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2025 Vol.29, Issue 4 Preview Page

Original Article

Effect of Prosthesis Materials and Cementation Techniques on Stress Distribution in Implant Fixtures
Ji-Hoon Jang1†
,
Yoon-Jeong Shin2†
,
Cheong-Hee Lee3*
1Graduate Student, Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Korea
2Department of Prosthodontics, Kyungpook National University Dental Hospital, Daegu, Korea
3Professor, Department of Prosthodontics, School of Dentistry, Kyungpook National University, Daegu, Korea
*Corresponding Author
†These authors contributed equally to this work.
31 December 2025. pp. 205-214
PDF XML Citation
Abstract

Purpose: This study aimed to measure the stress generated in implant fixtures based on the material used in three-unit fixed prostheses with implants, utilizing strain gauges for cementation methods, and to conduct a comparative analysis.

Materials and Methods: Three-unit implant-supported fixed prosthesis models were fabricated with two internal-connection implants placed in the mandibular left second premolar and second molar positions. Four strain gauges were attached to the cervical area of each implant fixture. A conventional cement-retained group (Co) and screw-cement-retained prosthesis (SCRP) groups using non-precious metal (Me), precious metal (Go), and zirconia (Zi) were prepared. In the SCRP groups, the abutments were tightened to either 10 or 30 Ncm before cementation and finally fixed at 30 Ncm. Cementation was performed under one- or two-point loading. Strain values were measured 10 min after cementation and final tightening. Absolute strain values were analyzed using independent t-tests for group comparisons.

Results: No significant differences were observed between one- and two-point loading in any group (p > .05). Significantly higher strain values were detected in the 10 Ncm SCRP groups than in the 30 Ncm SCRP and conventional cement-retained groups (p < .05). No significant differences were observed between the prosthesis materials.

Conclusion: In SCRP restorations using internal-connection implants, mismatched abutment tightening torque before and after cementation may induce increased stress around implant fixtures, whereas the prosthesis material and loading point have no significant influence.

Keywords
Cementation
Dental implants
Dental prosthesis
Strain gauge
Stress
References
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Wittneben JG, Joda T, Weber HP, Brägger U. Screw retained vs. cement retained implant‐supported fixed dental prosthesis. Periodontol 2000 2017;73:141-51.

10.1111/prd.12168
2

Wittneben JG, Millen C, Brägger U. Clinical performance of screw-versus cement-retained fixed implant-supported reconstructions–a systematic review. Int J Oral Maxillofac Implants 2014;29:84-98.

10.11607/jomi.2014suppl.g2.1
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Vigolo P, Givani A, Majzoub Z, Cordioli G. A 4‐year prospective study to assess peri‐implant hard and soft tissues adjacent to titanium versus gold‐alloy abutments in cemented single implant crowns. J Prosthodont 2006;15:250-6.

10.1111/j.1532-849X.2006.00114.x
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Wilson Jr TG. The positive relationship between excess cement and peri‐implant disease: a prospective clinical endoscopic study. J Periodontol 2009;80:1388-92.

10.1902/jop.2009.090115
5

Misch CE. Contemporary implant dentistry. Implant Dent 1999;8:90.

10.1097/00008505-199901000-00013
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Hebel KS, Gajjar RC. Cement-retained versus screw-retained implant restorations: achieving optimal occlusion and esthetics in implant dentistry. J Prosthet Dent 1997;77:28-35.

10.1016/S0022-3913(97)70203-8
7

Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants 2004;19:43-61.

15635945
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Garber D, Belser U. Restoration-driven implant placement with restoration-generated site development. Compendium of continuing education in dentistry. Compend Contin Educ Dent 1995;16:796, 798-802, 804.

8620398
9

Aparicio C. A new method for achieving passive fit of an interim restoration supported by Brånemark implants: a technical note. Int J Oral Maxillofac Implants 1995;10:614-8.

7591008
10

Preiskel HW, Tsolka P. The DIA anatomic abutment system and telescopic prostheses: a clinical report. Int J Oral Maxillofac Implants 1997;12:628-33.

9337023
11

Voitik A. The Kulzer abutment luting; Kal technique. A direct assembly framework method for osseointegrated implant prostheses. Implant Society 1991;2:11-4.

1883893
12

Heckmann SM, Karl M, Wichmann MG, Winter W, Graef F, Taylor TD. Cement fixation and screw retention: parameters of passive fit: An in vitro study of three‐unit implant‐supported fixed partial dentures. Clin Oral Implants Res 2004;15:466-73.

10.1111/j.1600-0501.2004.01027.x
13

Karl M, Graef F, Heckmann S, Taylor T. A methodology to study the effects of prosthesis misfit over time: an in vivo model. Int J Oral Maxillofac Implants 2009;24:689-94.

19885410
14

Asvanund P. A strain gauge analysis comparing external and internal implant-abutment connections. Implant Dent 2014;23:206-11.

10.1097/ID.0000000000000063
15

Lee JH, Kim DG, Park CJ, Cho LR. Axial displacements in external and internal implant‐abutment connection. Clin Oral Implants Res 2014;25:e83-e9.

10.1111/clr.12062
16

Epprecht A, Zeltner M, Benic G, Özcan M. A strain gauge analysis comparing 4-unit veneered zirconium dioxide implant-borne fixed dental prosthesis on engaging and non-engaging abutments before and after torque application. Clin Exp Dent Res 2018;4:13-8.

10.1002/cre2.9729744210PMC5813893
17

Watanabe F, Uno I, Hata Y, Neuendorff G, Kirsch A. Analysis of stress distribution in a screw-retained implant prosthesis. Int J Oral Maxillofac Implants 2000;15:209-18.

10795453
18

Bassit R, Lindström H, Rangert B. In vivo registration of force development with ceramic and acrylic resin occlusal materials on implant-supported prostheses. Int J Oral Maxillofac Implants 2002;17:17-23.

11858570
19

Karl M, Taylor TD, Wichmann MG, Heckmann SM. In vivo stress behavior in cemented and screw‐retained five‐unit implant FPDs. J Prosthodont 2006;15:20-4.

10.1111/j.1532-849X.2006.00064.x
20

Goiato MC, Tonella BP, do Prado Ribeiro P, Ferraço R, Pellizzer EP. Methods used for assessing stresses in buccomaxillary prostheses: photoelasticity, finite element technique, and extensometry. J Craniofac Surg 2009;20:561-4.

10.1097/SCS.0b013e31819ba3a6
21

Naconecy MM, Teixeira ER, Shinkai RS, Frasca LCF, Cervieri A. Evaluation of the accuracy of 3 transfer techniques for implant-supported prostheses with multiple abutments. Int J Oral Maxillofac Implants 2004;19:192-8.

15101589
22

Cehreli MC, Akkocaoglu M, Comert A, Tekdemir I, Akca K. Human ex vivo bone tissue strains around natural teeth vs. immediate oral implants. Clin Oral Implants Res 2005;16:540-8.

10.1111/j.1600-0501.2005.01140.x
23

Glantz PO, Rangert B, Svensson A, Stafford G, Arnvidarson B, Randow K, et al. On clinical loading of osseointegrated implants. A methodological and clinical study. Clin Oral Implants Res 1993;4:99-105.

10.1034/j.1600-0501.1993.040206.x
24

Dahab I, El-Gendy A, Eltorky I. In vitro stress analysis study of different prosthetic options using single posterior implant for management of mandibular unilateral distal extension saddle. Tanta Dental Journal 2015;12:7-15.

10.1016/j.tdj.2014.07.004
25

Cho YE, Park EJ, Koak JY, Kim SK, Heo SJ, Park JM. Strain gauge analysis of occlusal forces on implant prostheses at various occlusal heights. Int J Oral Maxillofac Implants 2014;29:1034-41.

10.11607/jomi.3040
26

Epprecht A, Zeltner M, Benic G, Özcan M. A strain gauge analysis comparing 4‐unit veneered zirconium dioxide implant‐borne fixed dental prosthesis on engaging and non‐engaging abutments before and after torque application. Clin Exp Dent Res 2018;4:13-8.

10.1002/cre2.9729744210PMC5813893
27

Owais AI, Shaweesh M, Abu Alhaija ES. Maximum occusal bite force for children in different dentition stages. Eur J Orthod 2013;35:427-33.

10.1093/ejo/cjs021
28

Van Der Bilt A, Tekamp A, Van Der Glas H, Abbink J. Bite force and electromyograpy during maximum unilateral and bilateral clenching. Eur J Oral Sci 2008;116:217-22.

10.1111/j.1600-0722.2008.00531.x
29

Al-Zarea BK. Maximum bite force following unilateral fixed prosthetic treatment: a within-subject comparison to the dentate side. Med Princ Pract 2015;24:142-6.

10.1159/00037021425612783PMC5588213
30

Karl M, Taylor TD. Effect of material selection on the passivity of fit of implant-supported restorations created with computer-aided design/computer-assisted manufacture. Int J Oral Maxillofac Implants 2011;26:739-45.

21841982
31

Lee JH, Lee W, Huh YH, Park CJ, Cho LR. Impact of intentional overload on joint stability of internal implant‐abutment connection system with different diameter. J Prosthodont 2019;28:e649-e56.

10.1111/jopr.12661
32

Jemt T, Book K. Prosthesis misfit and marginal bone loss in edentulous implant patients. Int J Oral Maxillofac Implants 1996;11:620-5.

8908860
33

Himmlova L, Dostálová Tj, Kácovský A, Konvickova S. Influence of implant length and diameter on stress distribution: a finite element analysis. J Prosthet Dent 2004;91:20-5.

10.1016/j.prosdent.2003.08.008
34

Wiskott HA, Belser UC. Lack of integration of smooth titanium surfaces: a working hypothesis based on strains generated in the surrounding bone. Clin Oral Implants Res 1999;10:429-44.

10.1034/j.1600-0501.1999.100601.x
1

Wittneben JG, Joda T, Weber HP, Brägger U. Screw retained vs. cement retained implant‐supported fixed dental prosthesis. Periodontol 2000 2017;73:141-51.

10.1111/prd.12168
2

Wittneben JG, Millen C, Brägger U. Clinical performance of screw-versus cement-retained fixed implant-supported reconstructions–a systematic review. Int J Oral Maxillofac Implants 2014;29:84-98.

10.11607/jomi.2014suppl.g2.1
3

Vigolo P, Givani A, Majzoub Z, Cordioli G. A 4‐year prospective study to assess peri‐implant hard and soft tissues adjacent to titanium versus gold‐alloy abutments in cemented single implant crowns. J Prosthodont 2006;15:250-6.

10.1111/j.1532-849X.2006.00114.x
4

Wilson Jr TG. The positive relationship between excess cement and peri‐implant disease: a prospective clinical endoscopic study. J Periodontol 2009;80:1388-92.

10.1902/jop.2009.090115
5

Misch CE. Contemporary implant dentistry. Implant Dent 1999;8:90.

10.1097/00008505-199901000-00013
6

Hebel KS, Gajjar RC. Cement-retained versus screw-retained implant restorations: achieving optimal occlusion and esthetics in implant dentistry. J Prosthet Dent 1997;77:28-35.

10.1016/S0022-3913(97)70203-8
7

Buser D, Martin W, Belser UC. Optimizing esthetics for implant restorations in the anterior maxilla: anatomic and surgical considerations. Int J Oral Maxillofac Implants 2004;19:43-61.

15635945
8

Garber D, Belser U. Restoration-driven implant placement with restoration-generated site development. Compendium of continuing education in dentistry. Compend Contin Educ Dent 1995;16:796, 798-802, 804.

8620398
9

Aparicio C. A new method for achieving passive fit of an interim restoration supported by Brånemark implants: a technical note. Int J Oral Maxillofac Implants 1995;10:614-8.

7591008
10

Preiskel HW, Tsolka P. The DIA anatomic abutment system and telescopic prostheses: a clinical report. Int J Oral Maxillofac Implants 1997;12:628-33.

9337023
11

Voitik A. The Kulzer abutment luting; Kal technique. A direct assembly framework method for osseointegrated implant prostheses. Implant Society 1991;2:11-4.

1883893
12

Heckmann SM, Karl M, Wichmann MG, Winter W, Graef F, Taylor TD. Cement fixation and screw retention: parameters of passive fit: An in vitro study of three‐unit implant‐supported fixed partial dentures. Clin Oral Implants Res 2004;15:466-73.

10.1111/j.1600-0501.2004.01027.x
13

Karl M, Graef F, Heckmann S, Taylor T. A methodology to study the effects of prosthesis misfit over time: an in vivo model. Int J Oral Maxillofac Implants 2009;24:689-94.

19885410
14

Asvanund P. A strain gauge analysis comparing external and internal implant-abutment connections. Implant Dent 2014;23:206-11.

10.1097/ID.0000000000000063
15

Lee JH, Kim DG, Park CJ, Cho LR. Axial displacements in external and internal implant‐abutment connection. Clin Oral Implants Res 2014;25:e83-e9.

10.1111/clr.12062
16

Epprecht A, Zeltner M, Benic G, Özcan M. A strain gauge analysis comparing 4-unit veneered zirconium dioxide implant-borne fixed dental prosthesis on engaging and non-engaging abutments before and after torque application. Clin Exp Dent Res 2018;4:13-8.

10.1002/cre2.9729744210PMC5813893
17

Watanabe F, Uno I, Hata Y, Neuendorff G, Kirsch A. Analysis of stress distribution in a screw-retained implant prosthesis. Int J Oral Maxillofac Implants 2000;15:209-18.

10795453
18

Bassit R, Lindström H, Rangert B. In vivo registration of force development with ceramic and acrylic resin occlusal materials on implant-supported prostheses. Int J Oral Maxillofac Implants 2002;17:17-23.

11858570
19

Karl M, Taylor TD, Wichmann MG, Heckmann SM. In vivo stress behavior in cemented and screw‐retained five‐unit implant FPDs. J Prosthodont 2006;15:20-4.

10.1111/j.1532-849X.2006.00064.x
20

Goiato MC, Tonella BP, do Prado Ribeiro P, Ferraço R, Pellizzer EP. Methods used for assessing stresses in buccomaxillary prostheses: photoelasticity, finite element technique, and extensometry. J Craniofac Surg 2009;20:561-4.

10.1097/SCS.0b013e31819ba3a6
21

Naconecy MM, Teixeira ER, Shinkai RS, Frasca LCF, Cervieri A. Evaluation of the accuracy of 3 transfer techniques for implant-supported prostheses with multiple abutments. Int J Oral Maxillofac Implants 2004;19:192-8.

15101589
22

Cehreli MC, Akkocaoglu M, Comert A, Tekdemir I, Akca K. Human ex vivo bone tissue strains around natural teeth vs. immediate oral implants. Clin Oral Implants Res 2005;16:540-8.

10.1111/j.1600-0501.2005.01140.x
23

Glantz PO, Rangert B, Svensson A, Stafford G, Arnvidarson B, Randow K, et al. On clinical loading of osseointegrated implants. A methodological and clinical study. Clin Oral Implants Res 1993;4:99-105.

10.1034/j.1600-0501.1993.040206.x
24

Dahab I, El-Gendy A, Eltorky I. In vitro stress analysis study of different prosthetic options using single posterior implant for management of mandibular unilateral distal extension saddle. Tanta Dental Journal 2015;12:7-15.

10.1016/j.tdj.2014.07.004
25

Cho YE, Park EJ, Koak JY, Kim SK, Heo SJ, Park JM. Strain gauge analysis of occlusal forces on implant prostheses at various occlusal heights. Int J Oral Maxillofac Implants 2014;29:1034-41.

10.11607/jomi.3040
26

Epprecht A, Zeltner M, Benic G, Özcan M. A strain gauge analysis comparing 4‐unit veneered zirconium dioxide implant‐borne fixed dental prosthesis on engaging and non‐engaging abutments before and after torque application. Clin Exp Dent Res 2018;4:13-8.

10.1002/cre2.9729744210PMC5813893
27

Owais AI, Shaweesh M, Abu Alhaija ES. Maximum occusal bite force for children in different dentition stages. Eur J Orthod 2013;35:427-33.

10.1093/ejo/cjs021
28

Van Der Bilt A, Tekamp A, Van Der Glas H, Abbink J. Bite force and electromyograpy during maximum unilateral and bilateral clenching. Eur J Oral Sci 2008;116:217-22.

10.1111/j.1600-0722.2008.00531.x
29

Al-Zarea BK. Maximum bite force following unilateral fixed prosthetic treatment: a within-subject comparison to the dentate side. Med Princ Pract 2015;24:142-6.

10.1159/00037021425612783PMC5588213
30

Karl M, Taylor TD. Effect of material selection on the passivity of fit of implant-supported restorations created with computer-aided design/computer-assisted manufacture. Int J Oral Maxillofac Implants 2011;26:739-45.

21841982
31

Lee JH, Lee W, Huh YH, Park CJ, Cho LR. Impact of intentional overload on joint stability of internal implant‐abutment connection system with different diameter. J Prosthodont 2019;28:e649-e56.

10.1111/jopr.12661
32

Jemt T, Book K. Prosthesis misfit and marginal bone loss in edentulous implant patients. Int J Oral Maxillofac Implants 1996;11:620-5.

8908860
33

Himmlova L, Dostálová Tj, Kácovský A, Konvickova S. Influence of implant length and diameter on stress distribution: a finite element analysis. J Prosthet Dent 2004;91:20-5.

10.1016/j.prosdent.2003.08.008
34

Wiskott HA, Belser UC. Lack of integration of smooth titanium surfaces: a working hypothesis based on strains generated in the surrounding bone. Clin Oral Implants Res 1999;10:429-44.

10.1034/j.1600-0501.1999.100601.x
Information
  • Publisher :The Korean Academy of Oral & Maxillofacial Implantology
  • Publisher(Ko) :대한구강악안면임플란트학회
  • Journal Title :Journal of implantology and applied sciences
  • Journal Title(Ko) :대한구강악안면임플란트학회지
  • Volume : 29
  • No :4
  • Pages :205-214
  • Received Date : 2025-11-30
  • Revised Date : 2025-12-22
  • Accepted Date : 2025-12-23
  • DOI :https://doi.org/10.32542/implantology.2025021
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