Three-dimensional finite element analysis of occlusal splint and implant connection on stress distribution in implant–supported fixed dental prosthesis and peri-implantal bone

Biomechanical effects of different materials for an occlusal device on implant-supported rehabilitation in a tooth clenching situation: A 3D finite element analysis

PURPOSE

The purpose of this 3D finite element analysis was to evaluate the biomechanical effects of different materials used to fabricate occlusal devices to achieve stress distribution in simulated abutment screws, dental implants, and peri-implant bone tissue in individuals who clench their teeth.

MATERIALS AND METHODS

Eight 3D models simulated a posterior maxillary bone block with three external hexagon implants (Ø4.0 × 7.0 mm) supporting a 3-unit screw-retained metal-ceramic prosthesis with different crown connection (splinting), and the use of an occlusal device (OD). The OD was modeled to be 2-mm thick. ANSYS 19.2 software was used to generate the finite-element models in the pre-and post-processing phases. Simulated abutment screws and dental implants were evaluated by von Mises stress maps, and simulated bone was evaluated by maximum principal stress and microstrain maps by using a finite element software program.

RESULTS

The highest stress values in the dental implants and screws were observed in single crowns without OD (M1). Furthermore, the highest stress values and bone tissue strain were found in single crowns without OD (M1). The simulated material for the OD did not cause many discrepancies in terms of the stress magnitude in the simulated dental implant and abutment screw for both single and splinted crowns; however, more rigid materials exhibited lower stress values.

CONCLUSION

The use of OD was effective in reducing stress in the simulated implants and abutment screws and stress and strain in the simulated bone tissue. The material used to simulate the OD influenced the biomechanical behavior of implant-supported fixed prostheses, whereas splints with rigid materials such as PEEK and PMMA exhibited better biomechanical behavior.

Analysis of the atrophic mandible rehabilitated with fixed total prosthesis on mono or bicortical implants

Rehabilitation of edentulous atrophic mandibles involves the placement of implants in the anterior segment of the mandible. The primary stability of these implants can be improved using the base of the mandible as complementary anchorage (bicorticalization). This study aimed to analyze the biomechanics of atrophic mandibles rehabilitated with monocortical or bicortical implants. Two three-dimensional virtual models of edentulous mandibles with severe atrophy were prepared. Four monocortical implants were placed in one model (McMM), and four bicortical implants were placed in the other (BcMM). An implant-supported total prosthesis was prepared for each model. Then, a total axial load of 600 N was applied to the posterior teeth, and its effects on the models were analyzed using finite element analysis. The highest compressive stresses were concentrated in the cervical region of the implants in the McMM (-32.562 Mpa); in the BcMM, compressive stresses were distributed in the upper and lower cortex of the mandible, with increased compressive stresses at the distal implants (-63.792 Mpa). Thus, we conclude that axial loading forces are more uniformly distributed in the peri-implant bone when using monocortical implants and concentrated in the apical and cervical regions of the peri-implant bone when using bicortical implants.

Stability Analysis of Plate-Screw Fixation for Femoral Midshaft Fractures

An understanding of the biomechanical characteristics and configuration of flexible and locked plating in order to provide balance stability and flexibility of implant fixation will help to construct and promote fast bone healing. The relationship between applied loading and implantation configuration for best bone healing is still under debate. This study aims to investigate the relationship between implant strength, working length, and interfragmentary strain (εIFM) on implant stability for femoral midshaft transverse fractures. The transverse fracture was fixed with a fragment locking compression plate (LCP) system. Finite element analysis was performed and subsequently characterised based on compression loading (600 N up to 900 N) and screw designs (conventional and locking) with different penetration depths (unicortical and bicortical). Strain theory was used to evaluate the stability of the model. The correlation of screw configuration with screw type shows a unicortical depth for both types (p < 0.01) for 700 N and 800 N loads and (p < 0.05) for configurations 134 and 124. Interfragmentary strain affected only the 600 N load (p < 0.01) for the bicortical conventional type (group BC), and the screw configurations that were influenced were 1234 and 123 (p < 0.05). The low steepness of the slope indicates the least εIFM for the corresponding biomechanical characteristic in good-quality stability. A strain value of ≤2% promotes callus formation and is classified as absolute stability, which is the minimum required value for the induction of callus and the maximum value that allows bony bridging. The outcomes have provided the correlation of screw configuration in femoral midshaft transverse fracture implantation which is important to promote essential primary stability.

Clinical Evaluation of Short (6 mm) and Longer Implants Placed Side by Side in Posterior Partially Edentulous Area: A 3-Year Observational Study

Background

Short implants have been proposed as an alternative solution for the rehabilitation of atrophic posterior region.

Purpose

To compare the clinical outcomes between 6 mm short implants and conventional implants placed under similar conditions of bone quality and occlusal loading.

Materials and Methods

Nine patients received atone 6 mm implant and one standard-length (8 mm length or longer) implants in a total of 10 partially edentulous areas. Implants were left submerged for 3-6 months healing period and the screw-retained splinted prostheses were delivered. When the provisional or final restoration was placed, and at each year after loading, standardized intraoral radiograph was taken for themarginal bone level (MBL) changes around the implants. Subsequently, the patients were recalled for the clinical examination evaluating the implant survival, sulcus bleeding index, suppuration, and the incidence of prosthetic complications at every 6 months after the definitive crown delivery. The observation period was continued to 3 years (mean follow-up was 3.4 ± 0.3 years) after functional loading.

Results

Nine patients (10 short implants and 10 standard length implants) were selected in this study. Cumulative survival rates of the short implants and standard-length implants were 100% in both groups, and no biological and prosthetic complication were found in 3 years observation period. Cortical bone thickness of implant insertion sites was 1.39 ± 0.45 mm at short implants and 1.38 ± 0.69 mm at standard-length implants, and trabecular bone computed tomography values of implant insertion sites was 424.1 ± 290.1 at short implants and 410.9 ± 267.9 at standard-length implants. The MBL changes were -0.30 ± 0.71 mm at short implants and -0.19 ± 0.78 mm at standard-length implants at 3 years follow-up visit. No significant difference was found in the average of MBL changes between implant length.

Conclusions

Within the limits of this study, it can be concluded that 6 mm short implants in a posterior edentulous region showed excellent results compared with conventional implants.

Analysis of Bone Stress and Primary Stability of a Dental Implant Using Strain and Torque Measurements

Introduction

The consensus among researchers is that early failure of dental implants is due to the lack of primary stability and compressive stress on the peri-implant bone that exceeds the physiological tolerance.

Objective

The objective of this work is to propose a new methodology to quantify bone stress during dental implant insertion and to correlate it with primary stability.

Materials and Methods

Titanium dental implants with a diameter of 3.75 mm were inserted in a 3.35 mm hole of a synthetic bone of polyurethane (PU) foam with a density of 20 PCF (0.32 g/cm³). During insertion, the insertion torque was measured with a digital torque meter and the bone strain was measured with strain gages located at 2, 4, 6, 8, and 10 mm from the coronal region.

Results

The tests showed that the compressive strain is maximum in the third coronal region and decreases in the apical direction. The data also showed that there is a relationship between strain, insertion torque, and the primary stability of dental implants.

Conclusion

The stress and strain on the bone progressively decreased from the coronal to the apical third. The maximum compressive stress (0.42 MPa) during insertion of the implant did not exceed bone strength. Insertion of 3.75 mm implants in type D2 bone with a 3.35 mm hole provides adequate primary stability without excessive compression of the bone.

Clinical Significance

For the implant-bone combination used in the present study, the compressive stress generated during implant insertion did not exceed the physiological limit of cortical and medullary bone to the point of impairing osseointegration.

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.

Bioengineering Tools Applied to Dentistry: Validation Methods for In Vitro and In Silico Analysis

This study aimed to evaluate the use of bioengineering tools, finite element analysis, strain gauge analysis, photoelastic analysis, and digital image correlation, in computational studies with greater validity and reproducibility. A bibliographic search was performed in the main health databases PUBMED and Scholar Google, in which different studies, among them, laboratory studies, case reports, systematic reviews, and literature reviews, which were developed in living individuals, were included. Therefore, articles that did not deal with the use of finite element analysis, strain gauge analysis, photoelastic analysis, and digital image correlation were excluded, as well as their use in computational studies with greater validity and reproducibility. According to the methodological analysis, it is observed that the average publication of articles in the Pubmed database was 2.03 and with a standard deviation of 1.89. While in Google Scholar, the average was 0.78 and the standard deviation was 0.90. Thus, it is possible to verify that there was a significant variation in the number of articles in the two databases. Modern dentistry finds in finite element analysis, strain gauge, photoelastic and digital image correlation a way to analyze the biomechanical behavior in dental materials to obtain results that assist to obtain rehabilitations with favorable prognosis and patient satisfaction.

Biomechanical Comparison of Six Different Root-Analog Implants and the Conventional Morse Taper Implant by Finite Element Analysis

Taper implants differ greatly from anatomical teeth in shape. In this study, seven three-dimensional finite element models were established, including a conventional taper implant and six root-analog implants with different root numbers and shapes. Vertical, horizontal, and oblique instantaneous loads of 100 N were applied to the models to obtain stress distribution in the implant, mucosa, cortical bone, and cancellous bone. ANSYS was used to perform the analysis under hypothetical experimental conditions. We find the stresses in all the implants and surrounding tissues varied by loading direction, the sequence of stress magnitude is vertical load, oblique load, and then horizontal load. The maximum stress values in root-analog implants were significantly less than in the taper implant. Moreover, stress distribution in the former was equalized contrary to the concentrated stress in the latter. Root-analog implants with different root geometry also revealed a pattern: stresses in multiple-root implant models were lower than those in single-root implants under the same load. The implant with a long and rounded root distributed the stress more uniformly, and it was mainly concentrated on the implant itself and cancellous bone. However, the opposite effect was observed in the short implant on mucosa and cortical bone. The root geometry of anatomical teeth can modify their functions. A uniform-shaped implant can hardly meet their functional requirements. Thus, the root-analog implant could be a possible solution.

Short Narrow Dental Implants versus Long Narrow Dental Implants in Fixed Prostheses: A Prospective Clinical Study

There is a paucity of studies that assess short and narrow dental implants. This prospective study aimed to evaluate the performance of both short (≤8 mm) and narrow (≤3.5 mm width) dental implants supporting fixed prostheses in the atrophic maxilla or mandible. Towards that aim, patients with short implants were included in the study. The control group was those with long and narrow dental implants (length > 8 mm and diameter ≤ 3.5 mm). Clinical and demographic variables were extracted from clinical records. During the follow-up, implant survival and marginal bone loss were evaluated and statistically analysed. Forty-one implants were included (18 and 23 implants in the test and control groups, respectively). The median follow-up time was 26 months since insertion in both groups. The results revealed that there was no implant failure and no statistically significant differences in terms of marginal bone loss. Only one screw-loosening effect occurred in the short implants group. Short, narrow dental implants could be an alternative for the restoration of severely resorbed jaws.

Finite Element Analysis of Stress in Anterior Prosthetic Rehabilitation with Zirconia Implants with and without Cantilever

Objectives The aim of this study was to evaluate using finite element analysis (FEA), the stress distribution in prostheses (lithium disilicate crowns) on monotype zirconia implants with and without cantilever in the anterior region of the maxilla.

Materials and Methods From a virtual reconstruction of bone model of the toothed maxilla from a computed tomography, three models (groups) were created: Zr (11–21)—implants placed in the area of 11 and 21 with cantilever; Zr (12–22)—implants placed in the area of 12 and 22 without cantilever; and Zr (11–22)—implants intercalated placed in the area of 11 and 22. In all models, monotype zirconia implant (4.1 × 12.0 mm) was used in single-body configuration. Lithium disilicate crowns were designed on the implants and pontics for all groups. A 150-N load was applied to the prostheses. The materials used were considered isotropic, homogeneous, and linearly elastic. FEA was performed to evaluate the maximum (tensile) and minimum (compressive) principal stresses in the implant, crowns, and bone tissue. Data were analyzed qualitatively and quantitatively.

Results For all groups, the highest maximum principal stress occurred in the palatal cervical area of the implant, with the high values for the Zr (12–22) group and the low values for the Zr (11–21) group. The maximum principal stress was concentrated in the cervical palatal area of the crown, with the Zr (11–21) group presented the highest values and the Zr (12–22) group showed the lowest values. In the bone tissue all the groups presented similar values of maximum and minimal principal stress, with the palatal (maximum principal) and vestibular (minimum principal) close to the cervical of the implants the area with the highest concentration of stresses.

Conclusions The position of monotype zirconia implant did not interfere in the bone tissue stress, and the implants placed in the 11–21 present lower stress in implants and higher in the crown. The cantilever does not increase the stress in the implants, crown, and bone tissue.

Effect of different fabrication methods of occlusal devices on periradicular stress distribution: A photoelastic analysis

STATEMENT OF PROBLEM

Investigations on the effectiveness of new methods for optimizing the fabrication of oral devices are lacking.

PURPOSE

The purpose of this in vitro study was to evaluate stress distribution with photoelastic analysis in the periradicular area of teeth supporting occlusal devices fabricated by 5 different processes.

MATERIAL AND METHODS

The occlusal devices were fabricated by vacuum thermoforming, heat-polymerized acrylic resin, chemical polymerized acrylic resin, 3-dimensional printing, and milling (computer-aided manufacturing). The devices were evaluated regarding initial fit, number of adjustments for passive fit, and stress distribution under 100-N and 400-N loads in the periradicular locations of posterior teeth.

RESULTS

The 3-dimensional printing device did not require any adjustment for initial adaptation to the photoelastic model and presented a little friction with the model. The heat-polymerized acrylic resin device did not seat initially, requiring more sites of adjustment until passive adaptation. At 100-N and 400-N loads, the use of the computer-aided manufacturing occlusal device resulted in the lowest stresses in periradicular areas (0.744 and 1.583, respectively), and the 3-dimensional printing occlusal device produced the highest stresses with a 400-N load application (2.427). The lowest mean of fringe pattern was observed for the computer-aided manufacturing device, and the highest mean of fringe pattern was observed for the vacuum thermoforming device.

CONCLUSIONS

The computer-aided design and computer-aided manufacturing milled occlusal device presented the best initial adaptation and transferred lower stresses to the periradicular areas than the other evaluated devices.

Biomechanical effect of an occlusal device for patients with an implant-supported fixed dental prosthesis under parafunctional loading: A 3D finite element analysis

STATEMENT OF PROBLEM

Whether providing an occlusal device for a patient with bruxism and an implant-supported fixed dental prosthesis leads to improved biomechanics is unclear.

PURPOSE

The purpose of this 3D finite element analysis (FEA) study was to evaluate the biomechanical behavior of 3-unit implant-supported prostheses under parafunctional forces with and without an occlusal device.

MATERIALS AND METHODS

Eight 3D models consisting of a posterior (type IV) maxillary bone block with 3 external hexagon implants (Ø4.0×7.0 mm) and 3-unit implant-supported prostheses with different crown connections (splinted or unsplinted) and an occlusal device under functional and parafunctional loading were simulated. The abutment screws were evaluated by von Mises stress maps, and the bone tissue by maximum principal stress and microstrain maps by using a finite element software program.

RESULTS

An occlusal device improved the biomechanical behavior of the prostheses by reducing stress in the abutment screws and stress and strain in the bone tissue. However, the use of an occlusal device was not sufficiently effective to negate the biomechanical benefit of splinting.

CONCLUSIONS

The use of splinted crowns in the posterior maxillary region with an occlusal device was the most effective method of reducing stress in the abutment screws and stress and strain in the bone tissue when parafunction was modeled.

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.

Biomechanical evaluation of anterior implants associated with titanium and zirconia abutments and monotype zirconia implants

PURPOSE

The present in silico study evaluated the behavior of titanium dental implants associated with abutments in zirconia and monotype zirconia implant using finite element analysis (FEA).

METHODS

A partial image of the anterior region of the maxilla was obtained by computed tomography. Three models of finite element were made using 3D modeling software (SolidWorks): Ti-Ti (control): implant morse cone (3.75 x 11mm; NobelActive) and titanium abutment (Esthetic Abutment); Ti-Zr: cone morse implant in titanium (3.75 x 11mm; NobelActive) and zirconia abutment (Procera Esthetic Abutment #9); Zr: monotype zirconia implant (4.1 x 12mm; Straumann Pure Ceramic). Computerized crowns of element 11 in lithium disilicate (IPS e.max Press, Ivoclar Vivadent) cemented in all groups were created. A load of 100N (45º) was applied simulating the excursion movement of the incisal guide. The von Mises, modified von Mises, maximum (tensile) and minimum (compression) principal stresses were obtained, compared and used for the quantitative and qualitative evaluation of the groups.

RESULTS

The Zr presented the lowest values of maximum, minimum, and von Mises tensions than the two pieces systems (Ti-Ti and Ti-Zr). Ti-Zr group had the highest values of tensions evaluated in this study.

CONCLUSIONS

The type of material as well as the geometry of implant influenc ed the tension values evaluated.

In silico evaluation of the stress fields on the cortical bone surrounding dental implants: Comparing root-analogue and screwed implants

Tooth loss is a problem that affects both old and young people. It may be caused by several conditions, such as poor oral hygiene, lifestyle choices or even diseases like periodontal disease, tooth grinding or diabetes. Nowadays, replacing a missing tooth by an implant is a very common process. However, many limitations regarding the actual strategies can be enumerated. Conventional screwed implants tend to induce high levels of stress in the peri-implant bone area, leading to bone loss, bacterial bio-film formation, and subsequent implant failure. In this sense, root-analogue dental implants are becoming promising solutions for immediate implantation due to their minimally invasive nature, improved bone stress distribution and because they do not require bone drilling, sinus lift, bone augmentation nor other traumatic procedures. The aim of this study was to analyse and compare, by means of FEA, the stress fields of peri-implant bone around root-analogue and screwed conventional zirconia implants. For that purpose, one root-analogue implant, one root-analogue implant with flaps, two conventional implants (with different threads) and a replica of a natural tooth were modelled. COMSOL was used to perform the analysis and implants were subjected to two simultaneous loads: 100 N axially and 100 N oblique (45°). RESULTS: revealed that root-analogue implants, namely with flaps, should be considered as promising alternatives for dental implant solutions since they promote a better stress distribution in the cortical bone when compared with conventional implants.

Finite element analysis of occlusal splint therapy in patients with bruxism

Background

Bruxism is among the habits considered generally as contributory factors for temporomandibular joint (TMJ) disorders and its etiology is still controversial.

Methods

Three-dimensional models of maxilla and mandible and teeth of 37 patients and 36 control subjects were created using in-vivo image data. The maximum values of stress and deformation were calculated in 21 patients six months after using a splint and compared with those in the initial conditions.

Results

The maximum stresses in the jaw bone and head of mandible were respectively 4.4 and 4.1 times higher in patients than in control subjects. Similar values for deformation were 5.8 and 4.9, respectively. The maximum stress in the jaw bone and head of mandible decreased six months after splint application by up to 71.0 and 72.8%, respectively. Similar values for the maximum deformation were 80.7 and 78.7%, respectively. Following the occlusal splint therapy, the approximation of maximum deformation to the relevant values in control subjects was about 2.6 times the approximation of maximum stress to the relevant values in control subjects. The maximum stress and maximum deformation occurred in all cases in the head of the mandible and the splint had the highest effectiveness in jaw bone adjacent to the molar teeth.

Conclusions

Splint acts as a stress relaxer and dissipates the extra stresses generated as well as the TMJ deformation and deviations due to bruxism. The splint also makes the bilateral and simultaneous loading possible and helps with the treatment of this disorder through regulation of bruxism by creating a biomechanical equilibrium between the physiological loading and the generated stress.