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Zhang C, Wang Y. Biomechanical Analysis of Axial Gradient Porous Dental Implants: A Finite Element Analysis. J Funct Biomater 2023; 14:557. [PMID: 38132811 PMCID: PMC10743419 DOI: 10.3390/jfb14120557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 11/17/2023] [Accepted: 11/20/2023] [Indexed: 12/23/2023] Open
Abstract
The porous structure can reduce the elastic modulus of a dental implant and better approximate the elastic characteristics of the material to the alveolar bone. Therefore, it has the potential to alleviate bone stress shielding around the implant. However, natural bone is heterogeneous, and, thus, introducing a porous structure may produce pathological bone stress. Herein, we designed a porous implant with axial gradient variation in porosity to alleviate stress shielding in the cancellous bone while controlling the peak stress value in the cortical bone margin region. The biomechanical distribution characteristics of axial gradient porous implants were studied using a finite element method. The analysis showed that a porous implant with an axial gradient variation in porosity ranging from 55% to 75% was the best structure. Under vertical and oblique loads, the proportion of the area with a stress value within the optimal stress interval at the bone-implant interface (BII) was 40.34% and 34.57%, respectively, which was 99% and 65% higher compared with that of the non-porous implant in the control group. Moreover, the maximum equivalent stress value in the implant with this pore parameter was 64.4 MPa, which was less than 1/7 of its theoretical yield strength. Axial gradient porous implants meet the strength requirements for bone implant applications. They can alleviate stress shielding in cancellous bone without increasing the stress concentration in the cortical bone margin, thereby optimizing the stress distribution pattern at the BII.
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Affiliation(s)
- Chunyu Zhang
- Xiangya Stomatological Hospital, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha 410008, China;
- Xiangya School of Stomatology, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha 410008, China
- Hunan 3D Printing Engineering Research Center of Oral Care, No. 64 Xiangya Street, Kaifu District, Changsha 410008, China
| | - Yuehong Wang
- Xiangya Stomatological Hospital, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha 410008, China;
- Xiangya School of Stomatology, Central South University, No. 72 Xiangya Street, Kaifu District, Changsha 410008, China
- Hunan 3D Printing Engineering Research Center of Oral Care, No. 64 Xiangya Street, Kaifu District, Changsha 410008, China
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Di Fiore A, Montagner M, Sivolella S, Stellini E, Yilmaz B, Brunello G. Peri-Implant Bone Loss and Overload: A Systematic Review Focusing on Occlusal Analysis through Digital and Analogic Methods. J Clin Med 2022; 11:jcm11164812. [PMID: 36013048 PMCID: PMC9409652 DOI: 10.3390/jcm11164812] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 08/12/2022] [Accepted: 08/12/2022] [Indexed: 11/18/2022] Open
Abstract
The present review aimed to assess the possible relationship between occlusal overload and peri-implant bone loss. In accordance with the PRISMA guidelines, the MEDLINE, Scopus, and Cochrane databases were searched from January 1985 up to and including December 2021. The search strategy applied was: (dental OR oral) AND implants AND (overload OR excessive load OR occlusal wear) AND (bone loss OR peri-implantitis OR failure). Clinical studies that reported quantitative analysis of occlusal loads through digital contacts and/or occlusal wear were included. The studies were screened for eligibility by two independent reviewers. The quality of the included studies was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. In total, 492 studies were identified in the search during the initial screening. Of those, 84 were subjected to full-text evaluation, and 7 fulfilled the inclusion criteria (4 cohort studies, 2 cross-sectional, and 1 case-control). Only one study used a digital device to assess excessive occlusal forces. Four out of seven studies reported a positive correlation between the overload and the crestal bone loss. All of the included studies had moderate to serious overall risk of bias, according to the ROBINS-I tool. In conclusion, the reported data relating the occlusal analysis to the peri-implant bone level seem to reveal an association, which must be further investigated using new digital tools that can help to standardize the methodology.
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Affiliation(s)
- Adolfo Di Fiore
- Department of Neurosciences, School of Dentistry, University of Padova, 35128 Padova, Italy
- Correspondence:
| | | | - Stefano Sivolella
- Department of Neurosciences, School of Dentistry, University of Padova, 35128 Padova, Italy
| | - Edoardo Stellini
- Department of Neurosciences, School of Dentistry, University of Padova, 35128 Padova, Italy
| | - Burak Yilmaz
- Department of Reconstructive Dentistry and Gerodontology, School of Dental Medicine, University of Bern, 3012 Bern, Switzerland
- Department of Restorative, Preventive and Pediatric Dentistry, School of Dental Medicine, University of Bern, 3012 Bern, Switzerland
- Division of Restorative and Prosthetic Dentistry, The Ohio State University, Columbus, OH 43210, USA
| | - Giulia Brunello
- Department of Neurosciences, School of Dentistry, University of Padova, 35128 Padova, Italy
- Department of Oral Surgery, University Hospital Düsseldorf, 40225 Düsseldorf, Germany
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Mirulla AI, Pinelli S, Zaffagnini S, Nigrelli V, Ingrassia T, Paolo SD, Bragonzoni L. Numerical simulations on periprosthetic bone remodeling: a systematic review. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 204:106072. [PMID: 33819822 DOI: 10.1016/j.cmpb.2021.106072] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/22/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE The aim of the present study was to review the literature concerning the analysis of periprosthetic bone remodeling through finite element (FE) simulation. METHODS A systematic review was conducted on 9 databases, taking into account a ten-year time period (from 2009 until 2020). The inclusion criteria were: articles published in English, publication date after 2009, full text articles, articles containing the keywords both in the abstract and in the title. The articles were classified through the following parameters: dimensionality of the simulation, modelling of the bone-prosthesis interface, output parameters, type of simulated prosthesis, bone remodeling algorithm. RESULTS Sixty-seven articles were included in the study. Femur and tooth were the most evaluated bone segment (respectively 41.8% and 29.9%). The 55.2% of the evaluated articles used a bonded bone-prosthesis interface, 73% used 3D simulations, 67.2% of the articles (45 articles) evaluate the bone remodeling by the bone density variation. At last, 59.7% of the articles employed algorithms based on a specific remodeling function. CONCLUSIONS Increasing interest in the bone remodeling FE analysis in different bone segments emerged from the review, and heterogeneous solutions were adopted. An optimal balance between computational cost and accuracy is needed to accurately simulate the bone remodeling phenomenon in the post-operative period.
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Affiliation(s)
- Agostino Igor Mirulla
- Department of Engineering, University of Palermo, Viale delle Scienze Ed.8, 90128 Palermo, Italy; Department of Biomedical and Neurmotor Sciences, University of Bologna, Via G. Pupilli 1, 40136 Bologna, Italy.
| | - Salvatore Pinelli
- Department of Information Engineering, University of Pisa, Pisa, Via G. Caruso 16, 56122 Pisa, Italy
| | - Stefano Zaffagnini
- Department of Biomedical and Neurmotor Sciences, University of Bologna, Via G. Pupilli 1, 40136 Bologna, Italy; 2nd Orthopaedic and Traumatologic Clinic, IRCCS Istituto Ortopedico Rizzoli, Via G. Pupilli 1, 40136 Bologna, Italy
| | - Vincenzo Nigrelli
- Department of Engineering, University of Palermo, Viale delle Scienze Ed.8, 90128 Palermo, Italy
| | - Tommaso Ingrassia
- Department of Engineering, University of Palermo, Viale delle Scienze Ed.8, 90128 Palermo, Italy
| | - Stefano Di Paolo
- Department of Biomedical and Neurmotor Sciences, University of Bologna, Via G. Pupilli 1, 40136 Bologna, Italy
| | - Laura Bragonzoni
- Department for Life Quality Studies, University of Bologna, Corso d'Augusto 237, 47921 Rimini, Italy
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He W, Yin X, Xie L, Liu Z, Li J, Zou S, Chen J. Enhancing osseointegration of titanium implants through large-grit sandblasting combined with micro-arc oxidation surface modification. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2019; 30:73. [PMID: 31187259 DOI: 10.1007/s10856-019-6276-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 05/27/2019] [Indexed: 06/09/2023]
Abstract
PURPOSE The demand for titanium dental implants has risen sharply. However, the clinical success rate of implant surgery needs to be improved. In this paper, we report a novel surface modification strategy, large-grit sandblasting combined with micro-arc oxidation (SL-MAO), aiming to promote peri-implant bone formation and osseointegration of titanium implants. MATERIALS AND METHODS Modified titanium samples were prepared by large-grit sandblasting and acid etching (SLA), micro-arc oxidation (MAO), and SL-MAO. The resulting topographical changes and chemical composition of the samples were examined by scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS), respectively, and the biocompatibility and bioactivity were analyzed by bone-marrow mesenchymal stem cells (BMMSC) adhesion tests. Modified titanium implants were also inserted into the femurs of beagle dogs, and their competence of osseointegration was appraised by quantitative histomorphometry and micro-computed-tomography (micro-CT) analyses. RESULTS Compared to SLA and MAO techniques, SL-MAO surface modification further enhanced titanium surfaces by creating a topographic morphology characterized by both micron-sized craters and sub-micron-scale pits, and resulted in superior chemical composition, which promoted cell adhesion, proliferation, and osteogenic differentiation. SL-MAO-modified titanium implants osseointegrated more efficiently than SLA or MAO controls, with significantly higher bone-area (BA) ratio and bone-implant contact (BIC) in the peri-implant region. CONCLUSIONS The SL-MAO surface modification technique optimized the surface properties of titanium implants and enhanced peri-implant bone formation and osseointegration.
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Affiliation(s)
- Wulin He
- Stomatological Hospital, Southern Medical University, No. 366, South Jiangnan Avenue, Guangzhou, 510280, Guangdong, China
| | - Xing Yin
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 610041, Chengdu, China
| | - Li Xie
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 610041, Chengdu, China
- College of Materials Science and Engineering, Sichuan University, 610064, Chengdu, China
| | - Zeping Liu
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 610041, Chengdu, China
| | - Jingtao Li
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 610041, Chengdu, China
| | - Shujuan Zou
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 610041, Chengdu, China
| | - Jianwei Chen
- State Key Laboratory of Oral Diseases & National Clinical Research Center for Oral Diseases, West China Hospital of Stomatology, Sichuan University, 610041, Chengdu, China.
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de Barros E Lima Bueno R, Dias AP, Ponce KJ, Wazen R, Brunski JB, Nanci A. Bone healing response in cyclically loaded implants: Comparing zero, one, and two loading sessions per day. J Mech Behav Biomed Mater 2018; 85:152-161. [PMID: 29894930 PMCID: PMC6035061 DOI: 10.1016/j.jmbbm.2018.05.044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2017] [Revised: 04/16/2018] [Accepted: 05/30/2018] [Indexed: 01/15/2023]
Abstract
When bone implants are loaded, they are inevitably subjected to displacement relative to bone. Such micro-motion generates stress/strain states at the interface that can cause beneficial or detrimental sequels. The objective of this study is to better understand the mechanobiology of bone healing at the tissue-implant interface during repeated loading. Machined screw shaped Ti implants were placed in rat tibiae in a hole slightly bigger than the implant diameter. Implants were held stable by a specially-designed bone plate that permits controlled loading. Three loading regimens were applied, (a) zero loading, (b) one daily loading session of 60 cycles with an axial force of 1.5 N/cycle for 7 days, and (c) two such daily sessions with the same axial force also for 7 days. Finite element analysis was used to characterize the mechanobiological conditions produced by the loading sessions. After 7 days, the implants with surrounding interfacial tissue were harvested and processed for histological, histomorphometric and DNA microarray analyses. Histomorphometric analyses revealed that the group subjected to repeated loading sessions exhibited a significant decrease in bone-implant contact and increase in bone-implant distance, as compared to unloaded implants and those subjected to only one loading session. Gene expression profiles differed during osseointegration between all groups mainly with respect to inflammatory and unidentified gene categories. The results indicate that increasing the daily cyclic loading of implants induces deleterious changes in the bone healing response, most likely due to the accumulation of tissue damage and associated inflammatory reaction at the bone-implant interface.
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Affiliation(s)
- Renan de Barros E Lima Bueno
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Ana Paula Dias
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Katia J Ponce
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - Rima Wazen
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada
| | - John B Brunski
- Department of Surgery, School of Medicine, Stanford University, Stanford, CA, United States
| | - Antonio Nanci
- Laboratory for the Study of Calcified Tissues and Biomaterials, Faculty of Dentistry, Université de Montréal, Montreal, QC, Canada.
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Sahrmann P, Schoen P, Naenni N, Jung R, Attin T, Schmidlin PR. Peri-implant bone density around implants of different lengths: A 3-year follow-up of a randomized clinical trial. J Clin Periodontol 2017; 44:762-768. [DOI: 10.1111/jcpe.12737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Philipp Sahrmann
- Clinic of Preventive Dentistry, Periodontology and Cariology; Center of Dental Medicine; Zurich Switzerland
| | - Patrizia Schoen
- Clinic of Preventive Dentistry, Periodontology and Cariology; Center of Dental Medicine; Zurich Switzerland
| | - Nadja Naenni
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; Zurich Switzerland
| | - Ronald Jung
- Clinic of Fixed and Removable Prosthodontics and Dental Material Science; Center of Dental Medicine; Zurich Switzerland
| | - Thomas Attin
- Clinic of Preventive Dentistry, Periodontology and Cariology; Center of Dental Medicine; Zurich Switzerland
| | - Patrick R. Schmidlin
- Clinic of Preventive Dentistry, Periodontology and Cariology; Center of Dental Medicine; Zurich Switzerland
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Jariwala SH, Wee H, Roush EP, Whitcomb TL, Murter C, Kozlansky G, Lakhtakia A, Kunselman AR, Donahue HJ, Armstrong AD, Lewis GS. Time course of peri-implant bone regeneration around loaded and unloaded implants in a rat model. J Orthop Res 2017; 35:997-1006. [PMID: 27381807 PMCID: PMC5800527 DOI: 10.1002/jor.23360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 07/02/2016] [Indexed: 02/04/2023]
Abstract
The time-course of cancellous bone regeneration surrounding mechanically loaded implants affects implant fixation, and is relevant to determining optimal rehabilitation protocols following orthopaedic surgeries. We investigated the influence of controlled mechanical loading of titanium-coated polyether-ether ketone (PEEK) implants on osseointegration using time-lapsed, non-invasive, in vivo micro-computed tomography (micro-CT) scans. Implants were inserted into proximal tibial metaphyses of both limbs of eight female Sprague-Dawley rats. External cyclic loading (60 or 100 μm displacement, 1 Hz, 60 s) was applied every other day for 14 days to one implant in each rat, while implants in contralateral limbs served as the unloaded controls. Hind limbs were imaged with high-resolution micro-CT (12.5 μm voxel size) at 2, 5, 9, and 12 days post-surgery. Trabecular changes over time were detected by 3D image registration allowing for measurements of bone-formation rate (BFR) and bone-resorption rate (BRR). At day 9, mean %BV/TV for loaded and unloaded limbs were 35.5 ± 10.0% and 37.2 ± 10.0%, respectively, and demonstrated significant increases in bone volume compared to day 2. BRR increased significantly after day 9. No significant differences between bone volumes, BFR, and BRR were detected due to implant loading. Although not reaching significance (p = 0.16), an average 119% increase in pull-out strength was measured in the loaded implants. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:997-1006, 2017.
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Affiliation(s)
- Shailly H. Jariwala
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Hwabok Wee
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Evan P. Roush
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Tiffany L. Whitcomb
- Department of Comparative Medicine, Pennsylvania State University College of Medicine, Hershey, PA 17033
| | - Christopher Murter
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Gery Kozlansky
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Akhlesh Lakhtakia
- Department of Engineering Science and Mechanics, Pennsylvania State University, University Park, PA 16802-6812
| | - Allen R. Kunselman
- Department of Public Health Sciences, Pennsylvania State University College of Medicine, Hershey, PA 17033
| | - Henry J. Donahue
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA 23284
| | - April D. Armstrong
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
| | - Gregory S. Lewis
- Division of Musculoskeletal Sciences, Department of Orthopedics and Rehabilitation, College of Medicine, Pennsylvania State University, Hershey, PA 17033
- Author to whom all correspondence should be addressed: Gregory S. Lewis, Ph.D*, Pennsylvania State University College of Medicine, 500 University Drive, Mailbox – H089, Hershey, PA-17033, Phone: (717) 531-5244, Fax no.: (717) 531-7583,
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Piccinini M, Cugnoni J, Botsis J, Ammann P, Wiskott A. Numerical prediction of peri-implant bone adaptation: Comparison of mechanical stimuli and sensitivity to modeling parameters. Med Eng Phys 2016; 38:1348-1359. [DOI: 10.1016/j.medengphy.2016.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Revised: 08/05/2016] [Accepted: 08/30/2016] [Indexed: 11/27/2022]
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