Clinical and Experimental

Health Sciences

Assessment of Micro-Gap in Hybrid Abutment-Crowns

Fabricated with Different Materials
Tuğçe Çetin1 , Yılmaz Umut Aslan2
1
Department of Prosthodontics, Faculty of Dentistry, Marmara University, İstanbul, Türkiye.
2
Department of Prosthodontics, Faculty of Dentistry, Marmara University, İstanbul, Türkiye.

Correspondence Author: Tuğçe Çetin

E-mail: [email protected]
Received: 06.12.2022 Accepted: 13.02.2023

ABSTRACT
Objective: The aim of this in vitro study is to evaluate the micro-gap changes in three dimensions after thermodynamic loading between hybrid
abutment crowns made of different materials and implants with internal conical connection.
Methods: A total of 10 morse cone connection implants (Straumann Bone Level Implant, Institut Straumann AG, Basel, Switzerland) were
used. In this study, two study groups were formed using lithium disilicate glass-ceramic (LD) and polymethyl methacrylate (PMMA) in hybrid
abutment-crown production (n=5). Hybrid abutment-crowns were fabricated by CAD/CAM system. Hybrid abutment crowns were designed
and manufactured digitally. A 4-month of clinical cycle was applied to the samples in the chewing simulator. The micro-gap at the implant-
abutment interface was visualized with micro-CT before and after thermodynamic loading. Micro-gap change was determined using these
obtained images. For comparisons, independent t-test was used.
Results: When comparing the micro-gap volumes before and after aging, no significant difference was observed between the LD and PMMA
groups. The micro-gap increase after loading was 0.68 ±0.209 in the LD group and 0.45 ±0.373 in the PMMA group. Although the increase was
higher in the LD group, there is no statistically significant difference between two groups.
Conclusion: he micro-gap in the interface of implants and hybrid abutment crowns increased after aging. Hybrid abutment-crown material
affected the micro-gap increase, but it was not statistically significant.
Keywords: Micro-gap, hybrid abutment-crown, implant-abutment connection.

1. INTRODUCTION

The implant-abutment connection (IAC) is the transition is important for the long-term success of the treatment
point from surgery to the prosthetic stage and it is the (10,11). With the development of CAD/CAM systems, hybrid
primary determinant of the success and stability of the restorations prepared by fixing the restoration on the original
implant-supported prosthesis (1). It has been stated that the titanium abutment of the implant system have become
implant-abutment connection is an important factor that popular (12). Hybrid restorations produced as a combination
determines the long-term prognosis of the treatment (2). of titanium abutments and various materials are very
Mismatch at the implant-abutment attachment interface advantageous in terms of low cost and easy application (13)
can cause increased stress at the connection part, leading to (14). In addition, soft tissue modeling can be performed
screw loosening, screw breakage, and implant overloading during healing using hybrid restorations in immediate
(3,4). This situation can also lead to peri-implant pathology loading applications (15,16). Hybrid restorations used in the
by causing microleakage and bacterial colonization (5,6,7). immediate loading protocol can be fabricated from ceramics
Various connection types have been developed to eliminate such as lithium disilicate (LD) or from different materials such
as hybrid ceramics, composites and polymethylmethacrylate
micro-gap caused by incompatibility between the implant
(PMMA) (17,18,19). Many studies have been conducted to
and abutment. Currently, the use of conical connections is
evaluate the effect of abutment production techniques and
most recommended to avoid micro-gaps (8,9).
restoration materials on the implant-abutment connection
In addition to the implant abutment connection, the choice (11,20). However, more studies are needed to evaluate
of abutment and material used in restoration production the effects of all-ceramic and polymer materials, which are

Clin Exp Health Sci 2023; 13: 871-875 Copyright © 2023 Marmara University Press
ISSN:2459-1459 DOI: 10.33808/clinexphealthsci.1215298
 Original Article
Evaluation of Micro-Gap Between Implant and Abutment

increasingly used in fabricating hybrid restorations, on the Liechtenstein). After checking the compatibility of the
implant-abutment connection. The aim of this study is to restoration with the ti-base abutment, the other LD crowns
evaluate the micro-gap volume between internal morse cone were produced with the same steps. The same design and
implants and hybrid abutment-crowns manufactured from milling processes were applied for PMMA (Telio CAD, Ivoclar
two different materials before and after dynamic loading. Vivadent, Schaan, Liechtenstein) crowns. Polishing of PMMA
crowns was finished with brush bur.
2. METHODS According to company instructions, all restorations were
cemented onto ti-base abutments with Multilink Hybrid
Abutment Cement (Ivoclar Vivadent, Schaan, Liechtenstein).
2.1. Design of Study
The implants were embedded in acrylic using a silicone index.
After thermodynamic loading, the effect of different The prepared hybrid abutment crowns were loaded onto the
restoration materials on the micro-gap change between implants with a torque wrench. A load of 35 N was applied
the implant and abutment was evaluated. In this present with a torque wrench.
study, these steps were followed to evaluate the micro-gap
changes: production of monolithic hybrid abutment-crowns Table 1. Sample distribution of the study groups according to tested
from LD blocks and PMMA blocks with a digital system for materials. (LD= Lithium disilicate ceramic; PMMA=Polymethyl
implants, cementation of the produced restorations on methacrylate)
titanium bases, loading of the prepared hybrid abutment
Group Materials (Product name, manufacturing N
crowns on the implants, three dimensionally (3D) evaluation company)
before aging, aging equal to 4-month oral use with a chewing LD Lithiumdisilicate ceramic (IPS e.max CAD, Ivoclar 5
simulator, after aging 3D evaluation, 3D superimposition of Vivadent, Schaan, Liechtenstein)
the obtained images, determination of micro gap change and PMMA Polymethyl methacrylate (Telio CAD, Ivoclar 5
statistical analysis of the results were performed respectively. Vivadent, Schaan, Liechtenstein)
Hybrid abutment crowns with LD blocks (IPS E-max CAD,
Ivoclar Vivadent, Schaan, Liechtenstein) and PMMA blocks 2.3. Determination of the Initial Micro-gap
(Telio CAD, Ivoclar Vivadent, Schaan, Liechtenstein) were Before aging, all samples were scanned with the micro-
prepared for the Straumann Bone Level Implants (Institut tomography device (Skyscan 1174, Skyscan, Kontich Belgium)
Straumann AG, Basel, Switzerland). The Straumann bone to determine the initial micro-gap volume. After finishing the
level implant-abutment connection is morse-conical. This scanning process, 3D images were obtained by rendering the
connection has a 15º tapered structure and four slots. Ten radiographic image sequences taken during 180° rotation.
implants with a diameter of 4.1mm and a length of 10mm CTan (Bruker, Kontich, Belgium) software was used to
were included in this study. Two study groups were formed determine the micro-gap volume, and CTVol (Bruker, Kontich,
for LD and PMMA materials. Five hybrid abutment crowns Belgium)
FIGURESsoftware was used for the 3D analysis of the images.
were fabricated from each material (n=5). Study groups and
sample numbers are given in Table 1.

2.2 Preparation of Samples

For the fabrication of the crowns, a ti-base abutment (TiBase
S BL 4.1 L, Sirona, Bensheim, Germany) was placed on the
implant. Scan post (ScanPost, Sirona, Bensheim, Germany)
were placed on the ti-base abutment, and digital impressions
were taken with a Cerec Omnicam intraoral camera
(Sirona, Bensheim, Germany). After the optical impression
process, STL data obtained with CEREC SW 4.5.1 software
(Sirona, Bensheim, Germany) on a portable computer were
transferred to CEREC inLab 4.5.1 program (Sirona, Bensheim,
Germany). A first premolar crown compatible with the ti-base Figure 1. All samples prepared to place in the chewing simulator
was designed by paying attention to anatomical details. The Figure 1. All samples prepared to place in the chewing simulator
designed crown data were saved as STL data and transferred
to CEREC SW 4.5.1 (Sirona, Bensheim, Germany) software.
Production of the crown was completed with the CAM unit
2.4. Aging of the Samples
CEREC MCX (Dentsply-Sirona Dental Systems, Bensheim,
Germany). All processes to complete the crystallization Thermodynamic aging of the samples was performed on
and polishing of the restoration were performed with a a dual-axle chewing simulator (SD Mechatronic Chewing
Programat P 310 porcelain furnace (Ivoclar Vivadent, Schaan, Simulator CS-4.2, Willytech, Munich, Germany). Hybrid

Clin Exp Health Sci 2023; 13: 871-875 872 DOI: 10.33808/clinexphealthsci.1215298
Evaluation of Micro-Gap Between Implant and Abutment Original Article

restoration-implant complexes were fixed in the sample observed when the two groups’ micro-gap volumes before
Figure 1. All samples prepared to place in the chewing simulator
holders of the device with acrylic (Figure 1). Metal parts of and after aging were compared. (p= 0,663 and p>0,541).
the device are fixed in the upper compartment for dynamic After loading in both groups, an increase in the micro-gap
loading application. Samples were simulated 80,000 cycles of volume was determined. The mean micro-gap increase (%)
chewing, equivalent to approximately four months of clinical was %0,68 ± 0.209 in the LD Group and %0,45 ± 0,37 in the
use. Dynamic loading was performed with 50 N at 5-55ºC. PMMA Group. Although the increase was higher in the LD
Group, no statistically significant difference was found (p=
0,273) (Table 3).
2.5. Determination of Micro Gap Change After Loading Figure 2. Representative micro-CT images for LD group before (a) and after (b) aging. The
dashed lines show the measured area (3.0x magnification). (I = Implant body, A = Abutment).
After loading, samples were scanned a second time with
microtomography, and 3D radiographic images were
obtained. 3D images of each sample before and after loading
were superimposed on three axes (x, y, z). The superimposing
process was performed with Skyscan Data Viewer (Bruker,
Kontich, Belgium) software. The area to measure of micro-
gap in the implant-abutment interface was determined on
these superimposed images. In the determined areas, the Figure 2. Representative micro-CT images for LD group before (a) and after (b) aging. The
Figure 2. Representative micro-CT images for LD group before (a)
change was determined by calculating the micro-gap volume dashed lines show the measured area (3.0x magnification). (I = Implant body, A = Abutment).
and after (b) aging. The dashed lines show the measured area (3.0x
before and after dynamic loading. magnification). (I = Implant body, A = Abutment).

Table 2. Comparison of micro-gap before and after aging

Groups LD PMMA P value
Micro-gap Before Aging (%) 2,65 ± 0,338 2,71 ± 0,59 0,863
(Mean+SD)
Micro-gap After Aging (%) 3,33 ± 0,444 3,16 ± 0,719 0,663
(Mean+SD)
Independent t test; Mean±Standart Deviation
LD= lithium disilicate ceramic; PMMA=polymethyl methacrylate
Figure 3. Representative micro-CT images for PMMA group before (a) and after (b)
Figure 3. Representative micro-CT images for PMMA group before
aging. The dashed lines show the measured area (3.0x magnification). (I = Implant body,
2.6. Statistical Analysis (a) and after (b) aging.A =The dashed lines show the measured area
Abutment).
(3.0x magnification). (I = Implant body, A = Abutment).
The IBM SPSS (Statistical Package for Social Sciences) for
Windows V22 (SPSS Inc, Chicago, USA) program was used
to evaluate the findings obtained in this present study.
Evaluations were done at 95% confidence interval and p<0.05 4. DISCUSSION
significance level. The assumption of normal distribution
Incompatibility, which creates micro-gaps and loss of
was checked with the Shapiro-Wilk test. Before and after
stabilization between the implant and abutment, causes
aging micro-gap values and micro-gap changes after aging
mechanical and biological problems. It has been reported
of the two groups using different restoration materials were
that the increased mechanical stress on the connection
evaluated. An Independent t-test was used as parametric test
components, the implant and the bone tissue surrounding
assumptions were provided in comparisons.
the implant neck may cause preload loss or mechanical
problems such as screw loosening/breakage (21,22,23,24).
Table 3. Comparison of micro-gap changes
The micro-gap increase can cause bacterial leakage, micro-
Groups Mean+SD (%) P value
movements and wear between two components that will
1.LD 0.68 ±0.209 affect osseointegration (6,11,25). Rack et al. reported that the
0,273
2.PMMA 0.45 ±0.373 micro-gap increase occurred under cyclic loading in different
Independent t test; Mean±Standart Deviation internal conical joint systems, causing the micro-motion
LD= lithium disilicate ceramic; PMMA=polymethyl methacrylate range to expand. They concluded that with an increasing
mismatch between the two components in the implant
3. RESULTS abutment joint, the amount of microleakage increases and
the mechanical properties of the joint weaken (26). In this
Representative μCT images of implant-abutment junction present study, it was observed that the micro-gap between
surface before and after aging from both study groups are implant and abutment increased in short-term loading in
shown in Figure 2-3. In this study, comparisons between both groups.
groups were achieved with percentage (%) values.
Comparisons of the micro-gap before and after aging are Many studies have been conducted to evaluate the
given in Table 2. Micro-gap was observed in all samples abutment production technique and the effect of materials
regardless of condition. No significant difference was used in restoration production on mechanical stability in

Clin Exp Health Sci 2023; 13: 871-875 873 DOI: 10.33808/clinexphealthsci.1215298
 Original Article
Evaluation of Micro-Gap Between Implant and Abutment

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How to cite this article: Çetin T, Aslan YU. Assessment of Micro-Gap in Hybrid Abutment-Crowns Fabricated with Different Materials.
Clin Exp Health Sci 2023; 13: 871-875. DOI: 10.33808/clinexphealthsci.1215298

Clin Exp Health Sci 2023; 13: 871-875 875 DOI: 10.33808/clinexphealthsci.1215298