• Title/Summary/Keyword: Screw Loosening

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Early Failure of Cortical-Bone Screw Fixation in the Lumbar Spinal Stenosis (요추부 협착에서의 피질골 궤도 나사못 고정의 초기 실패 사례에 대한 고찰)

  • Kwon, Ji-Won;Kim, Jin-Gyu;Ha, Joong-Won;Moon, Seong-Hwan;Lee, Hwan-Mo;Park, Yung
    • Journal of the Korean Orthopaedic Association
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    • v.55 no.5
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    • pp.405-410
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    • 2020
  • Purpose: Pedicle screw insertion has been traditionally used as a surgical treatment for degenerative lumbar spine disease. As an alternative, the cortical-bone trajectory screw allows less invasive posterior lumbar fixation and excellent mechanical stability, as reported in several biomechanical studies. This study evaluated the clinical and radiological results of a case of early failure of cortical-bone screw fixation in posterior fixation and union after posterior decompression. Materials and Methods: This study examined 311 patients who underwent surgical treatment from 2013 to 2018 using cortical orbital screws as an alternative to traditional pedicle screw fixation for degenerative spinal stenosis and anterior spine dislocation of the lumbar spine. Early fixation failure after surgery was defined as fixation failure, such as loosening, pull-out, and breakage of the screw on computed tomography (CT) and radiographs at a follow-up of six months. Results: Early fixation failure occurred in 46 out of 311 cases (14.8%), screw loosening in 46 cases (14.8%), pull-out in 12 cases (3.9%), and breakage in four cases (1.3%). An analysis of the site where the fixation failure occurred revealed the following, L1 in seven cases (15.2%), L2 in three cases (6.5%), L3 in four cases (8.7%), L4 in four cases (8.7%), L5 in four cases (8.7%), and S1 in 24 cases (52.2%). Among the distal cortical bone screws, fixation failures such as loosening, pull-out, and breakage occurred mainly in the S1 screws. Conclusion: Cortical-bone trajectory screw fixation may be an alternative with comparable clinical outcomes or fewer complications compared to conventional pedicle screw fixation. On the other hand, in case with osteoporosis and no anterior support structure particularly at L5-S1 fusion sites were observed to have result of premature fixation failures such as relaxation, pull-out, and breakage.

Coracoclavicular Screw Fixation for AC Dislocation and Unstable Distal Clavicle Fracture (견봉 쇄골 탈구와 쇄골 외측단 골절에서 일시적 오구 쇄골간 나사못 고정술)

  • Kim Jin Sub;Jun Jin Ho;Chung Yung Khee
    • Clinics in Shoulder and Elbow
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    • v.2 no.2
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    • pp.133-137
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    • 1999
  • Purpose: There are so many different methods with the their own advantages and disadvantages for acute AC dislocation and distal unstable clavicle fracture. We evaluated the usefulness of temporary Bosworth's coracoclavicular fixations using the cannulated screw and reviewed our clinical results. Materials and Methods: We evaluated 34 cases of temporary coracoclavicular fixations with cannulated screw and washer for acute AC dislocation(25cases in the Type V, Ⅲ) and distal unstable clavicle fracture(9cases in the Type ⅡB, Ⅱ+Ⅲ). All cases were fixed by the same techniques, guided cannulated screw under C-arm after the repair of the CC ligament within 1 week. Bases on the regular check, screws were removed at the 6-12 weeks under local anesthesia. The final clinical and radiological results(average 14 months follow-up) were rated with the UCLA scale. Results : All shoulders were gained nearly full ROM passively at the 3-4 weeks. The overall satisfactory resuIts(excellent or good) were achieved 88%(22/25) in the acute AC dislocation and all in the distal unstable clavicle fracture. There were no definite complications except three initial fixations loosening. Conclusion: Temporary Bosworth's coracoclavicular fixation using the cannulated screw with guided pin was simple precedure and provided enough initial stability for acute AC dislocation and distal unstable clavicle fracture.

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Comparison of the torque stability of Implant Torque Controllers

  • Kim, Dae-Gon;Cho, Lee-Ra;Park, Chan-Jin
    • Journal of Korean Dental Science
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    • v.2 no.1
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    • pp.19-27
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    • 2009
  • Tightening of the screws in implant restorations should be accurate and precise. If applied torque is too low, screw loosening would be occurred. With too high torque, the screw fracture might take place. Various torque generating devices are developed and employed to apply a proper torque. The purpose of this investigation was to determine and compare the accuracy of the torque controllers. In this study, 4 types of torque controllers were used; electronic torque controller, torque limiting device, torque indicating device and contra angle torque driver. Digital torque gauge was employed to measure the de-torque value. Thirty cycles of tightening and loosening were done with each torque controller. All implant torque controllers have shown slight errors and deviations. The torque liming device exhibited the most accurate data. No significant difference was found among the mean de-torque values of the electronic torque controller, torque indicating device and contra angle torque driver. In the limitation of this study, it would be recommended that the implant torque controllers should be checked whether uniformed and precise torque can be generated and a measuring error should be corrected.

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DETORQUE FORCE OF TiN-COATED ABUTMENT SCREW WITH VARIOUS COATING THICKNESS AFTER REPEATED CLOSING AND OPENING

  • Kim, Han-Su;Kim, Hee-Jung;Chung, Chae-Heon
    • The Journal of Korean Academy of Prosthodontics
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    • v.45 no.6
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    • pp.769-779
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    • 2007
  • Statement of problem. When TiN coating is applied to the abutment screw, occurrence of greater preload and prevention of the screw loosening could be expected due to decrease of frictional resistance. However, the proper thickness of TiN coating on abutment screw has not been yet reported. Purpose. The purpose of this study is to find out the appropriate TiN coating thickness by evaluating the detorque force and the surface change of titanium abutment screw with various TiN coating thickness. Material and methods. 1. Material Thirty five non-coated abutment screws were prepared for TiN coating. TiN coatings were prepared by Arc ion plating method. Depending on the coating deposition time(CDT), experimental groups were divided into 6 groups(CDT 30min, 60min, 90min, 120min, 150min, 180min) and those of 1 group was not coated as a control group. Each group was made up of 5 abutment screws. 2. Methods FE-SEM(Field Emission Scanning Electron Microscoper) and EDX(Energy Dispersive X-ray Spectroscopy) were used to observe the surface of the abutment screw. Electric scales was used to measure the weight of the abutment screw after the repeated closing and opening of 10 trials. Detorque force was measured with digital torque gauge, at each trial. Results. 1. As the coating deposition time increased, the surface became more consistent and smooth. 2. As for the abutment screws that were TiN coated for more than 60 minutes, no surface change was found after the repeated closing and opening. 3. The TiN coated abutment screws showed less weight change than the non-coated abutment screws. 4. The TiN coated abutment screws showed higher mean detorque force than the noncoated abutment screws. 5. The abutment screw coated for 60 minutes showed the highest mean detorque force. Conclusion. The coating layer of proper thickness is demanded to obtain consistent and smooth coating surface, resistance to wear, and increased detorque force of the abutment screw. In conclusion, the coating deposition time of 60 minutes indicated improved mechanical property, when TiN coating was conducted on titanium abutment screw.

Clinical and Computed Tomography Evaluation of Plate and Screw on the Cervical Lateral Mass : A Modified Magerl's Technique

  • Lee, Dong-Chan;Yoon, Seung-Hwan;Park, Hyung-Chun;Park, Jong-Oon;Hyun, Dong-Keun;Park, Heon-Seon
    • Journal of Korean Neurosurgical Society
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    • v.39 no.4
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    • pp.251-255
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    • 2006
  • Objective : To determine the clinical and radiological safety of 15 consecutive patients managed with plate and screw fixation systems applied to the cervical lateral mass. Methods : 15 patients who underwent posterior cervical and T1 arthrodesis were reviewed from Jan 2002 to Dec 2004. Posterior cervical screw and plate fixation was applied on the lateral mass of the cervical spine. The authors have tried lateral mass screw fixation using a modified Magerl's technique [$20^{\circ}$ lateral and $20{\sim}30^{\circ}$ rostral screw trajectory] under preliminary radiological study. The average patient age was $39.73^{\circ}{\pm}11.00\;years$, and the average follow-up period was $9.73^{\circ}{\pm}6.77\;months$. Computed tomography scans taken after surgery were reviewed to confirm the attempted screw trajectory correct and safety. Results : Three of 93 lateral mass screws were malpositioned but clinical damage was not noted. Two of 8 pedicle screws on the T1 vertebrae were not placed on the correct pedicle area. Screw and plate loosening was observed in one case but was not subjected to an additional procedure because of maintained screw position observed during follow-up periods. Conclusion : The results of this study indicate that lateral mass screw fixation using the Modified Magerl's technique on the cervical lateral mass may provide safe and effective application on the patients. In addition, the chance of incorrectly placed screws was higher in T1 pedicle screw fixation than in lateral mass screw fixation of the cervical area.

A Study of mechanical properties of oxide layer removed Co-Cr-Mo abutments

  • Ryu, Jae-ho;Huh, Jung-Bo;Ro, Jung-Hoon;Yun, Mi-Jung;Jeong, Chang-Mo
    • The Journal of the Korean dental association
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    • v.53 no.11
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    • pp.804-816
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    • 2015
  • PURPOSE: The aim of this study was to evaluate the influence of the oxide layer removal process in the Co-Cr-Mo (CCM) abutment after casting procedure on the prosthesis settlement and screw stability. MATERIALS AND METHODS: CCM abutments of four different interface conditions (CCM-M; machined, CCM-O; oxide layer formed, CCM-B; blasted, CCM-P; polished after blasted) and gold abutment (Gold-C; Cast with type III Gold alloy) were used. The initial settling values of abutments were evaluated according to the difference of implant-abutment length when the tightening torques were applied at 5 Ncm and 30 Ncm, and the settling values of abutments caused by loading were evaluated according to the difference of implant-abutment length before and after loading with 250 N, 100000 cycle. The loss ratios of removal torque for abutment screws were evaluated according to the difference in value of removal torques under 30 Ncm tightening torque applied before and after cyclic loading. RESULTS: The CCM-P and CCM-B group showed a higher initial settling value compared with the Gold-C group (P<.05), while the Gold-C group showed the highest settling values caused by loading (P<.05) and no significant differences were observed for between CCM groups (P>.05). The loss ratio of removal torque values for the CCM-B, CCM-P groups did not differ significantly from that of the Gold-C group (P>.05). CONCLUSION: Even though the oxide layer was removed by different methods, CCM abutment with internal conical connection structure showed lower abutment settling and similar screw loosening after cyclic loading compared with gold abutment.

An Optimization Design of the Insertion Part for Preventing the Screw Thread from Loosening (나사 풀림 방지를 위한 삽입 부품의 설계 최적화)

  • Park, Sangkun
    • Journal of the Korea Academia-Industrial cooperation Society
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    • v.16 no.4
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    • pp.2356-2363
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    • 2015
  • This study deals the optimization design with the simulation based design of a coil spring inserted into the lock nut for preventing the screw thread from loosening at the bolted joint when the high-strength steel bolt with the property class of 10.9 is used and the screw torque of 640 to 800 (Nm) is applied. In this study, structural analysis of assembly composed of bolt, nut and coil spring is carried out to evaluate its safety factors on the basis of the equivalent stress with commercial finite element analysis software. And the design strategy to extract the design improvement from these simulation results is established. An iterative process performed with the proposed design strategy is also proposed for improving the performance of the existing design. At the proposed procedure, the feasible design parameters using response surface method are found, and then these parameters are verified to be optimal or not by comparing with the response values and the simulation results obtained from the feasible parameters.

Clinical evaluation of retained preload and cement washout in screw- and cement-retained implant prosthesis (나사 시멘트 유지형 임플란트 보철물의 잔여 전부하 및 시멘트 파손에 대한 임상평가)

  • Chung, Chae-Heon;Son, Mee-Kyoung;Kim, Seok-Gyu
    • The Journal of Korean Academy of Prosthodontics
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    • v.53 no.4
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    • pp.301-309
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    • 2015
  • Purpose: The aim of this study was to evaluate the clinical performance of screw- and cement-retained implant prosthesis (SCP) design in terms of retained preload of abutment screws and cement washout. Materials and methods: Patients with the partial posterior edentulous areas comprised the study group. Implants were placed, and SCPs were delivered after 3 to 6 months healing. Follow-up examinations were performed. The implant survival rate and the prosthetic success rate were evaluated. The retained preload ratio of abutment screws and the prosthetic decementation ratio were measured. Results: Twenty one SCPs (forty three implants)in twenty patients were followed up to 64 months. All of the implants survived during the follow-up period (mean follow-up: 34 months). The prosthetic success rate was 100 % considering no abutment, screw, porcelain or metal frame fractures, as well as no screw loosening. The retained preload ratio of SCPs at the end of follow-up period was 97.61% (${\pm}16.29$) and the decementation ratio was 9.5 %. Conclusion: Within the limitations of this clinical study, SCP design showed favorable short-term clinical performances in respect of screw loosening and cement washout.

FIT OF FIXTURE/ABUTMENT/SCREW INTERFACES OF INTERNAL CONNECTION IMPLANT SYSTEM

  • Kim, Jin-Sup;Kim, Hee-Jung;Chung, Chae-Heon;Baek, Dae-Hwa
    • The Journal of Korean Academy of Prosthodontics
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    • v.43 no.3
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    • pp.338-351
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    • 2005
  • Statement of problem. Accurate fit between the implant components is important because the misfit of the implant components results in frequent screw loosening, irreversible screw fracture, plaque accumulation, poor soft tissue reaction, and destruction of osseointegration. Purpose. This study is to evaluate the machining accuracy and consistency of the implant fixture/ abutment/screw interfaces of the internal connection system by using a Stereoscopic Zoom microscope and FE-SEM(field emission scanning electron microscope) Materials and methods. The implant systems selected in this study were internal connection type implants from AVANA(Osstem^{\circledR}), Bioplant(Cowell-Medi^{\circledR}), Dio(DIO^{\circledR}), Neoplant(Neobiotech 􀋓), Implantium(Dentium􀋓)systems. Each group was acquired 2 fixtures at random. Two piece type abutment and one piece type abutment for use with each implant system were acquired. Screw were respectively used to hold a two piece type abutment to a implant fixture. The implant fixtures were perpendiculary mounted in acrylic resin block. Each two piece abutment was secured to the implant fixture by screw and one piece abutment also secured to the implant fixture. Abutment/fixture assembly were mounted in liquid unsaturated polyester. All samples were cross-sectioned with grinder-polisher unit. Finally all specimens were analysed the fit between implant fixture/abutment/screw interfaces Results and conclusions. 1. Implant fixture/abutment/screw connection interfaces of internal connection systems made in Korea were in good condition. 2. The results of the above study showed that materials and mechanical properties and quality of milling differed depending on their manufacturing companies.