Biomechanical evaluation of one-piece and two-piece small-diameter dental implants: In-vitro experimental and three-dimensional finite element analyses

Influence of dental implant/mini-implant design on stress distribution in overdentures: a systematic review

PURPOSE

Critically evaluate the existing literature and answer the question, "Does the dental implant/mini-implant design influence the stress distribution in prosthetic overdentures according to finite element analysis?".

METHODS

This systematic review was registered in the Open Science Framework (osf.io/2bquj) and followed the PRISMA protocols. The custom search strategy was applied to 4 databases. In vitro experimental studies that evaluated the influence of dental implant/mini-implant design on stress distribution in overdentures by FEM, without time and language restrictions, were included. The selection process was carried out in two stages by two reviewers independently. Risk of bias analysis was performed by a checklist of important parameters.

RESULTS

Sixty articles were evaluated by their title and abstract, four were selected for full reading, three were relevant, and nine were included by additional search. The 12 studies have a low risk of bias. The meta-analysis could not be performed due to the heterogeneity of the data (implant type, design variation, load intensity, and direction).

CONCLUSION

It can be inferred from the evaluated literature that design modifications influence the stress distribution, but as the FEM presents limitations inherent to the in vitro study, clinical trials are necessary to infer the effectiveness of the modifications. It should be noted that there is no consensus on which is the best thread design and that implants with a very narrow diameter are subject to the highest stress concentration.

Biomaterials and Clinical Application of Dental Implants in Relation to Bone Density-A Narrative Review

Titanium has been the material of choice for dental implant fixtures due to its exceptional qualities, such as its excellent balance of rigidity and stiffness. Since zirconia is a soft-tissue-friendly material and caters to esthetic demands, it is an alternative to titanium for use in implants. Nevertheless, bone density plays a vital role in determining the material and design of implants. Compromised bone density leads to both early and late implant failures due to a lack of implant stability. Therefore, this narrative review aims to investigate the influence of implant material/design and surgical technique on bone density from both biomechanical and biological standpoints. Relevant articles were included for analysis. Dental implant materials can be fabricated from titanium, zirconia, and PEEK. In terms of mechanical and biological aspects, titanium is still the gold standard for dental implant materials. Additionally, the macro- and microgeometry of dental implants play a role in determining and planning the appropriate treatment because it can enhance the mechanical stress transmitted to the bone tissue. Under low-density conditions, a conical titanium implant design, longer length, large diameter, reverse buttress with self-tapping, small thread pitch, and deep thread depth are recommended. Implant material, implant design, surgical techniques, and bone density are pivotal factors affecting the success rates of dental implant placement in low-density bone. Further study is required to find the optimal implant material for a clinical setting's bone state.

Stress distribution of one-piece and two-piece mini-Implant overdentures with various attachment systems and diameters: A finite element analysis

PURPOSE

We investigated and compared the stress distribution within one- and two-piece mini-implants for overdentures with three different attachments (ball, Locator, and magnet) and two different diameters using three-dimensional finite element (3D FE) analysis and a monotonic bending test. The goal was to identify the most beneficial implant attachment system design for mini-implant overdentures with a lower risk of implant fracture.

METHODS

Twelve 3D FE models simulating a mandible segment with one- and two-piece mini-implants with different attachment systems, diameters, and overdentures were created using three-dimensional computer-aided design (CAD) software. Vertical and oblique forces (45° to the longitudinal axis of the implant) of 100 N were applied to the dentures. The stress distribution was analyzed. A bending test was performed on a mini-implant (Locator, 2.4 mm) using a testing machine to quantify the load at yield stress.

RESULTS

One-piece mini-implants showed lower maximum stress compared to two-piece mini-implants. Among the three designs, the magnet attachment systems showed the maximum stress. The maximum von Mises stress occurred at the neck of the implants, which was surrounded by cortical bone in all models, and under both loading conditions.

CONCLUSIONS

Focusing on the attachments and one- and two-piece designs of mini-implant overdentures using CAD models to reduce confounding factors affecting the stress distribution, we concluded that one-piece mini-implants tended to show lower stress compared to two-piece mini-implants. Mini-implant overdentures with Locator and ball attachments demonstrated lower stress within the implants compared to those with magnet attachments under vertical and oblique loading conditions.

Finite element analysis in implant dentistry: State of the art and future directions

OBJECTIVE

To discuss the state of the art of Finite Element (FE) modeling in implant dentistry, to highlight the principal features and the current limitations, and giving recommendations to pave the way for future studies.

METHODS

The articles' search was performed through PubMed, Web of Science, Scopus, Science Direct, and Google Scholar using specific keywords. The articles were selected based on the inclusion and exclusion criteria, after title, abstract and full-text evaluation. A total of 147 studies were included in this review.

RESULTS

To date, the FE analysis of the bone-dental implant system has been investigated by analyzing several types of implants; modeling only a portion of bone considered as isotropic material, despite its anisotropic behavior; assuming in most cases complete osseointegration; considering compressive or oblique forces acting on the implant; neglecting muscle forces and the bone remodeling process. Finally, there is no standardized approach for FE modeling in the dentistry field.

SIGNIFICANCE

FE modeling is an effective computational tool to investigate the long-term stability of implants. The ultimate aim is to transfer such technology into clinical practice to help dentists in the diagnostic and therapeutic phases. To do this, future research should deeply investigate the loading influence on the bone-implant complex at a microscale level. This is a key factor still not adequately studied. Thus, a multiscale model could be useful, allowing to account for this information through multiple length scales. It could help to obtain information about the relationship among implant design, distribution of bone stress, and bone growth. Finally, the adoption of a standardized approach will be necessary, in order to make FE modeling highly predictive of the implant's long-term stability.

Influence of surface coatings on the stress distribution by varying friction contact at implant-bone interface using finite element analysis

The present work aims to evaluate the effect of various surface coatings of titanium dental implants by varying the friction coefficient (µ) at the interface between the dental implant and jawbone using finite element analysis (FEA) methods and to provide a comparative analysis between the various surface coatings and implant designs. An accurate model of the dental implant prosthetics consisting of the hard (cortical) and the soft (cancellous) bone, with the various titanium dental implant designs was modelled using a 3D CAD software, and the FE mesh model was generated using HyperMesh 13.0. Three coatings having different coefficient of friction values were selected: Titanium Nitride (TiN) with a friction coefficient of 0.19, Titanium Oxide (TiO₂) with a friction coefficient of 0.30 and Zirconium Nitride (ZrN) with a coefficient of friction of 0.49. The non-linear static stress analysis was conducted under three different loading conditions (vertical, lateral and oblique loading) using a CAE solver. The present study showed that surface coatings with high friction coefficients generated lower stresses in the cancellous bone while generating higher stresses in the cortical bone. However, for dental implants having microthreads in their neck region, surface coatings with a high coefficient of friction generated lower stresses at the interface between the cortical bone and the implant. The FEA results indicate that selecting suitable surface coatings would significantly decrease the stresses developed at the bone-implant interface, and future studies should conduct in vivo trials to validate the FEA results obtained.

Biomechanical evaluation of bridge span with three implant abutment designs and two connectors for tooth-implant supported prosthesis: A finite element analysis

Background/purpose

Bridge stability under loading was influenced by bridge span with the connector and implant abutment design. Thus, the purpose of this study was to evaluate the effects of rigid and non-rigid connector designs and pontic connections of different abutment systems in the tooth-implant supported prosthesis (TISP) at different span distances on the biomechanical stress distribution of the overall system components.

Materials and methods

For comparative analysis, rigid and non-rigid bridge connections were fitted with three implant abutment systems (one-piece, two-piece and three-piece), and five implant-to-natural tooth distance configurations (12 mm, 14 mm, 16 mm, 18 mm, and 20 mm) were provided.

Results

The maximum stress between TISP components occurred at the distal side of crown margin of cement1 in rigid connector with one-piece group and the bottom of the crown3 in non-rigid connector with one-piece group, while the other groups were more concentrated at the junction between the mesial side of the implant collar and the abutment. In addition, neither the rigid nor non-rigid connector model showed that stress distribution increased proportionally with the bridge span distance.

Conclusion

It was clinically recommended that if the implant with a shorter bridge distance of 12 mm from the natural tooth, the rigid connection of the three-piece abutment can be used as the TISP design. If the bridge distance was 18 mm longer, the non-rigid connection of the three-piece abutment could maintain the physiological movement of the natural tooth and avoid the excessive stress on the bone crest around the implant.

Strain based in vitro analysis of dental implant using artificial bone model and validation by numerical technique

BACKGROUND/PURPOSE

Dental implant fails due to mechanical failure of the implant contribute to about 10-15 % of implant failures. It is necessary to prevent the design failure of the implant since it leads to bone loss which further leads to complications in reimplantation. This makes it important to test the design of a dental implant using FEM and in vitro testing before its application. The purpose of this article is to test the design of a dental implant using in vitro testing by using an artificial bone model and validation of the data using Finite Element Method (FEM).

METHODS

A dental implant was selected for in vitro testing and 3D FE analysis was conducted to observe the stress values. The in vitro study was done on a custom designed testing rig where the implant was drilled into a ABS and sawbone (polyurethane) bone model. Vertical and lateral loads of 100 N and 40 N respectively, were applied to evaluate the micro-strains using strain gauge technique. 3D FEA technique was used to evaluate stress concentrations and micro-strains in the bone-implant interface.

RESULTS

The strain values were found to be higher in the case of lateral loading than vertical loading with in vitro testing. The von-mises stresses on the cortical bone were greater at the bone-implant interface near the neck region of the implant.

CONCLUSIONS

The results obtained from the in vitro analysis and FEA were found to have a good agreement with an error percentage of 2-5 %.

Influence of Abutment Design on Biomechanical Behavior to Support a Screw-Retained 3-Unit Fixed Partial Denture

This study aimed to evaluate the biomechanical behavior of Morse taper implants using different abutments (CMN abutment [(CMN Group] and miniconical abutments [MC Group]), indicated to support a screw-retained 3-unit fixed partial denture. For the in vitro test, polyurethane blocks were fabricated for both groups (n = 10) and received three implants in the "offset" configuration and their respective abutments (CMN or MC) with a 3-unit fixed partial denture. Four strain gauges were bonded to the surface of each block. For the finite element analysis, 3D models of both groups were created and exported to the analysis software to perform static structural analysis. All structures were considered homogeneous, isotropic, and elastic. The contacts were considered non-linear with a friction coefficient of 0.3 between metallic structures and considered bonded between the implant and substrate. An axial load of 300 N was applied in three points (A, B, and C) for both methods. The microstrain and the maximum principal stress were considered as analysis criteria. The obtained data were submitted to the Mann-Whitney, Kruskal-Wallis, and Dunn's multiple comparison test (α = 5%). The results obtained by strain gauge showed no statistical difference (p = 0.879) between the CMN (645.3 ± 309.2 με) and MC (639.3 ± 278.8 με) and allowed the validation of computational models with a difference of 6.3% and 6.4% for the microstrains in the CMN and MC groups, respectively. Similarly, the results presented by the computational models showed no statistical difference (p = 0.932) for the CMN (605.1 ± 358.6 με) and MC (598.7 ± 357.9 με) groups. The study concluded that under favorable conditions the use of CMN or MP abutments to support a fixed partial denture can be indicated.

Fracture analysis of one/two-piece clinically failed zirconia dental implants

OBJECTIVES

Analyzing factors that may have led to fracture of zirconia implants by macro/micro-fractography.

METHODS

Six one-piece and ten two-piece full-ceramic zirconia implants from two manufacturers, Z-Systems and CeraRoot, were retrieved after clinical failure. The time-to-failure ranged from 3 to 49 months. Optical and scanning electron microscopy (SEM) were used to analyze the fracture planes at the macro- and microscopic level. Treatment planning, surgical protocol, fracture-origin location and characteristic fracture features were assessed.

RESULTS

The fracture of all implants seemed to have been primarily due to overload in bending mode, while the fracture-initiation sites varied for the one- and two-piece implants. The fracture of all one-piece implants originated in the constriction region between two threads in the endosseous implant part. For two-piece implants, the abutment neck, internal abutment-implant connections and inner threads were found to be the main fracture-initiation sites. Surface defects at the root area for one-piece implants and damages at the abutment surface for two-piece implants were connected to the fracture origins. Importantly, the clinical failures of implants were often found to result from combined effects related to patient aspects, treatment planning/protocols, a high bending moment at the weakest link, implant-surface conditions and specific implant designs.

SIGNIFICANCE

This study provided information to be considered for future optimization of treatment planning and the surgical protocol for zirconia implants. Optimization of the surface conditions and the zirconia-starting powder were also suggested.

Biomechanical evaluations of the long-term stability of dental implant using finite element modeling method: a systematic review

PURPOSE

The aim of this study is to summarize various biomechanical aspects in evaluating the long-term stability of dental implants based on finite element method (FEM).

MATERIALS AND METHODS

A comprehensive search was performed among published studies over the last 20 years in three databases; PubMed, Scopus, and Google Scholar. The studies are arranged in a comparative table based on their publication date. Also, the variety of modeling is shown in the form of graphs and tables. Various aspects of the studies conducted were discussed here.

RESULTS

By reviewing the titles and abstracts, 9 main categories were extracted and discussed as follows: implant materials, the focus of the study on bone or implant as well as the interface area, type of loading, element shape, parts of the model, boundary conditions, failure criteria, statistical analysis, and experimental tests performed to validate the results. It was found that most of the studied articles contain a model of the jaw bone (cortical and cancellous bone). The material properties were generally derived from the literature. Approximately 43% of the studies attempted to examine the implant and surrounding bone simultaneously. Almost 42% of the studies performed experimental tests to validate the modeling.

CONCLUSION

Based on the results of the studies reviewed, there is no "optimal" design guideline, but more reliable design of implant is possible. This review study can be a starting point for more detailed investigations of dental implant longevity.

Stresses induced by one piece and two piece dental implants in All-on-4® implant supported prosthesis under simulated lateral occlusal loading: non linear finite element analysis study

Background

Correct choice of the implant design and the occlusal scheme is important for the success of implant supported restorations. So, the aim of the current study was to find out the difference in the stresses induced by the one piece dental implants designed to be used in the All-on-4® concept and the conventional two piece ones under simulated lateral occlusal schemes using nonlinear finite element analysis.

Methods

Two finite element models of the maxilla, implants, and prostheses were designed according to the All-on-4® concept. In the model TP, two piece dental implants were placed while in the model OP one piece dental implants were used. Two loading scenarios were applied to each model; the first one simulated a group function occlusal scheme while the second scenario simulated a canine guided one.

Results

The highest stress value was recorded in the model TP with the group function occlusion and the lowest stress value was in the model OP with the canine guidance occlusion.

Conclusion

The one-piece dental implants can be concluded to induce less stress compared to the two piece dental implants when used in the All-on-4® implant supported prosthesis in the different lateral occlusal schemes. Canine guided occlusion can be concluded to cause lower stress values in comparison to the group function occlusal scheme.

Biomechanical influence of thread form on stress distribution over short implants (≤6 mm) using finite element analysis

The macro and micro design is essential to the biomechanical performance of a short implant. In this study, the implant thread parameters of short implants used in edentulous maxillae will be discussed. The aim of the study is to analyse biomechanical distinctions in different thread parameters over short implants by applying the vertical or oblique load of 130 N on dental prosthesis. A 6*5 mm implant will be used in posterior maxillae arch, where the molar region locates. The CAD model has been assembled by three parts, a crown, an implant system and a jaw. By applying the vertical or oblique load to the crown, the Von-Mises stresses of cortical bone and trabecular bone will be evaluated in pairs along the lines v1–v2 & a1–a2. The results showed that the reverse buttress thread would induce more stresses in cancellous bone whereas the buttress did the opposite. The trapezoidal thread (V-thread) is more favourable than the reverse buttress thread in accordance to the FEA result. The rectangle threads will induce more uneven stresses in cancellous bones.

Effects of abutment screw preload and preload simulation techniques on dental implant lifetime

Background

This study aimed to investigate how the predicted implant fatigue lifetime is affected by the loss of connector screw preload and the finite element analysis method used to simulate preload.

Methods

A dental implant assembly (DI1, Biomet-3i external hex; Zimmer Biomet) was scanned using microcomputed tomography and measured using Mimics software (Materialise) and an optical microscope. Digital replicas were constructed using SolidWorks software (Dassault Systèmes). The material properties were assigned in Abaqus (Dassault Systèmes). An external load was applied at 30° off-axial loading. Eight levels of connector screw preload (range, 0-32 Ncm) were simulated for DI1. This assembly and an additional model (DI2) having a longer and narrower screw were compared regarding their fatigue limits (using fe-safe software [Dassault Systèmes]) for 2 preloading methods: (1) adding preload torque or (2) adding bolt axial tension.

Results

The maximum von Mises stresses of DI1 (on the connector screw threads) with and without preload were 439.90 MPa and 587.90 MPa. The predicted fatigue limit was the same for preloads from 100% through 80% of the manufacturer^'s recommendation and dropped precipitously between 80% and 70% preload. Adding a preload torque on the screw resulted in a more uniform stress distribution on the screw compared with bolt axial tension, especially for DI2, which had a longer and narrower screw than DI1.

Conclusions

A substantial loss of preload can be accommodated without compromising the fatigue resistance of this dental implant. Computer models should be constructed using torque instead of a bolt axial tension.

Biomechanical analysis of rigid and non-rigid connection with implant abutment designs for tooth-implant supported prosthesis: A finite element analysis

BACKGROUND/PURPOSE

The design of the connectors and implant abutments could affect the stress distribution of the tooth-implant supported prosthesis (TISP) entire system after loading. Therefore, the purpose of this study was to investigate the stress distribution of the TISP in different connectors and different implant abutments after loading.

MATERIALS AND METHODS

The TISP design used in this study was divided into six models. R1, R2 and R3 represented the tooth and the one-piece, two-piece and three-piece abutment implant system connected by a rigid connector, respectively, while NR1, NR2 and NR3 were the corresponding tooth-abutment implant systems connected by a non-rigid connector. A vertical occlusal load of 50 N was applied at a right angle on the 6 occlusal points of the occlusal surface.

RESULTS

As a result, regarding the maximum average stress distribution, R1 and NR1 appeared on the implant fixture, and the other four models were on the implant abutment. On the other hand, regardless of the abutment implant system, the maximum von Mises stress generated by the rigid connector was greater than the corresponding non-rigid connector in the cortical bone around implant. In addition, the three-piece abutment implant system had lower von Mises stress than the one-piece and two-piece implant systems in the cortical bone.

CONCLUSION

It is concluded that by adding a flexible non-rigid connector and three-piece abutment device design to TISP, the occlusal load of the implant was dispersed, and the stress could be gradually introduced into the relatively strong implant abutment.

Biomechanical analyses of one-piece dental implants composed of titanium, zirconia, PEEK, CFR-PEEK, or GFR-PEEK: Stresses, strains, and bone remodeling prediction by the finite element method

This work aimed to assess the biomechanics, using the finite element method (FEM), of traditional titanium Morse taper (MT) dental implants compared to one-piece implants composed of zirconia, polyetheretherketone (PEEK), carbon fiber-reinforced PEEK (CFR-PEEK), or glass fiber-reinforced PEEK (GFR-PEEK). MT and one-piece dental implants were modeled within a mandibular bone section and loaded on an oblique force using FEM. A MT implant system involving a Ti6Al4V abutment and a cp-Ti grade IV implant was compared to one-piece implants composed of cp-Ti grade IV, zirconia (3Y-TZP), PEEK, CFR-PEEK, or GFR-PEEK. Stress on bone and implants was computed and analyzed while bone remodeling prediction was evaluated considering equivalent strain. In comparison to one-piece implants, the traditional MT implant revealed higher stress peak (112 MPa). The maximum stresses on the one-piece implants reached ~80 MPa, regardless their chemical composition. MT implant induced lower bone stimulus, although excessive bone strain was recorded for PEEK implants. Balanced strain levels were noticed for reinforced PEEK implants of which CFR-PEEK one-piece implants showed proper biomechanical behavior. Balanced strain levels might induce bone remodeling at the peri-implant region while maintaining low risks of mechanical failures. However, the strength of the PEEK-based composite materials is still low for long-term clinical performance.

Comparison of stress distribution in partially and completely edentulous mandibles around splinted and non-splinted implant prostheses: A finite element study

BACKGROUND

In some treatments using multiple dental implants, the implants are inserted in the bone with splinted or non-splinted implant prostheses. There are some reports about the influence of the splinted and non-splinted implants on stress distribution in the bone using the finite element method (FEM), and there is a controversy in the literature regarding whether the splinted or non-splinted implants prostheses reduce the stress generated on the implant-surrounding bone more efficiently. Additionally, the simple shape of the jaw bones with limited bone area was used for FEM analysis in many studies at the expense of accurate analysis.

OBJECTIVE

The aim of this study was to evaluate the difference in stress distribution in the bone between the splinted and non-splinted implants, and between completely and partially edentulous mandibles.

METHODS

The implants were inserted in the first premolar, second premolar, and first molar regions of the partial and complete mandibles, and the splinted and non-splinted crowns were attached to the implants. Vertical load (100 N) or oblique load (70 N, 30° from its long axis towards the lingual) was applied on the first premolar.

RESULTS

When vertical load was applied to the partially edentulous mandible model, the stress was concentrated intensively on the cortical bone around the first premolar regardless of whether splinted or non-splinted implants were used. On the other hand, the vertical load applied to the completely edentulous mandible model caused the stress to be concentrated intensively on the cortical bone around the first premolar with non-splinted implants. With respect to the oblique load, the stress was concentrated intensively on the cortical bone around the first premolar only with the non-splinted implants, in both the partial and complete mandibles.

CONCLUSION

This study shows the different stress distributions of the cortical bone around the implants between the partial and complete mandible. This indicates that the complete mandible should be used for the analysis of bone stress distribution around the implants using FEM.

Evaluation of changes in mechanical properties of O-ring in one-piece and two-piece ball retained implant-supported overdentures: A three-year retrospective study

The o-rings in ball retained overdentures deteriorate with time and need replacement to restore the retentive quality. We evaluated retrospectively the mechanical properties of o-rings after 3 years in function in one and two-piece implant-supported overdentures. The o-rings were retrieved from one-piece (Myriad snap, Equinox-Straumann, 3.3 x 13mm) and two-piece (Neo Biotech, 3.3 x 13mm) implant-supported overdenture patients. A total of 16 pairs of matrices were tested for wear, type of damage and elasticity using Pin on Disc method, USB Digital Camera in 30x zoom and Universal Tensile Machine respectively. The statistical analysis for independent groups were done with the Mann-Whitney U test. Assessment of used O-rings showed 84% more wear in the two-piece system with an abrasive type of damage while 46% wear in the one-piece system with a compressive type of damage. The o-rings in one-piece system showed increase in elongation and maximum displacement to 2% and 7% respectively, while two-piece system showed decrease in elongation and maximum displacement by 13% and 6% respectively. In one-piece system, the loss of retention was more with slow wear rate and in two-piece system, the wear resistance of O-rings decreased due to increased stiffness. Further studies to evaluate the changes in O-ring with increased sample size and at interval 1 year will pave way for insight into the progressive changes in the mechanical properties of an O-ring.

Influence of Bone Definition and Finite Element Parameters in Bone and Dental Implants Stress: A Literature Review

Bone plays an important role in dental implant treatment success. The goal of this literature review is to analyze the influence of bone definition and finite element parameters on stress in dental implants and bone in numerical studies. A search was conducted of Pubmed, Science Direct and LILACS, and two independent reviewers performed the data extraction. The quality of the selected studies was assessed using the Cochrane Handbook tool for clinical trials. Seventeen studies were included. Titanium was the most commonly-used material in dental implants. The magnitude of the applied loads varied from 15 to 300 N with a mean of 182 N. Complete osseointegration was the most common boundary condition. Evidence from this review suggests that bone is commonly defined as an isotropic material, despite being an anisotropic tissue, and that it is analyzed as a ductile material, instead of as a fragile material. In addition, and in view of the data analyzed in this review, it can be concluded that there is no standardization for conducting finite element studies in the field of dentistry. Convergence criteria are only detailed in two of the studies included in this review, although they are a key factor in obtaining accurate results in numerical studies. It is therefore necessary to implement a methodology that indicates which parameters a numerical simulation must include, as well as how the results should be analyzed.

Design of dental implants at materials level: An overview

Due to the excellent restoration of masticatory function, satisfaction on aesthetics and other superiorities, dental implants represent an effective method to resolve tooth losing and damaging. Current dental implant systems still have problems waiting to be addressed, and problems are centralized on the materials of implant bodies. This review aims to summarize major developments in the field of dental implant materials, starting with an overview on structures, procedures of dental implants and challenges of implant materials. Next, implant materials are examined in three categories, that is, metals, ceramics, and polymers, their mechanical properties, biocompatibility, and bioactivity are summarized. And as an important aspect, strategies of surface modification are also reviewed, along with some finite element analysis to guiding the research direction of implant materials. Finally, the conclusive remarks are outlined to provide an outlook on the future research directions and prospects of dental implants.

Marginal Bone Loss Around One-Piece Implants: A 10-Year Radiological and Clinical Follow-up Evaluation

PURPOSE

This study was conducted to investigate one-piece narrow-diameter implants installed in maxillary lateral and mandibular incisor sites using immediate nonfunctional loading.

MATERIALS AND METHODS

In this 10-year clinical trial study, 42 narrow-diameter (3.0-mm) one-piece implants for 35 patients were inserted. Clinical and radiographic measurements were recorded in 10 years and analyzed statistically using t test.

RESULTS

A total of 26 patients (20 females and 6 males) with 30 implants were available for the 10-year follow-up. The 10-year implant survival rate was 100%. A statistically significant mean marginal bone loss was observed between 12 months and 10 years (0.18 ± 0.29 mm). The mean pocket depth increase was statistically significant (0.68 ± 0.83 mm). No bleeding on probing was observed around 90% of the implants. Full-mouth plaque index was registered at 20% of the implants.

CONCLUSION

The results obtained in this analysis suggest that modest marginal bone loss was observed around the implants. One-piece narrow-diameter implants (Maximus 3.0; BioHorizons) can predictably restore missing maxillary lateral incisors and mandibular incisors in cases of careful patient selection.

The importance of correct implants positioning and masticatory load direction on a fixed prosthesis

Background

Through the biomechanical study of dental implants, it is possible to understand the dissipation effects of masticatory loads in different situations and prevent the longevity of osseointegration. Aims: To evaluate the microstrains generated around external hexagon implants, using axial and non-axial loads in a fixed four-element prosthesis with straight implants and implants inclined at 17°.

Material and Methods

Three implants were modeled using CAD software following the manufacturer’s measurements. Then, implants were duplicated and divided into two groups: one with straight implants and respective abutments, and the other with angled implants at 17° and respective abutments. Both groups were arranged inside a block simulating bone tissue. A simplified fixed prosthesis was installed on both groups and the geometries were exported to CAE software. Five loads of 300N were performed at axial and non-axial points on the fixed prosthesis. Stress on the implants and strain on the block were both analyzed. An in vitro experiment was performed following all structures made in FEA in order to validate the model. In each experimental block, 4 strain gauges were linearly placed between the implants and the same loads were repeated with a loading applicator device.

Results

The deformations computed by the gauges were correlated with the FEA results, showing that the group with inclined implants had more damaging biomechanical behavior and was significantly different from the group with straight implants (P<0.005).

Conclusions

The mathematical model used is valid and inclined implants can induce unwanted bone remodeling.

Key words:Finite Element Analysis, Dental Implants, Fixed Prosthesis.

A REVIEW OF FINITE ELEMENT APPLICATIONS IN ORAL AND MAXILLOFACIAL BIOMECHANICS

Finite element method (FEM) is preferred to carry out mechanical analyses for many complex biomechanical structures. For most of the biomechanical models such as oral and maxillofacial structures or patient-specific dental instruments, including nonlinearities, complicated geometries, complex material properties, or loading/boundary conditions, it is not possible to accomplish an analytical solution. The FEM is the most widely used numerical approach for such cases and found a wide range of application fields for investigating the biomechanical characteristics of oral and maxillofacial structures that are exposed to external forces or torques. The numerical results such as stress or strain distributions obtained from finite element analysis (FEA) enable dental researchers to evaluate the bone tissues subjected to the implant or prosthesis fixation from the viewpoint of (i) mechanical strength, (ii) material properties, (iii) geometry and dimensions, (iv) structural properties, (v) loading or boundary conditions, and (vi) quantity of implants or prostheses. This review paper evaluates the process of the FEA of the oral and maxillofacial structures step by step as followings: (i) a general perspective on the techniques for creating oral and maxillofacial models, (ii) definitions of material properties assigned to oral and maxillofacial tissues and related dental materials, (iii) definitions of contact types between tissue and dental instruments, (iv) details on loading and boundary conditions, and (v) meshing process.

Effects of implant tilting and the loading direction on the displacement and micromotion of immediately loaded implants: an in vitro experiment and finite element analysis

Purpose

The purpose of this study was to investigate the effects of implant tilting and the loading direction on the displacement and micromotion (relative displacement between the implant and bone) of immediately loaded implants by in vitro experiments and finite element analysis (FEA).

Methods

Six artificial bone blocks were prepared. Six screw-type implants with a length of 10 mm and diameter of 4.3 mm were placed, with 3 positioned axially and 3 tilted. The tilted implants were 30° distally inclined to the axial implants. Vertical and mesiodistal oblique (45° angle) loads of 200 N were applied to the top of the abutment, and the abutment displacement was recorded. Nonlinear finite element models simulating the in vitro experiment were constructed, and the abutment displacement and micromotion were calculated. The data on the abutment displacement from in vitro experiments and FEA were compared, and the validity of the finite element model was evaluated.

Results

The abutment displacement was greater under oblique loading than under axial loading and greater for the tilted implants than for the axial implants. The in vitro and FEA results showed satisfactory consistency. The maximum micromotion was 2.8- to 4.1-fold higher under oblique loading than under vertical loading. The maximum micromotion values in the axial and tilted implants were very close under vertical loading. However, in the tilted implant model, the maximum micromotion was 38.7% less than in the axial implant model under oblique loading. The relationship between abutment displacement and micromotion varied according to the loading direction (vertical or oblique) as well as the implant insertion angle (axial or tilted).

Conclusions

Tilted implants may have a lower maximum extent of micromotion than axial implants under mesiodistal oblique loading. The maximum micromotion values were strongly influenced by the loading direction. The maximum micromotion values did not reflect the abutment displacement values.

Impacts of 3D bone-to- implant contact and implant diameter on primary stability of dental implant

BACKGROUND/PURPOSE

This study investigated the effects of three three-dimensional (3D) bone-to-implant contact (BIC) parameters-potential BIC area (pBICA), BIC area (BICA), and 3D BIC percentage (3D BIC%; defined as BICA divided by pBICA)-in relation to the implant diameter on primary implant stability, as well as their correlations were also evaluated.

METHODS

Dental implants with diameters of 3.75, 4, 5, and 6 mm and artificial bone specimens were scanned by microcomputed tomography to construct 3D models for calculating pBICA, BICA, and 3D BIC%. Indexes of the primary implant stability including the insertion torque value (ITV), Periotest value (PTV), and implant stability quotient (ISQ) were measured after implants with various diameters were placed into bone specimens. The Kruskal-Wallis test, Wilcoxon rank-sum test with Bonferroni adjustment, and Spearman correlations were all performed as statistical and correlation analyses.

RESULTS

The implant diameter significantly influenced pBICA and BICA, but not 3D BIC%. ITV and PTV were more sensitive to implant diameter than was ISQ. The coefficients of determination were high (>0.92) for the correlations between pBICA (or BICA) and indexes of the primary implant stability.

CONCLUSION

This study revealed how the implant diameter and the three-dimensional (3D) BIC influence the primary stabilities of dental implant. ITV and PTV were more sensitively influenced by the implant diameter than ISQ. The pBICA and BICA seem to be more important than 3D BIC % for using wider implant in treatment plan, since those two parameters are highly predictive of variations in the primary stability of dental implant.

Long-Term Fatigue and Its Probability of Failure Applied to Dental Implants

It is well known that dental implants have a high success rate but even so, there are a lot of factors that can cause dental implants failure. Fatigue is very sensitive to many variables involved in this phenomenon. This paper takes a close look at fatigue analysis and explains a new method to study fatigue from a probabilistic point of view, based on a cumulative damage model and probabilistic finite elements, with the goal of obtaining the expected life and the probability of failure. Two different dental implants were analysed. The model simulated a load of 178 N applied with an angle of 0°, 15°, and 20° and a force of 489 N with the same angles. Von Mises stress distribution was evaluated and once the methodology proposed here was used, the statistic of the fatigue life and the probability cumulative function were obtained. This function allows us to relate each cycle life with its probability of failure. Cylindrical implant has a worst behaviour under the same loading force compared to the conical implant analysed here. Methodology employed in the present study provides very accuracy results because all possible uncertainties have been taken in mind from the beginning.