The effect of implant diameter, restoration design, and occlusal table variations on screw loosening of posterior single-tooth implant restorations.

The purpose of this study was to (1) determine in vitro the effect of narrowing the buccolingual width of the occlusal table on the untightening torque required to loosen gold prosthetic screws after subjecting implants and implant-supported restorations to occlusal loads, and (2) to compare the incidence of screw loosening and values of untightening torque of the screws among crowns supported by 1 wide-diameter as opposed to 2 standard implants after loading in vitro. The restorations were divided into 4 groups (group 1, a narrow crown supported by one 5-mm wide-diameter implant; group 2, a narrow crown supported by 2 standard 3.75-mm-diameter implants; group 3, a wide crown supported by one 5-mm wide-diameter implant; and group 4, a wide crown supported by 2 standard 3.75-mm-diameter implants). A custom-designed chewing machine was used to simulate the grinding phase of the masticatory cycle and lateral excursions. The crowns were subjected to a 6-kg load for 16660 cycles over 5.5 hours and were loaded at the outer and inner inclines and cusp tips with an untightening loading pattern. The untightening torque was measured for the gold screws in the different groups before and after loading at 4 different locations for 8 cycles on the simulated chewing machine. A 1-way analysis of variance indicated a significant difference (P < .001) among the test groups. Pairwise multiple comparison tests (Scheffe) were carried out on mean "change scores." Group 3 was significantly different from the other groups, which were not significantly different from each other. Restoring missing molars with 1 wide-diameter implant had a greater incidence of screw loosening as compared with 2 implants. Narrowing the occlusal table of the restoration is critical when using 1 implant to support a missing molar. The untightening torque of gold screws was not affected by changing the width of the occlusal table of crowns supported by 2 implants.