Falhas relacionadas aos parafusos de retenção de próteses implantossuportadas

AUTORES

Gabriel Leonardo Magrin
Pós-doutorando em Implantodontia – Universidade Federal de Santa Catarina.
Orcid: 0000-0003-0724-0560.

Ana Clara Kuerten Gil
Mestranda em Implantodontia – Universidade Federal de Santa Catarina.
Orcid: 0000-0001-5544-8310.

César Augusto Magalhães Benfatti
Professor associado – Universidade Federal de Santa Catarina.
Orcid: 0000-0002-4209-0054.

RESUMO

Objetivo: a fratura e o afrouxamento de parafusos protéticos são complicações frequentes na prática clínica. Portanto, o objetivo deste artigo foi revisar a literatura científica a respeito das falhas relacionadas aos parafusos de retenção de próteses implantossuportadas. Material e métodos: foi empregada uma metodologia de pesquisa bibliográfica buscando artigos relacionados ao tema nas bases de dados PubMed e Google Scholar. A seleção dos artigos foi feita a partir da leitura dos títulos e, em seguida, dos resumos. A partir da leitura dos textos na íntegra, foram selecionados os estudos a serem incluídos nesta revisão. Resultados: apertos manuais de parafusos, perda de pré-carga, regime oclusal inadequado, entre outros fatores, são os principais responsáveis pelo afrouxamento ou fratura dos parafusos protéticos. Estudos longitudinais demonstraram que as falhas de parafuso aumentam com o passar do tempo, principalmente após o período de cinco anos em função. Fraturas de parafuso são menos comuns do que os afrouxamentos e, muitas vezes, a fratura é uma consequência do afrouxamento ao longo do tempo. Conclusão: sugere-se, a partir dessa revisão, que os afrouxamentos e fraturas de parafuso derivam da sobrecarga mecânica gerada sobre o sistema protético parafusado. O controle dos fatores causais, como a perda de pré-carga e os constantes reapertos do parafuso, poderia diminuir a ocorrência destas falhas.

Palavras-chave – Falha de restauração dentária; Prótese dentária fixada por implante; Parafusos protéticos; Implantes dentários.

ABSTRACT

Objective: fracture and loosening of prosthetic screws are frequent complications in the clinical practice. Therefore, the aim of this article was to review the scientific literature regarding failures related to retention screws in implant-supported prostheses. Material and methods: a bibliographic search method was employed based on articles related to the topic in PubMed (MEDLINE) and Google Scholar databases. To select the articles, first, the title reading was performed, followed by the reading of abstracts. After full-text reading, selected studies were finally included in this review. Results: manual screw tightening, preload loss, inadequate occlusal regimen, among other factors, are the main factors responsible for loosening or fracture of prosthetic screws. Longitudinal studies have shown that screw failures increase over time, especially after a 5-year period of function. Screw fracture is less common than loosening, and it is frequently a consequence of loosening over time. Conclusion: based on this review, it can be suggested that screw loosening and fracture derive from the excessive mechanical load on the implantsupported prosthetic system. The control of etiological factors, such as the loss of preload and constant screw retightening, could reduce the occurrence of those failures.

Key words – Dental restoration failures; Implant-supported protheses; Prosthetic screws; Dental implants.

Recebido em fev/2022
Aprovado em mai/2022

Referências

Albrektsson T, Zarb G, Worthington P, Eriksson AR. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Int J Oral Maxillofac Implants 1990;5(4):347-59.

Chochlidakis K, Fraser D, Lampraki E, Einarsdottir ER, Barmak AB, Papaspyridakos P et al. Prosthesis survival rates and prosthetic complications of implant-supported fixed dental prostheses in partially edentulous patients. J Prosthodont 2020;29(6):479-88.

Chrcanovic BR, Kisch J, Larsson C. Retrospective clinical evaluation of implant-supported single crowns: mean follow-up of 15 years. Clin Oral Implants Res 2019;30(7):691-701.

Jung RE, Zembic A, Pjetursson BE, Zwahlen M, Thoma DS. Systematic review of the survival rate and the incidence of biological, technical, and aesthetic complications of single crowns on implants reported in longitudinal studies with a mean follow-up of 5 years. Clin Oral Implants Res 2012;23(suppl.6):2-21.

Carlsson GE. Dental occlusion: modern concepts and their application in implant prosthodontics. Odontology 2009;97(1):8-17.

Bickford Jr. JH. An introduction to the design and behavior of bolted joints. New York: Marcel Dekker, 1981. p.528-42.

Patel RD, Kan JYK, Jonsson LB, Rungcharassaeng K. The use of a dental surgical microscope to aid retrieval of a fractured implant abutment screw: a clinical report. J Prosthodont 2010;19(8):630-3.

Magrin GL, Dalago HR, Filho GS, Rodrigues MAP, Junior NDB, Benfatti CAM et al. Avaliação transversal retrospectiva do desempenho clínico dos parafusos protéticos do sistema Implacil De Bortoli com cinco ou mais anos em função. ImplantNews 2014;2(4)514-8.

Jemt T. Failures and complications in 391 consecutively inserted fixed prostheses supported by Brånemark implants in edentulous jaws: a study of treatment from the time of prosthesis placement to the first annual checkup. Int J Oral Maxillofac Implants 1991;6(3):270-6.

Naert I, Quirynen M, van Steenberghe D, Darius P. A study of 589 consecutive implants supporting complete fixed prostheses. Part II: prosthetic aspects. J Prosthet Dent 1992;68(6):949-56.

Korsch M, Walther W. Retrospective analysis of loosening of cement-retained vs screw-retained fixed implant-supported reconstructions. Quintessence Int 2015;46(7):583-9.

Gross M, Zozak D, Laufer BZ, Weiss EI. Manual closing torque in five implant abutment systems: an in vitro comparative study. J Prosthet Dent 1999;81(5):574-8.

Cardoso M, Torres MF, Lourenço EJV, Telles DM, Rodrigues RCS, Ribeiro RF. Torque removal evaluation of prosthetic screws after tightening and loosening cycles: an in vitro study. Clin Oral Implants Res 2012;23(4):475-80.

Siamos G, Winkler S, Boberick KG. Relationship between implant preload and screw loosening on implant-supported prostheses. J Oral Implantol 2002;28(2):67-73.

Martin WC, Woody RD, Miller BH, Miller AW. Implant abutment screw rotations and preloads for four different screw materials and surfaces. J Prosthet Dent 2001;86(1):24-32.

Barbosa GAS, Bernardes SR, das Neves FD, Neto AJF, de Mattos MGC, Ribeiro RF. Relation between implant/abutment vertical misfit and torque loss of abutment screws. Braz Dent J 2008;19(4):358-63.

Adell R, Eriksson B, Lekholm U, Brånemark PI, Jemt T. Long-term follow-up study of osseointegrated implants in the treatment of totally edentulous jaws. Int J Oral Maxillofac Implants 1990;5(4):347-59.

Ramamoorthi M, Narvekar A, Esfandiari S. A meta-analysis of retention systems of implant-supported protheses in partially edentulous jaws. J Prosthet Dent 2017;118(5):587-95.

Imam AY, Moshaverinia A, Chee WWL, McGlumphy EA. A technique for retrieving fractured implant screws. J Prosthet Dent 2014;111(1):81-3.

Ow RK, Ho KH. Retrieval of the resilient element in an osseointegrated implant system. J Prosthet Dent 1992;68(1):93-5.

Paiva MSM, Oliveira SN, Dias JVA, Queiroz JRC, Oliveira EA, Júnior ACF. Influência do tipo de conexão (quadrado ou hexagonal) na resistência à deformação do conjunto chave-parafuso de retenção de prótese sobre o implante. Full Dent Sci 2017;8(31):68-73.

Huang Y, Wang J. Mechanism of and factors associated with the loosening of the implant abutment screw: a review. J Esthet Restor Dent 2019;31(4):338-45.

Vetromilla BM, Brondani LP, Pereira-Cenci T, Bergoli CD. Influence of different implant-abutment connection designs on the mechanical and biological behavior of single-tooth implants in the maxillary esthetic zone: a systematic review. J Prosthet Dent 2019;121(3):398-403.

Cibirka RM, Nelson SK, Lang BR, Rueggeberg FA. Examination of the implant-abutment interface after fatigue testing. J Prosthet Dent 2001;85(3):268-75.

Vigolo P, Gracis S, Carboncini F, Mutinelli S, AIOP (Italian Academy of Prosthetic Dentistry) Clinical Research Group. Internal– vs external-connection single implants: a retrospective study in an Italian population treated by certified prosthodontists. Int J Oral Maxillofac Implants 2016;31(6):1385-96.

Riedy SJ, Lang BR, Lang BE. Fit of implant frameworks fabricated by different techniques. J Prosthet Dent 1997;78(6):596-604.

Byrne D, Houston F, Cleary R, Claffey N. The fit of cast and premachined implant abutments. J Prosthet Dent 1998;80(2):184-92.

Jorge JRP, Barão VAR, Delben JA, Assunção WG. The role of implant/abutment system on torque maintenance of retention screws and vertical misfit of implant-supported crowns before and after mechanical cycling. Int J Oral Maxillofac Implants 2013;28(2):415-22.

Winkler S, Ring K, Ring JD, Boberick KG. Implant screw mechanics and the settling effect: overview. J Oral Implantol 2003;29(5):242-5.

Haack JE, Sakaguchi RL, Sun T, Coffey JP. Elongation and preload stress in dental implant abutment screws. Int J Oral Maxillofac Implants 1995;10(5):529-36.