Inuence of sterilization on the

retention properties of magnetic

attachments for dental implants
Arne F. Boeckler
Dean Morton
Carolin Ehring
Juergen M. Setz
Authors afliations:
Arne F. Boeckler, Carolin Ehring, Juergen M. Setz,
Department of Prosthodontics, Martin-Luther-
University Halle-Wittenberg, Halle (Saale),
Germany
Dean Morton, Department of Diagnostic Sciences,
Prosthodontics and Restorative Dentistry,
University of Louisville, Louisville, KY, USA
Correspondence to:
Dr Arne F. Boeckler
Department of Prosthodontics
Martin-Luther-University Halle-Wittenberg
Grosse Steinstrasse 19
06108 Halle (Saale)
Germany
Tel.: 49 345 557 3704
Fax: 49 345 557 3779
e-mail: arne.boeckler@medizin.uni-halle.de
Key words: autoclave sterilization, breakaway force, implants, magnets, overdentures,
retention
Abstract
Objectives: When used with dental implants advantages of the magnetic attachments
include control of load transmitted to implants, improvements in stability, support and
retention for the prosthesis, and the relative ease of prostheses fabrication. Clinically, the
use of sterilized components is required, and this may be problematic as magnetic alloys are
sensitive to temperature. The purpose of this study was to evaluate the inuence of
autoclave sterilization on the maximum retentive forces and characteristic curves for
magnetic attachments recommended for use with dental implants.
Material and methods: Eleven SmCo and NeFeB implant magnetic attachments were
evaluated as provided by the respective manufacturers. Implant magnetic abutment and
the corresponding denture magnet (n5 magnet pairs) were tested before and after
standardized autoclave sterilization (10min at 1341C). Each magnet pair was tested 10 times
in a calibrated universal testing machine using a non-magnetic test device (s 40mm,
v 20 mm/min). Results were recorded electronically and statistically analyzed using t-test
and ANOVA (Welch and Brown-Forsythe test; Po0.05).
Results: After autoclave sterilization all magnetic pairs produced lower (though statistically
insignicant) overall retention forces compared with the untreated pairs. After sterilization
mean maximum retentive forces (SD) ranged from 5.65 (0.33) to 1.41 (0.07) N. The
characteristic forcedisplacement curves of the tested magnetic systems showed differences
among the single products.
Conclusions: Autoclave sterilization caused a non-signicant reduction in retentive force
of 0.0414.6% when compared with the unsterilized magnet pairs. There were differences
between the tested magnetic pairs for both the initial breakaway forces and the
characteristic forcedisplacement curves. Within the limitations of this study all tested
magnetic attachments were sterilized in an autoclave without signicant change of
retention properties. Nevertheless magnetic implant abutments should be sterilized with
caution to reduce the risk of alterations of the retention properties.
Magnetic attachments have been utilized
to improve the stability, support, and re-
tention of conventional removable dental
prostheses (Thompson 1964; Gillings
1983; Jonkman et al. 1995). The use of
magnetic attachments in conjunction with
endosseous implants has also been de-
scribed (Carlyle et al. 1986; Jackson
1986). Although initially restricted to max-
illofacial indications, including craniofacial
deciencies, magnetic attachments have
been used successfully for a range of
Date:
Accepted 13 May 2009
To cite this article:
Boeckler AF, Morton D, Ehring C, Setz JM. Inuence of
sterilization on the retention properties of magnetic
attachments for dental implants.
Clin. Oral Impl. Res. 20, 2009; 12061211.
doi: 10.1111/j.1600-0501.2009.01759.x
1206 c 2009 John Wiley & Sons A/S
implant-retained removable dental pros-
theses (Carlyle et al. 1986; Naert et al.
1992; Walmsley et al. 1993; Burns et al.
1995a, 1995b; van Waas et al. 1996;
Walmsley & Frame 1997; Setz et al.
1998). Retentive force is an important
consideration in the selection of attach-
ments (Naert et al. 1994; Burns et al.
1995a, 1995b; Cune et al. 2005). In con-
trast to other implant attachments, reten-
tion forces in magnetic attachments do not
appear to be reduced by cycled pull-off tests
(Jackson 1986; Setz et al. 1998; Chung et
al. 2004).
Contemporary systems consist of samar-
iumcobalt (SmCo) or neodymiron
boron (NdFeB) magnets (Sagawa et al.
1984). The magnets can be divided into
open and closed systems (Riley et al. 2001).
For open systems, a static magnetic eld
exists around the two magnetic compo-
nents when they are proximity. For closed
systems the magnetic eld lies within the
components that are in contact with each
other (Chopra et al. 2007). Differences are
also evident between mono and duo sys-
tems (Riley et al. 2001; Chopra et al. 2007;
Boeckler et al. 2008). In mono systems, the
magnetic pair incorporates a soft alloy with
no static magnetic eld, but that can easily
be magnetized. A duo system consists of
two polarized magnets, one of which acts
as a keeper (as part of the abutment) requir-
ing denitive positioning in the mouth.
Recent studies indicate comparable suc-
cess rates and patient satisfaction for im-
mediate loading protocols with splinted and
unsplinted implants in the edentulous jaw
(Payne et al. 2001, 2002; Raghoebar
et al. 2003; Chiapasco 2004; Naert et al.
2004; Turkyilmaz et al. 2006). Therefore,
immediate functional loading of unsplinted
implants with overdentures may become
more widespread as a simplied and ef-
cient treatment option for edentulous pa-
tients (Kawai & Taylor 2007). Clinical and
in vitro studies conrmed the advantages of
magnetic attachments for these treatment
indications (Naert et al. 1994; Heckmann
et al. 2001). Advantages included control of
load transmitted to implants, and the rela-
tive ease of prostheses fabrication even
when implants are poorly inclined (Takaha-
shi et al. 2006; Chopra et al. 2007).
Instruments and devices intended for use
in the body should have a high sterility
assurance level (Skaug 1983). Examples in
implant dentistry include implants and
abutments positioned during a surgical pro-
cedure. For immediate loading protocols, the
magnetic attachments must be positioned
immediately following implant placement,
as part of the surgical procedure itself. The
attachments must therefore be sterilized as
for other surgical instruments and compo-
nents (Skaug 1983). A widely used method
for heat sterilization is the autoclave. Dental
steam autoclaves commonly use saturated
water steam heated to 1211C or 1341C. To
achieve sterility, a holding time of at least
15min at 1211C or 3min at 1341C is
required (Brusca et al. 2004; Vadrot & Dar-
bord 2006). Additional sterilizing time is
usually required for instruments packed in
layers of cloth, as they may take longer to
reach the required temperature.
Magnetic alloys are sensitive to increased
temperature (Lemon et al. 2004). The max-
imum temperature for use (T
max
) is approxi-
mately 2203501C for SmCo. NeFeB is
more sensitive to temperature and T
max
is
approximately 1002001C. Heating beyond
these temperatures can lead to a reversible
decrease in magnetic forces. On cooling the
magnetic force should be re-established.
Higher temperatures, however, can result
in irreversible demagnetization. Thus, it is
reported that the heat produced during poly-
merization of acrylic resins (Yeung et al.
1995; Vallittu 1996; Lai et al. 2004) may
cause a decrease in the magnetic retention
force (Tsutsui et al. 1979; Noar & Evans
1999; Lemon et al. 2004).
Temperatures used in the dental steriliza-
tion process should not have any inuence
on the retention performance of implant
magnetic systems approved for this process
by the respective manufacturers.
It can be hypothesized that the thermal
sterilization process may have a decreasing
effect on the mean maximum retention
force of the tested products. The objective
of this study was to investigate the inu-
ence of a sterilization process (dental auto-
clave) on the retentive force of 11 magnetic
implant attachment systems used in remo-
vable dental prosthodontics.
Material and methods
Three open duo systems (ODS), two open
(OMS), and six closed mono systems (CMS)
were investigated. The magnetic alloy was
SmCo in three systems and NeFeB in all
others. Magnetic abutments for implants
are provided for various implant systems in
differing designs by the respective manufac-
turers (Fig. 1) (Table 1). In this study, all
abutments were tested for one implant
system(Straumann Implant System; Strau-
mann AG, Basel, Switzerland). Five mag-
net pairs, consisting of an implant
abutment and the corresponding prosthesis
magnet, were tested for each product as
provided by the respective manufacturers.
According to the respective manufacturers,
all tested systems were suitable for a ster-
ilization process in a dental steam auto-
clave. For the retentive testing the static
part of a specially fabricated non-magnetic
test device (Chopra et al. 2007) was xed to
the base plate of a calibrated universal test
machine (Z005, Zwick, Ulm, Germany).
The opposing component was connected to
the measuring device with a non-stretch-
able and non-magnetic wire.
As there are no generally valid instruc-
tions available for obtaining the character-
istic curves of magnetic attachments
(Chung et al. 2004), measurements at a
crosshead speed of 20 mm/min and a
movement of 40 mmwere made. Prelimin-
ary tests found that no retention remained
for most of the products after 2mm of
movement. Measurements were repeated
10 times for each magnetic pair (two
components) and the mean was taken as
the result for the tested magnet pair. After-
wards all abutments from each product
were sterilized for 10 min at 1341C in a
dental steam autoclave (A35-B; WEBECO,
Bad Schwartau, Germany). The steam
autoclave fullled the requirements of
the European Standard DIN EN
13060:2004. The steamautoclave steriliza-
tion process performed in this investigation
was according to the standard protocol
Fig. 1. Magnetic attachments for implants: mono/
closed-system (Aichi Magt-IP BFN/IFN - right),
duo/open-system (steco X-Line).
Boeckler et al . Retention properties of sterilized magnets
c 2009 John Wiley & Sons A/S 1207 | Clin. Oral Impl. Res. 20, 2009 / 12061211
recommended for the sterilization of surgi-
cal and dental instruments (Sebben 1984;
Dellinges & Curtis 1996; Davis & BeGole
1998).
Results were recorded electronically.
The mean and the 95 condential intervals
of the tested magnet pairs of each product
before and after sterilization were ana-
lyzed (SPSS, Chicago, IL, USA). The differ-
ences between the retention forces of
the magnetic implant attachments before
and after standardized sterilization were
statistically analyzed by a paired t-test
(Po0.05).
Differences among the 11 products in
the treated group and the sterilized group
were calculated and statistically analyzed
by ANOVA analysis (Welch test and
Brown-Forsythe test; Po0.05).
Results
For the tested magnetic abutments the
characteristic forcedislodgement curves
showed differences among the single pro-
ducts. For all tested abutments, the char-
acteristic curves indicated that autoclave
sterilization reduced the retentive forces
when compared with non-sterilized com-
ponents. The statistical analysis conrmed
a normal distribution of the results before
and after sterilization (KolmogorovSmir-
nov test, P40.05). However, the paired t-
test (Po0.05) indicated that all reductions
in the tested retention forces induced by
the sterilization process were not signi-
cant (Table 2).
Differences among the 11 products were
found in the untreated group, as well as
among the sterilized products. Because the
variances were not equal (Levene test,
Po0.001), differences among the 11 pro-
ducts were calculated by the Welch test and
the BrownForsythe test (Po0.05). Signif-
icant differences between the tested groups
were additionally proofed by non-para-
metric KruskalWallis test (Po0.05).
For the tested magnetic abutments for
implants the signicant highest mean in-
itial retention forces (SD) varied from 5.76
(0.55) to 4.77 (0.51)1N. The lowest mea-
sured retention forces (SD) varied from
1.45 (0.11) to 2.14 (0.1) N (Table 2, Figs
25). The characteristic forcedislodge-
ment curves showed differences among
the single products.
For the tested magnetic implant abut-
ments after sterilization the highest mean
Table1. Tested magnetic attachment systems
Manufacturer Product Magnet system Magnetic eld Magnetic alloy
Implant abutment Prosthetic magnet
Aichi (Tokyo, Japan) Magt-IP-IDN abutment keeper Magt-IP-IDN dome type Mono Closed NeFeB
Magt-IP-IFN abutment keeper Magt-IP-IFN at type Mono Closed NeFeB
Dyna (Bergen op Zoom,
the Netherlands)
Secondary-Medical-Parts WR-Magnet S3 small Mono Open NeFeB
Secondary-Medical-Parts WR-Magnet S5 standard Mono Open NeFeB
Steco (Hamburg, Germany) X-line Titan magnetics Insert X-line Titan magnetics Duo Open SmCo
Z-line Titanmagnetics insert Z-line Titanmagnetics Duo Open SmCo
K-line Titanmagnetics insert K-line Titanmagnetics Duo Open SmCo
Technovent (Leeds, UK) Magnabutment Mini Magna Cap Micro Mono Closed NeFeB
Magnabutment Mini Magna Cap Mini Mono Closed NeFeB
Magnabutment Maxi Magna Cap Midi Mono Closed NeFeB
Magnabutment Maxi Magna Cap Maxi Mono Closed NeFeB
Table2. Results for tested implant magnetic attachment systems before and after sterilization (each specimen was determined 10 times;
P-values are signicant for Po0.05)
Product (n5) Maximum
retention
force
(mean) (N)
95% condence interval Maximum
retention
force after
sterilization
(mean) (N)
95 % condence interval Percentage
between
retention
force before
and after
sterilization
(%)
P-value
referring to
retention
force
before and
after
sterilization
(%)
Minimum
level (N)
Maximum
level (N)
Minimum
level (N)
Maximum
level (N)
Magt-IP BDN/IDN 4.77 4.13 5.4 4.61 4.24 4.98 96.6 0.504
Magt-IP BFN/IFN 5.34 4.8 5.88 5.05 4.66 5.44 94.6 0.391
WR-Magnet S3 1.45 1.32 1.58 1.41 1.32 1.5 97.2 0.237
WR-Magnet S5 2.14 2.02 2.27 2.11 1.98 2.24 98.6 0.417
K-line 1.49 1.45 1.54 1.43 1.37 1.48 96 0.095
X-line 1.58 1.52 1.64 1.57 1.54 1.59 99.4 0.595
Z-line 2.98 2.89 3.07 2.97 2.79 3.14 99.7 0.775
Magna Cap Micro Magna
Abutment mini
2.61 2.14 3.08 2.23 1.83 2.62 85.4 0.094
Magna Cap Mini Magna
Abutment Mini
3.09 2.37 3.8 2.91 2.28 3.54 94.2 0.446
Magna Cap Midi Magna
Abutment Maxi
4.97 4.31 5.64 4.78 4.38 5.17 96.2 0.526
Magna Cap Maxi
Magna Abutment Maxi
5.76 5.08 6.44 5.65 5.24 6.05 98.1 0.626
Boeckler et al . Retention properties of sterilized magnets
1208 | Clin. Oral Impl. Res. 20, 2009 / 12061211 c 2009 John Wiley & Sons A/S
initial retention forces (SD) varied from
5.65 (0.33) to 5.05 (0.32) N. The lowest
retention forces varied from 1.41 (0.07) to
2.11 (0.11) N.
Discussion
The purpose of this study was to investi-
gate the inuence of a sterilization process
on the retentive force of magnetic implant
attachment systems. The dental steriliza-
tion process did not have a signicant
inuence on the maximum retention force
or on the dynamic retention performance of
the tested implant magnetic systems.
Hence, within the limitations of this study
the data support a rejection of the null
hypothesis that sterilization would signi-
cantly decrease retention.
The maximum retention force of a mag-
netic attachment is the force that is re-
quired to cause initial separation of the
magnet from its opposing attractive ele-
ment, which, in this study, was a magnetic
implant abutment. The breakaway force of
magnetic attachments also depends on the
speed of separation of the two components
(Akaltan & Can 1995; Chopra et al. 2007).
As there are no generally valid instructions
or ISO norms available for xing the char-
acteristic forceattraction curves of mag-
netic attachments, measurements were
made in accordance to previous studies in
a calibrated universal test machine using a
specially made, non-magnetic test device
at a crosshead speed of 20 mm/min and a
movement of 40 mm (Yiu et al. 2004;
Chopra et al. 2007).
It was found that the untreated magnetic
attachments showed differences between
the diverse systems. Although high forces
can be produced even by small magnets,
the force produced by any two magnets is
inversely proportional to the square of the
distance between them. This means that
the force between any two magnets de-
creases dramatically with distance (Noar
& Evans 1999). The characteristic force
dislodgement curves of OMS, CMS, and
ODS were representative for the respective
arrangement of the corresponding magnets,
the polarization of the rare earth magnets
(Highton et al. 1986; Akaltan & Can 1995;
Riley et al. 1999), and the tested magnetic
alloys. (Sagawa et al. 1984).
In general, surgical instruments and de-
vices that enter a sterile part of the body
must have a high sterility assurance level
(Skaug 1983). Examples in implant dentis-
try include the implants and the abutments
torqued to the implants during a surgical
procedure. A widely used method for heat
sterilization is the autoclave. Dental steam
autoclaves commonly use saturated water
steam heated to 1211C or 1341C. To
achieve sterility, a holding time of at least
15 min at 1211C or 3min at 1341C is
required (Brusca et al. 2004; Vadrot &
Darbord 2006). Additional sterilizing time
is usually required for instruments packed
in layers of cloth, as they may take longer
to reach the required temperature.
The steam autoclave used in this study
fullled the requirements of the european
standard DIN EN 13060:2004. With a
holding time of 10 min and a steam tem-
perature of 1341C, the sterilization process
performed in this investigation was accord-
ing to the standard protocol for the sterili-
zation of surgical instruments and also met
the recommendations of the manufacturer
of the autoclave. The applied heat caused a
Fig. 2. Details of the characteristic force-displacement curves for Aichi magnetic implant abutments before
and after sterilization.
Fig. 3. Details of the characteristic force-displacement curves for Dyna magnetic implant abutments before
and after sterilization.
Boeckler et al . Retention properties of sterilized magnets
c 2009 John Wiley & Sons A/S 1209 | Clin. Oral Impl. Res. 20, 2009 / 12061211
reduction of the initial breakaway force in
all tested magnetic systems. Comparison
with the retentive forces before sterilization
demonstrated retention forces between
99.6% and 85.4% of the non-sterilized
pairs. However, the reduction was not
signicant (P0.09 and 0.63, Table 2).
Therefore, if the products evaluated are to
be sterilized under the protocol used in this
study a reduction in the initial retention
forces is anticipated, although it is not
likely to be signicant or clinically rele-
vant. Nevertheless, to prevent the risk of
alterations of the retention properties, mag-
netic implant abutments should be steri-
lized with caution, especially with
sterilization protocols not evaluated in
this study.
In the dental literature, it is reported that
the heat produced during polymerization of
acrylic resins may cause a permanent de-
crease in the magnetic retention force.
Lemon et al. (2004) found a signicant
reduction of approximately 12% compared
with the initial values after 25min of mi-
crowave polymerization of acrylic speci-
mens containing SmCo magnets. The
authors, however, did not measure the tem-
perature during the polymerization process.
The temperatures and cycles of polymer-
ization of dental acrylic resins differ be-
tween products and reach temperatures
between 401C and 901C (Yeung et al.
1995; Vallittu 1996; Noar & Evans 1999)
over a period of up to 9h (Lai et al. 2004).
The authors have considered a possible
negative inuence of the exothermic poly-
merization reaction on the retention force of
magnets embedded inacrylic resins (Tsutsui
et al. 1979; Noar & Evans 1999). However,
besides the previously cited studies, the
problem has yet to be investigated in detail,
and this is an area for future research.
Conclusion
In this study, the autoclave sterilization of
the tested magnetic attachments for use on
dental implants caused a non-signicant
reduction compared with the initial reten-
tive forces. Considering the restrictions of
this study magnetic implant abutments
may therefore be sterilized with caution
with no undue increase in the risk of
alterations of the retention properties.
Acknowledgements: We would like
to thank the company Straumann AG
for the kind support for this study. Also,
we would like to thank Mrs Ingrid
Haufe, Data Processing Center of the
Martin-Luther-University Halle-
Wittenberg, Germany, for their support
in the statistical analysis of the data.
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