• The Journal of Korean Academy of Prosthodontics
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• v.35 no.4
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• pp.767-780
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• 1997

One of the most common problems of implant prosthesis is the screw loosening of abutment screws. This brings on discomfort in mastication, inflammation in the peri-implant tissue due to poor oral hygiene and fracture of prosthesis or loss of osseointegration. To prevent screw loosening, appropriate implantation to direct the occlusal force to the long axis of the implant, accurate design of the superstructure, decrease of the occlusal table, and adequate torque on the abutment screw are necessary. In this study the screw loosening torque was evaluated in implants with dimples or flutes in the internal surface of abutment screw holes. The abutments were fastened with slot type and hexagonal type abutment screws and were sealed with vinyl poly siloxane impression and bite registration material respectively. The screw loosening torque was evaluated after 1,800 and 12,600 times loading under a loading machine. The results were as follows. 1. The flute form group showed significantly higher loosening torque compared to the dimple form group and the group with no inner surface treatment (p<0.05). 2. There was no statistical difference in loosening torque according to the sealing materials. 3. The loosening torque according to the types of abutment screw showed no significant difference. 4. The loosening torque was significantly higher after 1800 times loading compared to 12600 times loading(p<0.05). From the above results. it is thought that formation of a flute in the internal surface of the screw hole decreases the chance of screw loosening, but the sealing materials and types of abutment screw did not show significant difference in prevention of screw loosening.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.46 no.2
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• pp.133-142
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• 2020

Objectives: In this study, we determined the incidence and pattern of screw loosening in patients who received dental implants. Materials and Methods: Patients who received implants between January 2008 and October 2013 and completed their prosthetic rehabilitation were evaluated for the incidence, frequency, and onset of screw loosening using dental charts and radiographs. The association between each factor and screw loosening was analyzed using the chi-square test and a multivariate analysis with binary logistic regression models (P<0.05). Results: Total 1,928 implants were placed in 837 patients (448 males, 389 females), whose follow-up period after loading varied from 0.25 to 70 months (mean period, 31.5 months). Screw loosening occurred in 7.2% of implants. Most cases occurred less than six months after loading. Among those, 22.3% experienced recurrent screw loosening. Screw loosening was most common in the molar region (8.5%) and frequently associated with an implant diameter of ≥5 mm (14.2%). External implant-abutment connections (8.9%) and screw-retained implant prostheses (10.1%) showed higher incidence of problems than internal implant-abutment connections and cement-retained implants, respectively. Screw loosening was most common in implant prostheses with single crowns (14.0%). Conclusion: Within the limits of the current study, we conclude that the incidence of screw loosening differs significantly according to the position of implant placement, the type of implant and manufacturer, implant diameter, the type of implant-abutment connection, the type of retention in the implant prosthesis, and the type of implant prosthesis.

• The Journal of Korean Academy of Prosthodontics
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• v.34 no.1
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• pp.1-14
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• 1996

Abutment screw loosening of dental implant is a major problem in the treatment of dental implant. The purpose of this study was to examine the effect on the prevention of screw loosening according to tightening method and using of washer. In the first experiment, using a implant fixture and precisely fabricated temporary cylinder, the loosening torque was measured by tightening the screw 5 times repeatedly. In the second experiment, the fabricated crown and implant fixture was tightened by the screw that is attatched washer and then the loosening torque was measured after loading it 1800, 12600 times under the force of 150N. The results were as follows. 1. The highest loosening torque appeared after tightening 3 times repeatedly(p<0.01). 2. When the washer was used, the loosening torque was increased significantly under the loading 1800 times(p<0.01), 3. When the washer was used, the loosening torque was increaed under the loading 12600 times, but it is statistically not significant(p<0.01). The first experiment results mean that 3 times repeated tightening screw is most effective clinically. The second results mean that washer is effective in prevention screw loosening, but the effect is decreased with increasing load.

• Journal of Korean Neurosurgical Society
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• v.58 no.4
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• pp.357-362
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• 2015

Objective : To investigate risk factors for S1 screw loosening after lumbosacral fusion, including spinopelvic parameters and paraspinal muscles. Methods : We studied with 156 patients with degenerative lumbar disease who underwent lumbosacral interbody fusion and pedicle screw fixation including the level of L5-S1 between 2005 and 2012. The patients were divided into loosening and non-loosening groups. Screw loosening was defined as a halo sign larger than 1 mm around a screw. We checked cross sectional area of paraspinal muscles, mean signal intensity of the muscles on T2 weight MRI as a degree of fatty degeneration, spinopelvic parameters, bone mineral density, number of fusion level, and the characteristic of S1 screw. Results : Twenty seven patients showed S1 screw loosening, which is 24.4% of total. The mean duration for S1 screw loosening was $7.3{\pm}4.1$ months after surgery. Statistically significant risk factors were increased age, poor BMD, 3 or more fusion levels (p<0.05). Among spinopelvic parameters, a high pelvic incidence (p<0.01), a greater difference between pelvic incidence and lumbar lordotic angle preoperatively (p<0.01) and postoperatively (p<0.05). Smaller cross-sectional area and high T2 signal intensity in both multifidus and erector spinae muscles were also significant muscular risk factors (p<0.05). Small converging angle (p<0.001) and short intraosseous length (p<0.05) of S1 screw were significant screw related risk factors (p<0.05). Conclusion : In addition to well known risk factors, spinopelvic parameters and the degeneration of paraspinal muscles also showed significant effects on the S1 screw loosening.

• The Journal of Korean Academy of Prosthodontics
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• v.43 no.5
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• pp.671-683
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• 2005

Statement of problem: The most commonly reported problem associated with dental implant restoration is the loosening of the screws. Purpose: This study compared the efficacy of an implant system incorporating an anti-rotational locking sleeve(Anti-Rotating Inner Post Screw System(ARIPS-system)) with other, traditional implant systems as a means of minimizing vibration loosening. Materials and methods: Three implant systems were examined; the conventional external hex type, the ARIPS-system, and the internal taper type implant system 30 specimens(10 samples per group)were fabricated and each abutment screw was secured to the implant future with 32Ncm of torque force and loosening torque was measured using a Torque Gauge. The procedure was repeated 3 times, recording initial loosening torque each time. The re-tightened abutment screw was subjected to a cyclic load having a maximum forte of 200N and minimum of 20N at 2Hz over a period of 12,600 cycles. after which the loosening torque was measured. Measured values were calaulated for statistical analysis. Analysis of measured value was performed by 3 methods: (i) as a percentage average of the initial 3 loosening-torque values(initial loosening value) to the tightening torque of 32Ncm, (ii) as a percentage of the loosening torque value after a load of 200N(experimental value) to the initial loosening value, and (iii) as a percentage of the experimental value to the 32Ncm of tightening torque. The analyses shows the amount of initial loosening at the screw, loosening by repetitive load and the the final loosening value. Results: The results of this study were as follows (1) Percentage of initial loosening value to tightening-torque was increased in order of external hex, ARIPS-system and internal taper and all values between each groups showed statistical significance (p<0.05). (2) Percentage of experimental value to initial loosening value was increased in order of external hex, ARIPS-system and internal taper. Value of internal taper showed significant difference with those of external hex and ARIPS-system (p<0.05). (3) Percentage of experimental value to tightening torque was increased in order of external hex, ARIPS-system and internal taper and all values between each groups showed statistical significance (p<0.05). Conclusion: The results of the analysis of the final loosening level value, which are closely correlated to clinical use, show that the ARIPS-system can be a useful means of minimizing abutment screw loosening when compared to the external hex type system. Although further clinical studies need to be made, the ARIPS-system should be considered to maximize the long-term success of the implant prosthesis.

• Journal of Korean Neurosurgical Society
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• v.57 no.4
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• pp.229-234
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• 2015

Objective : Pedicle screw fixation for spine arthrodesis is a useful procedure for the treatment of spinal disorders. However, instrument failure often occurs, and pedicle screw loosening is the initial step of a range of complications. The authors recently used a modified transpedicular polymethylmethacrylate (PMMA) screw augmentation technique to overcome pedicle screw loosening. Here, they report on the laboratory testing of pedicle screws inserted using this modified technique. Methods : To evaluate pullout strengths three cadaveric spinal columns were used. Three pedicle screw insertion methods were utilized to compare pullout strength; the three methods used were; control (C), traditional transpedicular PMMA augmentation technique (T), and the modified transpedicular augmentation technique (M). After control screws had been pulled out, loosening with instrument was made. Screw augmentations were executed and screw pullout strength was rechecked. Results : Pedicle screws augmented using the modified technique for pedicle screw loosening had higher pullout strengths than the control ($1106.2{\pm}458.0N$ vs. $741.2{\pm}269.5N$; p=0.001). Traditional transpedicular augmentation achieved a mean pullout strength similar to that of the control group ($657.5{\pm}172.3N$ vs. $724.5{\pm}234.4N$; p=0.537). The modified technique had higher strength than the traditional PMMA augmentation technique ($1070.8{\pm}358.6N$ vs. $652.2{\pm}185.5N$; p=0.023). Conclusion : The modified PMMA transpedicular screw augmentation technique is a straightforward, effective surgical procedure for treating pedicle screw loosening, and exhibits greater pullout strength than traditional PMMA transpedicular augmentation. However, long-term clinical evaluation is required.

• The Journal of Korean Academy of Prosthodontics
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• v.38 no.6
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• pp.765-781
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• 2000

The purpose of this study was to compare the screw loosening characteristics of three avail-able cementation type abutments: one-piece cementation type abutment; two-piece cementation type abutment using titanium abutment screw; two-piece cementation type abutment using gold abutment screw. Two implant supported three-unit superstructures were fabricated using a pair of 3 kinds of abutments for each experimental model. Cyclic loading was applied on the specimen, and made to stop when the superstructure showed movement over threshold range. The loaded cycle was counted until the machine stopped. Frequency analysis was done to measure the change of natural frequency before and after the application of cyclic load and to find the effect of screw loosening on the change of natural frequency. The specimen assembly was modeled to perform the finite element analysis to see the distribution of the stress induced by the application of preload over the screw joint and to compare the pattern of the distribution of stress induced by the external force with the change of the preload condition. The following results were obtained: 1. The failure loading cycle of two-piece cementation type abutment using gold screw was significantly greater than those of the other groups. 2. One-piece cementation type abutment applied to multi-unit restoration case did not show greater resistance to screw loosening compared to two-piece cementation type abutments. 3. Frequency analysis showed decrease in natural frequency when screw loosening occured.

• The Journal of Korean Academy of Prosthodontics
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• v.45 no.3
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• pp.345-353
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• 2007

Statement of problem. Implant abutment screw joints tend to loosen under clinical conditions. Abutment screw loosening results in loss of preload in function. Purpose. Anti-rotational inner post screw (ARIPS) systems were compared with conventional abutment screws to reduce screw loosening. Reverse torque values were evaluated. Material and methods. 32 implant assemblies (Warentec, Co, Ltd, Seoul, Korea) were organized as the 30-Ncm-torque conventional groups and 30-Ncm-torque ARIPS groups in external and internal system. The specimens were tested to 106 cycles at a load of 200N. Preload reverse torque, postload reverse torque, and the ratio of postload reverse torque to preload reverse torque were evaluated. The data were analyzed with unpaired t-test in external and internal systems. Results. In the ratio of postload reverse torque to preload reverse torque, the ARIPS groups showed significant differences than the conventional screw group in both external and internal system. Conclusion. Within the limitations of this study, abutment screw loosening was effectively reduced using ARIPS system.

• Journal of Dental Rehabilitation and Applied Science
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• v.18 no.2
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• pp.81-91
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• 2002

Dental implant systems have shown many post-surgical problems and One of the most frequent problem is screw loosening. To reduce screw loosening, a number of methods have been tried and recently fundamental modification of fixture-abutment connection structure was developed and used the most frequently. Former implant system structure, such as Br${\aa}$nemark, had external hex with the height of 0.7 mm and later, fixture with external hex of 1.0 mm height and internal hex structure were developed. In addition, the method of morse taper application was introduced to reduce screw loosening. In this study, the level of screw loosening of each implant systems was compared based on the vibration loosening measurement of abutment screw of each implant systems. Analysis of measured value was performed using 3 kinds of methods, (i) Percentage of average of initial 3 times loosening-torque value(initial loosening value) to tightening-torque of 30 Ncm, (ii) Percentage of loosening-torque value after 200 N strength loaded(experimental value) to initial loosening value and (iii) Percentage of experimental value to 30 Ncm of tightening-torque. Each result of analyses shows the value of initial loosening, loosening by repetitive load and final loosening level. The results of this study were as follows. (1) Percentage of initial loosening value to tightening-torque was increased in order of 0.7 mm external hex, 1.0 mm external hex, internal hex and internal taper and all values between each groups showed statistical significance (p<0.05). (2) Percentage of experimental value to initial loosening value was increased in order of internal hex, 0.7 mm external hex, 1.0 mm external hex and internal taper. Value of internal taper showed significant difference with that of 0.7 mm external hex and internal hex (p<0.05). (3) Percentage of experimental value to tightening torque was increased in order of 0.7 mm external hex, 1.0 mm external hex, internal hex and internal taper. Values of all groups showed statistical significance (p<0.05) except between the groups of 1.0 mm external hex and internal hex. Based on those results, there was no significant difference of loosening-torque by repetitive loading except internal taper. It is supposed that implant system with high resistant capability against initial loosening could be recommended for clinical use. In addition, in case of single implant restoration, 1.0 mm external hex or internal hex could be recommended rather than 0.7 mm external hex, and the use of internal taper would be the most useful way to reduce screw loosening.

• The Journal of Korean Academy of Prosthodontics
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• v.40 no.2
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• pp.193-200
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• 2002

For the purpose of decreasing the chair time in implant cases, the time needed to loosening and fastening the screw must be shortened. Nowadays, the two typical designs of screw head are slot and hexa form. This study aimed at the shortening of loosening and fastening time by modifying the slot and hexa form. Total of twelve dentists participate in these experiments, four of them were experienced and eight of them were novice dentists. 1. There were many differences in the speeds of screw loosening and fastening between personal experiences. Experienced dentists are faster than novice dentists. 2. There were many differences in the speeds by angulation of the implant, by the conditions of the muscle tonicity. 3. Revised slot and hexa Heads show the slightly shortened time for acrew looseing and fastening.