Brånemark Implant® Abutments

Abstract: The aim of this prospective study was to present the results after 5 years of loading of 65 CeraOne (Nobel Biocare) crowns. Sixty-two implants in the maxilla and 3 implants in the mandible were placed in 57 patients. Sixty-two all-ceramic and three metal-ceramic crowns were cemented. The group comprised the first patients treated with the CeraOne prosthodontic concept. Eight patients did not complete the study. Only one implant failed, giving a cumulative success rate for crowns of 98.5%. The failed implant was replaced: a crown was cemented and then followed for 5 years without any complications. Four crowns were recorded as failures, giving a cumulative success rate for crowns of 93.7%. It should be observed that this result was very positive, as all crown failures were related to extraordinary causes and not one was a result of common bite forces or fatigue, The initial bone loss was in accordance with other studies on Brånemark implants, and a stable situation was recorded after 2 years for the supporting bone around implants and adjacent teeth when the conical implants were excluded. Soft tissues around implants and adjacent teeth appeared healthy, and the cementation and the placement of the abutment shoulder in the peri-implant sulcus did not cause any recession of the peri-implant mucosa.
Conclusions: CeraOne experienced virtually no complications and proved to be a highly predictable and a safe prosthodontic concept. CeraOne also eliminated problems with abutment screw loosening and created a platform for good esthetic results and satisfied patients.

Abstract: A new prosthetic concept, available under the name CeraOne™, for single tooth replacement with the Brånemark system is described. This concept is characterized by a new design of the prefabricated components. A mechanical torque driver is used together with a gold screw and a special counter-torque device to ensure that the screw is tightened in an optimal manner to resist screw loosening and only transmit minor stress to the fixture interface. Another characteristic is the use of a prefabricated cap of sintered aluminum oxide as the basis for the ceramic crown. The crown is cemented to provide better esthetic possibilities even in situations of somewhat unfavorable fixture placement.
Conclusions: The new abutment has been used with clinical success.

Abstract: This is a 2-year report from an ongoing prospective 5-year multicenter study. The aim of the study was to evaluate the short- and long-term clinical function of CerAdapt ceramic abutments supporting short-span fixed partial dentures (FPD). Initially, 105 Brånemark System implants were placed in a total of 32 patients at 3 different clinics. After initial healing 103 implants remained. For the support of 36 FPDs, 53 ceramic and 50 titanium abutments were connected, 19 on ceramic and 17 on titanium abutments. All patients remained in the study after 2 years. There was a cumulative survival rate of 97.1% for implants and a cumulative success rate of 97.2% for FPDs (94.7% for ceramic and 100% for titanium abutment-supported FPDs). One of the 53 ceramic but none of 50 titanium abutments failed, giving a cumulative success rate of 98.1% and 100%, respectively, for the abutments. Soft tissue around abutments and adjacent teeth appeared healthy. More crown margins were placed submucosally at titanium (31%) than at (14%) abutments, and the level of the periimplant musoca was relatively stable in relation to the abutment/crown. No differences were seen between ceramic and titanium abutments regarding bleeding to the periimplant mucosa. There was a minimal marginal bone loss recorded after 1 year, which was lightly more at titanium (0.4mm) than at ceramic (0.2mm) abutments. All patients and dentists were satisfied with the achieved esthetic result and no FPD was remade because of compromised esthetics.
Conclusions: So far the ceramic abutments have worked very well and the 2-yaear results have been very encouraging for CerAdapt abutments supporting short-span FPDs. However, ceramic materials tend to undergo static fatigue, and it is therefore important to wait for the 5-year results before making a more definite statement about the long-term prognosis for CerAdapt abutments.

Abstract: This is the final report of a prospective 5-year multicenter study. The aim was to evaluate short- and long-term clinical function of CerAdapt ceramic abutments compared to titanium abutments supporting short-span fixed partial dentures (FPDs). Initially, 105 Brånemark System implants were placed in a total of 32 patients at three different clinics. One hundred three implants remained after initial healing. Fifty-three ceramic and 50 titanium abutments were connected to support 36 FPDs, 19 on ceramic and 17 on titanium abutments. Thirty patients with 29 of initially 36 inserted FPDs were examined after 5 years. There was a cumulative success rate (CSR) of 97.2% for FPDs (94.7% for ceramic and 100% for titanium abutment-supported FPDs). One of 53 ceramic and none of 50 titanium abutments failed, giving a CSR of 98.1% and 100% respectively. There was a mean marginal bone loss of 0.3 mm and 0.4 mm respectively for ceramic and titanium abutments. Soft tissues around abutments and adjacent teeth appeared healthy and no significant differences were recorded for mucosal bleeding and plaque when ceramic and titanium abutments were compared (P>0.05). Crown margin at FPD insertion was positioned as follows: 21% submucosally, 33% at the mucosal margin and 45% supramucosally. Changes of the mucosal level were recorded as 12% of the abutments with 73% of all changes recorded at ceramic abutments. There was a balance between more or less exposed crown margins during the first 2 years in contrast to the 2-5 year period, when all changes meant less exposed margins. All patients and dentists were satisfied with the achieved esthetic results and no FPD was remade because of compromised esthetics.
Conclusions: The results demonstrate that alumina ceramic abutments supporting short span FPDs work well also in a 5-year perspective with respect to function and esthetics.

Abstract: The aim of the study was to compare results after 1 and 3 years when single crowns supported by CerAdapt (test) ceramic abutments or CeraOne (control) titanium abutments were loaded. The material was divided into two groups: in group A, 69 (34 test, 35 control) abutments/crowns from all involved clinics were followed for 1 year; and in group B, 20 (10 test, 10 control) abutments/crowns from one of the clinics were followed for 3 years. No implant failed, giving a cumulative success rate of 100% for the implants. Two CerAdapt abutments in group A fractured, giving a cumulative success rate of 93% for the CerAdapt and 100% for the CeraOne abutments after 1 year. No abutment failed in group B, giving a cumulative success rate 100 % both for the CerAdapt and the CeraOne abutments between 1 and 3 years. The CerAdapt fractures might have been due to the fact that the abutments were impaired through too-extensive preparation and/or had been exposed to a too-high bending moment. Almost no marginal bone loss was recorded, indicating a stable bone situation both a CerAdapt and CeraOne abutments on single-tooth implants. Healthy conditions, with a relatively stable level of the periimplant mucosa in relation to the abutment/crown, were recorded for soft tissues both at CerAdapt and CeraOne abutments. Both clinicians and patients rated the esthetic result as excellent for practically all cases.
Conclusions: The results demonstrate the esthetic possibilities and the safety of single-tooth replacement when accepted treatment concepts are followed and documented components are used. The tested abutments worked well, although the fractured CerAdapt abutments indicate that ceramic abutments are more sensitive to handling procedures than the titanium abutments.

Abstract: Clinicians who are comfortable with traditional porcelain fused to metal restorations may find the thickness of veneering porcelain addition to the CeraOne single tooth ceramic cap disconcerting. When using a premanufactured ceramic cap to fit the space of the final restoration, substantial amounts of “unsupported” veneer porcelain may be required to achieve tooth contact to adjacent or opposing dentition. A potential problem of weak, unsupported veneer porcelain has been addressed by a modification of an existing manufacturing process.
Conclusions: By using CAD/CAM technology, a custom-designed Procera AllCeram coping can be created for the implant abutment that eliminates any concerns regarding the resultant design of the underlying ceramic cap substructure.

Abstract: This study examined the tightening force transmitted to the implant with and without the use of a counter-torque device during the tightening of the abutment screw. Forty Brånemark implants and 10 CeraOne, Estheticone, Procera, and AuraAdapt abutments formed the experimental populations. Samples in each group were further divided into 2 groups, 1 group was tightened with a torque controller without the use of a counter-torque device, whereas the other used counter-torque device. Samples were positioned in a special holder within the grips of a Tohnichi BTG-6 torque gauge for measuring transmitted forces. There were significant differences (P=.0001) in the tightening forces transmitted to the implant with and without the use of a counter-torque device when tightening the abutment screws.
Conclusions: An average of 91% of the recommended preload tightening torque was transmitted to the implant-bone interface in the absence of a counter-torque device. In all abutments systems, less that 10% of the recommended preload tightening torque was transmitted to the implant when the counter-torque de vice was used. Although the uncontrolled force transmitted as a result of tightening without a counter-torque device is only speculative at this point in time, it may lead to premature loss of implants. The allowable magnitude of force that the implant-bone interface can withstand is presently unknown.

Abstract: The purpose of this investigation was to measure the in-vitro tensile bond strength of two cements when bonding titanium to densely sintered aluminum oxide and titanium to gold. Forty disks of Grade I titanium, twenty (20) disks of densely sintered aluminum oxide (Procera® AllCeram, Nobel Biocare, AB), and twenty (20) gold samples formed the experimental population for this study. The samples were divided among four groups. Group 1 consisted of 10 titanium disks that were bonded to 10 aluminum oxide disks using Fuji Plus. Group 2 consisted of 10 titanium disks bonded to 10 air-abraded gold samples using Fuji Plus. Group 3 consisted of 10 titanium disks bonded to 10 silanated aluminum oxide disks with Panavia 21. Group 4 consisted of 10 titanium disks bonded to 10 air-abraded gold samples with Panavia 21. In each group the cements were applied according to the manufacturers’ instructions. All samples were kept in 100% humidity at room temperature for 7 days following cementation. After 7 days, the 40 samples were subjected to a tensile load using an Instron testing machine at a cross-head speed of 0.5 mm/min. The tensile bond strength for Group 1 or titanium bonded to aluminum oxide using Fuji Plus was 13.60 ± 3.35 MPa. Group 2 or titanium bonded to air-abraded gold using Fuji Plus was 11.32 ± 4.53 MPa. Group 3 or titanium bonded to silanated aluminum oxide disks using Panavia 21 was 15.95 ± 6.25 MPa. Group 4 or titanium bonded to air-abraded gold using Panavia 21 was 16.81 ± 6.14 MPa.
Conclusions: A two-way ANOVA demonstrated a significantly higher bond strength (P> 0.05) for Group 4 or titanium bonded to air-abraded gold using Panavia 21 (16.81 ± 6.14 MPa) as compared to Group 2 or titanium bonded to air-abraded gold using Fuji Plus (11.32 ± 4.53 MPa). No significant differences were found when bonding titanium to aluminum oxide using Fuji Plus (13.60 ± 3.35 MPa) as compared to Panavia 21 (15.95 ± 6.25 MPa).

Abstract: Custom preparable abutments for dental implants require preparation prior to the fabrication of implant supported restorations. The purpose of this study was to determine the implant-abutment joint stability following preparation procedures in an in-vivo simulation, and to evaluate the joint stability after repeated tightening and loosening of retaining screws. Nobel Biocare implant/custom abutment units were used in this study. Thirty implant/abutment samples were divided into 3 groups. Group 1 consisted of 10 Brånemark® 3.75 mm implants with 10 TiAdapt® Regular Platform (RP) abutments. Group 2 consisted of 10 Brånemark® 3.3 mm implants with 10 Narrow Platform (NP) abutments. Group 3 consisted of 10 Brånemark® 5.0 mm implants with 10 Wide Platform (WP) abutments. The abutments were placed on their respective implant samples aand tightened to the appropriate level for each implant/abutment system Each group was further subdivided into 2 groups (A and B) with 5 abutments in each group. Group A abutments were prepared with appropriate instrumentation and Group B was not prepared and served as the controls. A Tohnichi BTG-6 torque gauge was used to record the force required to loosen the abutment from the implant following preparation. Following the recording of the initial loosening data, each sample was retighten and loosened again and the data recorded. Tighten-loosening procedure was repeated for five sequences for each sample. Data was analyzed with the Student’s t-test, an analysis of variance, and the Post-Hoc test for multiple comparisons.
Conclusions: The mean de-torque value for the prepared NP implant/abutment samples were significantly different from the mean de-torque value of the NP implant/abutment control samples. No significant differences were observed between the 5 tightening-loosening sequences with the RP implant/abutments but a significant difference was found for both NP and WP groups. The Post-Hoc test demonstrated that there was a significant difference between the first loosening of the retaining screw and the other 4 tightening-loosening sequences in the NP and WP implant/abutments. In this in-vivo simulation model, the preparation of titanium custom abutments did not appear to negatively effect the torque-to-loosen the retaining screws.

Abstract: The purpose of this study was to determine the implant/abutment joint stability following preparation procedures using the Nobel Biocare Ceradapt® abutment. Two groups formed the experimental populations. Group 1 consisted of ten (10) Ceradapt abutments combined with ten (10) Brånemark 3.75 mm Regular Platform implants. One (1) implant and one (1) abutment formed a sample. Group 1 was further subdivided into two groups of five (5) samples. For Group 1A, the abutment preparation involved the total length of the abutment. For Group 1B, the abutment preparation involved only the incisal one-third. Group 2 consisted of five (5) Ceradapt abutments combined with five (5) Brånemark 3.75 mm Regular Platform implants. The samples in Group 2 formed the controls that were not prepared. The abutments in Groups 1 and 2 were positioned onto their respective implants and the abutment screws were tightened using the appropriate tightening torque. Samples in Groups 1A and 1B were then prepared according to the preparation guidelines. Following preparation a Tohnichi BTG-6 torque gauge was used to record the force needed to loosen the abutment screws in Groups 1 and 2. The mean torque required to loosen the abutment screws in Group 1A = 24.43 Ncm. The mean torque for Group 1B = 21.41 Ncm. The mean torque for the control Group 2 = 21.70 Ncm. The loosening torque data were subjected to a One-way ANOVA. No significant differences were found when the screw loosening data for Groups 1A and 1B were compared to Group 2.
Conclusions: Preparation of the Ceradapt® abutment when positioned onto a Brånemark 3.75 mm Regular Platform implant does not significantly effect the screw joint stability at the abutment/implant interface.

Abstract: Implant transmucosal abutments fabricated in densely sintered aluminum oxide have been developed for attachment to titanium implants. While offering the advantages of improved esthetics with excellent biocompatibility, the potential for micromovement of the abutment and possible damage to the bearing surface of the implant has not been investigated. The purpose of this investigation was to measure the wear of titanium when opposed by aluminum oxide or titanium in a simulated in-vivo environment. A specially designed wear machine was used to measure the vertical loss in height of titanium abraders that opposed disks of aluminum oxide and titanium. Titanium abraders were positioned in contact opposing sample disks of aluminum oxide or titanium. The abrader was rotated against the opposing disk for 10,000 cycles in a simulated oral environment under a load of 454 gms. Wear was reported as mean wear in microns and the data was analyzed using an analysis of variance (ANOVA).
Conclusions: The wear of the titanium abrader when opposed by aluminum oxide was 192 microns while the wear of the titanium abrader when opposed by titanium was 165 microns. The analysis of variance demonstrated that although a higher wear was observed for titanium when opposed by aluminum oxide no significant difference was found when compared to the wear of titanium when opposed by titanium P=0.39).

Abstract: Eight clinics in Europe and the United States will participate in this study. This aim of the project is to evaluate the short- and long-term clinical function of Al2O3 ceramic abutments with regard to hard and soft tissue reactions. The study is also evaluating the mechanical function of the ceramic abutments. The patients included in this study will receive one or two single-tooth restorations in the premolars, canines or incisors regions. The CeraOne abutment will be used as a control abutment, and the choice between a test or a control abutment will be made according to a randomization procedure. Patients included in this study will be followed for five years according to a specific study design with scheduled follow-up visits.

Abstract: The purpose of this project is to evaluate the influence of the external hexagon of the implant and the internal hexagon of the abutment on the implant/abutment interface and screw joint stability for the CeraOne abutment. The null hypothesis to be tested will be: “There is no change in the screw joint stability following an application of a cyclic light functional load when the interface between the implant fixture hex head and the abutment component internal hex are in tight contact as compared to the joint stability under conditions of a minimal and non-existent hex interlock.” The experimental design for this project will require the establishment of three populations. The first population (A) will examine the screw joint stability in the presence of the normal hex interlock. Condition (B) will examine the joint stability under the condition of a minimal hex interlock and condition (C) will examine a non-existent hex interlock. Five samples will form the experimental populations for each condition. Each condition will be examined using the Universal Instron testing device under conditions of a cyclic light functional load. Data from this project will be correlated with a similar experiment using the finite element method.