Influence of occlusal contact and cusp inclination on the biomechanical character of a maxillary premolar: A finite element analysis

The effect of porous compliance bushings in a dental implant on the distribution of occlusal loads

Porous dental implants are clinically used, but the mechanism of load distribution for stepped implant shaft surrounded by compliance bushings is still not known, especially for different bone conditions. The aim of the study was to assess the impact of the design of a dental implant with compliance bushings (CBs) on the occlusal load distribution during primary and secondary stability using finite element simulation (FEA), with a distinction between low and high quality cervical support under primary stability. The FEA of the oblique occlusal load transfer (250 N; 45°) was carried out for implants under variable bone conditions. The stepped shaft in the intermediate part of the dental implant was surrounded by CBs with an increasing modulus of elasticity of 2, 10 and 50 GPa. With a smaller Young's modulus of the bushings the increase of stress in the trabecular bone indicated that more bone tissue can be protected against disuse. The beneficial effect for the trabecular bone derived from the reduction of the stiffness of the bushings in relation to the loss of the implant's load bearing ability can be assessed using the FEM method.

Biomechanical evaluation of custom-made short implants with wing retention applied in severe atrophic maxillary posterior region restoration: A three-dimensional finite element analysis

Severe bone atrophy in the maxillary posterior region poses a big challenge to implant restoration. Digitally designed and customized short implants with wing retention provide a safer and minimally invasive implant restoration scheme in such circumstances. Small titanium wings are integrated with the short implant supporting the prosthesis. Using digital designing and processing technology, the wings fixed by titanium screws can be flexibly designed, providing the main fixation. The design of the wings will influence the stress distribution and implant stability. This study analyzes the position, structure, and spread area of the wings fixture scientifically by means of three-dimensional finite element analysis. The design of the wings is set to linear, triangular, and planar styles. Under the simulated vertical and oblique occlusal forces, the implant displacement and stress between the implant and the bone surface are analyzed at different bone heights of 1 mm, 2 mm, and 3 mm. The finite element results show that the planar form can better disperse the stress. By adjusting the cusp slope to reduce the influence of lateral force, short implants with planar wing fixtures can be used safely even if the residual bone height is only 1 mm. The results of the study provide a scientific basis for the clinical application of this new customized implant.

Peri-implant stress distribution assessment of various attachment systems for implant supported overdenture prosthesis by finite element analysis - A systematic review

Background

Various attachments like ball, bar-clip, magnetic attachments are used in implant supported overdentures. Finite Element Analysis (FEA) a newly innovated technology has been used in dental implantology to evaluate stress distribution patterns. There is little evidence available regarding the stress distribution in peri-implant region for implant supported overdentures. The purpose of the review was to generate scientific evidence on peri-implant stress distribution in FEA model with different types of attachments employed in implant supported overdentures.

Materials and methods

Systematic review was conducted as per the Preferred Reporting Items for Systematic Reviews Guidelines and Meta-Analyses statement (PRISMA). A comprehensive search was undertaken by two reviewers from January 2020 to June 2020 with no year limits to published articles. Only in-vitro FEA studies were included. Following electronic databases were searched for published studies- PubMed, Web of Science. Characteristics of the studies tabulated and analysis of articles was done to compare different attachment systems.

Results

Locator attachments showed better stress distribution than ball attachment system in all the studies but one. Two studies showed results in favour of ball attachment compared to bar-clip attachment system when stress was evaluated distal to the implants. No significant difference in terms of stress concentration could be generated between ball versus magnetic/equator versus locator attachment system due to less number of studies and conflicting results.

Conclusion

Various studies showed different results due to heterogenicity in selected attachment systems and study designs. Locator attachments showed favourable stress distribution around peri-implant bone than other attachments.

A critical analysis of research methods and experimental models to study the load capacity and clinical behavior of the root filled teeth

The prognosis of root‐filled teeth depends not only on a successful root canal treatment but also on the restorative prognosis. This critical review discusses the advantages and limitations of various methodologies used to assess the load capacity or clinical survivability of root‐filled teeth and restorations. These methods include static loading, cyclic loading, finite element analysis and randomized clinical trials. In vitro research is valuable for preclinical screening of new dental materials or restorative modalities. It also can assist investigators or industry to decide whether further clinical trials are justified. It is important that these models present high precision and accuracy, be reproducible, and present adequate outcomes. Although in vitro models can reduce confounding by controlling important variables, the lack of clinical validation (accuracy) is a downside that has not been properly addressed. Most importantly, many in vitro studies did not explore the mechanisms of failure and their results are limited to rank different materials or treatment modalities according to the maximum load capacity. An extensive number of randomized clinical trials have also been published in the last years. These trials have provided valuable insight on the survivability of the root‐filled tooth answering numerous clinical questions. However, trials can also be affected by the selected outcome and by intrinsic and extrinsic biases. For example, selection bias, loss to follow‐up and confounding. In the clinical scenario, hypothesis‐based studies are preferred over observational and retrospective studies. It is recommended that hypothesis‐based studies minimize error and bias during the design phase.

Effect of occlusal anatomy of CAD/CAM feldspathic posterior crowns in the stress concentration and fracture load

OBJECTIVES

This study evaluated the effect of restoration occlusal design on the maximum fracture load and stress distribution of a feldspathic ceramic crown.

MATERIALS AND METHODS

Twenty dentin analogues were used to simulate a full-crown preparation. Next, 20 feldspathic crowns were milled according to the occlusal design parameter available in the CAD database (Young or Adult). The crowns were cemented with dual cure resin-cement and loaded until fracture at 1 mm/min crosshead speed. Data were analyzed by using one-way ANOVA and Tukey tests (p < 0.05). The same geometry and experimental setup was modeled and exported to the computer aided engineering software and tensile stress concentration was calculated using the finite element method with 300 N occlusal load simulation.

RESULTS

The occlusal anatomy significantly influenced the load-to-fracture (p < 0.05). Adult design showed higher mean values (1149 ± 201 N) than Young design (454 ± 77 N). The maximum principal stress criteria showed similar stress pattern for both designs, however, the highest stress concentration was calculated for Young design (91 MPa) in the occlusal surface.

CONCLUSIONS

An anatomy design with reduced cusp angulation and less evident occlusal sulcus can reduce the stress concentration and increase the fracture load for feldspathic CAD/CAM posterior crowns.

Risk Indicators Affecting the Survival of the Mandibular First Molar Adjacent to an Implant at the Mandibular Second Molar Site: A Retrospective Study

This study aimed to compare the survival of mandibular first molars (MnM1s) adjacent to implants placed in mandibular second molar sites (ImM2s) with MnM1s adjacent to mandibular second molars (MnM2s) and to investigate risk indicators affecting the survival of MnM1s adjacent to ImM2s. A total of 144 patients who had MnM1s adjacent to ImM2s and MnM1s adjacent to MnM2s on the contralateral side were included in this study. Clinical variables and radiographic bone levels were evaluated. The survival of MnM1s adjacent to ImM2s or MnM2s was evaluated using a Kaplan–Meier analysis and Cox proportional hazards model. The 5-year cumulative survival rates of MnM1s adjacent to ImM2s and MnM2s were 85% and 95%, respectively. MnM1s adjacent to ImM2s of the internal implant-abutment connection type had higher multivariate hazard ratios (HR) for loss. MnM1s that had antagonists with implant-supported prostheses also had higher HR for loss. The multivariate HR for the loss of MnM1s adjacent to ImM2s with peri-implant mucositis was 3.74 times higher than MnM1s adjacent to healthy ImM2s. This study demonstrated several risk indicators affecting the survival of MnM1s adjacent to ImM2s. It is suggested that supportive periodontal and peri-implant therapy combined with meticulous occlusal adjustment can prolong the survival of MnM1s and ImM2s.

Acoustic emission and finite element study on the influence of cusp angles on zirconia dental crowns

OBJECTIVE

The effect of cusp angle on the load-carrying capacity and failure behaviour of BionZ Diamond zirconia crowns is carried out using experimental and numerical investigations.

METHODS

The experimental program using monolithic crowns were divided into three groups (n = 14) for three cusp angles, 60, 80 and 120 degrees and were tested to failure under the static load. A 2-channel acoustic emission (AE) system was used to monitor the failure process while the piezo sensors were attached to the rigid stainless-steel jig for recoding the AE events. Load-displacement and AE response were simultaneously monitored until failure of specimens. Parametric AE analysis was conducted for the factors such as amplitude, energy released, signal duration and cumulative counts, for each AE signal. Fast Fourier transform (FFT) was conducted to assess the frequency at failure. Linear finite element analysis (FEA) was carried out using commercial software Ansys Workbench 19.1 to present the stress distribution and failure modes. Post-failure surface morphology study was carried out using scanning electron microscopy (SEM) and statistical analysis was performed using Weibull analysis.

RESULTS

All the samples in three different groups have failed at the mid-line, splitting the zirconia crowns into two equal pieces. The load to failure was directly proportional to the cusp angle in crowns; 120° group had the highest load-carrying capacity of 2.93 ± 0.26 kN while 60 and 80° groups had a failure load of 2.46 ± 0.53 and 2.52 ± 0.16 kN, respectively. Parametric AE analysis revealed that the failure was instantaneous and 60-degree samples had higher AE signature. FE analysis showed the crack initiation at the occlusal surface of the crown which is in agreement with the SEM images. A close agreement of results for the load and stress distribution from FEA complemented with the experimental study.

SIGNIFICANCE

Optimisation of cusp-angle could help clinicians to accurately design the monolithic zirconia crown focussing on maximum load-carrying capacity, increasing the restoration life.

Effect of Fiber Posts on Stress Distribution of Endodontically Treated Upper Premolars: Finite Element Analysis

By means of a finite element method (FEM), the present study evaluated the effect of fiber post (FP) placement on the stress distribution occurring in endodontically treated upper first premolars (UFPs) with mesial–occlusal–distal (MOD) nanohybrid composite restorations under subcritical static load. FEM models were created to simulate four different clinical situations involving endodontically treated UFPs with MOD cavities restored with one of the following: composite resin; composite and one FP in the palatal root; composite and one FP in the buccal root; or composite and two FPs. As control, the model of an intact UFP was included. A simulated load of 150 N was applied. Stress distribution was observed on each model surface, on the mid buccal–palatal plane, and on two horizontal planes (at cervical and root-furcation levels); the maximum Von Mises stress values were calculated. All analyses were replicated three times, using the mechanical parameters from three different nanohybrid resin composite restorative materials. In the presence of FPs, the maximum stress values recorded on dentin (in cervical and root-furcation areas) appeared slightly reduced, compared to the endodontically treated tooth restored with no post; in the same areas, the overall Von Mises maps revealed more favorable stress distributions. FPs in maxillary premolars with MOD cavities can lead to a positive redistribution of potentially dangerous stress concentrations away from the cervical and the root-furcation dentin.

Influence of Different Implants on the Biomechanical Behavior of a Tooth-Implant Fixed Partial Dentures: A Three-Dimensional Finite Element Analysis

This study analyzed the biomechanical behavior of rigid and nonrigid tooth-implant supported fixed partial dentures. Different implants were used to observe the load distribution over teeth, implants, and adjacent bone using three-dimensional finite element analysis. A simulation of tooth loss of the first and second right molars was created with an implant placed in the second right molar and a prepared tooth with simulated periodontal ligament (PDL) in the second right premolar. Configurations of two types of implants and their respective abutments-external hexagon (EX) and Morse taper (MT)-were transformed into a 3D format. Metal-ceramic fixed partial dentures were constructed with rigid and nonrigid connections. Mesh generation and data processing were performed on the 3D finite element analysis (FEA) results. Static loading of 50 N (premolar) and 100 N (implant) were applied. When an EX implant was used, with a rigid or nonrigid connection, there was intrusion of the tooth in the distal direction with flexion of the periodontal ligament. Tooth intrusion did not occur when the MT implant was used independent of a rigid or nonrigid connection. The rigid or nonrigid connection resulted in a higher incidence of compressive forces at the cortical bone as well as stress in the abutment/pontic area, regardless of whether EX or MT implants were used. MT implants have a superior biomechanical performance in tooth-implant supported fixed partial dentures. This prevents intrusion of the tooth independent of the connection. Both types of implants studied caused a greater tendency of compressive forces at the crestal area.

The effect of different occlusal contact situations on peri-implant bone stress - A contact finite element analysis of indirect axial loading

Implant restoration is one of the basic treatments in dentistry today, yet implant loss from occlusal overload is still a problem. Complex biomechanical problems such as occlusal overload are often analyzed by means of the finite element method. This numerical method makes it possible to analyze in detail the influence that different loading situations have upon implants and tissues, which is a key element in optimizing these dental procedures. This study was designed to investigate the stress distribution in peri-implant bone of a single-tooth implant crown using the finite element method. The load was applied indirectly via an occluding tooth through a three and five contact setup into the implant crown. The friction coefficient values between the crown and antagonist were varied between 0.1 and 1.0. Additionally, three crowns with cusp inclinations of 20°, 30° and 40° were modeled. Non-linear contact computations indicated that an increase in friction changed the direction and magnitude of contact forces, which also led to reduced stresses in the bone. Furthermore, the stress magnitudes were higher when cusps of a greater inclination were used. The intensity of stress alterations was strongly dependent on the distribution and number of contacts, and the contact force vector. In maximum intercuspation, a resulting axial load due to well-distributed contacts prevented high stresses in bone even with high cusp inclinations and low friction. Therefore for long-term clinical success, particular attention should be paid to occlusal adjustment so as to prevent oblique loading onto dental implant restorations.

3-D finite element analysis of the effects of post location and loading location on stress distribution in root canals of the mandibular 1st molar

Objective

The purpose of this study was to evaluate, by using finite element analysis, the influence of post location and occlusal loading location on the stress distribution pattern inside the root canals of the mandibular 1^st molar.

Material and Methods

Three different 3-D models of the mandibular 1^st molar were established: no post (NP) – a model of endodontic and prosthodontic treatments; mesiobuccal post (MP) – a model of endodontic and prosthodontic treatments with a post in the mesiobuccal canal; and distal post (DP) – a model of endodontic and prosthodontic treatments with a post in the distal canal. A vertical force of 300 N, perpendicular to the occlusal plane, was applied to one of five 1 mm² areas on the occlusal surface; mesial marginal ridge, distal marginal ridge, mesiobuccal cusp, distobuccal cusp, and central fossa. Finite element analysis was used to calculate the equivalent von Mises stresses on each root canal.

Results

The DP model showed similar maximum stress values to the NP model, while the MP model showed markedly greater maximum stress values. The post procedure increased stress concentration inside the canals, although this was significantly affected by the site of the force.

Conclusions

In the mandibular 1^st molar, the distal canal is the better place to insert the post than the mesiobuccal canal. However, if insertion into the mesiobuccal canal is unavoidable, there should be consideration on the occlusal contact, making central fossa and distal marginal ridge the main functioning areas.

Association between dental implants in the posterior region and traumatic occlusion in the adjacent premolars: a long-term follow-up clinical and radiographic analysis

Purpose

The aim of this retrospective study was to determine the association between dental implants in the posterior region and traumatic occlusion in the adjacent premolars, using data collected during from 2002 to 2015.

Methods

Traumatic occlusion in the adjacent premolars was assessed by examining clinical parameters (bleeding on probing, probing pocket depth, fremitus, and tooth mobility) and radiographic parameters (loss of supporting bone and widening of the periodontal ligament space) over a mean follow-up of 5 years. Clinical factors (gender, age, implant type, maxillary or mandibular position, opposing teeth, and duration of functional loading) were evaluated statistically in order to characterize the relationship between implants in the posterior region and traumatic occlusion in the adjacent premolars.

Results

The study inclusion criteria were met by 283 patients, who had received 347 implants in the posterior region. The incidence of traumatic occlusion in the adjacent premolars was significantly higher for splinted implants (P=0.004), implants in the maxillary region (P<0.001), and when implants were present in the opposing teeth (P<0.001). The other clinical factors of gender, age, and duration of functional loading were not significantly associated with traumatic occlusion.

Conclusions

This study found that the risk of traumatic occlusion in the adjacent premolars increased when splinted implants were placed in the maxillary molar region and when the teeth opposing an implant also contained implants.

Effects of different cusp coverage restorations on the fracture resistance of endodontically treated maxillary premolars

STATEMENT OF PROBLEM

Cusp coverage restorations for the restoration of endodontically treated teeth represent a conservative approach in terms of function and esthetics. However, limited scientific data are available regarding the optimum reduction design and thicknesses.

PURPOSE

The purpose of this in vitro study was to evaluate the fracture resistance and fracture patterns of cusp coverage restorations with different cusp reduction designs and reduction thicknesses on endodontically treated maxillary premolars (ETMPs) with mesio-occluso-distal (MOD) cavities.

MATERIAL AND METHODS

One hundred sixty-five extracted intact human maxillary premolars were divided into 11 groups: G1-10 (test groups) and G11 (intact group). In the test groups, all of the teeth were restored with composite resin after canal treatments with MOD cavities. However, the cusps of the G1-9 teeth were reduced with combinations of different thicknesses (1.5, 2.5, and 3.5 mm) and designs (beveled, horizontal, and anatomic). The specimens were subjected to 10(5) cycles of 50 N mechanical loading. Next, the specimens were subjected to a compressive load at a crosshead speed of 0.5 mm/min until fracture. The fractured specimens were analyzed to determine the fracture pattern. Two-way ANOVA followed by the Fisher least significant difference (LSD) test was used to analyze the interaction between groups.

RESULTS

The fracture resistance values increased with increases in the cusp reductions. The fracture resistance values of the G6 (2.5 mm, anatomic) and G9 (3.5 mm, anatomic) groups were significantly greater than that of the MOD group. However, the G6, G8 (3.5 mm, horizontal), and G9 groups were comparable with G11. The highest restorable fracture rates were observed in G6 and G9.

CONCLUSIONS

Cusp reduction design and thickness influenced the fracture resistance and fracture patterns of cusp coverage restorations of ETMPs with MOD cavities. The teeth restored with anatomic cusp reduction designs with reduction thicknesses of at least 2.5 mm exhibited greater fracture resistance and more frequent restorable fractures.

Finite element analysis: A boon to dentistry

The finite element analysis (FEA) is an upcoming and significant research tool for biomechanical analyses in biological research. It is an ultimate method for modeling complex structures and analyzing their mechanical properties. In Implantology, FEA has been used to study the stress patterns in various implant components and also in the peri-implant bone. It is also useful for studying the biomechanical properties of implants as well as for predicting the success of implants in clinical condition. FEA of simulated traumatic loads can be used to understand the biomechanics of fracture. FEA has various advantages compared with studies on real models. The experiments are repeatable, there are no ethical considerations and the study designs may be modified and changed as per the requirement. There are certain limitations of FEA too. It is a computerized in vitro study in which clinical condition may not be completely replicated. So, further FEA research should be supplemented with clinical evaluation.