RESEARCH

Photoelastic Analysis of Cemented or

Screwed Implant-Supported Prostheses
With Different Prosthetic Connections
Bianca Piccolotto Tonella, DDS, MSc1
Eduardo Piza Pellizzer, DDS, MSc, PhD1*
Renato Ferraco, DDS, MSc1
Rosse Mary Falcon-Antenucci, DDS, MSc1
Paulo S. Perri de Carvalho, DDS, MSc, PhD2
Marcelo Coelho Goiato, DDS, MSc, PhD1

The aim of this study was to evaluate the stress distribution of different retention systems
(screwed or cemented) associated with different prosthetic connections (external hexagon,
internal hexagon, and Morse taper) in 3-unit implant-supported fixed partial dentures
through photoelasticity. Six models were fabricated with photoelastic resin PL-2, and each
model contained two implants of 4.0 3 10.0 mm. The models presented different retention
systems (screwed and cemented) and different connections (external hexagon, internal
hexagon, and Morse taper). The prostheses were standardized and fabricated in Ni-Cr alloy. A
circular polariscope was used and axial and oblique (45u) loads of 100 N were applied in a
universal testing machine. The results were photographed and analyzed qualitatively with a
graphic software (Adobe Photoshop). The screwed retention system exhibited higher number
of fringes for both axial and oblique loadings. The internal hexagon implant presented better
and lower stress distribution for both cemented and screwed prostheses. The oblique loading
increased the number of fringes in all models tested. The cemented retention system presented
better stress distribution. The internal hexagon implant was more favorable according to the
biomechanical standpoint. The oblique load increased stress in all systems and connections
tested.

Key Words: dental implants, fixed partial denture, implant-supported fixed partial
denture

INTRODUCTION the components, stability at implant/abut-

ment interface, and the resistance of this

T
he success of implant-supported
restoration and the health of interface submitted to masticatory loads.1,2
surrounding tissues are related The stability at implant/abutment inter-
to the accuracy and fit between face may be influenced by several factors
such as connection type1,3 and retention
1
Department of Dental Materials and Prosthodontics, system. Therefore, the selection of the
Aracatuba School of Dentistry Sao Paulo State
University UNESP, Sao Paulo, Brazil.
retention system is a widely discussed topic
2
Department of Surgery, Aracatuba School of Dentistry that may be determined by subjective
Sao Paulo State University UNESP, Sao Paulo, Brazil.
* Corresponding author, e-mail: ed.pl@uol.com.br
preferences. The option for cemented or
DOI: 10.1563/AAID-JOI-D-10-00044 screwed prosthesis depends on such aspects

Journal of Oral Implantology 401

Stress Distribution on Implant-Supported Prostheses

TABLE 1
Models
Model Description

1 Screwed 3-unit fixed partial denture with external hexagon connection

2 Screwed 3-unit fixed partial denture with internal hexagon connection
3 Screwed 3-unit fixed partial denture with Morse taper connection
4 Cemented 3-unit fixed partial denture with external hexagon connection
5 Cemented 3-unit fixed partial denture with internal hexagon connection
6 Cemented 3-unit fixed partial denture with Morse taper connection

as reversibility,2,46 predictability of reten- MATERIALS AND METHODS

tion,2 esthetics, and complexity of laboratory
techniques.
Another factor that influences the force
transferring to the bone/implant interface is
the connection type between the abutment
and the implant. The connections can be
external or internal.7 The external connection
is a joint in the external hexagon of the
implant platform, while the internal connec-
tion exhibits the implant/abutment interface
into the implant in the same manner as the
Morse taper connection. However, the ta-
pered design of the mating surfaces gener-
ates more accurate fit with the Morse taper
connection.3
Experimental studies with different con-
nection types have demonstrated significant
improvement in the performance for internal
connection,79 mainly for the Morse taper
connection.10,11 Some studies evaluated dif-
ferent implant designs,1214 and other studies
compared the screwed and cemented reten-
tion systems.2,4,13,1518 However, there is a
lack of research focusing on stress distribution
with different implant connections,3,19 and
there is no study associating the different
connection types and the prosthetic reten-
tion systems.
Therefore, the aim of this study was to
evaluate the stress distribution of different
retention systems (screwed and cemented)
associated with different prosthetic connec-
tions (external hexagon, internal hexagon,
and Morse taper) in 3-unit implant-supported
fixed partial dentures through photoelasticity.
Six blocks (44 3 22 3 10 mm) were fabricated
with photoelastic resin PL-2 (Vishay Precision
Group Inc, Raleigh, NC) that was manipulated
according to the manufacturers instructions.
Each model contained 2 implants of 4.0 3
10.0 mm (Conexao Sistemas de Protese Ltda,
Sao Paulo, Brazil) with the same connection
type (external hexagon, internal hexagon, and
Morse taper) (Table 1).
Conventional techniques were used to
fabricate the fixed dentures in Ni-Cr alloy (Fit
CastSB Plus, Talladium do Brasil, Curitiba,
Parana, Brazil). A silicone matrix was used to
standardize the crowns. The crowns were
fabricated on stone casts to avoid tension in
the photoelastic models. The prostheses were
screwed or cemented with provisional cement
(TempBond, Kerr Corporation, Orange, Calif)
on the implant in the photoelastic models.
The photoelastic models were positioned in
the circular polariscope, and a universal testing
machine (EMIC-DL 3000, Sao Jose dos Pinhais,
Parana, Brazil) applied axial and oblique (45u)
loads of 100 N in fixed points on the occlusal
surface of all crowns. The models were
positioned in a device with preestablished
angulation of 45u for oblique loading.
The results were recorded by a digital
camera (Nikon D80, Nikon Corp, Japan) and
analyzed with a graphic software (Abobe
Photoshop CS3, Adobe Systems, San Jose,
Calif) to allow visualization, comprehension,
and interpretation of the localization and
intensity/concentration of stress distributed
surrounding the implants.

402 Vol. XXXVII/No. Four/2011


TABLE 2
Number of fringes of high intensity
Model Axial Oblique
1 11 13
2 8 9 number of fringes for both axial and oblique
3 21 26
4 6 8
5 5 7 Comparing the models with screwed
6 15 11
Qualitative analysis was used in the
present study as suggested by Caputo and
Standlee,20 French et al,21 Clelland et al,22 and
da Silva et al.23 According to these authors,
the number and order of the fringes indicate
stress intensity, while the proximity between
them represents stress concentration.
Photoelasticity demonstrates the distri-
bution of force in an object by fringe
patterns that appear as a series of successive
and contiguous different colored bands
(isochromatic fringes), and each fringe order
is counted by the passage of fringe:
N fringe of order N 5 0 (black)
N fringe of order N 5 1 (transition red/blue)
low intensity
N fringe of order N 5 2 (transition red/green)
medium intensity
N fringe of order N 5 3 (transition pink/green)
high intensity
The initial photo was recorded with no
loading to assess the presence of tensions in
the photoelastic model. All models were
tension-free, which is necessary to avoid
reading mistakes during the experiments.
RESULTS
The analysis was divided according to the
number of fringes of high intensity (tran-
sition pink/green) and the area of stress
concentration. All images were evaluated by
the same operator.
The number of fringes of high intensity
Table 2 shows models 3 (screwed 3-unit
fixed partial denture with Morse taper
Tonella et al
connection) and 6 (cemented 3-unit fixed
partial denture with Morse taper connection)
exhibited the highest number of fringes, and
models 2 and 5 presented the lowest
loading.
and cemented prostheses, the models with
cemented prostheses exhibited a lower
number of fringes. Considering the number
of fringes of high intensity, models 3
(screwed 3-unit fixed partial denture with
Morse taper connection), 6 (cemented 3-
unit fixed partial denture with Morse taper
connection), 1 (screwed 3-unit fixed partial
denture with external hexagon connec-
tion), 4 (cemented 3-unit fixed partial
denture with external hexagon connec-
tion), 2 (screwed 3-unit fixed partial den-
ture with internal hexagon connection),
and 5 (cemented 3-unit fixed partial den-
ture with internal hexagon connection)
presented the highest to lowest stress
intensity, respectively.
Area of fringe concentration
Screwed Prosthesis Axial Load
According to models 1 (screwed 3-unit
fixed partial denture with external hexagon
connection) and 2 (screwed 3-unit fixed
partial denture with internal hexagon
connection) (Figures 1a and b, and 2a and
b), the loading on the premolar, pontic,
and molar generated stress concentration
on the middle and apical thirds of the
implant (premolar), with higher stress
when the load was applied on the premo-
lar. The largest area of stress concentration
between the implants occurred with load-
ing on the pontic.
In model 3 (screwed 3-unit fixed partial
denture with Morse taper connection) with
loading on the premolar and pontic (Figure 3a
and b), a large area of fringe concentration was
observed surrounding the body of the implant
(premolar), mainly from the middle to the
Journal of Oral Implantology 403
Stress Distribution on Implant-Supported Prostheses

FIGURES 13. FIGURE 1. (a,b,c) Axial loading on the premolar, pontic, and molar on screwed 3-unit fixed
partial denture with external hexagon connection. FIGURE 2. (a,b,c) Axial loading on the premolar, pontic,
and molar on screwed 3-unit fixed partial denture with internal hexagon connection. FIGURE 3. (a,b,c)
Axial loading on the premolar, pontic, and molar on screwed 3-unit fixed partial denture with Morse
taper connection.

apical third, and a small area of stress at the
apex of the implant (molar). When the load
was applied on the molar (Figure 3c), the
stress was distributed from the middle to the
apical third of both implants with a larger area
in the implant (molar). The largest area of
stress between the implants was observed
with loading on the premolar.
Comparing the 3 models (Figures 1
through 3), model 3 (screwed 3-unit fixed
partial denture with Morse taper connec-
tion) exhibited the highest concentration of
stress.
Screwed Prosthesis Oblique Load
In models 1 (screwed 3-unit fixed partial
denture with external hexagon connection)
and 2 (screwed 3-unit fixed partial denture
with internal hexagon connection) (Figures
4a and b, and 5a and b) with loading on the
premolar and pontic, the stress was distrib-
uted in the photoelastic model with con-
centration in the apical third of the implant
(premolar) and a small area at the apex of
the implant (molar). For the loading on the
molar (Figures 4c and 5c), the number of

404 Vol. XXXVII/No. Four/2011

 Tonella et al

FIGURES 46. FIGURE 4. (a,b,c) Oblique loading on the premolar, pontic, and molar on screwed 3-unit fixed
partial denture with external hexagon connection. FIGURE 5. (a,b,c) Oblique loading on the premolar,
pontic, and molar on screwed 3-unit fixed partial denture with internal hexagon connection. FIGURE 6.
(a,b,c) Oblique loading on the premolar, pontic, and molar on screwed 3-unit fixed partial denture with
Morse taper connection.

fringes increased and was concentrated at
the side opposite to the load.
In model 3 (screwed 3-unit fixed partial
denture with Morse taper connection) with
loading on the premolar and pontic (Fig-
ure 6a and b), stress concentration was
observed in the middle and apical thirds of
the implant (premolar) with lower intensity
surrounding the body of the implant (molar).
For the loading on the molar (Figure 6c), the
stress was concentrated in the middle and
apical thirds of the implant, with greater
quantity at the side opposite to the load.
A large area of stress was observed between
the implants with loading on the premolar.
Comparing the 3 models (Figures 4, 5,
and 6), the highest area and concentration of
stress were shown in model 3.
Cemented Prosthesis Axial Load
In models 4 (cemented 3-unit fixed partial
denture with external hexagon connection)
and 5 (cemented 3-unit fixed partial denture
with internal hexagon connection) (Figures
7a and b, and 8a and b) with loading on the
premolar and pontic, stress was concentrated

Journal of Oral Implantology 405

Stress Distribution on Implant-Supported Prostheses

FIGURES 79. FIGURE 7. (a,b,c) Axial loading on the premolar, pontic, and molar on cemented 3-unit fixed
partial denture with external hexagon connection. FIGURE 8. (a,b,c) Axial loading on the premolar, pontic,
and molar on cemented 3-unit fixed partial denture with internal hexagon connection. FIGURE 9. (a,b,c)
Axial loading on the premolar, pontic, and molar on cemented 3-unit fixed partial denture with cone
Morse connection.

in the middle and apical thirds of the implant
(premolar), with a small area of stress
concentration at the apical level of the
implant (molar). For the loading on the molar
(Figures 7c and 8c), stress was concentrated
surrounding the body of the implant with the
highest intensity at the apex.
In model 6 (cemented 3-unit fixed partial
denture with Morse taper connection) (Fig-
ure 9a, b, and c) with loading on the
premolar, stress of high intensity was ob-
served surrounding the body of the implant
(premolar) and a small area at the apex of
the implant (molar). For the loading on the
pontic, stress of high intensity was concen-
trated in the apical region of both implants.
For the loading on the molar, a large area of
stress concentration was noticed surround-
ing the body of the implant and a small area
of stress was exhibited at the apex of the
implant (premolar).
Comparing the 3 models (Figures 7, 8,
and 9), model 3 (screwed 3-unit fixed partial
denture with Morse taper connection) pre-
sented the highest area and concentration of
stress.

406 Vol. XXXVII/No. Four/2011

 Tonella et al

FIGURES 1012. FIGURE 10. (a,b,c) Oblique loading on the premolar, pontic, and molar on cemented 3-unit
fixed partial denture with external hexagon connection. FIGURE 11. (a,b,c) Oblique loading on the
premolar, pontic, and molar on cemented 3-unit fixed partial denture with internal hexagon
connection. FIGURE 12. (a,b,c) Oblique loading on the premolar, pontic, and molar on cemented 3-unit
fixed partial denture with Morse taper connection.

Cemented Prosthesis Oblique Load
In models 4 (cemented 3-unit fixed partial
denture with external hexagon connection)
and 5 (cemented 3-unit fixed partial denture
with internal hexagon connection) (Figures
10a and b, and 11a and b) with loading on
the premolar and pontic, stress concentra-
tion was exhibited in the middle and apical
thirds of the distal region of the implant
(premolar) and a small area of stress of low
intensity was observed at the apex of the
implant (molar). For the loading on the molar
(Figures 10c and 11c), a large area of stress
surrounding the body of the implant and a
higher number of fringes concentrated at
the side opposite to the load were observed.
In model 6 (cemented 3-unit fixed partial
denture with Morse taper connection) (Fig-
ure 12a and b) with loading on the premolar
and pontic, stress was concentrated in the
distal apical third of both implants. This
stress was higher in the implant (molar) for
the loading on the pontic. In the molar, the
stress was concentrated surrounding the

Journal of Oral Implantology 407

Stress Distribution on Implant-Supported Prostheses
body of the implant (molar) with greater
concentration and intensity at the side
opposite to the load.
Comparing the 3 models (Figures 10, 11,
and 12), the highest area and concentration
of stress were noticed in the implant (molar)
for the loading on the molar.
DISCUSSION
Considering the results obtained with the
screwed and cemented prostheses for both
axial and oblique loading, the cemented
prostheses presented a more favorable
situation for stress distribution. This result is
in accordance with the laboratory and
clinical research15,16 that compared the bio-
mechanical behavior of multiple cemented
and screwed prostheses. This may result
from the damping effect of the cement
between the prosthesis and the abutment.
Opposite results were observed by
Weber et al18 in a 3-year prospective study
evaluating the peri-implant condition and
esthetics of cemented and screwed prosthe-
ses. The authors reported that the peri-
implant tissues surrounding the screwed
implant-supported prostheses exhibited bet-
ter condition than those surrounding the
cemented prostheses, and there was no
recession of soft tissue for both prostheses.
Although the cemented implant-supported
prostheses were preferred by the dentists,
the patients reported no preference. How-
ever, this study does not allow analysis of
stress transference at the peri-implant inter-
face.
Considering the stress distribution with
different implant connections, the internal
connection generated better results than the
external and Morse taper connections in the
present study. This fact results from the
stability at the implant/abutment interface
with the internal connections that exhibit
contact between the surface of the abut-
ment and the internal surface of the implant,
408 Vol. XXXVII/No. Four/2011
which decreases the micromovement during
loading.7,9,24
Nevertheless, Cehreli et al,3 using photo-
elasticity and strain gauge methodologies
for external, internal, and Morse taper
connections under axial and oblique (20u)
loading, did not find differences between
the systems for both loadings. In this
study, there was no consistency due to
the different sizes of the implants (length,
diameter), shapes (conical and cylindrical
Branemark, conical and cylindrical Astra
Tech implants, and ITI solid screw implant),
surface (machined, turned surface, TiO2-
blasted, and blasted large-grid acid-etched),
and thread design (microthreads in the collar
region, V-thread, buttress thread), which may
have influenced the results.
For the Morse taper connection, the
results indicated better stress distribution
according to a biomechanical standpoint.
Studies with different methodologies10,14,25
evaluating the external and Morse taper
connections concluded that the Morse taper
connection supports and distributes lateral
forces better than the implants with external
connection. However, these studies evaluat-
ed single prostheses instead of multiple
prostheses as in the present study. This
difference may have modified the biome-
chanical behavior of the Morse taper con-
nection due to splinting of implants, which
generated higher stress at the bone/implant
interface. Although the Morse taper connec-
tion seems to be the best option for single
prostheses, additional studies are necessary
to assess the stress distribution in fixed
dentures.
Considering the load type, the results of
the present study demonstrated increased
stress for oblique loading for all systems
tested, which is in agreement with previous
studies.1,7,24,26 In addition, there was higher
torque at the prosthesis/implant/bone as-
sembly.26,27 High stress concentration was
observed at the side of the load at the

cervical level in all models with oblique load.
This indicates a compressive area that was
also observed by the studies of Cehreli et al3
and French et al21 using photoelasticity.
However, clinically the bone is strongest
under compressive forces, weaker under
tensile loads, and even weaker yet in shear
loads.27
CONCLUSIONS
According to the methodology, it was
concluded that:
N The cemented implant-supported prosthe-
ses exhibited better distribution and lower
intensity of stress.
N The internal hexagon connection generat-
ed better stress distribution for both
prostheses types.
N Stress increased with oblique loading in all
models.
ACKNOWLEDGMENTS
Foundation to Support to Research of the
State of Sao Paulo FAPESP, Process
Number: 07/55061-3. Conexao Sistemas de
Protese Ltda.
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