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The aim of this study was to clarify the difference in the stress distribution patterns between implants with external-hex or internal-hex connection systems using in vitro models. Three 13 mm fixtures with external-hex and internal-hex connections were installed into an acrylic bone analogue. One piece abutments of 7 mm height was connected. Strain gauges were attached to the abutment surface, and the cervical and fixture tip areas of the bone analogue surface. Vertical and horizontal load applied was 30 N. Data were normalized for each model by obtaining values relative to the sum of the three values. Almost the same force distribution pattern was found under vertical load in both systems. Fixtures with external-hex showed an increase in strain at the cervical area under horizontal load, while in internal-hex fixtures the strain was at the fixture tip area. Within limitations of our model study, it was suggested that fixtures with internal-hex showed widely spread force distribution down to the fixture tip compared with external hex ones.
Maeda et al. (Sun,) studied this question.