Investigation of bone inelastic response in interaction phenomena with dental implants

On the limits of finite element models created from (micro)CT datasets and used in studies of bone-implant-related biomechanical problems

Patient-specific approach is gaining a wide popularity in computational simulations of biomechanical systems. Simulations (most often based on the finite element method) are to date routinely created using data from imaging devices such as computed tomography which makes the models seemingly very complex and sophisticated. However, using a computed tomography in finite element calculations does not necessarily enhance the quality or even credibility of the models as these depend on the quality of the input images. Low-resolution (medical-)CT datasets do not always offer detailed representation of trabecular bone in FE models and thus might lead to incorrect calculation of mechanical response to external loading. The effect of image resolution on mechanical simulations of bone-implant interaction has not been thoroughly studied yet. In this study, the effect of image resolution on the modeling procedure and resulting mechanical strains in bone was analyzed on the example of cranial implant. For this purpose, several finite element models of bone interacting with fixation-screws were generated using seven computed tomography datasets of a bone specimen but with different image resolutions (ranging from micro-CT resolution of 25 μm to medical-CT resolution of 1250 μm). The comparative analysis revealed that FE models created from images of low resolution (obtained from medical computed tomography) can produce biased results. There are two main reasons: 1. Medical computed tomography images do not allow generating models with complex trabecular architecture which leads to substituting of the intertrabecular pores with a fictitious mass; 2. Image gray value distribution can be distorted resulting in incorrect mechanical properties of the bone and thus in unrealistic or even completely fictitious mechanical strains. The biased results of calculated mechanical strains can lead to incorrect conclusion, especially when bone-implant interaction is investigated. The image resolution was observed not to significantly affect stresses in the fixation screw itself; however, selection of bone material representation might result in significantly different stresses in the screw.

Effect of load-induced local mechanical strain on peri-implant bone cell activity related to bone resorption and formation in mice: An analysis of histology and strain distributions

The purpose of this study was to investigate the effect of load-induced local mechanical strain on bone cell activity of peri-implant bone in mice. Titanium implants were placed in the maxillae of 13-week-old male C57BL/6J mice and subjected to intermittent 0.15 N, 0.3 N, or 0.6 N loads for 30 min/day for 6 days. The animals were sacrificed 2 days after the final loading. Unloaded mice were used as controls. An animal-specific three-dimensional finite element model was constructed based on morphological data retrieved from in vivo microfocus computed tomography for each mouse to calculate the mechanical strain distribution. Strain distribution images were overlaid on corresponding histological images of the same site in the same animal. The buccal cervical region of the peri-implant bone was predetermined as the region of interest (ROI). Each ROI was divided by four strain intensity levels: 0-20 με, 20-60 με, 60-100 με, and ≥100 με, and the bone histomorphometric parameters were analyzed by the total area of each strain range for all loaded samples. The distance between the calcified front and calcein labeling as a parameter representing the mineral apposition rate was significantly greater in the areas with strain intensity ≥100 με than in the area with strain intensity <100 με, suggesting that the bone formation activity of osteoblasts was locally enhanced by a higher mechanical strain. However, the shrunken osteocytes and the empty osteocyte lacunae were significantly lower in the highest strain area, suggesting that osteoclastogenesis was more retarded in higher strain areas than in lower strain areas. The histomorphometric parameters were not affected geometrically in the unloaded animals, suggesting that the load-induced mechanical strain caused differences in the histomorphometric parameters. Our findings support the hypothesis that bone cell activity related to bone resorption and formation is local strain-dependent on implant loading.

Micro finite element analysis of dental implants under different loading conditions

Osseointegration is paramount for the longevity of dental implants and is significantly influenced by biomechanical stimuli. The aim of the present study was to assess the micro-strain and displacement induced by loaded dental implants at different stages of osseointegration using finite element analysis (FEA). Computational models of two mandible segments with different trabecular densities were constructed using microCT data. Three different implant loading directions and two osseointegration stages were considered in the stress-strain analysis of the bone-implant assembly. The bony segments were analyzed using two approaches. The first approach was based on Mechanostat strain intervals and the second approach was based on tensile/compression yield strains. The results of this study revealed that bone surrounding dental implants is critically strained in cases when only a partial osseointegration is present and when an implant is loaded by buccolingual forces. In such cases, implants also encounter high stresses. Displacements of partially-osseointegrated implant are significantly larger than those of fully-osseointegrated implants. It can be concluded that the partial osseointegration is a potential risk in terms of implant longevity.

A novel in silico method to quantify primary stability of screws in trabecular bone

Insufficient primary stability of screws in bone leads to screw loosening and failure. Unlike conventional continuum finite-element models, micro-CT based finite-element analysis (micro-FE) is capable of capturing the patient-specific bone micro-architecture, providing accurate estimates of bone stiffness. However, such in silico models for screws in bone highly overestimate the apparent stiffness. We hypothesized that a more accurate prediction of primary implant stability of screws in bone is possible by considering insertion-related bone damage. We assessed two different screw types and loading scenarios in 20 trabecular bone specimens extracted from 12 cadaveric human femoral heads (N = 5 for each case). In the micro-FE model, we predicted specimen-specific Young's moduli of the peri-implant bone damage region based on morphometric parameters such that the apparent stiffness of each in silico model matched the experimentally measured stiffness of the corresponding in vitro specimen as closely as possible. The standard micro-FE models assuming perfectly intact peri-implant bone overestimated the stiffness by over 330%. The consideration of insertion related damaged peri-implant bone corrected the mean absolute percentage error down to 11.4% for both loading scenarios and screw types. Cross-validation revealed a mean absolute percentage error of 14.2%. We present the validation of a novel micro-FE modeling technique to quantify the apparent stiffness of screws in trabecular bone. While the standard micro-FE model overestimated the bone-implant stiffness, the consideration of insertion-related bone damage was crucial for an accurate stiffness prediction. This approach provides an important step toward more accurate specimen-specific micro-FE models. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2415-2424, 2017.

Patient-specific fracture risk assessment of vertebrae: A multiscale approach coupling X-ray physics and continuum micromechanics

While in clinical settings, bone mineral density measured by computed tomography (CT) remains the key indicator for bone fracture risk, there is an ongoing quest for more engineering mechanics-based approaches for safety analyses of the skeleton. This calls for determination of suitable material properties from respective CT data, where the traditional approach consists of regression analyses between attenuation-related grey values and mechanical properties. We here present a physics-oriented approach, considering that elasticity and strength of bone tissue originate from the material microstructure and the mechanical properties of its elementary components. Firstly, we reconstruct the linear relation between the clinically accessible grey values making up a CT, and the X-ray attenuation coefficients quantifying the intensity losses from which the image is actually reconstructed. Therefore, we combine X-ray attenuation averaging at different length scales and over different tissues, with recently identified 'universal' composition characteristics of the latter. This gives access to both the normally non-disclosed X-ray energy employed in the CT-device and to in vivo patient-specific and location-specific bone composition variables, such as voxel-specific mass density, as well as collagen and mineral contents. The latter feed an experimentally validated multiscale elastoplastic model based on the hierarchical organization of bone. Corresponding elasticity maps across the organ enter a finite element simulation of a typical load case, and the resulting stress states are increased in a proportional fashion, so as to check the safety against ultimate material failure. In the young patient investigated, even normal physiological loading is probable to already imply plastic events associated with the hydrated mineral crystals in the bone ultrastructure, while the safety factor against failure is still as high as five. Copyright © 2016 John Wiley & Sons, Ltd.

Finite element analysis of dental implant loading on atrophic and non-atrophic cancellous and cortical mandibular bone - a feasibility study

The first aim of this study was to assess displacements and micro-strain induced on different grades of atrophic cortical and trabecular mandibular bone by axially loaded dental implants using finite element analysis (FEA). The second aim was to assess the micro-strain induced by different implant geometries and the levels of bone-to-implant contact (BIC) on the surrounding bone. Six mandibular bone segments demonstrating different grades of mandibular bone atrophy and various bone volume fractions (from 0.149 to 0.471) were imaged using a micro-CT device. The acquired bone STL models and implant (Brånemark, Straumann, Ankylos) were merged into a three-dimensional finite elements structure. The mean displacement value for all implants was 3.1 ±1.2 µm. Displacements were lower in the group with a strong BIC. The results indicated that the maximum strain values of cortical and cancellous bone increased with lower bone density. Strain distribution is the first and foremost dependent on the shape of bone and architecture of cancellous bone. The geometry of the implant, thread patterns, grade of bone atrophy and BIC all affect the displacement and micro-strain on the mandible bone. Preoperative finite element analysis could offer improved predictability in the long-term outlook of dental implant restorations.

Experimental and computational investigation of Morse taper conometric system reliability for the definition of fixed connections between dental implants and prostheses

Nowadays, dental implantology is a reliable technique for treatment of partially and completely edentulous patients. The achievement of stable dentition is ensured by implant-supported fixed dental prostheses. Morse taper conometric system may provide fixed retention between implants and dental prostheses. The aim of this study was to investigate retentive performance and mechanical strength of a Morse taper conometric system used as implant-supported fixed dental prostheses retention. Experimental and finite element investigations were performed. Experimental tests were achieved on a specific abutment-coping system, accounting for both cemented and non-cemented situations. The results from the experimental activities were processed to identify the mechanical behavior of the coping-abutment interface. Finally, the achieved information was applied to develop reliable finite element models of different abutment-coping systems. The analyses were developed accounting for different geometrical conformations of the abutment-coping system, such as different taper angle. The results showed that activation process, occurred through a suitable insertion force, could provide retentive performances equal to a cemented system without compromising the mechanical functionality of the system. These findings suggest that Morse taper conometrical system can provide a fixed connection between implants and dental prostheses if proper insertion force is applied. Activation process does not compromise the mechanical functionality of the system.

Physical modeling with orthotropic material based on harmonic fields

Although it is well known that human bone tissues have obvious orthotropic material properties, most works in the physical modeling field adopted oversimplified isotropic or approximated transversely isotropic elasticity due to the simplicity. This paper presents a convenient methodology based on harmonic fields, to construct volumetric finite element mesh integrated with complete orthotropic material. The basic idea is taking advantage of the fact that the longitudinal axis direction indicated by the shape configuration of most bone tissues is compatible with the trajectory of the maximum material stiffness. First, surface harmonic fields of the longitudinal axis direction for individual bone models were generated, whose scalar distribution pattern tends to conform very well to the object shape. The scalar iso-contours were extracted and sampled adaptively to construct volumetric meshes of high quality. Following, the surface harmonic fields were expanded over the whole volumetric domain to create longitudinal and radial volumetric harmonic fields, from which the gradient vector fields were calculated and employed as the orthotropic principal axes vector fields. Contrastive finite element analyses demonstrated that elastic orthotropy has significant effect on simulating stresses and strains, including the value as well as distribution pattern, which underlines the relevance of our orthotropic modeling scheme.

Finite element analysis of stress concentration in three popular brands of fiber posts systems used for maxillary central incisor teeth

AIMS AND OBJECTIVES

To study the stress concentrations in endodontically treated maxillary central incisor teeth restored with 3 different fiber post systems subjected to various oblique occlusal loads.

MATERIALS AND METHODS

FEM analysis was used to analyze stress concentrations generated in maxillary anterior teeth. Computer aided designing was used to create a 2-D model of an upper central incisor. Post systems analyzed were the DT Light Post (RDT, Bisco), Luscent Anchor (Dentatus) & RelyX (3M-ESPE). The entire design assembly was subjected to analysis by ANSYS for oblique loading forces of 25N, 80N & 125 N RESULTS: The resultant data showed that the RelyX generated the least amount of stress concentration.

CONCLUSIONS

Minimal stress buildups contribute to the longevity of the restorations. Thus RelyX by virtue of judicious stress distribution is the better option for restoration of grossly decayed teeth.

Modelling of mandible bone properties in the numerical analysis of oral implant biomechanics

The biomechanical efficiency of oral implants is deeply influenced by mechanical properties of cortical and trabecular bone in the jaw and, in particular, in the peri-implant region. When the mechanical response of the implant-bone system is analysed by means of numerical models, the effective mechanical properties of bone and the possible change as a function of spatial position must be carefully considered. The procedure presented provides for the attribution of the mechanical properties of bone, considered as anisotropic elastic material, as a function of the spatial position making use of Fourier series and polynomial functions. The procedure is implemented in a general purpose finite element software, adopted to develop biomechanical analyses of prosthetic systems. This procedure allows for an accurate representation of bone tissue properties. Results pertaining to the analysis of commercial oral implants show the potential of the method adopted.

Evaluation of the stress distribution in CFR-PEEK dental implants by the three-dimensional finite element method

CFR-PEEK (carbon fiber reforced-poly ether ether ketone) has been demonstrated to be excellent substitute titanium in orthopedic applications and can be manufactured with many physical, mechanical, and surface properties, in several shapes. The aim of this study was to compare, using the three-dimensional finite element method, the stress distribution in the peri-implant support bone of distinct models composed of PEEK components and implants reinforced with 30% carbon fiber (30% CFR-PEEK) or titanium. In simulations with a perfect bonding between the bone and the implant, the 30% CFR-PEEK presented higher stress concentration in the implant neck and the adjacent bone, due to the decreased stiffness and higher deformation in relation to the titanium. However, 30% CFR-PEEK implants and components did not exhibit any advantages in relation to the stress distribution compared to the titanium implants and components.

Multiscale modelling and nonlinear finite element analysis as clinical tools for the assessment of fracture risk

The risk of osteoporotic fractures is currently estimated based on an assessment of bone mass as measured by dual-energy X-ray absorptiometry. However, patient-specific finite element (FE) simulations that include information from multiple scales have the potential to allow more accurate prognosis. In the past, FE models of bone were limited either in resolution or to the linearization of the mechanical behaviour. Now, nonlinear, high-resolution simulations including the bone microstructure have been made possible by recent advances in simulation methods, computer infrastructure and imaging, allowing the implementation of multiscale modelling schemes. For example, the mechanical loads generated in the musculoskeletal system define the boundary conditions for organ-level, continuum-based FE models, whose nonlinear material properties are derived from microstructural information. Similarly microstructure models include tissue-level information such as the dynamic behaviour of collagen by modifying the model's constitutive law. This multiscale approach to modelling the mechanics of bone allows a more accurate characterization of bone fracture behaviour. Furthermore, such models could also include the effects of ageing, osteoporosis and drug treatment. Here we present the current state of the art for multiscale modelling and assess its potential to better predict an individual's risk of fracture in a clinical setting.

The importance of cortical bone orthotropicity, maximum stiffness direction and thickness on the reliability of mandible numerical models

AIM

To identify mechanical and geometrical variables affecting the biofidelity of numerical models of human mandible. Computed results sensibility to cortical bone orthotropy and thicknesses is investigated.

METHODS

Two mandible numerical models of different bone complexities are setup. In the low-complexity model, cortical bone is coupled with isotropic materials properties; constant thickness for cortical bone is adopted along the mandible structure. In the higher complexity model, the cortical bone is considered as an orthotropic material according to an independent mechanical characterization performed on fresh human dentate mandibles. Cortical thickness distribution, the values of the principal elastic moduli and principal directions of orthotropy are considered as piecewise heterogeneous. Forces for masseter (10 N), medial pterigoid (6 N), anterior (4 N) and posterior (4 N) temporalis muscles are applied to the models. Computed strains fields are compared with those experimentally measured in an independent test performed on a real human mandible in the same loading conditions.

RESULTS

Under closure muscles forces both models shows similar strain distribution. On the contrary, strain fields values are significantly different between the presented models.

CONCLUSIONS

The mandible structure is sensible to compact bone orthotropy and thickness at the facial side of condylar neck, retro molar area and at the lingual side of middle portion of the corpus in molars area, anterior margin of the ramus. In these areas, it is advisable to use orthotropic properties for cortical bone to accurately describe the strain state.