Vertical deviations in the implant and abutment connection (the implant-abutment gap measured vertically) between the implant platform and reference line on the titanium base were measured. The Kruskal-Wallis and Mann-Whitney U tests (a=.05) were used to compare different implant-supported zirconia specimens on each definitive cast. Results. When 1 screw was tightened, both engaging specimens had higher vertical deviations (ranging from 40.1 to 131.1 mu m) in 35-and 70-mu m horizontal misfit levels, as compared with engaging and nonengaging (19.8 to 85.1 mu m) and both nonengaging (6.6 to 14.3 mu m) specimens. Comparing medians of the 100-mu m misfit in horizontal (engaging and nonengaging 140.4 mu m; both nonengaging 151.6 mu m) and vertical (engaging and nonengaging 49.8 mu m; both nonengaging 42.6 mu m) directions, the horizontal misfits caused larger vertical deviations. When both screws were tightened in 50-, 100-, and 150-mu m vertical misfit groups, the vertical gap increase in the engaging and nonengaging specimens was significantly higher than that in both the nonengaging specimens (P<.001). Conclusions. As the level of simulated misfit increased, the vertical gap between the implant and abutment increased. Horizontal misfits were less tolerated than vertical ones and may be more detrimental. Both nonengaging 2-implant-supported zirconia frameworks were found to tolerate the different misfit levels better, followed by engaging and nonengaging and both engaging frameworks. (J Prosthet Dent 2023;129:589-96)

Automated summary

This in vitro study aims to evaluate the tolerance of misfit levels in implant-supported screw-retained prostheses with different combinations of engaging and nonengaging titanium bases. The results demonstrate that as the simulated misfit levels increase, the vertical gap between the implant and abutment also increases. Horizontal misfits are less tolerated than vertical misfits and may be more damaging. Both nonengaging 2-implant-supported zirconia frameworks show better adaptation to different misfit levels, followed by engaging and nonengaging and both engaging frameworks.