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The Effect of Different Implant-Abutment

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The in vitro effect of different implant

angulations and cyclic dislodgement on
the retentive properties of an
overdenture at tachment system
Suhail Ali Al-Ghafli, BDS, MS,a Konstantinos X. Michalakis,
DDS, MSc, PhD,b Hiroshi Hirayama, DDS, DMD, MS,c and Kiho
Kang, DDS, DMD, MSd
Tawam Hospital, Al-Ain, United Arab Emirates; Tufts University
School of Dental Medicine, Boston, Mass; Aristotle University
School of Dentistry, Thessaloniki, Greece
Statement of problem. The retentive capacity of ball attachments may be altered by a change in implant angulations.
Purpose. The purpose of this in vitro study was to investigate the effect of cyclic dislodgement on the retention of an
overdenture attachment system when 2 implants were placed at angulations of 0, 5, 10, 15, and 20 degrees.
Material and methods. Twelve acrylic resin blocks were fabricated and divided into 6 groups of 2 pairs each. In each
of the 6 groups, 1 acrylic resin block was used to house the implants (block A), while the other (block B) was used
to house the overdenture attachments. Two implants positioned at 0/0 degrees, with a standard plastic component
(white) designed for 0-degree angulations, served as a control (CTRL), while the other 5 pairs of implants were placed
in 5 different angulations: 0D: 0/0 degrees, 5D: 5/5 degrees, 10D: 10/10 degrees, 15D: 15/15 degrees, 20D: 20/20
degrees (n=5). The extended range (green color) attachment was used for all groups except the control group. Implants (4.3 mm x 13 mm, internally hexed) were placed in blocks B. All angled implants were mesially tilted. Thirty
pairs of attachments (Locator) were used. Dislodging cycles were applied to the overdenture attachment system. The
initial retentive forces among the groups were not identical. The cycles required for the retentive forces of the attachments to decrease from the initial values to 60 N, and then to 40 N and 20 N, were recorded for standardization purposes. One-way ANOVA and Tukey HSD tests were used to analyze the difference in retention loss among the 6 groups
(=.05). A regression analysis (=.05) was also performed to investigate the relationship between the implant angulation, the retentive force, and the logarithm of the number of cycles required for ball attachment retention decrease.
Results. The 1-way ANOVA and the Tukey HSD tests revealed significant differences for the number of cycles required
by different implant angulation groups for the initial retentive values to decrease to 60 N, 40 N, and 20 N (P<.001).
The 0D and 5D groups required the longest time for retention loss, while 20D and CTRL groups demonstrated the
shortest time for retention loss. The results of the regression analysis of the logarithmic number of cycles on retentive
force and implant angulation demonstrated a significant effect (P<.001).
Conclusions. Implant angulations negatively affect attachment retention longevity. (J Prosthet Dent 2009;102:140147)

Clinical Implications

Based on the results of this study, implants should be placed

parallel to each other and perpendicular to the horizontal plane
for the nylon component of the attachment system evaluated to
retain its retentive capacity for a longer period of time.
a
Consultant, Tawam Hospital; Adjunct Instructor, Department of Operative Dentistry and Prosthodontics, Division of Graduate
and Postgraduate Prosthodontics, Tufts University School of Dental Medicine.
b
Adjunct Associate Professor, Department of Prosthodontics and Operative Dentistry, Division of Graduate and Postgraduate
Prosthodontics, Tufts University School of Dental Medicine; Assistant Professor, Department of Removable Prosthodontics, Aristotle University School of Dentistry; private practice, Thessaloniki, Greece.
c
Professor, Director of Graduate and Postgraduate Prosthodontics, Tufts University School of Dental Medicine.
d
Clinical Associate Professor, Department of Operative Dentistry and Prosthodontics, Division of Graduate and Postgraduate
Prosthodontics, Tufts University School of Dental Medicine.

The Journal of Prosthetic Dentistry

Al-Ghafli et al

141

September 2009
Edentulous patients with severely
resorbed mandibles may experience
problems with conventional dentures
because of impaired load-bearing capacity. These problems include pain
during mastication, as well as insufficient stability and retention of the
denture.1 Perhaps the most significant
biological condition associated with
loss of stability and retention in mandibular complete dentures is physiological alveolar ridge resorption,
which also results in diminished oral
tissue volume for denture support.2
It is not always possible to achieve
optimal results using conventional
complete denture treatment. Therefore, alternatives should be considered. When satisfactory denture support is present, denture adhesives
can improve the treatment outcome.
However, when problems arise from
inadequate supporting tissue volume
for the mandibular denture, denture
adhesives can prove inadequate.3 Alveolar ridge augmentation using a
variety of natural and synthetic materials has been suggested as an alternative to increase supporting tissue
volume.4 Similarly, alveoloplasty and
tissue extension procedures have been
used to expose additional intraoral
tissues. Muscles can also be repositioned to increase denture support. It
should be noted, however, that these
treatments have occasionally introduced significant complications and
morbidity.5
Studies have shown that unsatisfactory retention and stability can
be successfully managed by fabricating a fixed prosthesis supported by 5
or 6 endosseous implants.6-9 Another
treatment modality used to provide
predictable retention and stability for a severely resorbed mandible
is mandibular implant overdenture
treatment. This treatment has a reported implant survival rate of 94.5100%.10,11
Currently, the placement of 2
implants and the fabrication of an
implant-retained overdenture is considered by some to be the standard of
care.12 Implants can be used in con-

Al-Ghafli et al

junction with attachments to enhance

the retention and stability of overdentures.13 Many different attachments
are currently available. Most of these
attachments are compatible with the
majority of implant systems.
Attachment systems used for implant-retained overdentures are divided into 2 major categories: bars and
balls.14-16 The bar systems are used
to splint the implants, and they provide different degrees of movement
towards the tissue, depending on the
specific cross-sectional shape. Balltype attachments are used on solitary
abutments. Ideally, ball attachments
should be parallel to each other to
provide ease of insertion and removal
and reduce wear potential.17 The selected attachments for an implant
overdenture should have adequate retentive properties to enhance the retention of the prosthesis. At the same
time, the attachments should allow
for easy placement and removal of the
prosthesis by the patient.18
Implant-retained overdentures using ball-type retentive attachments
have been shown to be a successful
and cost-effective oral rehabilitation
approach for edentulous individuals
with resorbed mandibular ridges.19
Despite the popularity of these attachments, postinsertion maintenance of both the ball and bar attachments used for implant-retained
overdentures is high.15,20,21 Nevertheless, there is little information available regarding: (1) the required retention for masticatory efficiency, and
(2) the wear resistance of the components.
Caldwell22s tudiedtheadhesive
nature of foods and calculated that
a mandibular distal extension removable partial denture with acrylic
resin teeth would require a retaining
force of 15 to 20 N, when sticky toffee was masticated. This force would
be reduced to about 10 N for normal
foods. It would therefore be logical
to assume that an attachment would
require a retentive capacity of 10 to
20 N to maintain the denture in position.23,24 In another in vitro study,25 the

maximum dislodging forces ranged

between 27 and 37 N. On the basis of
these findings, the authors concluded
that the clinician may be able to make
empirical decisions regarding attachment selection, depending on the
amount of retention desired and the
specific clinical situation.25,26
Gamborena et al27 investigated
the retention of 4 different colorcoded ERA attachments (Sterngold
Dental; Attleboro, Mass) prior to and
after various levels of fatigue loading. After a simulated 3 years of attachment placement and removal,
an overall retention loss ranged from
80% to 85%. The retentive forces and
wear of commercially available attachments of 4 implant systems: 3i
(Biomet 3i, Palm Beach Gardens,
Fla), Friatec/IMZ (Friadent GmbH,
Mannheim, Germany), Nobel Biocare
(Nobel Biocare USA, Yorba Linda,
Calif ) and ITI Straumann (Straumann
Co, Waltham, Mass) have also been
described.28 After 15,000 cycles, most
of the attachments showed little loss
of retention compared to the initial
retentive forces. It was concluded that
conventional fatigue tests with applied axial loads do not simulate clinical fatigue adequately. Stewart and
Edwards29 tested the wear and the
retentive properties of 5 precision attachments, and concluded that each
attachment behaved differently. For 1
attachment, an increase of retentive
forces similar to those that occurred
in the initial cycles of the study was
found. An increase in the retention in
the first 100-120 cycles of each model
was demonstrated, and then the retention decreased gradually during
the experiment. The authors suggested that the initial increase could be
due to an increase in surface roughness after initial wear occurred.
Although there has been ample research on the retentive properties of
different attachments, there is limited
information as to whether implant
angulation has an effect on prosthesis retention. Gulizio and Taylor30 investigated the retention of gold and
titanium overdenture attachments

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Volume 102 Issue 3

when placed on ball abutments positioned off axis. Four ball abutments
hand tightened on ITI dental implants
(Institut Straumann AG, Basel, Switzerland) were placed in an aluminum
device that allowed positioning of the
implants at 0, 10, 20, and 30 degrees
from a vertical reference axis. Gold
and titanium matrices were coupled
to ball abutments at various angles
and then subjected to pull tests at a
rate of 2 mm/s. Gold matrices used
for the testing produced consistent
retention values when compared to
titanium matrices. The study demonstrated that there was a large variability in retention. It was also shown that
angle had an effect on the retention
of gold matrices, but not on the retention of titanium matrices.
The purpose of this in vitro study
was to evaluate the retention of mandibular overdenture attachments
placed on 2 implants at different
angles (0, 5, 10, 15, or 20 degrees)
and to estimate the longevity of the
attachment system. The null hypothesis was that mandibular overdenture
attachment retention longevity would
not be affected by different implant
angulations.

MATERIAL AND METHODS

A rectangular wooden box with internal dimensions of 15 x 30 x 60 mm
was fabricated for this study. Both
the bottom and top of the box were
removable. Autopolymerizing polymethyl methacrylate (PMMA) acrylic
resin (Coldpac; Yates-Motloid Co,
Chicago, Ill) was mixed according to
the manufacturers instructions and
injected into the wooden box. The
cover of the box was placed on top
and secured with rubber bands, and
the assembly was placed in a compression chamber (Wiropress; BEGO, Bremen, Germany) using 3 bars of pressure for 15 minutes. Twelve 15 x 30 x
60-mm acrylic resin blocks were fabricated and divided into 6 groups of 2
pairs each. In each of the 6 groups, 1
acrylic resin block was used to house
the dental implants (block A), while

the other block (block B) was used to

house the overdenture attachments.
Two pin holes were drilled (Pindex
machine; Coltne/Whaledent, Inc,
Cuyahoga Falls, Ohio) at a distance
of 6 mm from the edges of each of
the acrylic blocks A. Three-mm-diameter pins (Pindex Pins; Coltne/
Whaledent, Inc) were stabilized in the
holes by friction only. The collars of
the pins were flush with the bases of
the acrylic blocks. The corresponding
plastic sleeves were then placed over
the pins, with the flat sides of their
bases facing each other.
Each of the acrylic blocks with
the pin and sleeve was coupled to a
second acrylic resin block (B) with
corresponding holes. The sleeves
were inserted into the holes of block
B passively. An acrylic resin mixture
was then used to reline the sleeve in
block B and allowed to polymerize
for 20 minutes. A surgical drill bur
(Navigator Twist Drill; Biomet 3i) was
attached to a slow-speed handpiece
(Biomet 3i) mounted on the vertical
arm of a milling machine (MP 3000;
Metalor Technologies SA, Neuchatel,
Switzerland), and 2 holes were drilled
at a distance of 15 mm from the edges
of the acrylic resin blocks B, for the
placement of 2 implants at 5 different angulations relative to the vertical
axis (0, 5, 10, 15, or 20 degrees). The
angulations were determined with a
goniometer (Gottlieb Nestle GmbH,
Dornstetten, Germany) in relation
to the vertical axis. Two 4.3 mm x
13-mm internally hexed implants
(Biomet 3i) were then placed using
a slow-speed handpiece (Biomet 3i)
mounted on the milling machine. All
angled implants were mesially tilted.
Attachments (Locator; Zest Anchors,
Inc, Escondido, Calif ) were used. The
matrix component was attached to
each implant, while the patrix component (Extended Range, Green; Zest
Anchors, Inc) was then attached to
the matrix. This patrix component
was chosen because, according to the
manufacturer, it allows angle correction of up to 40 degrees between divergent implants. The white standard

The Journal of Prosthetic Dentistry

patrix components were used as a

control.
Two holes were then drilled in
acrylic blocks A for placement of the
attachment patrix components. Autopolymerizing acrylic resin (Coldpac; Yates-Motloid Co) was used to
incorporate the patrix components
into acrylic blocks A and allowed to
polymerize for 15 minutes. The pins
(Pindex Pins; Coltne/Whaledent,
Inc) were then removed from blocks
A.
After completion of implant placement, the following 6 groups were
formed: (1) control (CTRL): 2 implants positioned parallel to each other and perpendicular to the horizontal
plane, with a standard plastic component (white), designed for use with
implants that have no angulations;
(2) 0D: 2 parallel implants; (3) 5D: 2
implants angulated at 5 degrees; (4)
10D: 2 implants angulated at 10 degrees; (5) 15D: 2 implants angulated
at 15 degrees; (6) 20D: 2 implants
angulated at 20 degrees (n=6). For
all angulated implants, the extended
range (green) patrix component was
used.
Block B was attached on the instruments fixed table, while block A
was attached to the upper, movable
member. The assembly was placed in
a plastic container filled with saliva
substitute (Oralube; Orion Laboratories Pty Ltd, Balcatta, Australia).
Five pairs of attachments were tested
for each of the 6 groups. Dislodging
cycles were applied to the overdenture
attachment system using a texture
analyzer (TA.XT2i Texture Analyser;
Stable Micro Systems Ltd, Godalming, Surrey, UK), which was connected
to a personal computer (VAIO; Sony
Corp, Tokyo, Japan). Appropriate
software (Exponent; Stable Micro Systems Ltd) was used for the collection
of the data and analysis of the retention reduction. Dislodging cyclic forces were applied in a vertical direction
at a rate of 10 cycles/min. The forces
applied were the minimum for attachment dislodgement, and they were automatically adjusted throughout the

Al-Ghafli et al

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September 2009

Table I. Percentage of retention decline in each cycle for all groups (n=5)
Control
Percentage
(%)

Mean
Force
ORC* (N)

0D

5D

Mean
Mean
Force
Force
ORC* (N) ORC* (N)

10D

15D

20D

Mean
Force
ORC* (N)

Mean
Force
ORC* (N)

Mean
Force
ORC* (N)

100

81.31

81.75

91.94

104.72

84.86

78.04

75

217

60.98

484

61.31

514

68.96

243

78.54

371

63.65

180

58.53

50

598

40.66

1217

40.87

1220

45.97

725

52.36

914

42.43

581

39.02

25

2313

20.33

6497

20.40

4990

22.99

2949

26.18

3210

21.22

2234

19.51

*ORC: overdenture removal cycles

experiment.
Under normal circumstances,
a patient places/removes an overdenture prosthesis 4 times each day
(in the morning (placement), after
breakfast, after lunch, after dinner
(removal and replacement), and before bedtime (removal)).31 Based on
this assumption, time was calculated
by the equation:
Days = Number of cycles / 4
The attachments included in this
study were tested for loss of retention after being subjected to 720
(6 months), 1440 (1 year), 2880 (2
years), 7200 (5 years), and 14,400
(10 years) cycles of overdenture removal.31,32 According to the studies of
Caldwell,22 Walmsley et al,23 and Petropoulos et al,25,26 it can be assumed
that an initial retentive force of 20 N
is sufficient for overdentures in the
edentulous mandible. Consequently,
retention loss (and estimated replacement time), was defined as the number of cycles required for the dislodgement force to drop below 20 N.
The initial retentive forces among
the groups were not identical. In 4
of the 6 groups included, it was observed that the initial retentive values
were in the range of 80 N. The mean
initial retentive values of the 2 remaining groups (5D and 10D) were 91.94
N and 104.72 N, respectively (Table
I). As a result, the loss of attachment
retention was difficult to compare.
Therefore, the dislodging retentive

Al-Ghafli et al

forces among the 6 groups had to be

standardized. The cycles required for
the attachments retentive forces to
decrease from the initial values to 60
N, and then to 40 N and 20 N, were
recorded for standardization purposes, and they corresponded approximately to the 75%, 50%, and 25% of
the total retentive force of each ball
attachment. The values identified for
inclusion in analysis were selected
from a computer-generated data set
which contained the calculated average retentive values from 5 separate
tests within each of the 6 implant angulated groups.
One-way ANOVA (=.05) was
used to analyze the difference in retention loss (the number of days it
took for retentive values to drop below 20 N) among the 6 groups. Tukey
HSD test (=.05) was used to determine the existence of statistically significant differences. A regression analysis (=.05) was also performed to
investigate the relationship between
the implant angulation, the retentive
force, and the logarithm of the number of cycles required for ball attachment retention decrease. Statistical
software (SAS, version 9.1; SAS Institute, Inc, Cary, NC) was used for the
statistical analysis.

RESULTS
The results of the 1-way ANOVA
for the number of cycles required for

the retentive forces to decrease from

the registered initial values to 60 N
revealed a significant effect for the
different implant angulation groups
(F=25.92, P<.001). Group 5D demonstrated the greatest number of
cycles, while CTRL and 20D demonstrated the smallest number of cycles
to decrease to the 60-N level, and no
significant difference was detected
between these 2 groups. Groups 0D,
10D, and 15D did not present significant differences (Table II).
The results of the 1-way ANOVA
for the cycles required for the retentive forces to drop to the 40-N level
were significantly different (F=22.34,
P<.001). Group 5D demonstrated
the greatest number of cycles before
reaching the 40-N level. No significant difference was found between
groups 5D and 0D (P=.055). Groups
0D, 10D, and 15D did not present
significant differences (P=.172). No
significant difference was found between groups 15D and 20D (P=.229),
or between groups 20D and CTRL
(P=.733) (Table III).
The results of the 1-way ANOVA showed a significant difference
for the number of cycles that each
group required to reach the 20-N
level (F=36.75, P<.001). Group 5D
demonstrated the greatest number of
cycles before reaching the 20-N level.
No significant difference was detected
between groups 5D and 0D (P=.235).
Groups 10D and 15D did not pres-

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Volume 102 Issue 3

Table II. Mean (SD) cycles, per group, for retentive force to decline from initial value to 60 N (n=5)
Group

Overdenture Removal
Mean Cycles (SD)

Time of Mean
(Months/Days)

Group
Comparison*

Control

242.40 (37.51)

2M

0D

546.40 (47.50)

4M/17D

5D

753.40 (103.59)

6M/7D

10D

571.80 (102.56)

4M/24D

15D

422.20 (139.97)

3M/15D

20D

235.40 (54.79)

2M

*Means with same uppercase letter are not significantly different (P>.05), according to Tukey
HSD test.

Table III. Mean (SD) cycles, per group, for retentive force to decline from initial value to 40 N (n=5)
Group

Overdenture Removal
Mean Cycles (SD)

Time of Mean
(Years/Months/Days)

Group
Comparison*

Control

655.00 (109.75)

5M/14D

0D

1281.40 (174.29)

10M/20D

CD

5D

1590.60 (167.84)

1Y/1M/7D

10D

1187.40 (170.78)

9M/27D

15D

1030.40 (202.06)

8M/12D

BC

20D

796.00 (118.59)

6M/19D

AB

*Means with same uppercase letter are not significantly different (P>.05), according to Tukey
HSD test.

Table IV. Mean cycles, per group, for retentive force to decline from initial value to 20 N (n=5)
Group

Overdenture Removal
Mean Cycles (SD)

Time of Mean
(Years/Months/Days)

Group
Comparison*

Control

2399.80 (396.03)

1Y/8M

0D

6974.00 (396.78)

4Y/10M/4D

5D

8300.40 (1863.19)

5Y/9M/5D

10D

4977.00 (863.14)

3Y/5M/14D

15D

3553.80 (683.06)

2Y/5M/18D

AB

20D

2272.60 (115.73)

1Y/6M/28D

*Means with same uppercase letter are not significantly different (P>.05), according to Tukey
HSD test.

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Al-Ghafli et al

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September 2009

Table V. Regression analysis of logarithmic number of cycles on angle and retentive force
Model

Sum of
Squares

df

Mean
Square

290.76

<.001

Regression

74.76

24.92

Residual

6.09

71

0.09

Total

80.85

74

Unstandardized Coefficients
Model

Standard
Error

Constant

10.12

0.155

Angle

0.06

0.013

0.41

Force

0.06

0.004

Angle x force

<0.001

<0.001

ent significant differences (P=.175),

nor was a significant difference found
among groups 15D, CTRL, and 20D
(P=.267) (Table IV).
The results of the regression analysis of the logarithmic number of cycles
on retentive force and implant angulation demonstrated a significant effect (F=290.92, P<.001). However,
the interaction of implant angulation
and retentive force did not exhibit a
significant effect (P=.219) (Table V).

DISCUSSION
The present in vitro study investigated the effect of implant angulation and cyclic dislodgement on the
retentive properties of green ball attachments. The results of this study
indicate that implant angulations
negatively affect the attachment retention longevity. Therefore, the null
hypothesis is rejected.
Retentive forces of attachments
found in this study are in agreement
with those reported previously in the
literature. Setz et al28 reported that
retentive forces of ball attachments
range from 3 to 85 N, while Petropoulos et al4 reported that the retentive
forces for ball attachments ranged
from 27.2 4.2 to 34.6 18.8 N.
The results of the present study

Al-Ghafli et al

Standardized
Coefficients
t

65.32

<.001

4.75

<.001

0.97

17.14

<.001

0.12

1.24

.219

Beta

demonstrated a gradual decrease in

retention during the cyclic dislodgement in all 6 groups (control, 0, 5, 10,
15, and 20 degrees). An important
finding is that the same pattern of retention decrease was demonstrated
for all groups in this study.
This study provided each model
with a standard condition to eliminate variables which might affect the
results. As previously explained, the
initial retentive force of each model of
the same group is not identical. This
fact could be due to small differences
occurring during the manufacturing
process. As previously mentioned, the
majority of the implant angulation
groups demonstrated initial retentive
forces in the range of 80 N. The number of cycles required by each group
for the initial retentive force value to
decrease to the 60-N, 40-N, and 20-N
levels was used for standardization
purposes. The 20-N level was judged
to be critical since, according to the
literature, this force is required to
maintain a denture in position.22-24
The 60-N and the 40-N levels were
selected as intermediate reference
points between the 80-N and 20-N
levels. The results indicate that there
are significant differences among
the 6 groups included in the present
study. Therefore, it can be concluded

that there is an association between

the nylon component wear and the
implant angulation.
Determination of an estimated period of time until attachments must
be replaced has not been previously
reported. The results of the present
study indicate that the replacement
time can be approximately estimated
by the number of insertion/removal
cycles. It has been demonstrated that
attachments with dislodging forces of
<20 N can retain their retentive force
for 5 to 6 years when implants are at
0- or 5-degree angles to each other.
However, the control group and ball
attachments on implants angulated at
20 degrees seem to need replacement
after 1.8 years. An important finding
of the present study is that ball attachments on implants angulated at
5 degrees exhibited the least retention
loss. Thus, it can be assumed that a
small offset from the vertical axis may
be beneficial in terms of attachment
resistance against retention loss. A
possible explanation for this phenomenon is that the 5-degree angulation
probably provides an ideal friction
between the patrix and the matrix
components, without nylon wear acceleration.
The amount of wear of the nylon
component of the attachment system

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Volume 102 Issue 3

is proportional to insertion/removal
cycles, and, according to the present
study, it is also related to implant angulation. As the angulation increases
from 5 to 20 degrees, the wear of the
ball attachments nylon components
occurs more quickly. Therefore, the
restorative dentist can provide the patient with some information regarding
recall and maintenance of the attachments. However, accurate prediction
of the longevity of attachments is difficult, since other factors, such as the
number and position of the implants,
type and material of attachments, and
design of the prosthesis are important
as well. It should also be noted that
during function, an overdenture, as
well as the attachments, is subjected
to a variety of forces applied in different directions. A limitation of the
present as well as previous studies is
that only the resistance to withdrawal
of the attachments along the path of
insertion was evaluated. In the present study, only 2 implants were used.
However, the use of a greater number
of implants increases the potential for
variations in alignment and position.
These factors likely have an important role in the use and success of a
particular implant overdenture treatment. Implant-retained overdentures
using a minimal number of implants
are dependent on the denture-bearing capacity of the soft tissues, as well
as on relative movement allowed by
the combined nature of hard and soft
tissue support. These prostheses may
cause increased wear to the attachments due to the increased resilience
of the supporting soft tissues. An increase in the number of supporting
implants decreases the potential for
single-axis fulcrum movement between attachment points and lessens
the effect of a specific retention release period during functional movement. The results of the present study
apply only to overdentures retained
with 2 implants. Further in vitro and
in vivo studies using a greater number
of implants with different angulations
are indicated to draw definite conclusions.

CONCLUSIONS
Within the limitations of this in
vitro study, the following conclusions
were drawn:
1. Implant angulations contribute
significantly to the rate of retention
loss of the implant attachment system
evaluated.
2. Zero- and 5-degree angulations
demonstrated the greatest longevity,
or longest period of time before the
components of the attachment system required replacement.
3. Control (0/0 degrees with standard plastic component) and 20-degree angulations presented the shortest longevity, or shortest period of
time before attachment system components required replacement.

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Corresponding author:
Dr Konstantinos X. Michalakis
3, Greg. Palama str.
Thessaloniki 546 22
GREECE
Fax: +30 2310 272-228
E-mail: kmichalakis@the.forthnet.gr
Copyright 2009 by the Editorial Council for
The Journal of Prosthetic Dentistry.

Noteworthy Abstracts of the Current Literature

Correlation between polymerization shrinkage and marginal fit of temporary crowns
Balkenhol M, Knapp M, Ferger P, Heun U, Wstmann B.
Dent Mater 2008;24:1575-84.
Objectives: During polymerization, temporary c&b materials (t-c&b) undergo shrinkage which may lead to marginal
inaccuracies of the temporary restoration. The degree of correlation between these two factors is still unknown.
Hence, the objective of this study was to determine the polymerization shrinkage of t-c&bs and to evaluate, to which
degree the shrinkage is correlated to the width of the marginal gap.
Methods: Six different t-c&bs (2 monomethacrylates and 4 dimethacrylates) were used to fabricate temporary crowns
(n = 12) on two prepared teeth (stainless steel) of different diameters (5 and 7 mm). The crown diameters and marginal discrepancy were measured at various storage times after mixing (10, 30, 60 min) using a travelling microscope.
In addition, the shrinkage (bonded-disk method) and content of inorganic filler (ashing method) were recorded. The
statistical analysis was carried out using parametric tests, the F-test and Pearsons correlation (P = 0.05).
Results: The marginal discrepancies increased as a function of increasing storage time (10 min: 0.1620.218 mm; 60
min: 0.2710.521 mm). Lower values were recorded for monomethacrylates than for the dimethacrylates (greatest
changes recorded during the first 30 min). The shrinkage values recorded 10 min after mixing varied between 3.25 and
4.10%. There was no significant relationship between the width of the marginal gap and shrinkage (P > 0.05).
Significance: Shrinkage values are not suitable to predict the marginal accuracy of a temporary restoration. At least 30
min should elapse between fabricating and trimming temporary crowns to avoid further inaccuracies.
Reprinted with permission from the Academy of Dental Materials.

Al-Ghafli et al